Vesta Lodge

We found the following examples of good practice.

¿ The service was receiving visitors with robust infection control procedures in place. Face to face visits, where one nominated visitor and people could meet and hold hands, were taking place in a designated area, or within people’s bedrooms if this was required. Visits were pre-arranged, with visitors being provided with a rapid test for COVID-19, guidance and personal protective equipment (PPE). Other visitors were also able to continue visiting, with visits being facilitated via a screened ‘pod’ in the designated area. All visiting areas were cleaned between visits.

¿ People were admitted safely to the service. Each admission was carefully planned, and a 14-day period of isolation was completed by each person.

¿ The service was clean and hygienic. Robust cleaning regimes were in place, which were methodically completed throughout the day. Isolation, cohorting and zoning had been successfully implemented across the service.

¿ The service was engaged in the routine testing scheme, with all staff and people living at the service being tested for COVID-19 on a regular basis.

¿ The provider had developed a package of policies and procedures in response to the COVID-19 pandemic. Regular infection prevention and control audits were completed with action promptly taken to address any issues identified.

Vesta lodge is a purpose-built care home providing accommodation and personal care for up to 61 older people. At the time of this inspection 60 people were using the service.

Vesta lodge has four units over two floors. There were multiple communal areas including quiet areas.

People’s experience of using this service and what we found

People, and their relatives said the care and support people received was safe. The manager ensured people were protected from the risk of harm or abuse. Risks to people`s health and well-being were assessed, and measures put in place to mitigate identified risks. The manager operated safe and effective recruitment practices. People, their relatives and staff told us there were enough staff available to meet people’s needs in a timely manner.

People’s medicines were managed safely, and people received their medicines regularly from staff who had received training and had their competency checked. There were infection control procedures in place and the environment was clean and bright with a nice fresh smell throughout the service. The manager demonstrated they reflected on any adverse incidents and shared any learning with staff.

Vesta lodge is arranged over two floors. Assessments were completed prior to people moving into the home to establish if people`s needs could be fully met. Staff received training, support and supervision to enable them to carry out their roles effectively. People said they enjoyed the food provided and were offered choice. Staff knew people well and were able to identify any changes in people’s needs and seek timely intervention from appropriate healthcare professionals.

Staff treated people with kindness and dignity. People and their relatives made positive comments about staff members kindness and the attention they showed to people. People were encouraged and supported to be involved with their care choices. People’s care plans were person centred and supported staff with understanding people`s current needs while supporting them to remember important life experiences, likes, dislikes and preferences. Visitors were made to feel welcome at all times.

People received care and support as they wished. Staff knew what people liked and offered people meaningful choices throughout the day. There was clear signage throughout the home so that communal areas, bathrooms and people’s bedrooms were easily identifiable for people and their visitors. People enjoyed a wide range of opportunities for social interaction. People were comfortable to raise concerns if they needed to and felt they were listened to and issues were resolved. When people were nearing the end of their lives action was taken to keep them as comfortable as possible and to remain at the service if this was their choice.

People said the manager was extremely approachable and was seen around the home regularly. People, their relatives, external professionals, and staff, told us the home was well managed, and there had been many improvements. The manager used the manager’s robust governance systems to help identify and resolve issues in the home. People had regular meetings to discuss the service and make suggestions about how the home performed. The manager obtained feedback from people to help make continuous improvements at the home. The manager had developed good working relationships with external health professionals ensuring people's social and health needs were promptly met.

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

Rating at last inspection

The last rating for this service was Good. (published 25 March 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

Vesta Lodge provides accommodation for up to 61 people with residential and dementia needs. At the time of this inspection there were 57 people living at the service.

There was a manager in post who was in the process of registering with CQC. 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.

When we last inspected the service on 22 October 2015 we found the provider was meeting the regulations. At this inspection we found that the provider was continuing to meet the regulations. However, improvements were required to ensure continued compliance with the regulations in relation to the delivery of personal care.

There was a welcoming and calm atmosphere throughout the home. Hand cleaning dispensers were placed around the home to enable staff and visitors to sanitise their hands regularly and reduce the risk of infection, and the home mostly smelt fresh and clean and was well maintained. However, there was an unpleasant odour on one of the units. The environment within the unit for people living with dementia could benefit from being more dementia friendly to help people find their way around the unit and to provide stimulation.

There was plenty of information on notice boards such as guidance to support people who were living with dementia, pictures of staff on duty, date and weather boards on each unit, activities for the week, thank you cards and safeguarding information. There were also suggestion boxes for people to provide feedback about the service on each unit. People told us they felt safe living at Vesta Lodge. Staff understood how to keep people safe and risks to people's safety and well-being were assessed and kept under regular review to help to keep them safe. People's medicines were managed safely by staff who had received training.

People had their needs met in a timely way and we observed there were sufficient numbers of staff who had the right skills and experience to support people safely in a timely manner. There was a robust recruitment process in place. However we found some historic recruitment files did not meet the current standards that were currently in place. The manager undertook to review these with a view to bringing them up to the same standard of the current recruitment process. This helped to ensure that staff who were employed at the service were suitable to work in a care setting.

Staff received regular support from their line managers which included one to one supervision and team meetings. Staff told us they felt well supported. People received the assistance they needed to eat and drink sufficient amounts to help keep them well. People were supported to maintain their physical and mental health and staff made referrals to healthcare professionals when required.

We saw that people had not always been assisted with personal care in a timely way. In some cases this meant that people’s dignity was compromised. Although staff told us they completed detailed records of personal care provided we found that sometimes the detail was not included and therefore it was difficult to establish how or if they had been assisted. Staff were knowledgeable about people’s individual requirements in relation to their care and support needs and preferences. People and or their relatives had been involved in the planning of their care where they were able to and where this was appropriate. Visitors were welcomed to the home at all times and were invited to join in events and celebrations throughout the year.

People were supported to participate in some activities that were provided. This was an area that required improvement as activities were not always relevant to people’s individual’s interests and abilities. We also found that people who were cared for in their bedrooms had little engagement or stimulation.

There were arrangements in place to receive feedback from people who used the service and their relatives. People were able to raise any concerns they had and told us that in most cases they were confident they would be listened to and any concerns raised would be addressed.

People and their relatives were mostly positive about the staff and management at the service. However we did receive some less positive feedback. This was discussed with the manager and we found that some of the issues referred to concerns that had be raised some time ago, most of which had been addressed. However there was an action plan in place to address other areas where the manager had identified shortfalls in the standards at the service. There were systems and processes in place to regularly monitor the quality of the care and support provided for people who used the service. Where shortfalls were identified actions were in place to make the required improvements.

is the service responsive, is the service safe, is the service effective and is the service well led? The inspection was carried out by one inspector over one day.

Below is a summary of our findings.

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. We asked one person, 'Do you feel safe.' They responded 'Oh very much so, the staff are nice and helpful.'

We looked at the staff training. We noted that staff were up to date with and had received relevant training. That meant staff had the skills and experience needed to support people.

We noted from the care plans that an assessment of needs had been carried out before people came to the home. We saw evidence from the care plans that risks had been assessed and instructions on how the risks should be managed by staff was provided so that people were safe.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We noted capacity assessments and best interest had been completed. We saw one completed DoLS' Standard Authorisation' There have been other applications for DoLS.

Is the service effective?

We noted from the care plans we had looked at that each person or their relatives had signed the service provision 'information on admission' checklist. The checklist provided information about the home including the type of care they provided.

People who used the service and their relatives had also given their consent to have photographs taken for the use of identification by the home. The staff members we spoke with said that they always consulted the people on how they would like to be supported with their personal care and other activities.

Is the service caring?

People who lived in the home spoke very positively about their experience and said they had been consulted on all aspects of their care. One relative said, 'She did not have any concerns about the quality of care for her [Relative].' Another said, 'I have no concerns about the care and the staff. They are very nice and are very busy, would like [Relative] to have some stimulating activity, particularly mid-morning when they are alert.'

Is the service responsive?

We noted that the care plans had been written from the person's perspective and were centred on their needs. The staff we spoke with told us that the care plans were easy to follow and that they were aware of people's identified needs and that they ensured that people's needs were met appropriately. Care plans were reviewed on a regular basis.

We saw the provider had a complaints policy in place. We looked at the complaints log and saw that complaints were looked at in line with home's policy.

Is the service well-led?

The provider had sent out annual surveys to residents and their families and or advocates. There were regular staff and residents meetings. We saw action plans that had been compiled from questionnaires. This meant people's views and comments were sought by the provider.

We saw that there were policies in place for infection control, moving and handling and medicine. Regular audits had taken place. We saw the provider had a business continuity plan that had contact details for suppliers in case of an emergency.

People we spoke to told us that people were 'looked after well' and were 'happy', but that staff were 'always busy' and seemed 'over stretched'. Staff we spoke to told us that they 'enjoyed' working at the home and felt that the management was 'doing their best'. We were told by some staff and people at the service that 'sometimes' there was not enough staff.

We found that the provider was meeting the regulation for informing the commission of any deaths that occurred within the home and used the correct reporting procedures. We did however find that the provider was not meeting the standards for providing a sufficient number of staff to protect people from the risk of harm because on the day of our inspection we observed that on two of the four units people were left unsupervised in communal areas.

We carried out an additional inspection at Vesta Lodge on 28 October 2013 to see if the provider had addressed the concerns we had identified. At this inspection we looked at the kitchen areas; peoples care plans and their nutrition and fluid charts. We found that the provider was meeting the requirements of this standard.

We saw that the quality of the food provided to people had been maintained but that the provider had introduced regular stock checks within the kitchen to ensure that food was stored and labelled correctly at all times.

People told us that the staffing team was an 'all round team' who supported each other and that the house keeping was 'on the ball' and ensured that everything was always clean and hygienic. Whilst at the service we found that people looked happy and that their personal care needs had been met. We noted that some people were in the communal seating areas whilst others had chosen to sit in their rooms or were freely moving about the home. We did however find that the provider had not satisfied the requirements relating to people's nutritional needs.