Archived: Vancouver House

Updated 21 October 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was undertaken by an inspection manager, five inspectors and a medicines inspector.

Service and service type

Vancouver House 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 service does not have a manager registered with the Care Quality Commission. This means the provider is legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 19 August 2021 and ended on 24 August 2021.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all this information to plan our inspection.

During the inspection

We spoke with two people who used the service and a relative about their experience of the care provided. We spoke with fifteen members of staff including the provider, managers, nursing staff, care staff and kitchen staff.

We reviewed a range of records. This included five people’s care records and several medication records. We looked at staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found.

Updated 21 October 2021

About the service

Vancouver House is a care home providing personal and nursing care to adults aged over 18. The service can support up to 32 people. 17 people currently live at Vancouver House.

There are four units across two floors and all four units are in use. Vancouver House supports people with a learning disability, autism and people with mental health needs.

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

The service was not safe. People’s support plans were not always followed and there was a high reliance on agency staff. This meant staff did not always have the right knowledge or experience to meet people’s assessed needs. The medicines policy was not always followed, and we found gaps in how the provider reduced the risk of spread of infection.

The service was not effective. People’s needs were not always met in line with guidance. Staff did not have the right level of induction, training, skills or experience. We were not assured the provider always had consent to care and treatment in line with law and guidance.

The service was not well led. The concerns noted during the inspection had not been addressed by managers, and there had been no improvement since the previous inspections. There was a poor culture at all staff levels and management.

People were supported to have maximum choice and control of their lives. Although there were policies in place, staff did not always support people in the least restrictive way possible, and this was not monitored effectively by the provider.

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.

This service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. Health and social care providers are required to ensure autistic people and people with a learning disability have the choices, dignity, independence and good access to local communities that most people take for granted.

The model of care had an institution type feel and did not meet the principle of Right support. Some staff were committed to providing person-centred care however sometimes people’s dignity and privacy were not respected.

The provider acknowledged these issues and planned changes, however, were met with logistical challenges making it difficult to make the desired changes. Plans included reducing the size of the service to one unit instead of four, and to update and modernise the environment.

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 1 April 2021) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulation.

Why we inspected

Through regular meetings with the provider and commissioners, all parties were aware of and acknowledged concerns in relation to the management of incidents, staffing and leadership of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well led.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the relevant key question sections of this full report. You can see what action we have asked the provider to take at the end of this full report. The provider has taken some action to mitigate the risks which is under constant review.

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.

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

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 staff recruitment, management of risk, monitoring the quality of the service, and ensuring consent for care and treatment.

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.

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 act 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.