Archived: Canal Vue

Canal Vue is a residential home providing personal care to up to 70 people. The service provides support to older people and people living with a dementia. At the time of our inspection there were 53 people using the service. The home provides care over 3 floors with a range of communal spaces for dining, activities and relaxation.

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

There were not always enough staff to support people with their individual needs. People’s risks were assessed and detailed in their care plans, however staff were not always deployed effectively to meet people’s needs.

The culture of the home did not always promote positive person-centred care and some staff and relatives did not always feel management adopted an honest and open culture. Systems in place to monitor the quality of the service did not always identify shortfalls in people’s records.

Staff were recruited safely and people receive their prescribed medicines on time. Staff received regular supervision and training to carry out their roles. People were protected from the risk of abuse. Staff received safeguarding training and understood the procedures of how to raise a concern.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Correct infection and prevention control measures were followed. Accidents and incidents were recorded and actions taken to prevent the risk of reoccurrence. The provider worked with a range of healthcare professionals to help meet people’s outcomes.

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 21 June 2021).

Why we inspected

We received concerns in relation to staffing. As a result, we undertook a focused inspection to review the key questions of safe and well-led only

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Canal Vue on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to staffing and governance. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Canal Vue is a care home providing personal and nursing care to 35 people aged 65 and over at the time of the inspection. The service can support up to 70 people across three floors of a purpose build building. People were only living on the ground and first floor at the time of inspection.

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

Staff understood how to keep people safe and knew how to identify potential abuse. Where concerns were identified, staff understood their role to report concerns to protect people from future potential harm. Care records were personalised, contained people's preferences and included risk assessments to mitigate the risks of harm.

There were suitable numbers of staff supporting people who had been recruited safely to ensure they could work with people. There were systems in place to ensure people received their medicines as prescribed. People were protected from the risks associated with the spread of infection and personal protective equipment was worn to reduce the risk of transmission of infection. Where improvements were needed, the provided had recognised and learnt from any mistakes.

Systems and processes were in place to monitor the service provision and identify where improvements were needed. There were regular meetings to keep the team updated on training and good care practice. The staff worked in partnerships with health and social care professionals to ensure people’s needs were met and reviewed.

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 1 January 2020)

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Canal Vue is a residential care home providing personal care to 11 people at the time of the inspection. The service can support up to 70 people in across three floors of a purpose build building. People were only living on the ground floor at the time of inspection.

The systems in place to monitor people’s health and wellbeing were now effective and led to good outcomes for people. All staff understood their responsibilities and this joined up approach helped to drive continuous improvement. There was good communication with staff and people who lived at the home to ensure their feedback was followed up. Communication was adapted to be accessible for people when there was an assessed need.

People received safe care. There were enough staff to support them and they were recruited to ensure that they were safe to work with people. People were protected from the risk of harm and potential abuse. There were robust systems to analyse when things went wrong to understand the cause and try to avoid repetition. People received their prescribed medicines safely and there were good systems embedded to manage the risks associated with them.

People received caring and kind support from staff who respected their dignity and privacy. They were encouraged to be independent and staff understood their needs well. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff were skilled in understanding the needs of people and engaged them in meaningful activities. Staff knew them well and understood how to care for them in a personalised way. Care plans were informative and regularly reviewed to support staff.

People were supported to maintain good health and nutrition; including partnerships with other organisations when needed. The registered manager was approachable and there were meetings in place which encouraged people and staff to give their feedback. People and relatives knew how to raise a concern or make a complaint. The environment was adapted to meet people’s needs.

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 Inadequate (published 28 June 2019)

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations. This service has been in Special Measures since April 2018. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

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.

About the service:

Canal Vue is a care home that provides personal care for up to 70 people. The accommodation is available over three floors. However, at the time of the inspection only the ground floor was in use. The ground floor contains bedrooms, bathing facilities, a communal lounge, with a dining area and a further two communal spaces. At the time of the inspection there were 13 people using the service.

People’s experience of using this service:

Some improvements had been made to some areas of the home. However, the provider had not ensured the required improvements had been made to all areas of the service. Good care is the minimum that people receiving services should expect and deserve to receive and we found the systems in place to ensure improvements were made and sustained were not effective.

Systems to monitor the service had not identified the improvements that were still needed. People were not always protected from harm as action had not been taken where risk had been identified. Quality monitoring had been inconsistent, we saw that audits had been completed, however they did not always identify concerns. Any concerns raised were not always addressed to ensure changes and improvements were embedded.

Notifications had not always been completed to inform us of events or concerns.

During the inspection we saw there were sufficient staff to support people’s needs. However, it was identified by the staff that at some periods in the day and night there were not always enough staff to ensure people’s safety.

People’s risks had been identified, however these were not always followed or reflective when people’s needs changed. Some areas of the home were not always cleaned to a standard to reduce the risk or control of infection.

Lessons had been learnt in some areas, however other areas still required further commitment in ensuring when changes were required they were carried through and sustained.

Some people’s independence had not been promoted when they had their meals. When people spent time in their rooms they did not always have access to a call bell to enable them to request support.

The summary care plans were not always up to date to reflect people’s needs at a glance. However, the main care plans were detailed and reflected people’s needs.

Improvements had been made in relation to the activities and daily choices being made available to people.. The care people received was respectful and caring. Relatives were welcome. Their views had been considered and these had influenced the food choices available.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Staff were recruited to ensure the relevant checks had been completed. People’s weight had been monitored

The service worked in partnership with a range of health and social care professionals and these relationships had supported peoples to have good health outcomes and consider their wellbeing.

Rating at last inspection: Inadequate (Published November 2018)

Why we inspected: This was a planned inspection based on the rating at the last inspection which was Inadequate. Which means the location was placed in special measures. At this inspection we saw improvements had been made, however not enough for us to remove the rating of ‘Inadequate’ and remove the service from ‘special measures’.

This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

Enforcement: At our last inspection we placed positive conditions on the provider in relation to this location. These required the provider to consult us ahead of any new admissions and to provide us with a monthly report in relation to quality improvements. Although improvements had been made, this did not reflect a sustained approach and we felt it to be appropriate for the conditions to remain at the location until our next inspection.

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 back of the full version of the report.

Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals are added to reports after representations and appeals have been concluded.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per 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

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Canal Vue is a 'care home'. People in care homes receive accommodation and nursing or personal care as a 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 is provided in one building across three floors. At the time of this inspection people were only living on the ground floor. There are communal living areas and a separate dining area on that floor. The home provides accommodation and nursing care for up to 70 people who are living with dementia. However, after our last inspection they were not able to take any new admissions and there were now 13 people living at the home.

There was not 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. There was an interim manager on the day of the inspection visit and a new manager due to start the following week.

We found that risk was not managed sufficiently to ensure that people were kept safe. Staff had not received additional training in supporting people living with dementia and we found that they were not always skilled in assisting people whose behaviours put themselves or others at risk of harm. Risk assessments and care plans were not always regularly reviewed to take account of all incidents which had occurred. Staff did not always recognise and report suspected abuse. The provider did not always learn from when things went wrong to ensure that action was taken to avoid it happening again. They did not ensure that staff understood how to avoid further recurrence.

At the previous three inspections we found that the Mental Capacity Act 2005 (MCA) was not fully embedded, we found some improvements at this inspection. Capacity assessments had been completed to assist people to make decisions which were in their best interest. However, staff were not aware who had safeguards in place when there were restrictions on their liberty. They also did not demonstrate an understanding of when restrictions could be applied. Therefore, people were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

Quality improvement systems were not consistently completed and there was limited provider oversight of the actions required to improve the service. This meant that risks to people’s safety and wellbeing were not actioned sufficiently and lessons were not learnt when things went wrong. There was no provider oversight of complaints received to ensure that the procedure was managed by a registered person. There were no regular meetings or other ways of getting feedback from people who lived at the home and their relatives to evaluate and improve the service.

The provider did not always comply with the requirements of their registration. Notifications of incidents and events were not always made, they had not reviewed their statement of purpose in line with changes to the service provided and they did not always report as they were required to do after their last inspection.

Care plans were not always up to date or regularly reviewed to ensure that staff had relevant information to assist them to support people. This included plans for people who were at the end of their life.

People did not always have their dignity and privacy respected. They did not always have enough stimulation and engagement in activities.

There had been some improvements since the last inspection. Medicines were managed and administered effectively to ensure that people had them as prescribed. There were enough staff deployed to meet people’s needs. Safe recruitment procedures were established to ensure that staff were safe to work with people. People had enough to eat and were offered a choice at mealtimes.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures

Canal Vue 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 is provided in one building across three floors. There are communal living areas and dining areas on each of the floors. The home provides accommodation and nursing care for up to 70 people who are living with dementia. There were 58 people living at the service when we visited; although two moved out on the day of inspection.

There was 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.

We found that risk was not managed sufficiently to ensure that people were kept safe. Plans were not followed to ensure that people received safe care. Risk was not reviewed when people’s needs changed to prevent further harm; for example, from falls. When people’s behaviour put themselves and others at risk of harm staff did not always respond and there was not always detailed plans to direct them how to. Medicines were not always managed and administered to ensure that people had them as prescribed. Records which were in place to support the care people received so that staff understood what they needed to do were not always up to date or clear.

Staff did not always recognise and report any suspected abuse. The provider did not always learn from when things went wrong to ensure that action was taken to avoid it happening again. They did not ensure that staff understood how to avoid further recurrence.

There were not enough staff deployed to meet people’s needs and this meant that people did not always have their dignity respected. Staff did not always recognise when dignity and privacy was compromised for people living at the home. Safe recruitment procedures were not followed to ensure that staff were safe to work with people.

At the previous three inspections we have found that staff needed additional support and training in understanding the needs of people living with dementia and at this inspection we found that this had still not been provided. It meant that they did not always respond to people consistently to ensure that they reduced their distress.

Quality improvement systems were not effective in highlighting and addressing concerns. This meant that concerns around infection control, medicines management and falls were not actioned sufficiently and lessons were not learnt when things went wrong.

At the previous two inspections we found that the Mental Capacity Act 2005 (MCA) was not fully embedded and we found that this was still the case at this inspection. Some people had safeguards in place which staff were not aware of and the conditions had not been met to ensure they were legal. Safeguards had not been considered for others who required them because there were restrictions on their liberty. Therefore, people were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice

Care plans were not always up to date or regularly reviewed for people to ensure that staff had relevant information to assist them to support people. This included plans for people who were at the end of their life. Some care plans were not followed as required to ensure that people had their healthcare needs met. People were also not always supported to have enough to eat and drink. They did not always have enough stimulation and engagement in activities.

We found that the provider did not always respond to complaints in line with their procedure. They did not always respond to feedback from staff about the quality of the service. Notifications of incidents and events were not always made in line with their registration.

Families were welcomed to visit without restrictions.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We completed a previous comprehensive inspection on 11 May 2016 and found that improvements were required in a number of areas. This included regulatory breaches in the amount of staff available to meet people’s needs safely and staff understanding of restrictions under the Mental Capacity Act 2005 (MCA). After the comprehensive inspection the provider sent us an action plan within the timescales we requested to demonstrate how they would make improvements. At this inspection we found that some of these actions had been put in place; for example, staffing levels had been reviewed and we saw that there were enough to support people. We saw that people did not have to wait for assistance and that staff had time to spend socialising and reassuring them. However, the staff’s understanding of the MCA was still not fully embedded. Some improvements had been made in applying for legal safeguards when people did not have the capacity to consent; however, staff were not aware what these were. Also, best interest decisions had not been considered for every restriction in place. Furthermore, some improvements that we found at the comprehensive inspection in May 2016 had not been sustained. For example, safe recruitment procedures had not been in place in the comprehensive inspection in May 2015 and were found to require improvement again at this inspection.

At each inspection (in May 2015, May 2016 and June 2017) we found that staff needed to be provided with training in supporting people who live with dementia and who may behave in a way which is challenging. We found that this had not been provided and staff recognised that it was required. The plans in place to support staff to know how to assist people when they behaved in a way which could harm themselves or others were not detailed enough to assist them. There was limited recording of when these behaviours occurred or when people took medicines to assist them to become calmer when it happened.

Other risks associated with medicines were not managed to ensure that people received them as required. The audits which were completed were not effective in identifying these issues. The high turnover of staff and managers impacted on the ability to manage quality improvement and to sustain it.

People were kept safe by staff who understood their responsibilities to protect them. Posters helped to explain to people how to raise a concern or make a complaint. They were also assisted to make choices about their care and how they wanted to be supported. They had care plans in place to support this and these were regularly reviewed.

Staff were knowledgeable about people’s needs and understood the risks to people’s health and wellbeing. They supported them to see healthcare professionals regularly to maintain good health. Mealtimes were well planned to ensure that people received the support they needed, including specialist diets.

Staff had positive relationships with people and respected their privacy and dignity. People were encouraged to participate in activities and important relationships with friends and relatives were encouraged. People and their relatives were communicated with so that their feedback could contribute to the development of the service.

We found 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 back of the full version of the report.

Canal Vue provides personal and nursing care for up to 70 older people. It is a purpose built establishment over three floors. There were 43 people living at the home at the time of our inspection.

The home is required to have a registered manager in post. 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. There was no registered manager in post at the time of inspection.

At the last inspection we saw that safe recruitment procedures were not always followed. At this inspection we saw the provider had ensured that staff were safe to work with people. Improvements had been made to ensure that the provider met their legal requirements to ensure that people consented to their care. However, some people’s capacity to make certain decisions had not been assessed or decisions made in their best interest.

At the last inspection the provider was not always meeting the needs of people living with dementia. Some activities were now being offered and the environment had been designed to assist them. However, people we spoke with and their families said that there was not always enough to do. At the last inspection we saw that the provider had not notified us of all significant events and now they had, which enabled us to ensure that they took the appropriate action.

We saw that there were not always enough staff to safely meet people’s needs and that people had to wait for support and assistance. This impacted on the lunchtime experience in one area of the home as people had to wait for a significant amount of time in a hot environment. Staff did not always have the skills and understanding to effectively support people with their health needs and communication with healthcare professionals was not always maintained to ensure that relevant referrals were made.

There was no registered manager in post but the provider had established a leadership team and there was recently a temporary manager in place who staff said was approachable. Quality systems had been implemented which were driving improvements and complaints were responded to in a timely fashion with learning recorded.

Medicines were administered and managed safely to reduce the risks associated with them. Other risks to people’s health and wellbeing had been assessed and actions put in place to address and reduce them. People had care plans which were detailed, reviewed and altered to represent their changing needs. We saw that staff followed the guidance and supported people in a caring manner. Staff developed meaningful relationships with people and were aware of their likes and dislikes. People had their privacy and dignity upheld and visitors were welcomed at any time.

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

There were 38 people using the service, two people were in hospital on the days of the inspection. We spoke with four people who used the service, seven staff and five relatives or friends and three visiting professionals. We spoke to the provider, a senior manager from the organisation, and registered manager from another home owned by the provider. They were all supporting the manager. There was no registered manager in post at the time of the inspection. A registered manager is a person who has responsibility with the Care Quality Commission (CQC) to manage the service and has legal responsibility for meeting the requirements of the law: as does the provider. However a new manager was appointed into a management position. They told us they had no previous experience of managing a care service and received support through other managers.

During our inspection we wanted to understand people's experience of the service they were using. We did this by spending time sitting and talking with people. We 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. SOFI allowed us to observe the care experiences of people who had communication difficulties. SOFI was used in the communal setting of the dining rooms. We observed the way staff responded to people. We read three care records about people's care and spoke with staff about people's needs.

The evidence we collected helped us to answer five key questions;

Below is a summary of what we found.

Is the service safe?

People we spoke with told us that they felt safe living at the home. We saw that staff were able to meet people's basic needs but there were times when they were not available to provide extra support to people. Agency staff when available were appointed to provide cover at the home.

Staff told us that they often worked without sufficient staff to maintain cover for the three floors. They told us that they found it difficult to perform their roles safely. This meant people could be placed at risk from receiving care that was not always safe because of inadequate staffing numbers, supervision and support.

Staff recruitment was underway to address staff shortages. However, we found unsafe recruitment practices had taken place historically because relevant safety checks were not always undertaken before staff were employed. The provider told us that adjustments were made to ensure safer practices were followed.

Is the service effective?

We saw that people with capacity to make decisions chose whether they took part in activities. We found from reviewing some people's care records, their rights were protected because meetings had been held to determine that actions taken were in people's best interests. Deprivation of Liberty Safeguard (DoLS) applications had been made to ensure people's rights were appropriately protected. This is where a person is restricted of their freedom and considerations are made in the person's best interest.

We saw that people received a diet that was varied, nutritional and prepared so that they could eat it safely. We saw improvements could be made to the management of meal times. This could include having more staff available to help serve and assist people at meal times.

Staff received training to enable them to provide care in an effective way and communicated with other professionals including community nurses, chiropodists and doctors when people were unwell. Care records and assessments were in place and were kept under review. Regular staff understood people's support needs and people were asked for their consent to care.

Is the service caring?

People told us that they received care provided by staff that were kind to them and knew their individual needs well.

Is the service responsive?

People and their family representatives were provided with an opportunity to attend and share their views at regular meetings where they were able to comment on the care received. They told us they were listened to and actions were taken to address their comments. Concerns and complaints were taken seriously and investigated.

Is the service well led?

People were positive about their life at the home. They told us the staff were helpful and the nurses were approachable.

A registered manager was not in post. However, a manager was in post and they were supported by the management team. This was because the manager did not have the knowledge and relevant experience for managing a care home with nursing. The provider told us that managers were supported for up to three weeks and further time was given to support this new manager.

Staff did not always feel supported by the management team and did not always feel confident to report their concerns directly to them. We found that the management team needed more time to improve and build relationships with the staff team.

Quality assurance systems meant that people's views and those acting on their behalf were obtained and acted on. Although, checks were made by the provider for the quality of the service, people were not always protected from some of the risks associated with regular staff shortages. This could have an adverse impact on the care people received.