About the service:

Vera James House is a residential care home that was providing personal care to 32 older people at the time of this inspection.

People’s experience of using this service:

People we met and spoke with were happy with the care home and the staff that provided their care. A visitor told us that the home was, “Overall really good.”

People felt safe living at the home because staff knew what they were doing, they had been trained and cared for people in the way people wanted. Risks in the home were assessed and reduced as much as possible. There were enough staff, and the registered manager also spoke with people regularly. Key recruitment checks were obtained before new staff started work.

People received their medicines and staff knew how these should be given. Medicine records were completed accurately and with enough detail. Staff supported people with meals and drinks. They used protective equipment, such as gloves and aprons. Staff followed advice from health care professionals and made sure they asked people’s consent before caring for them.

People liked the staff that cared for them. Staff were kind and caring, they involved people in their care and made sure people’s privacy was respected. Staff worked well together, they understood the home’s aim to deliver high quality care, which helped people to continue to live as independently as possible.

Staff kept care records up to date and included national guidance if relevant. Complaints were dealt with and resolved quickly.

Systems to monitor how well the home was running were carried out well. Where concerns were identified, the registered manager followed this up to make sure action was taken to rectify the issue. Changes were made where issues had occurred elsewhere, so that the risk of a similar incident occurring again was reduced. People were asked their view of the home and action was taken to change any areas they were not happy with.

Rating at last inspection: Requires Improvement (last report published 25 April 2018)

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as scheduled in our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 20 and 26 February 2018. It was unannounced.

Vera James House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates up to 41 people in one purpose built property. There were 41 people living at the home at the time of our inspection visit.

At our previous inspection the service was rated as Good. At this inspection the service had deteriorated to Requires Improvement. This was because incidents of possible harm or abuse were not reported to us (CQC), which is a legal requirement. They were also not referred to the local authority safeguarding team. This put people at risk of further harm and prevented independent investigation of these incidents if this was appropriate. This was a breach of our regulations. You can see what action we told the provider to take at the back of the full version of the report.

People’s personal and health care needs were met but care records did not provide staff with guidance in how to meet people’s diabetes needs. There were activities for people to do and take part in but not everyone was able to continue hobbies or pastimes, or use social media to keep in touch with relatives. A complaints system was in place, although not all people knew who to speak with if they had concerns.

The provider’s monitoring process looked at systems throughout the service and identified issues. Not all of these issues were addressed and not all of the issues found at this visit had been identified.

There was a registered manager at the service. 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 felt safe and staff knew how to respond to possible harm and how to reduce risks to people. Lessons were learnt about accidents and incidents and these were usually shared with staff members quickly to ensure changes were made to staff practise or the environment, to reduce further occurrences. There were enough staff who had been recruited properly to make sure they were suitable to work with people. Medicines were stored and administered safely, and records were completed correctly. Regular cleaning made sure that infection control was maintained and action was taken to address issues.

People were cared for by staff who had received the appropriate training and had the skills and support to carry out their roles. People received a choice of meals, which they liked, and staff supported them to eat and drink. People were referred to health care professionals as needed and staff followed the advice professionals gave them. Adaptations were made to ensure people were safe and able to move around their home as independently as possible. Staff members understood and complied with the principles of the Mental Capacity Act 2005 (MCA). People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were caring, kind and treated people with respect. People were listened to and were involved in their care and what they did on a day to day basis. People’s right to privacy was maintained by the actions and care given by staff members. Staff gathered information about people’s end of life wishes, so that they could support and care for them in the right way.

Staff worked well together and felt supported by the management team, which promoted a culture for staff to provide person centred care. People’s views were sought and changes made if this was needed.

We

Vera James House provides accommodation and personal care for up to 41 older people. There were 36 people living at the service at the time of our inspection.

This unannounced inspection took place on 25 July 2017. At the last inspection on 23 July 2015 the service was rated as ‘good’. At this inspection we found overall the service remained ‘good’.

A registered manager was in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 their visitors said that staff were kind and caring. People’s privacy and dignity was not always respected.

Staff were only employed after the provider had obtained satisfactory pre-employment checks. Staff understood their roles and responsibilities and were supported by the registered manager to maintain and develop their skills and knowledge by way of supervision, observations, and appraisals. Staff were trained to provide safe and effective care which met people’s individual needs and they knew people’s care requirements well.

Staff were clear about the procedure to follow to protect people from being harmed. Risks to people who lived at the service were identified, and plans were put into place by staff to minimise these risks and enable people to live as independent and safe life as possible.

People had health, care, and support plans in place which took account of their needs. These recorded people’s individual choices, their likes and dislikes and any assistance they required.

Medicines were well managed and people received their medicines as prescribed.

Staff supported people to make everyday decisions in the least restrictive way as possible; the policies and systems in the service supported this practice.

People and their visitors were able to raise any suggestions or concerns they might have with the registered manager and team of staff. They said that they felt listened to as communication with the registered manager and staff team was good.

Arrangements were in place to ensure the quality of the service provided for people was regularly monitored. We found that people who lived at the service and their visitors were encouraged to share their views and feedback about the quality of the care and support provided.

Further information is in the detailed findings below.

Vera James House is registered to provide accommodation and non-nursing care for up to 41 people, some of whom live with dementia. Short and long term stays are offered. The home is situated within the city of Ely. At the time of our inspection there were 28 people using the service.

The previous registered manager left their position on 31 December 2013 and their registration was cancelled 13 February 2014. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. At the time of our visit there was a manager in post and they were applying to be registered with the CQC.

We carried out an unannounced inspection of this service on 09 and 11 September 2014. Breaches of four legal requirements were found in relation to people’s dignity and privacy, their care and welfare, staffing numbers and the quality assurance of the service. We undertook an unannounced follow up inspection on 17 and 19 November 2014 to check the provider had met the requirements of the regulations associated with care and welfare and the quality assurance. We found that the provider had taken appropriate action to meet the requirements of these two regulations.

After the unannounced inspection of 09 and 11 September 2014, the provider wrote to us to say what they would do to meet the legal requirements in relation to people’s privacy and dignity and staffing numbers. We found that the provider had followed their plan which they told us would be completed by 30 November 2014 and 31 December 2014 respectively, and legal requirements had been met

This comprehensive inspection was carried out on 23 July 2015 and was unannounced.

People were safe and staff were knowledgeable about reporting any incident of harm. People were looked after by enough staff to support them with their individual needs. Pre-employment checks were completed on staff before they were judged to be suitable to look after people who used the service. People were supported to take their medicines as prescribed and medicines were safely managed.

People were supported to eat and drink sufficient amounts of food and drink. They were also supported to access a range of health care services and their individual health needs were met.

People’s rights in making decisions and suggestions in relation to their support and care were valued and acted on.

People were supported by staff who were trained and supported to do their job, which they enjoyed.

The CQC monitors the operation of the Mental Capacity Act 2005 (MCA 2005) and the Deprivation of Liberty Safeguards (DoLS) which applies to care services. DoLS applications had been made to the appropriate authorities to ensure that all of the rights of people’s were protected. The provider had been in contact with the appropriate agencies in relation to this matter.

People were treated by kind, respectful and attentive staff. They and their relatives were involved in the review of people’s individual care plans.

Support and care was provided based on people’s individual needs and they were supported to maintain contact with their relatives and the local community. People took part in a range of hobbies and interests. There was a process in place so that people’s concerns and complaints were listened to and these were acted upon.

The manager had experience in care and management and they were supported by their manager. Staff enjoyed their work and were supported and managed to look after people in a safe way. Staff, people and their relatives were able to make suggestions and actions were taken as a result. Quality monitoring procedures were in place and action had been taken where improvements were identified.

As this inspection was to assess improvements made in relation to shortfalls identified during our previous inspection on 25 September 2013, we did not request information directly from people using the service on this occasion.

Overall, we found that the provider had taken sufficient action to ensure that there were accurate records kept in relation to the care and treatement people had received.

We observed how staff members interacted with people using the service and found that staff members were gentle, congenial and listened to people.

We found that improvements had been made to people’s risk assessments and their care plans and staff were able to tell us how they cared for and supported people.

People were provided with a choice of suitable and nutritious food and drink. We observed the lunchtime and found that people were supported to eat and drink when needed.

Staff members confirmed that they felt staffing levels were adequate and this allowed them to provide timely care to people.

We found that there were not always accurate records of the care people had received.

You can see our judgements on the front page of this report.

As the purpose of this inspection was to assess improvements made in relation to shortfalls identified during our previous inspection undertaken in April 2012 we did not request information directly from people using the service on this occasion.

We found that the home was compliant with those regulations where there had been non compliance identified during our inspection in April 2012.

People we spoke with told us they liked living at Vera James House and that they received a good quality of care from the staff that looked after them. They told us there were enough staff around to meet their needs and one person complimented the night staff stating, “They always come quickly when I’m having a panic”. One person told us that the majority of staff were very good and respectful but that, “The odd one or two don’t appreciate me very well and get a bit peeved when I tell them how to wash me”. Another person complained of the noise at night from other residents which really affected his sleep and another person told us that some clothing had gone missing in the laundry and that staff had been unable to find the missing item. A family member also voiced concerns about the home’s laundry management but reported that it was getting better, although she often found other people’s clothes in her relative’s wardrobe.

Family members we spoke with regarded the home highly. One relative told us “I am very happy with the care my relative gets. He can be very demanding; the staff are so patient and tolerant and always stop to chat with him if they can”. Many praised the quality of the staff and felt able to raise any concerns or issues easily with them. One family member told us, “There’s a happy atmosphere at the home and staff are open and willing to listen”. Family members also told us that staff at the home were good at keeping them informed of what was happening with their relative. One family member reported that every month staff emailed her the home’s monthly ‘What’s on’ newsletter and that she found this really useful to know what was going on in the home.

One GP who visits the home regularly told us, “It’s one of the better homes in the area and on the whole I’m rather impressed by it, I have no areas of concern at all and think the care is good”. A consultant geriatrician told us, “Whenever I visit the home I always ask lots of questions about the residents and staff really seem to know them well”.

Our inspection on 17 November 2014 and 19 January 2015 was carried out by an adult social care Inspection Manager and Inspector. We carried out this inspection to check compliance with two warning notices that had been served on the provider as a result of the previous inspection on 09 and 11 September 2014.

We found that improvements had been made to people's risk assessments and care plans so that staff had the information they required to meet people's individual needs. Staff were able to tell us how they met people's needs and records confirmed that people received appropriate care and support when they needed it.

Discussion with staff and looking at records confirmed that an effective quality assurance system was in place. This meant that improvements had been made to ensure that people received the care and support they needed.