Archived: Vicarage Road

About the service

Vicarage Road is a residential care home providing personal/ and nursing care to four people at the time of the inspection. The service is registered to support up to eight people. At the time of the inspection the provider had applied to reduce this number to up to six people. Vicarage Road is a three-storey terraced house with a small courtyard garden. Accommodation is provided over the three floors, with a small communal lounge and kitchen located on the first floor. At the time of the inspection three people were accommodated in self-contained flats which provided a bathroom and lounge area.

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

Based on our review of safe, responsive, and well-led the service was not able to demonstrate they were meeting some of the underpinning principles of Right support, right care right culture.

Right Support

The model of care did not maximise people's choice, control and independence. The physical environment did not meet people’s needs and placed people at an increased risk of harm. People were not given proper control over how they spent their day as this was compromised due to poor staffing levels and a lack of planning. There was a lack of focus on outcomes for people such as promoting independence.

Right Care

People were not receiving person-centred and safe care. The ability to provide person-centred care was compromised due to low staffing levels, poor care planning and poor engagement with relevant people, such as health and social care professionals. The systems in place to promote person-centred support were not being utilised effectively. There was no meaningful goal planning or activity planning. As a result, people were receiving a poor-quality service. People’s rights were not promoted as processes around consent and safeguarding were not effectively implemented

Right culture

Governance systems were ineffective and did not promote a person-centred high-quality culture. Staff morale was impacted negatively by the staffing levels and this in turn impacted on the delivery of the support provided. The provider had not taken timely action to ensure improvements had been made. Engagement with people, their relatives, and other external professionals was not taking place to help identify and ensure improvements were made.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 03 March 2022). The previous inspection was carried out on 26 August 2021. Following this inspection conditions were imposed on the provider’s registration at this location. At this inspection we found the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about staffing, the environment and the management of the service. A decision was made for us to inspect and examine those risks. The information received raised concerns on how the service was applying the principles of right support, right care, right culture. We assessed the application of these principles during this inspection.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, safeguarding, consent, person-centred care, staffing, and good governance.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘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.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Vicarage Road is registered to provide; Accommodation for persons who require nursing or personal care up to six people. At the time of our inspection there were five people using the service, two people had moved in the day before from another Jeesal Residential Care Services Limited which had recently closed. The service provided single accommodation over three floors, some of which were self- contained. There were a number of shared facilities over two floors.

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

The inspection was carried out due to concerns about Jeesal Residential Care Services Limited ability to ensure people were safe and well cared for. This included concerns from the Local Authority. People using the service had experienced a lot of change. Two people who had moved in the day before our inspection had the opportunity to visit several times before moving but their care records were not fully transferred or complete. They were supported by redeployed staff from their previous home who knew them well. The existing staff team did not have much knowledge of the people moving in. No transitional plans were in place. We were unable to see how the service had considered the compatibility of each persons’ needs and the skills and training needs of staff to meet their needs. Prior to admission staff had not received behavioural strategy training and core staff teams were not in place. For everyone using the service there was a need for people to have clear routines, boundaries and planned activity schedules to help them feel safe and ensure predictability.

We were not assured that accurate records were maintained. The electronic recording system had good capability if used to its full advantage, but we found many sections of the care and support plans were blank. Some information was out of date and risk assessments were generic rather than specific to the health needs and behaviours of people using the service. Poor planning, recording, reviewing and accessibility of information meant we could not clearly see how people’s needs were being met or that staff had all the information required to safely meet people’s needs.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. Based on our review of the key questions: Safe, Effective and Well led we found the provider was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

•The model of care and setting did not maximise people’s choice, control and independence. Restricted social activity was noted due to COVID-19 pandemic. However, we noted creative solutions had not been found to enable people to continue to access things they enjoyed. Goals were not dynamic, and people did not have the same opportunities as others in the community. There was limited involvement of people in clubs, societies, memberships or access to both community facilities and community transport. People had little choice about where they lived or who they lived with.

Right care:

•The Care and support was not person centred as people were not supported and encouraged to develop their life skills and live purposeful, meaningful lives. Activities were often repetitive and short lived based around staff shift patterns and availability of shared transport.

Right culture:

• Staff spoken with felt disempowered with little direction, leadership and support from the senior management teams. Staff felt supported by the current acting manager but there was no registered manager to implement and sustain change. Staff felt their hard work was not acknowledged, and they felt undervalued. Staff training did not reflect the needs of people using the service. Governance and oversight had been poor resulting in both a fall of care standards and people’s living conditions.

The provider had not been proactive in ensuring the property was safe and routinely maintained. Ongoing maintenance work was underway but more as a result of concerns expressed by other agencies including the CQC and the local authority. Radiators and pipework were uncovered which could pose a risk of scalding. Risk assessments had been put in place and the acting manager ensured us their long-term improvement plan was to cover the radiators to eliminate any risk. Environmental risks had not been considered in line with people’s known behaviours particularly the risk from destroying property and breaking glass, electrical sockets and other items. This exposed people to the risk of avoidable harm and the environment had not been sufficiently adapted.

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 and in their best interests; the policies and systems in the service did not support this practice. Deprivation of liberty safeguards, ( DoLS) were in place for some people, but for at least one person their DoLS status was not known and for another person staff restricted their access to the community due to associated risks but these had not been considered in terms of the persons rights and wishes.

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

The last rating for this service was good (published 26 June 2019)

Why we inspected

The inspection was prompted in part due to concerns about the provider and their locations and in part by information of concern received about this location. A decision was made to carry out of focused inspection to look at the key questions Safe and Well led, which we extended further to cover Effective.

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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to: consent, safe care and treatment, staffing, and good governance and there being no registered manager.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Vicarage Road is a residential care home that provides personal care to up to six people with a learning disability. At the time of the inspection, five people were living in the service.

People’s experience of using this service:

People received a person-centred service that respected their wishes and choices and supported them to reach their potential. Staff were committed to their roles and supported by a management team that were knowledgeable, experienced and skilled.

People were supported by staff who knew how to keep them safe and protect them from avoidable harm. There were enough safely recruited staff to meet people’s needs on an individual basis and the staff were flexible in their approach. Risks to people and others had been identified and managed. People received their medicines safely and as prescribed as staff had received training and followed good practice guidance. The premises were clean, and staff followed infection prevention and control procedures.

People’s needs were assessed and care and support was planned with individuals to achieve their wishes. Care was delivered by staff who were well trained and knowledgeable about people’s needs. Staff felt supported and empowered in their roles. People chose what they wished to eat and drink and were supported to make choices to aid a healthy lifestyle.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People told us staff were kind and supported them in their lives. We saw that interactions were warm and engaging and there was a calm and friendly atmosphere within the home. People’s dignity and privacy was maintained, and they were supported to be as independent as possible. Staff supported people to be fully involved in the care and support they received.

Staff were responsive to, and knowledgeable about, people’s needs, wishes and personalities and care was planned accordingly. People were involved in decisions around their care and reviews were regular and in-depth. Communication was tailored to each individual and information was available in different, accessible formats. Staff supported people to engage in their hobbies and interests.

The service continued to be well-led by experienced and skilled managers. They supported an environment that was open, positive and inclusive. Systems were in place to monitor the service and make improvements as necessary whilst taking into account people’s views. The service worked well with others and respected their input.

Rating at last inspection:

At the last inspection the service was rated good (report published on 7 November 2016).

Why we inspected:

This was a scheduled comprehensive inspection; its timing based on its previous rating.

Follow up:

We will continue to monitor the intelligence we receive about this service until we return to visit as per our inspection schedule. We have made a recommendation around Disclosure and Barring Service (DBS) checks and will follow this up at our next inspection.

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

The registered manager had been in post since 2010. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

There were systems in place to ensure that people lived and worked in a safe environment. Risks to people’s health and wellbeing were identified and mitigated. Detailed risk assessments informed staff of how to minimise the risk of harm to people. There was consistently enough staff on duty to safely support people with their care needs. There were safe practices around staff recruitment in order to recruit suitable staff to work in the home.

Accidents and incidents were recorded and reported appropriately. Root cause analysis was carried out to learn from incidents and highlight any action that the manager needed to take.

Medicines were managed, stored and administered safely and people received their medicines as prescribed. Staff’s competency in the administration of medicines was regularly reviewed.

People were supported by staff who were skilled and knowledgeable in their role. A comprehensive induction was completed by all staff and staff were able to access training to support people with their specific support needs. Staff were further supported through regular supervisions and annual appraisals.

Staff had an understanding of the principles of the Mental Capacity Act 2005 and how to support people who lacked capacity to make some decisions. The service had identified that some people may need to be deprived of their liberty to keep them safe. Applications had been made to the authorising body to ensure that people were protected. Staff supported people to make choices about their care and day to day activities.

Prompt and timely referrals were made to relevant healthcare professionals where there were concerns about a person’s health or wellbeing. Guidance from professionals was reflected in people’s support plans. People were able to choose what they wanted to eat and drink and they were supported to maintain a sufficient dietary intake.

People were supported by caring staff who treated people according to their individual needs and preferences. People were treated with respect and dignity and their right to privacy was upheld.

Detailed support plans and care records were written with people so their views and preferences could be sought in every aspect of their life. Support plans and risk assessments were reviewed and updated regularly to reflect people’s most current support needs.

Staff supported people to maintain their independence by encouraging people to pursue their interests and get involved in daily household tasks. People were able to have relatives and friends visit them and visits home and to family occasions were facilitated by staff.

Complaints were dealt with appropriately and in a timely manner. People felt able to raise a complaint if needed.

The service was well run and the manager was approachable. They maintained open and frequent communication with people and the staff who worked in the home.

There were systems in place to monitor and assess the quality of the service being delivered. The manager carried out regular audits, as did the provider’s quality assurance manager. Remedial action was taken in response to any findings from the audits.

We spoke with five people who used the service. Everyone spoke positively about the staff and about the support which they received. One person said,'I like everything here and all the staff are good.'

The people we spoke with told us about a wide variety of activities which they were involved with outside of the home and they were very enthusiastic and happy when telling us about all the things that they were involved with.

We spoke with two members of staff. Both told us that they felt well supported by the management team and enjoyed working at the service.They both told us that they had undertaken training which helped them to support the people living at Vicarage Road.

We saw that people were offered healthy and nutritious meals. We saw from the support plans that people's individual needs had been assessed.The staff understood how to support those people who had special dietary needs.

We observed that staff were able to safely administer medication and that they followed the appropriate policies and procedures.

The provider had a clear complaints procedure in place and we saw that this procedure had been followed. Both people who used the service and visitors knew how to make a complaint.