We carried out this unannounced focused inspection on 1 November 2018. This inspection was prompted by concerns raised about the safety and the management of the service.

We last inspected this service in February 2018 where we rated the service ‘good’. At this inspection we have changed the rating to ‘requires improvement’.

‘St Vincent’s 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. At the time of the inspection there were 90 people using the service.

The service had not had a registered manager since the previous registered manager had resigned in April 2018. 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.

Since the resignation of the previous registered manager there had been several interim managers, the most recent of which had started work at the service on 29 October 2018. None of these managers had applied to become the registered manager. It is a condition of the provider’s registration that they have a registered manager in place at this location.

Staff were recruited in line with safer practices. There were assessments carried out of staffing levels but we found at times there were not enough staff to safely meet people’s needs. In the early morning hazards were not addressed promptly. The provider intended to improve allocations and include falls champions to reduce risks to people but these were not yet in place. People using the service told us that staff appeared very busy.

There were systems in place to assess risks to people and manage these. Care workers were trained in safe moving and handling but lacked an awareness on how to prevent falls. Records were kept of actions staff had taken to keep people safe, such as welfare checks or repositioning people, but sometimes these were filled in later. People were safeguarded from abuse and care workers understood their responsibilities to report this.

The provider kept records of incidents and accidents and had an appropriate response to falls. However, systems were not used effectively to record and detect trends accurately. There were suitable infection control measures in place.

There had been frequent changes of manager due to the provider being unable to recruit a permanent home manager. People and their relatives told us they didn’t always know who was in charge and that this impacted on communication. There was good joint working with health professionals and medicines were safely managed.

There were governance systems including internal and external audit. These were effective at detecting issues with the service but were not always consistently applied. Care plans and risk assessment were stored in different locations which sometimes lead to confusion about the contents.

We found breaches of regulations relating to staffing and good governance. You can see what action we told the provider to take at the back of the full version of this report.

We carried out this unannounced comprehensive inspection on 13 and 14 February 2018. At our last comprehensive inspection in October 2016 we rated the service “requires improvement” and found a breach of regulations regarding good governance. We subsequently carried out a focussed inspection in March 2017 where we found the provider was now meeting these requirements.

At this inspection we found that the service had significantly improved in many areas, but that this improvement needed to continue to reach a consistently good standard in some areas.

St Vincent’s House is a care home with nursing. 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.

St Vincent’s House accommodates up to 92 people across four separate units, each of which have separate adapted facilities. There are shared facilities such as a coffee bar and cinema on the ground floor. Two of the units specialises in providing care to people living with dementia. At the time of our inspection there were 82 people using the service.

The service had a registered manager who had been registered since January 2018. 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.

The registered manager had clear systems in place for monitoring the performance of the service, and when areas were identified for improvement there were action plans in place. There were good systems of communication with staff and relatives, including surveys and regular meetings. Where relatives had expressed concern about staff communication regarding their family member’s wellbeing, the provider had implemented a resident of the day system, which combined a holistic review of the person’s care with updating relatives. Relatives we spoke with told us they were now kept informed of their family member’s care.

Managers had improved systems of recording, which were well maintained. We saw that risk management plans and care plans were of a greatly improved standard, but in some areas lacked detail on some areas of healthcare needs.

The service worked well with other agencies to promote good health, and we saw that there were good standards of wound management and pressure sore prevention in place. People’s needs were assessed at the time of admission to the service and this was used to put together personalised and detailed care plans which staff followed to meet people’s needs and preferences. People received well planned care at the end of their lives.

The provider was actively recruiting staff in order to reduce their reliance on agency staff, and this was carried out in line with safer recruitment measures to make sure staff were qualified and suitable for their roles. We found that staffing levels were safe to meet people’s needs, but sometimes staff were stretched and were not always effectively deployed. The service was in the process of reorganising staffing roles; we have made a recommendation about this. Medicines were safely managed by staff with the skills to do so.

The building was clean and well maintained, and was designed in order to meet peoples’ needs in a dementia-friendly way. There were thorough systems of checks to ensure it remained a safe environment. A system of key pads had been implemented to prevent people leaving the building in a way which may not be safe, but we have made a recommendation about how this was applied to the lift system, as people were able to operate lifts without knowing the code. People were assessed to see if restrictions were placed on their movement and the provider had applied to the local

The Care Quality Commission received information of concern from an anonymous whistleblower that alleged people using the service were got out of bed by night duty staff early in the morning, against their wishes and not in line with any identifiable and valid reasons to protect and promote their safety, health and wellbeing. The anonymous information alleged that people were got up from 5.30am onwards and provided with personal care, in order to minimise the level of care and support that staff would need to provide during the day shift.

This report only covers our findings in relation to this area. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Vincents House on our website at www.cqc.org.uk.

St Vincents House is a 92 bedded care home for older people. The service comprises four separate units and provides care and accommodation for older people with general health care needs and older people living with dementia. Accommodation is located over three storeys and the building has a passenger lift.

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. The registered manager was present for part of the inspection.

We arrived at the service at 6.20am and did not find any evidence to indicate that there was a planned approach in place for getting people up at an unacceptably early hour. The vast majority of people were asleep in their beds and the small number of people who were sitting in their armchairs within their bedrooms confirmed that this was in accordance with their own wishes. People who were out of bed told us they were comfortable, had been offered the support they needed and had been provided with fluids.

The staff on duty consisted of health care assistants and registered nurses. The staff team told us they did not routinely get people out of bed early and demonstrated that they were aware of people’s individual sleep routines and their preferred times to get up. We spent time on each of the three floors and did not find any evidence to suggest that staff proposed to get up more people, for example trolleys with fresh linen or hot drinks had not been prepared. The communal lighting was still subdued and staff conducted themselves in a quiet manner so that people who wished to continue sleeping were not unnecessarily disturbed.

The service is rated as Requires Improvement. We will review the rating at our next comprehensive inspection.

We conducted a comprehensive inspection of this service on 26, 27 and 30 October, and 3 November 2016. One breach of legal requirements was found in relation to inaccurate completion of records to demonstrate people’s needs were responded to in accordance with their individual care plans. After this inspection, the provider wrote to us to say what actions they would take to meet legal requirements in relation to the breach. After that inspection we received information of concern in relation to the quality of the care and support for people living with dementia. We wrote to the provider requesting information about this concern. Shortly before this unannounced inspection we received information of concern that insufficient staff were deployed to ensure people received appropriate care and support to meet their needs.

We carried out this inspection to check that the provider had adhered to their action plan, to establish if they now met legal requirements and to examine these concerns. This report only covers our findings in relation to these areas. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for St Vincents House on our website at www.cqc.org.uk.

St Vincents House is a 92 bedded care home with nursing for older people, and there were 76 people using the service at the time of the inspection. The service comprises four separate units and provides care and accommodation for older people with general health care needs and older people living with dementia. Accommodation is located over three storeys and the building has a passenger lift.

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.

At this inspection we found that the provider had improved the quality of record keeping and was continuing to support staff to maintain satisfactory record keeping. The improvement in record keeping meant that staff now had clear information to enable them to identify if people were not receiving the care they needed, for example if people were at risk of malnutrition, dehydration and either the development of new pressure ulcers or the further deterioration of existing skin damage. There were systems in place for staff to liaise with other professionals when they identified concerns, so that people’s needs could be promptly addressed. The management team had established a programme of monitoring and auditing of care practices and accompanying records, in order to ensure that all staff were aware of their role and responsibilities. Following this inspection, we concluded that the provider had met the legal requirements of the Warning Notice we had issued.

At this inspection we found that staffing levels had not been decreased, which was a potential concern expressed by staff at the previous inspection. The provider stated that ongoing recruitment was needed in order to reduce the use of agency staff, so that people using the service and the permanent staff team benefitted from better continuity and stability. We noted that improvements had been made since the previous inspection in order to promote people’s safety. There was a noticeable increase in staff compliance with wearing an identification badge, to enable people and visitors to identify who they were speaking with. The cleaning programme had addressed issues of clutter and dust within the premises.

We did not observe any concerns with the care and support provided for people living with dementia. Comments from relatives and external professionals indicated that people’s needs were understood and met.

This inspection was conducted on 26, 27 and 30 October and 3 November 2016. At our previous inspection on 7, 8 and 15 March 2016 we found the provider was in breach of two regulations of the Health and Social Care Act 2014. There was a breach of Regulation 11 in relation to the provider not ensuring that care was provided with the consent of service users in accordance with the Mental Capacity Act 2005, and a breach of Regulation 17 as the provider had not maintained an accurate, complete and contemporaneous record in respect of each service user. The provider sent us a plan following the inspection setting out how they proposed to address these issues. We carried out this inspection to check that improvements had been achieved and sustained in line with the provider’s action plan. At this inspection we found that satisfactory progress had been attained in relation to the provider ensuring that people’s care and treatment was provided in a manner that took into account their capacity to give consent. However, we did not find consistent evidence to demonstrate that sufficient improvements had been achieved with the quality of record keeping for people who use the service.

St Vincents House is a 92 bedded care home with nursing for older people, and there were 72 people using the service at the time of the inspection. The service is divided into four separate units and provides care and accommodation for older people with general health care needs and older people living with dementia. Accommodation is provided over three storeys and the building is served by a passenger lift.

At the previous inspection we noted that the provider had appointed a new permanent manager, who has subsequently been confirmed as the registered manager of the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered provider, 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 told us they felt safe with staff and systems were in place to protect people from abuse. The provider had supported staff to confidently increase their understanding about whistleblowing so that they understood how to protect people through reporting poor conduct in the workplace.

Recruitment practices were thorough and there were sufficient numbers of staff deployed to meet people’s needs. Comments from people, their relatives and staff, along with our own observations, indicated that staffing levels would need to be closely monitored as and when more people move into the service. Staff were provided with the training and support they needed to effectively carry out their roles. They had been provided with training about how to maintain accurate record keeping to demonstrate that people were given the level of care and support they needed, and the provider was committed to continuing to support staff to achieve this.

The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report on our findings. DoLS are in place to protect people where they do not have capacity to make decisions and where it is necessary to restrict their freedom in some way, to protect themselves or others. The provider demonstrated that people’s capacity was assessed where necessary and the principles of DoLS were understood and correctly applied.

Systems were in place to consult with people about their food choices. A range of home cooked foods was produced to accompany the meals provided by the external catering company. People told us that they were suitably supported to meet their health care needs and the provider had worked with local health services to address concerns about the quality of documentation sent by care home staff to local hospitals when people wer

This inspection took place on 7, 8 and 15 March 2016. At our previous inspection on 2 and 3 March 2015 we found the provider was in breach of Regulation 18 in relation to the provider not ensuring that people who used the service were protected from the risks of not receiving care from sufficient numbers of suitably qualified and competent staff. The provider sent us a plan after the inspection setting out how they planned to address these issues. We conducted this inspection to check that improvements had been achieved and sustained in accordance with the provider’s action plan. During this inspection we found that sufficient staff were deployed to safely meet people’s needs, although there were now significantly fewer people using the service than at the time of our previous inspection.

St Vincents House is a 90 bedded care home with nursing for older people, and 69 people were using the service at the time of this inspection. It is divided into four separate units and provides care and accommodation for older people with general health care needs and older people living with dementia. The original premises was formerly a convent and residential home for older people. Accommodation is provided over three storeys and the building is served by a passenger lift.

During this inspection St Vincents House did not have a registered manager in post. 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. The service was being managed by a peripatetic manager. The provider had appointed a new permanent manager, who we met during the inspection as they were at the service attending their induction training.

Staff were safely recruited in order to ensure that they were suitable to work with people who used the service. Staff told us they were pleased with the quality of training that the provider supported them to undertake. The provider had introduced a new system for providing staff with regular supervision and an annual appraisal, so that staff had appropriate support to carry out their roles and responsibilities.

Although staff demonstrated that they understood how to identify the signs of abuse and report their concerns to their line manager, some staff did not fully understand the provider’s whistleblowing policy, in relation to what is meant by whistleblowing and the legal protection afforded to employees who whistleblow.

Risks to people’s safety and welfare were identified in the risk assessments, and guidance was in place to mitigate these risks. Appropriate systems were in place to make sure that people safely received their prescribed medicines, which included medicines training for nursing staff and regular medicines audits.

The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report upon our findings. DoLS are in place to protect people where they do not have capacity to make decisions and where it is regarded as necessary to restrict their freedom in some way, to protect themselves or others. Staff had received training and we noted that there were DoLS authorisations in place. However, we found limited evidence to demonstrate that people’s capacity was assessed and recorded in their care files. There was also a lack of documentation in relation to people giving their consent for their care and support.

People expressed some mixed views about the quality of the food service. We observed that they were offered a range of choices and provided with staff support for eating and drinking, where applicable. Discussions with people and their representatives, and notes within people’s care files, indicated that they were able to access a

This inspection was carried out in one day by an inspection team of three people; two inspectors and a specialist advisor. We carried out this inspection as we had received safeguarding notifications about the quality of care people received. People and their representatives told us they were mainly happy with the care and liked the home. One person told us, "They look after me lovely" and another person said, "I am definitely content living here. Staff listen to me and they care." One person showed us how the staff arranged their pillows and table every day so that they could independently read their Bible and said, "I have no problem with staff, they do help me a lot."

We found that although appropriate care plans and risk assessments were in place, some risk assessments needed more frequent reviewing. We also found that some of the Do Not Attempt Resuscitation (DNAR) forms that we looked at did not have sufficient evidence that discussions had taken place with people and/or their representatives. Most of the people we spoke with said they felt the food service could be improved and some people wanted to be offered more frequent activities and entertainments.

Staff spoke positively about their training and said they felt supported. The training records showed that staff were provided with mandatory training and could also attend other training to meet the needs of people using the service, for example palliative care training sessions. There were some gaps in the provision of supervision for staff, particularly supervision for night duty registered nurses employed via the provider's bank staffing arrangements.

The service had sought the views of people who use the service and their representatives, however we were not shown how people's feedback about improvements needed was acted on. People said they were confident about making a complaint and the complaints we looked at had been fully investigated. The service did not have a system in place for recording complaints made verbally to the manager or other staff.

St Vincent's House provides care and support to 92 older people. People with a diagnosis of dementia (48) were accommodated on the 2nd and 3rd floor of the home. We visited and spoke with people in both of these units during the inspection.

Regular staff were present and provided a consistent level of care, they were familiar with the people they looked after and knew their life histories, they were able to apply this knowledge to the care and support they offered to people on a daily basis.

Staff training provided care staff with essential knowledge and skills to care for and understand the needs of people with dementia.

We saw that care staff interacted with and engaged well with people using the service, these interactions were a positive experience for people. When staff offered people assistance and support including at mealtimes they focused on the person and gave them their undivided attention which made them feel valued.

Throughout the inspection we observed the environment was calm, people's requests for assistance were responded to promptly by staff.

People using the service and their families and friends were listened to and included in the decision making, One person told us, “I am happy here and wherever I am as long as people consider my point of view and do not do things over my head, staff always ask my views, they are a good group of people .”

Staff at the home worked well with other health and social care professionals and were actively involved in promoting and supporting the health needs of people living in the home.

Staff demonstrated an awareness of the benefits of reducing hospital admissions for older people especially those with dementia. Staff worked together with other health and social care professionals in reducing unscheduled hospital admissions, and of making the most of community based services to enable them support people appropriately in the home.

We spoke to seven people using the service and also to relatives who were visiting at the time of the inspection.

People told us they were happy at this home. One person we spoke with said “We’re well looked after. Everyone knows me". Another person said the information provided in the home's brochure was "useful" and they "knew what to expect" .

We observed staff knocking on doors and waiting for a response before entering and introducing themselves to the person in the room.

We saw care records had detailed moving and handling care plans. We spoke with staff and they were able to describe the moving and handling care plan as recorded in the care record.

Staff at the home had received mandatory training in safeguarding adults. This was refreshed on an annual basis. Staff we spoke with were able to describe how to recognise signs of abuse. People we spoke with said they felt safe at the home.

All staff were required to complete mandatory induction training. There were annual mandatory training courses for all staff relevant to their role. Staff we spoke with said the induction and annual training was relevant and helpful in supporting them to carry out their role.

We saw that the provider carried out separate annual feedback surveys from people who use the service and relatives. The majority of comments from people who responded were positive and people said they were satisfied with the service provided.

People who use the service and their representatives told us that they felt safe, well informed and well cared for in the home. They said that their views mattered and were taken seriously.

People also told us that there were enough staff and that the home was kept clean and hygienic.

We carried out this inspection in response to information we received.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an Expert by Experience (people who have experience of using services and who can provide that perspective) and a practising professional.

We spoke to seven people using the service and a relative of one of the residents. They told us that people at the home were given appropriate information about their care as well as options about how they were cared for and treated. They said they had options about what activities at the home they got involved with and that religious and cultural needs were accommodated. They praised the quality and choice of the food they received, and said that they felt safe in the home.

We also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. At St Vincents House there are a number of people who have dementia or find it difficult to communicate verbally.

People told us that they were well looked after at the home. They said that the staff were “very nice” and “kind” and said they felt safe in the home.

We spoke to some people who use the service and they were all happy with the care provided at St Vincent’s House. They felt involved in their care and that staff were friendly and helpful. We saw good interactions between people that use the service and staff.

This inspection took place on 2 and 3 March 2015. The first day of the inspection was unannounced and we informed the registered manager we were returning on the second day. At our previous inspection on 1 August 2014 we found the provider was not meeting the regulation relating to the provider having effective processes to seek the views of people living at the service and their representatives, in regard to the quality of the food service.

St Vincents’ House is a 92 bedded care home with nursing and provides care, accommodation and support for older people with general nursing care needs, people who are living with dementia and people with palliative care needs.

The service was managed by a registered manager. 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 their relatives told us there were not always enough staff on duty to keep people safe and meet their needs.

People told us they liked the staff and felt safe with them. Staff had received safeguarding training, although some staff needed more support and guidance in order to fully understand the provider's whistleblowing policy.

The service conducted risk assessments to ensure people were safe, while taking into account their wishes and rights.

People were protected by rigorous staff recruitment practices. Staff received training, support and supervision to carry out their roles and responsibilities. However, improvements were needed to ensure that the supervision was meaningful and focused upon staff member’s individual circumstances.

There were robust systems in place to ensure people were safely supported with their medicine needs.

We were informed by staff that sometimes they did not have enough equipment such as hoists, gloves and incontinence pads; however, satisfactory supplies were available on both days of the inspection.

Improvements had been made to the quality of the food service, although some on-going work was needed to ensure that the food was consistently served at the correct temperature.

Most staff were aware of the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which care homes are required to meet. The service understood how to act within legal requirements when determining if people needed to be deprived of their liberty to keep them safe.

People’s healthcare needs were identified in their care plans and they were supported by the service to meet these needs.

People told us that staff were kind and talked with them. We observed that some staff appeared to be more task orientated when they provided care and did not offer a more personalised approach.

Although people and their relatives told us they took part in activities we saw limited evidence of this during the inspection.

People’s dignity and privacy was promoted. We saw that staff knocked on people’s doors before entering and closed doors if they were providing personal care.

There were systems in place to regularly review and update people’s care plans.

The service had systems in place to meet the needs of people who were at risk of developing pressure ulcers. However, there were gaps with the recording of the preventative care and how the staff treated pressure ulcers.

People told us they had received information about how to make a complaint and thought that the registered manager would respond well to any concerns.

People and their relatives told us they could speak with the registered manager and most people thought that the service was well managed.

Some staff expressed concerns to us that they did not feel consulted or valued by the management team.

The provider carried out surveys and audits in order to improve the quality of the service.

We found two breaches of regulation, relating to sufficient staff on duty to ensure people's safety and ensuring that people are always treated in a caring and compassionate way.

You can see what actions we told the provider to take at the back of the full version of this report.