Archived: Vancouver House

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.

Vancouver House is a residential care home providing personal and nursing care for up to 32 people living with a learning disability/autism and/or a mental health condition. The service was supporting 20 people at the time of the inspection. Vancouver House accommodates people across four separate units, each of which has separate adapted facilities.

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

People were not always safe. We found appropriate numbers of staff on duty. However, there was a lack of information to demonstrate that staff were deployed effectively, in line with people’s commissioning agreements. In addition, agency staff were sometimes working with people on a one to one basis and did not always have the correct skills to meet people’s individual needs. Actions were in place to update all staff with their training and supervision. Medicines were sometimes safely managed. We have made a recommendation about the management of some medicines and the delegation of nursing tasks.

The service was not always effective. During the inspection process professionals alerted us to concerns in regard to records. We saw some improvements had been made to support plans, but records did not always contain person-centred information for people. The management team acknowledged they were still working to improve all records.

The service was not consistently well-led. The development and structure of the service showed some improvement in standards of care but quality standards were not consistent. Governance and auditing systems were not always effective and had not identified concerns we found during our visit.

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. However, records and monitoring of people’s Deprivation of Liberty Safeguards (DoLS) and conditions needed further overview to ensure consistent practice with records. We have made a recommendation about this.

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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The manager and staff were taking action to improve all aspects of person-centred care for everyone at the service. The manager was reviewing this model of support and revising the identity of the service to help maximises people’s choice, control and independence.

People told us they really liked living at the service. Relatives were very positive and told us they were happy with all aspects of support provided to their family members. The environment was safely managed and kept clean and tidy.

Staff were very complimentary about their management team and were fully supportive in driving positive changes.

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 requires improvement (published 8 December 2020). The service remains requires improvement. The service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about gaps in record keeping of people’s support plans and in part by notification of a specific incident. This incident is subject to a police investigation. As a result, this inspection did not examine the circumstances of the incident. A decision was made for us to inspect the service and examine risks.

As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. 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 remained as Requires Improvement. This is based on the findings at this inspection.

We also 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 coronavirus and other infection outbreaks effectively.

We have identified a breach in relation to concerns related to the governance of the service.

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 Vancouver House on our website at www.cqc.org.uk.

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.

Vancouver House is a residential care home providing personal and nursing care for up to 32 people living with a leaning disability/autism and/or a mental health condition. The service was supporting 24 people at the time of the inspection.

Vancouver House accommodates people across four separate units, each of which has separate adapted facilities. One of the units specialises in providing care to people living with autism.

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

At this inspection, although we found significant improvements had been made, the service required further time to embed safe practices and to demonstrate consistency of those practices.

Since the last inspection, another new manager had been appointed. They were supported by a deputy manager. People, their relatives and staff spoke positively about the new management team. They told us how managers were more visible in the service and on hand to provide support.

The new manager had quickly identified issues which had developed at the service and had put an action plan in progress to remedy those issues and improve practices. The manager was keen to tell us how improvements to people’s care and support were being implemented to ensure people had ownership and say over what support they received from staff.

Systems and processes had been introduced which helped care staff to learn from any safeguarding incidents and to improve the safety and quality of care and support being provided. The management team undertook daily walkarounds of the service to help identify any issues and to make improvements as a result.

Safe recruitment practices were in place. The service ensured that any potential employees were safe to work with vulnerable people.

We observed warm and genuine interactions between staff and people living at the service. There was a calm atmosphere and people appeared relaxed in their environment.

Infection prevention control practices, including those against Covid-19, were practised by staff and the service appeared clean and well maintained.

At the time of our inspection, one of the units was closed for refurbishment and the service was in the process of installing a fully equipped sensory room for people to use.

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.

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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting some of the underpinning principles of ‘Right support, right care, right culture’. People were supported to participate in activities they had a genuine interest in. Training and guidance in promoting a positive culture had been provided to staff in order to help deliver compassionate, dignified and person-centred care. The ethos, values, attitudes and behaviours of the management team and care staff ensured people using the service led confident, inclusive and empowered lives.

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 requires improvement (published 2 April 2020).

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

At this inspection, although significant improvements had been made, further time was needed for good practices to become embedded and sustained.

Why we inspected

We responded to our current risk rating of this service, which showed the service as high risk. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 remained as Requires Improvement. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm. Please see the Safe and Well-led sections of this full report.

We also 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 coronavirus and other infection outbreaks effectively.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Vancouver House is a care home providing personal and nursing care for up to 32 adults with learning disabilities, autism and mental health conditions. The accommodation is in four units over two floors. At the time of the inspection there were 31 people living at the service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a purpose-built property. Despite the size of the building exceeding best practice guidelines, it was evident that people received person centred support. Staff were discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

During our last inspection, we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulated Activities 2014. These breaches related to consent and to quality processes. This meant that Vancouver House was not providing effective care to people in line with their consent, and was poorly led and managed.

At this inspection, although we found significant improvements had been made and the breaches had been met, the service required further time to embed safe and effective practices and to demonstrate consistency of those practices.

People's consent and capacity were managed appropriately. This meant that 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.

Since the last inspection, a new registered manager had been appointed. People, relatives and staff spoke positively about the registered manager. They told us how the culture and atmosphere of the service had improved since the manager's arrival.

The new manager was taking appropriate and proactive action to uncover and address the issues which had developed at the service. Governance processes had been stripped back and re-developed. More appropriate systems had been introduced which helped to monitor the safety and quality of care being provided.

The registered manager had also introduced robust systems to identify and analyse any risks and potentially unsafe practices.

Staff had received additional training in safeguarding and were knowledgeable about how to recognise and report on any abusive practices. This helped keep people safe from harm.

Safe recruitment practices were in place for staff. The service ensured that any potential employees were safe to work with vulnerable people.

We observed positive and warm interactions between staff and people living at the service. It was clear that staff knew the needs of the people they supported. People were encouraged and supported to be a part of both their local and wider community.

Medicines were managed in a safe way. Infection prevention control practices were practised by staff and the service appeared clean and well maintained.

People were able to decorate their room to their own tastes meaning that each room was unique. New kitchens had recently been installed to aid people’s independence. The registered manager informed us that there were plans in place to improve the service to make the environment more stimulating and homely.

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 March 2019) and there were breaches of regulation.

During our last inspection, we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulated Activities 2014 in respect of Regulation 11 and 17 of the Health and Social Care Act 2014 Regulations.

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 that although significant improvements had been made and the provider was no longer in breach of regulation, a longer period was required to demonstrate continuity of good practice.

Why we inspected

Although the service was due to be inspected, the inspection was also prompted in part by notification of safeguarding concerns, following which people using the service allegedly sustained abuse. These incidents are subject to investigation by the Local Authority. As a result, this inspection did not examine the circumstances of those incidents.

The information CQC received about the incidents indicated concerns about the management of safeguarding incidents.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe section of this full report.

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

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.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will monitor the progress of the registered provider's action plan to mitigate risk and improve practices. We will work with the local authority to monitor progress.

We will return to visit as per our re-inspection programme. If we receive any concerning information we may return sooner.

Vancouver House 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.

Vancouver House accommodates 32 people in one adapted building. At the time of inspection there were 29 people living in the home. The home has three floors. Each bedroom is en-suite, incorporating toilet, wash hand basin and shower. There is a lift to the first floor. There are four units over the first two floors, each has its own dining and kitchen area with the manager’s office on the top floor.

The home had 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.

The care service has not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. Registering the Right Support CQC policy.

Registering the Right Support gives guidance surrounding the maximum amount of people a home providing support to people with learning disabilities should have. Guidance states this should be six, Vancouver House had been registered since 2011 to provide a service to 32 people. However, we saw that the home itself was situated in a residential area and that people with learning disabilities who were using the service were encouraged to live as ordinary a life as any citizen despite the constraints of the size of their home and their living environment..

During our inspection, we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulated Activities 2014 in respect of Regulation 11 and 17 of the Health and Social Care Act 2014 Regulations. These breaches related to consent and to the quality processes.

Some best interest meetings had been held for people in regard to their daily living however there was no evidence of people’s consent to their care within their care files. We also identified that some aspects of the service had no auditing processes in place. Issues we identified during this inspection should have been actioned had audits been in place.

Care plans and risk assessments were person centred and they detailed how people wished and needed to be cared for. The care files records we looked at were at times confusing, however did contain the information needed about the support people required and recognised people's needs. All records we saw were up to date and regularly reviewed.

The environment was in places bare and unwelcoming, however the registered manager informed us that there were plans in place to improve this as it gave an impression of being institutionalised.

People had developed positive and friendly relationships with the staff. Staff could tell us about people’s likes, dislikes, interests and the support they needed. People’s different communication needs were considered and met in line with the Accessible Information Standard. This included people’s audial, visual and language support needs.

We reviewed the home’s complaints records and accident and incident records and found that these were appropriately recorded, action and/or responded to in a timely manner.

Policies and procedures were in place and updated, such as safeguarding, complaints, medication and other health and safety topics. infection control standards were monitored and managed appropriately. There was an infection control policy in place to minimise the spread of infection, all staff were provided with appropriate personal protective equipment such as gloves and aprons. There was also a series of health and safety checks in place to ensure the building was safe.

Vancouver House is a purpose built building for up to 32 people who require nursing care. It is located in the Gateacre area of Liverpool. There are four separate units. There are communal lounges in each unit, a dining room, and bedrooms. All bedrooms have en-suite wet rooms incorporating toilet, wash hand basin and shower. There is a passenger lift for ease of access and the home is fully wheelchair accessible. There is also a shared games room with pool table. There is a large outdoor space and car parking available.

At the time of the inspection 32 people lived at the home. Three units were for people with learning disabilities, mental health difficulties and behaviour that challenged and one unit for people with acquired brain injury.

At the last inspection in November 2013. The service was meeting the requirements of the regulations that were inspected at that time.

There was a registered manager in place. 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.

Where possible we spoke with people about their experiences. However about a third of the 32 people who lived at Vancouver House had limited communication and were unable to converse with us. To understand their experience of Vancouver House we observed the care and interactions by staff.

People told us they felt safe living at Vancouver House nursing home. The management team had procedures in place and there was an open and transparent culture in the home. Risk assessments, guidance and management strategies were in place including those around behaviour that challenged. These reduced the risk of distress or injury. People we spoke with told us staff were good and helpful. We saw people’s health needs were met and any deterioration in health was managed promptly.

Staff had all received safeguarding training and knew what to do if they saw or suspected abuse. We saw care was usually good, with staff showing kindness, patience and consideration to people they supported.

We looked at how the home was being staffed. We saw there were enough staff on shifts to ensure safe care and to support in house and in the community.

Appropriate checks were made when recruiting prospective staff. This gave senior staff information about their employment history and character and reduced the risk of employing unsuitable people. Staff were trained and had the skills and knowledge to provide support to the people they cared for.

Staff managed medicines safely. Staff gave people their medicines correctly and when they needed them. We saw they were given as prescribed and stored and disposed of correctly.

The home was clean and hygienic when we visited. There were no unpleasant odours and staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). Applications had been submitted where needed. This showed us staff were working within the law to support people who may lack capacity to make their own decisions.

Most people spoken with said they liked the meals. These were provided pre-cooked by a specialist food company. Staff made sure people’s dietary and fluid intake was sufficient for good nutrition.

We saw staff were familiar with people’s history and support needs. They encouraged people to make decisions and choices. Staff were respectful and usually considered people’s needs and wishes.

Care records were personalised but not always reviewed regularly.

Staff recognised the importance of social and leisure activities. People went out on activities daily and there were some in-house activities offered . These varied on each unit. People told us they enjoyed the activities.

People able to talk with us told us they knew how to raise a concern or to make a complaint if they were unhappy with something. They said they could talk to staff and make their views known.

There were procedures in place to monitor the quality of the service. Senior staff sought people’s views in a variety of ways and dealt with any issues of quality quickly and appropriately.

"It's good"; "I'm happy" and "I can speak to the staff they help me sort things."

People were encouraged to discuss anything important to them during meetings they had with staff and included topics such as: holidays, activities and the laundry. We looked at a sample of recent surveys completed by people living at the service. Their results were very positive regarding their opinions about the service.

The service has its own hairdressing and therapy room. People living at the service told us about how they liked this room and one person told us they liked the massages they received from the therapist. Staff told us this was a service provided by the company and offered to everyone including staff.

We found that the building was clean and tidy throughout our visit. The environment was a purpose built building and was highly maintained. The service had recorded checks carried out by the services maintenance person and contractors. These checks helped to ensure that the building was kept safe and was well maintained.

"They’re very good here"

“Money can't buy the care you get here”

People told us that they were happy with the care and support they/their relatives received and that they were involved making decisions about their relatives care and support. People said staff were respectful towards them and protected the privacy, dignity and independence of people living at the service.

People told us that they felt they could discuss any problems or concerns with staff or with the manager, and described staff as being caring and attentive.

We also spoke with a number of visiting professionals. They gave us good feedback about the service and said they felt the standards of care were very good. They told us they had never had reason to make a complaint and that they felt the atmosphere at the service was open and welcoming and that staff communicated well with them.