Vaughan Lee House

Vaughan Lee House is a residential care home providing personal care to up to 30 people. The service provides support to older people. At the time of our inspection there were 24 people using the service.

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

People's records did not always contain all the information staff needed to provide safe care. Some individual risks to people were not always thoroughly assessed and mitigated, and records relating to people's care were not always complete and reviewed.

The medicines system was not always robust. The recording of topical creams administration was not completed. Some people were prescribed medicines to be taken when required, there was a lack of guidance when this medicine should be administered.

People were not always supported to have maximum choice and control of their lives. The service could not always demonstrate they were working within the principles of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

Recruitment procedures were not always robust, and staff did not always have appropriate training, support and detailed guidance to ensure people received safe care at all times.

The governance systems had failed to identify the areas for improvement that we found during the inspection. The shortfalls identified did not have any impact on the care and support people received. We discussed our concerns with the nominated individual and registered manager who were responsive to our feedback and started to take action to address the issues identified.

Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.

People told us they were happy; they felt safe, and the staff were kind and caring. Throughout the inspection we observed kind, relaxed, compassionate, and caring interactions between people and staff. Activities were provided for people, and they were supported to spend their time how they chose.

Rating at last inspection

The last rating for this service was good (published 18 May 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well-led sections of this full report. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, safeguarding (DoLS), staff training and support and good governance at this inspection.

We have also made recommendations in relation to medicines, recruitment and need for consent.

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.

People’s experience of using this service:

People received care and support that was safe. The provider had a robust recruitment programme which meant all new staff were checked to ensure they were suitable to work with vulnerable people. All staff had received training in safeguarding vulnerable people.

Risk assessments were in place to identify any risk to people and staff understood the actions to take to ensure people were safe. There were sufficient staff to support people with their daily living and activities

People received effective care and support. Staff demonstrated a clear understanding of people’s needs and received training relevant to their role and the needs of people living in the home. People enjoyed a healthy balanced and nutritious diet based on their preferences and health needs.

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

The provider had invested in improvements to the property and people had been involved in decisions about décor and changes made to the home. There was a bright warm atmosphere in all areas of the home.

People received care from staff who were kind and caring. Staff always respected people’s privacy and dignity. Staff encouraged people to be involved in their care planning and reviews. People were supported to express an opinion about the care provided and the day to day running of the home.

People received responsive care and support which was personalised to their individual needs and wishes and promoted independence. There was clear guidance for staff on how to support people in line with their personal wishes, likes and dislikes.

The provider looked at innovative ways to support people in maintaining their choice, control and independence. They also supported people to continue to follow hobbies and interests, as well as maintain links with their local community. People were supported to access health care services and to see healthcare professionals when necessary.

People were supported by a team that was well led. The registered manager and provider demonstrated an open and positive approach to learning and development. Everybody spoken with said they felt the manager was open, approachable and the home was well led.

There were systems in place to monitor the quality of the service, ensure staff kept up to date with good practice and to seek people’s views. Records showed the service responded to concerns and complaints and learnt from the issues raised.

Rating at last inspection: At our last inspection we rated the service Good. The report was published September 2016.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained Good overall.

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

Vaughan Lee House is owned by Ilminister and District (OPW) Housing Society Limited which is a non-profit making charity run by a committee. It is registered to provide care and accommodation for up to 30 people. It specialises in the care of older people.

The last inspection of the home was carried out in August 2015. At that inspection the service was rated as Requires Improvement. We found that improvements were needed because some records were not easily available and others, such as care plans, were not always up to date and reflective of people’s current needs. We also found that staff were not clear about how to make decisions when people lacked the mental capacity to make decisions for themselves.

At this inspection we found improvements had been made.

There is 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.

The registered manager had only been in post about 8 months but had already started to make improvements. Systems had been put in place to make sure records were available and up to date. A new care plan system had been implemented and the registered manager informed us they planned to expand on this to make sure care plans were comprehensive and person centred.

The provider was committed to continually improving the service offered to people and carried out regular monitoring visits. The registered manager sought people’s views by informal chats and resident’s meetings. Suggestions made by people were acted upon where appropriate.

There were procedures in place to help to keep people safe. These included a robust recruitment process and training for all staff to make sure they were able to recognise and report any suspicions of abuse. People told us they felt safe at the home.

Staff were kind and caring and treated people with respect and dignity. One person said “Kindness is everything and you cannot fault them.” Another person told us “They help me to have a bath and they are so gentle and kind.”

New systems had been put in place to make sure staff had the training they needed to safely and effectively support people. One person said “Staff are properly trained about how to speak to people and how to treat people.”

People had their needs assessed and received care and support in accordance with their needs and wishes. People said they were able to make choices about their day to day lives and were involved in decisions about their care and support.

People received meals in accordance with their needs and preferences. Where people required support to eat and drink this was provided in a discreet and dignified manner.

Staff monitored people’s health and sought advice from healthcare professionals to meet people’s specific needs. People had access to equipment to assist them to maintain their independence and to ensure their comfort.

Staff assisted people to administer their own medicines if they wished to. If people chose not to take responsibility for their medicines they were safely administered by staff who had received specific training.

People were able to take part in activities both at the home and in the local community. There was a mini bus which enabled people to get out and about on a regular basis. One person said “We are very lucky to get out so much. It’s nice to be able to do a bit of shopping and go for a coffee.”

At our last inspection carried out in May 2013 we found that there were no systems in place to comprehensively monitor the practices in the home or record keeping.

At this inspection we found that monthly monitoring inspections had become more robust and comprehensive. We saw that reports of the monthly visits still included discussions with people who lived and worked at the home and observation of the premises. Recent reports showed that the committee members who carried out the visits also looked at records and care practices.

All complaints received were fully investigated to make sure any shortfalls in the service were identified and rectified.

Since the last inspection care plans had been reviewed to ensure that they provided up to date information about people's needs. This meant that staff had appropriate information to enable them to provide care to the people who lived at the home.

The provider may find it useful to note that because information about individuals was recorded in a number of different places it was not easy to see an overall picture of the person's health and wellbeing. This could lead to changes in a person's health not being identified promptly which may lead to a delay in treatment.

People we spoke with said they made choices about their day to day lives. One person told us 'I'm free to come and go as I please and can have visitors at anytime.' Another person said 'You are never forced to do anything. You can please yourself up to a point but obviously you have to consider other people.'

People were well dressed and presented which demonstrated that staff took time to assist people with their personal care. We were told that staff assisted people in an unhurried manner and allowed people to maintain independence where possible. One person said 'I never feel rushed or that I am nuisance because I am slow with washing and dressing.' A member of staff told us 'We have enough staff, you never have to rush anyone.'

We saw no evidence that care plans, incidents or medication practices were audited. This meant that shortfalls may not be identified and addressed in a timely manner.

Each person who lived at the home had a personal file which contained assessments of need and risk. There were also details of how care should be provided. We noted that care plans were not always kept up to date and staff used information in the handover file to inform their practice instead of referring to individual care plans.

People we spoke with were very happy with the care that they received. Comments included; 'people are looked after really well,' 'I can't fault the care that I receive' and 'nothing could be better.'

People who lived at the home said that they felt safe with the staff who supported them. One person said 'I always feel very safe and I know that I can get help with anything.' Another person said 'since moving in I have complete peace of mind, everyone is so caring and gentle.'

People said that they were aware that staff were always busy but they never felt rushed. People said that if they rang their bell for assistance staff responded promptly. One person said 'if you ring that bell, day or night, they come straight to you.'

People we spoke with said that they would be comfortable to raise any worries or concerns with a member of staff or the manager. One person said 'we are always being told not to be afraid to raise anything we aren't happy with.' Another person told us 'I don't have any complaints but if I did I know the manager would want to sort it out.'