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Inspection carried out on 27 February 2020

During a routine inspection

About the service

Vermont House is registered to provide support to up to nine people and there were five people using the service at the time of our inspection. The service is larger than recommended by best practice guidance. However, we have rated this service good because they had arranged the service in a way that ensured people received person-centred care and were supported to maximise their independence, choice, control and involvement in the community.

The service was working in accordance with 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 large home, bigger than most domestic style properties. The building design fitted into the residential area as there were other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also 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

Timely action had not been taken by the provider to ensure people lived in a safe and well-maintained home. Following our inspection visit the provider did act and replaced fire doors to ensure the home was safe and began the renewal programme that had been developed.

People felt safe, and staff provided support that met their individual needs. Staff knew how to escalate concerns and were aware of potential risks when providing support. People received their medicines when they needed them. Staff wore gloves and aprons when needed to ensure they protected people from cross infection. Systems were in place to review incident and accidents to see if there were any lessons to learn from these.

Staff felt valued and supported in their roles and confirmed they had the training they needed to support people effectively. People’s healthcare needs were monitored and met, and staff worked in partnership with healthcare professionals. People, as much as practicably possible, had choice and control of their lives and staff were aware of how to support them in the least restrictive way and in their best interests; the policies and systems in the service supported this practice. People and relatives made positive comments about the staff that supported them, describing them as friendly and supportive.

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.

A complaints procedure was in place and people and their relatives knew how to raise concerns and felt confident these would be addressed. People, relatives and staff thought the service was managed well and told us positive changes were being made since the arrival of the new registered manager. The registered manager was described as approachable, supportive and open and transparent in the way they managed the service. Systems were in place to monitor the delivery of the service.

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 good (Published 3 November 2017).

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 o

Inspection carried out on 21 September 2017

During a routine inspection

This comprehensive inspection took place on 21 September and was unannounced.

Vermont House provides accommodation for up to nine people who require support with personal care and who have a learning disability and/ or autism spectrum disorder. At the time of our visit five people lived at the home.

Prior to this inspection we received information that people were not supported safely and they did not have enough food to eat.

We checked and found enough staff were on duty during our visit to keep people safe and meet their support needs. The provider's recruitment procedures minimised the risks to people safety. Some staff had left their employment at the home since our last inspection. There were three staff vacancies at the home at the time of our visit and plans were in place to recruit new staff to the vacant positions. New staff were provided with effective support when they first started work.

Staff understood their responsibilities to care for people effectively in line with their wishes. Records showed a programme of regular training supported staff to keep their skills and knowledge up to date. People thought staff had the skills and knowledge they needed to provide the care and support they required.

Staff assisted people to plan food menus and we saw a variety of foods which people enjoyed were available to them. Staff demonstrated a good understanding of people’s dietary needs.

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 home was last inspected on 26 August 2016. At that focused inspection we and rated the service 'Requires improvement ' in ‘Safe.’ We identified checks that took place in relation to the fire safety at the home did not occur at the frequency the registered provider had specified. Also, the way people’s medicines were managed was not consistently safe. We found during this visit the required improvements had been made.

A variety of effective systems were in place to monitor the quality of the home. Since our last inspection the frequency of the checks in relation to fire safety at the home had increased. This assured the provider people and the staff were kept as safe as possible if a fire was to occur. Staff had completed fire safety training to improve their understanding of fire safety. Improvements had also been made to the level of information recorded to inform staff and the emergency services of the support people required to evacuate the building safely.

Since our last inspection improvements had been made to how medicines including PRN medicines were managed and administered. The frequency of medicine checks had also increased. This meant people had received their medicines when they needed them. However, medication errors had occurred since our last inspection. Action had been taken to reduce the risk of further errors occurring; staff had also completed further training to increase their knowledge and confidence to administer medicines correctly.

People felt safe living at the home and procedures were in place to protect them from harm. Staff had competed safeguarding adults training and were knowledgeable about the risks associated with people's care. Records showed the management team knew how to correctly report safeguarding concerns which meant any allegations of abuse could be investigated.

Risk assessments and management plans were in place and contained clear guidance to support staff to manage risks. However, some staff felt under pressure as they had found dealing with recent incidents of challenging behaviour difficult.

The provider and the management team were aware of the challenges staff faced and had taken positive actions in an a

Inspection carried out on 26 August 2016

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of this service on 13 October 2015 and rated the service ‘Good’ in all areas. After that inspection we received concerns in relation to the safety of the service. We undertook an unannounced focussed inspection of this service on 25 April 2016 to look into these concerns. At that time we identified concerns relating to monitoring of the safety of the equipment at the premises and found that the registered provider had breached a regulation. After the inspection the registered provider sent us an action plan detailing what they would do to address the issues identified at the inspection.

We carried out this unannounced focussed inspection on 26 August 2016 to see if the registered provider had followed their plan and to determine if they were now meeting legal requirements. This report only covers our findings in relation to this focussed inspection which looked at whether the service was safe. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Vermont House on our website at www.cqc.org.uk.

Vermont House provides accommodation for up to nine people who require support with personal care and who are living with learning disabilities and/ or autism spectrum disorder. At the time of the focussed inspection the home had five people living there.

There was a registered manager at the service. 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. During the inspection we spoke with the current manager of the service who was undergoing a period of induction into the service with the aim of applying to become the registered manager. We contacted the registered manager and a representative of the registered provider following the inspection.

We found that some improvements had been made to ensure the premises and equipment kept people safe and the provider was no longer breaching regulation. Although improvements had been made systems in place were not robust and had failed to ensure regular monitoring was undertaken. Records that detailed the individual support needs of people in the event of a fire had not been updated which placed people at risk of receiving inconsistent support.

Other areas of concern that were raised at the last inspection around the skill mix of staff and management of medicines had not been fully addressed as per the provider’s action plan. We found that although the management of medicines given on an ‘as required’ basis had improved the monitoring of medicine administration required further improvement.

Following the inspection the registered manager sent us an action plan detailing how they would ensure these issues would be addressed.

Inspection carried out on 25 April 2016

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of this service on 13 October 2015. After that inspection we received concerns in relation to the safety of the service. As a result we undertook an unannounced focussed inspection of this service on 25 April 2016 to look into those concerns. This report only covers our findings in relation to this focussed inspection which looked at whether the service was safe. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Vermont House on our website at www.cqc.org.uk.

Vermont House provides accommodation for up to nine people who require support with personal care and who are living with learning disabilities and/ or autism spectrum disorder. At the time of the focussed inspection the home had five people living there.

There was a registered manager at the service who was present throughout the inspection. 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 systems in place to monitor the safety of the premises were not always robust and timely action had not been taken to resolve an issue identified with some of the safety equipment in the home.

Whilst people received their daily medicines safely we found that the management of medicines given on an ‘as required’ basis needed improving. Staff did not always have access to the information needed to administer ‘as required’ medicines consistently and safely.

Safe recruitment practices had been followed. We found that there was a lack of consideration of the competencies of staff when planning staffing levels.

Staff had information about how to support people in emergency situations. However, we found that information had not been updated when a person’s needs changed which may lead to an inconsistent approach from staff when supporting the person in emergency situations.

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

Following the inspection we received assurance from the registered manager that the issues identified would be addressed.

Inspection carried out on 13 October 2015

During a routine inspection

This inspection took place on 13 October 2015 and was unannounced. This was the home’s first inspection since it was registered in October 2014.

The home was providing accommodation and personal care for nine people with learning disabilities and /or autistic spectrum disorders. At the time of the inspection there were four people living in the home.

There was no registered manager in post at the time of the inspection. At the time of our inspection there had been no registered manager in place for over six months. 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 provider and the current manager assured us that an application for the current manager to become registered was going to be submitted soon. There was also another staff member who was being supported to develop the skills and experience required to also apply for this role if ever necessary.

People were kept safe from the risk of harm. Staff knew how to recognise signs of abuse and who to raise concerns with. People had assessments which identified actions staff needed to take to protect people from risks associated with their specific conditions and challenges to themselves and others. Medicines were well managed and this helped to keep people well.

People were supported by enough staff to keep people safe and to give support when requested. There were recruitment and induction processes in place to ensure new members of staff were suitable to support the people who were living in the home. People were happy with how staff supported them and staff demonstrated skills and knowledge to ensure people were supported effectively and safely.

The care manager and staff we spoke with were knowledgeable of the requirements of the Mental Capacity Act 2005. Staff sought consent from people before providing support and at times this meant that some people made unwise decisions or refused support that would help them. People’s rights were protected as they had control over their lives unless action had been taken to legally restrict their liberty. People were given choices unless multidisciplinary agreed processes were in place to act in the person’s best interest.

People were supported to have a choice of suitable food and drink that met their health needs. They were supported to have food that was healthy and where required respected any religious or cultural requirements. There was access to health professionals to keep people physically and mentally as well as possible.

People were happy about the relationships they had with the staff that supported them. Staff spoke about people with concern about the difficult challenges some faced. Staff knew how to communicate with people and how to allow people to have privacy, control and confidentiality when supporting their needs.

People did not have any complaints about the support they received and two people said it was excellent. Although people told us that staff would listen, there had been complaints about the support people received in the home earlier in the year. The health professional we spoke with and the provider’s independent quality assurance results indicated that the home was improving. There were some systems that needed further review to ensure that there was a consistent check on quality.