About the service: Vecta House is a residential care home that was providing personal and nursing care to 42 people aged 65 and over at the time of the inspection. Vecta House provides a service for people living with dementia who also require nursing care.

During the previous inspection in May 2018 we identified eight breaches of regulations three of which had been repeated from the inspection in April 2017. We met with the provider and registered manager and told them they must make improvements to ensure effective systems were operated to ensure compliance with regulations and to monitor and improve the quality of the service provided. At this inspection we found improvements had been made; however, there was a need to sustain the improvements made and to make further improvements. The service has been rated requires improvement as it met the characteristics for this rating in most key questions. More information is in the full report.

People’s experience of using this service:

¿ People were happy living at Vecta House. Their relatives told us their needs were met by staff who were competent, kind and caring.

¿ However, not all individual and environmental risks such as ensuring people always received the correct texture of food were managed appropriately.

¿ Relatives were involved in the development of care plans that were reviewed regularly. However, some people had a specific known health care need of epilepsy which was not well managed.

¿ There were times when staff were not readily available for people.

¿ People's rights and freedoms were upheld and they were empowered to make choices and decisions where able. People were treated with dignity and respect.

¿ Staff were well trained and received support and supervision. Medicines were usually managed safely and risks of infection control were well managed.

¿ The provider’s quality assurance system helped the management implement improvements that would benefit people. Action had been taken to become compliant with the eight breaches of regulation identified at the previous inspection.

Rating at last inspection: At the last inspection the service was rated Inadequate. (Report published 31 October 2018).

This service has been in Special Measures. Services that are in special measures are kept under review and inspected again within six months. We expect services to make significant improvements within this time frame. During this inspection the service demonstrated to us that improvements have been made and is no longer rated inadequate overall or in any key questions. Therefore, this service is now out of Special Measures.

Why we inspected: This was a scheduled/planned inspection based on the service’s previous rating.

Follow up: We will continue to monitor the service to ensure the improvements we found are maintained.

This inspection took place on the 10 and 18 May 2018 and was unannounced; at time of the inspection 48 people were accommodated at the service.

Vecta House is a ‘care home’ and is registered to accommodate up to 54 people. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The CQC regulates both the premises and the care provided, and both were looked at during this inspection. This home provides a service to older people with dementia or mental health needs.

The home had a manager who had recently taken up this position; they were not yet registered with the Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

We last inspected the service in April 2017 and rated it ‘Requires Improvement’ overall. We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, good governance and safeguarding service users from abuse and improper treatment. At this comprehensive inspection we found eight breaches of regulations. All three regulatory breaches from the last comprehensive inspection in April 2017 were repeated. There were systemic failings identified during this inspection that demonstrated a significant deterioration in the quality and safety of the service since its last comprehensive inspection.

The provider had failed to ensure effective oversight of service provision. Quality and safety monitoring systems were ineffective in identifying and directing the service to act upon and mitigate risks to people who used the service and ensure the quality of service provision.

Following the inspection we wrote to the provider informing them of our concerns and requiring them to send us weekly action plans detailing how they were addressing the areas of immediate concern. These have been received as required. The provider has also voluntarily agreed not to admit new people to Vecta House until they are satisfied that all necessary action has been taken and people will be safe.

Statutory notifications are information about specific important events the service is legally required to send to us. We found that these had not always been made as required.

Records relating to the management of the service had not been effectively reviewed and assessed; we found errors and discrepancies that had not been identified by the quality assurance systems in place.

Care plans were not consistently person centred and lacked detailed guidance for staff to ensure people received care in a person centred and safe way. Risk assessments that related to peoples health, safety and the environment did not ensure that all risks were effectively assessed. Action had not always been taken to reduce identified risks to ensure the safety of people. This exposed people to a risk of neglect and unsafe or inappropriate care or treatment.

People were not always treated with dignity and respect; we observed occasions when staff treated people without compassion and kindness. People living with dementia were not always treated as adults.

Staff said they knew how to prevent and report abuse. We were concerned however that staff practice which amounted to omissions of care had not been considered as neglect by them.

There were not enough sufficiently skilled staff to meet people’s needs. Staffing needs had not been fully assessed and there was a high reliance on agency staff; we observed that the staff on duty lacked the skills and knowledge to care for the people in residence. People therefore did not receive person centred care.

Staff received training and supervision however we were not assured of quality

This inspection took place on 19 and 26 April 2017 and was unannounced. Vecta House provides accommodation, nursing and personal care for up to 54 people living with dementia. There were 54 people living at the home when we visited.

There was a registered manager at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. People's families told us they felt the home was well-led and were positive about the registered manager who understood the responsibilities of their role.

The provider’s quality assurance procedures had failed to identify the areas of concern we found. These included the recording of restraint and the failing to ensure all medicines were administered as prescribed. Nursing and care staff had failed to self-monitor their practice such as leaving potentially dangerous fluid thickening powder available to people and not following up on gaps in administration records for insulin.

There were generally enough staff to meet people's needs although activities staff were supporting care staff meaning they were unable to provide a full range of activities and management staff were supporting nursing shifts meaning they were not able to complete all management tasks. Relatives identified that people would benefit from additional mental and physical stimulation. We have made a recommendation about this.

Whilst the majority of interactions we observed between staff and people were positive, with people being cared for with kindness and compassion we also observed occasions when this was not the case. People felt safe and staff knew how to identify, prevent and report abuse. Staff offered people choices and respected their decisions. People were supported and encouraged to be as independent as possible and their dignity was promoted.

Care plans provided comprehensive information about how people wished to be cared for and staff were aware of people's individual care needs and preferences. Reviews of care were conducted regularly. People had access to healthcare services and were referred to doctors and specialists when needed.

Relatives and external health professionals were positive about the service people received. People enjoyed their meals and received support if required to ensure they had a nutritious diet. At the end of their life people received appropriate care to have a comfortable, dignified and pain free death.

The recruitment process helped ensure staff were suitable for their role. Staff received appropriate training and were supported in their work.

People and relatives were able to complain or raise issues on a formal and informal basis with the registered manager and were confident these would be resolved. This contributed to an open culture within the home. Visitors were welcomed and there were good working relationships with external professionals.

Staff worked well together, which created a relaxed and happy atmosphere that was reflected in people's care.

We found three breaches of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the end of the full version of the report.

We spoke with five of the 52 people who were living at the home and ten relatives. All people and relatives were very happy with the care provided. One said “It’s a happy place”, another “The girls are all friendly and we all mix in”.

A visitor said “I’m [x] friend and come in 3 times a week. [X] is looked after very well. There is always someone available to feed and dress them. She’s always clean and dressed nicely. It’s a happy place. When someone has a birthday everyone gets involved, Christmas is great”. A relative told us “It’s a lovely atmosphere, beautiful really. No one is ill-treated, you see some awful things on the telly but that’s not what happens here”. Other relatives expressed similar positive comments about the home and staff.

We spent time observing care in communal areas. We found people had positive experiences. We observed staff were courteous and respectful of people's dignity. Choices were offered and people’s preferences were respected. The care we observed corresponded with care plans and risk assessments viewed. There were sufficient staff who had received training, support and supervision giving them the skills required to meet people’s needs.

We spoke with nursing and care staff. Staff were aware of how people should be supported, individual likes and dislikes and the help they required. Staff stated they felt they had sufficient time to meet people’s needs. Staff also told us they had attended relevant training and had all the necessary equipment to safely care for people.

There was a complaints procedure. Relatives felt able to raise issues and said these were resolved to their satisfaction.

We spoke with three of the 49 people living at the home. They told us they had choices such as what time they got up and what food they had. People told us staff were all very good and they were happy with the care and support they received.

Other people were unable to tell us about their experiences as they had dementia. We observed that interactions between staff and people were friendly and positive and staff were responsive to people’s needs. Choices were offered and where necessary informal consent was obtained. Staff knew what support people needed and respected people’s wishes. The support that we saw being given to people matched what their care plan said they needed.

We also spoke with nine visitors to the service. They were all very positive about the home and care people received. We found that people received an appropriate diet, medication was correctly managed and care plans were relevant to people. Recruitment procedures were in place with pre employment checks completed. All necessary records were maintained.

People who live at Vecta House have dementia and therefore not everyone was able to tell us about their experiences. To help us to understand the experiences people have we used our Short Observational Framework for Inspection (SOFI) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences. Some people using the service were able to tell us about their experiences and we also spoke with visitors to the service and other health professionals.

Visitors were positive about the way the home meets the needs of their relatives. Visitors confirmed that they are kept informed about any illness or untoward incidents and this gives them peace of mind when they are not visiting. Visitors felt that health and personal care needs were being met. Visitors were positive about staff and felt they did a good job. Visitors said that they did not have any concerns or complaints but would raise these with the staff or the manager if they did.

We also spoke with other professionals involved in the care of people. They stated that they had no concerns about the home.

This inspection took place on 5 and 8 October 2015 and was unannounced. The home provides accommodation, nursing and personal care for up to 54 people living with dementia. There were 53 people living at the home when we visited.

There was a registered manager at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

People and relatives were positive about the service they received. They praised the staff and care provided. People were also positive about meals and the support they received to ensure they had a nutritious diet.

People felt safe and staff knew how to identify, prevent and report abuse.

Legislation designed to protect people’s legal rights was followed correctly. People’s ability to make decisions had been recorded appropriately, in a way that showed the principles of the Mental Capacity Act (MCA) had been complied with. Staff were offering people choices and respecting their decisions appropriately.

The Deprivation of Liberty Safeguards (DoLS) were applied correctly. DoLS provides a process by which a person can be deprived of their liberty when they do not have the capacity to make certain decisions and there is no other way to look after the person safely.

Plans were in place to deal with foreseeable emergencies and staff had received training to manage such situations safely. There was an environment maintenance and improvement program with consideration and action taken to ensure the environment supported people living with dementia or those with visual perception difficulties.

Care plans provided comprehensive information about how people wished to be cared for and staff were aware of people’s individual care needs. People had access to healthcare services and were referred to doctors and specialists when needed. Reviews of care involving people or relatives (where people lacked capacity) were conducted regularly. A range of daily activities were offered with people able to choose to attend or not.

There were enough staff to meet people’s needs. Contingency arrangements were in place to ensure staffing levels remained safe. The recruitment process was safe and helped ensure staff were suitable for their role. Staff received appropriate training and were supported.

People and relatives were able to complain or raise issues on a formal an informal basis with the registered manager and were confident these would be resolved. This contributed to an open culture within the home. Visitors were welcomed and there were good working relationships with external professionals. Staff worked well together which created a relaxed and happy atmosphere, which was reflected in people’s care.

The registered manager and providers representatives were aware of key strengths and areas for development of the service and there were continuing plans for the improvement of the environment. Quality assurance systems were in place using formal audits and regular contact by the provider and registered manager with people, relatives and staff.