Archived: Vaughan House

Vaughan House is a residential care home providing accommodation and personal care for up to 10 people living with a range of learning disabilities and autism. There were eight people living at the home when we inspected it.

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 not able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture. Care provided was not person centred, it did not put people first, to keep them safe, meet their mental health needs, promote their interests and hopes for the future. As a result of this people were being put at risk of harm and were not experiencing a good quality of life. The provider has started to act about these failures, but it is early days, and more improvements are needed.

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

A relative told us, “Vaughan House should be Priory’s [name of provider] flagship home, with all the inspections, visits from the local authority, and managers over the years, but it’s not. I blame Priory.”

We still found there was a poor closed culture. Staff had not formed positive and personal working relationships with the people they were there to support and care for. Activities were very limited and there were missed opportunities during lock down and after this time to promote people’s interests. Creative solutions to help people to explore their interests, develop new interests and have fun had not been considered. Some staff treated the environment as their own space and were not putting people first.

The environment was poor, and the provider had not identified this issue and taken action or made plans to do so, until this was pointed out to them by the local authority. We also found additional concerns with the environment and with the equipment used when we inspected. Safe processes and practices to manage infection control and COVID-19 were not routinely taking place at the home.

Improvements had been made with elements of how people’s medicines were being managed, but we still found problems with this area of people’s care. Some people’s risk assessments were not complete. When issues had been identified in terms of emergency evacuations, timely actions were not completed to check these issues had been fixed.

Despite a change in management, and COVID-19, the provider did not effectively continue to monitor the service and test the quality of the care provided, to check the previous concerns had not returned. Audits and senior management oversight which did take place, failed to identify these issues and concerns.

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 was Requires Improvement (published on18 July 2019). Improvements at this inspection had not been sustained. There were continued breaches of the regulations at the most recent inspection.

Why we inspected

The inspection was prompted due to concerns received about institutionalised abuse, people receiving poor care and support, concerns relating to medicines, and staffing recruitment checks and support. We were told by the provider they were taking action, we wanted to check this and see how effective this had been so far. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end 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 providing safe care, responding to safeguarding concerns, poor nutrition and hydration, a lack of person-centred care and support, poor maintenance of the building and equipment, ineffective leadership and provider oversight at this service.

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.

Vaughan House is a residential care home. It provided personal care to eight people who were living with different types of learning disabilities and health needs, at the time of the inspection. The service can support up to 10 people.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 10 people. Currently eight people were using the service. This is larger than current best practice guidance. There had been a reduction in people living at the home due to an embargo on admissions put in place by the local authority due to the last rating. Relatives told us that their family members were happier with the reduction of people at the home. There were deliberately no identifying signs, intercom, cameras, but there were industrial bins located outside which could indicate it was a care home. However, when we spoke with the provider's representative and the registered manager, they had not considered this new guidance of ‘Registering The Right Support’ in a meaningful way. This is to ensure the size of the home and the care provided meets people’s social, physical, emotional and mental health needs. They had not reviewed the number of people the service supports. To ensure the accommodation could meet people’s needs.

People’s experience of using this service:

We have made a recommendation about the provider reviewing and implementing our 'Registering the Right Support' policy to ensure the service is meeting people's needs now and in the future, including the amount of people the home accommodates.

Improvements had been in terms of people’s care and experiences at the home. However, we still found some hygiene and infection control issues in people’s rooms and the storage of cleaning items in one person's room had not been risk assessed. Another issue effecting one person had not been identified with any action taken to reduce this risk.

There had been improvements in the leadership of the home, but there were still issues with the registered manager and provider’s oversight about aspects of the quality of some of the care provided. Such as the hygiene issues and a development plan had not been created. To demonstrate existing and future improvements to the building and managing the service, in order to improve people’s experiences of living at the home.

People’s medicines were stored and administered in a safe way. When in place people had good risk assessments and care plans to assist staff in meeting their needs. Staff knew how to promote people’s identified needs. People told us they felt safe and people’s relatives agreed with them.

Staff had a good knowledge of people’s needs and what was important to them. Staff now received regular checks from the management to test if they were competent and knew their job well. People had choice with what they ate and drank, and the staff were promoting healthy options. People were supported to have more choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests.

Staff were thoughtful and caring towards the people they supported. It was understood by staff that Vaughan House was people’s own home. People’s privacy was respected by staff. People were involved in the planning of their care.

People had personalised assessments and care plans. People had been asked to identify goals and ambitions that were important to them. Staff had been supporting people to realise these. Further work was still needed in this area, but progress had been made. Events and outings were also taking place.

Staff were well directed. Relatives commented on this positive change.

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 Inadequate (published on 20 December 2018) and there were multiple breaches of the 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 the provider had resolved some breaches of the regulations. However, some improvements had not been made and the provider was still in breach of the regulations.

This service has been in Special Measures since 19 December 2018. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

You can see what action we have asked the provider to take at the end of this full report.

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.

We inspected this service in June 2016 and rated the home as ‘Good’ overall. When we inspected the service on 8 November 2018 we rated the service as Inadequate overall. This is the first time Vaughan House has been rated as Inadequate overall. This inspection was not announced.

Vaughan 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.

Vaughan House provides personal care and accommodation for people who have a range of learning disabilities. Vaughan House can provide care for up to ten adults. At the time of the inspection ten people were living at the home. Vaughan House comprises of accommodation over two floors.

This 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. These principles were not being promoted and actively introduced into the home.

There was a registered manager in place when we inspected the home. 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.

There was poor oversight and leadership of the service. Provider and internal audits were not effective. They had not identified the issues which we found at this inspection. They had identified in the summer that the service was not delivering good care to people. However, they had not taken timely action to correct this. The day to day management of the home was also not always effective.

Plans to keep people safe were not always being followed by staff. A combination of ineffective staff practice and risk assessments meant people’s safety was not routinely promoted at the home. People’s medication was not always stored and managed in a safe way. Specialist advice and guidance was not sought to keep people safe.

There was a poor culture at the home. Staff did not always treat people in a kind way. Staff sometimes did not respect that this was people’s own home.

Staff knowledge and ability to perform well in their work varied. Despite this being known by the management and provider action had not been taken to address and resolve this issue. The management team had not created strong systems to monitor staff abilities. Staff training was not always effective.

People were not involved on an individual basis with what they could eat and drink. The meal experience was not a social one. Independence with food preparation and healthy eating and life styles were not promoted at the home.

Staff did not spend real time with people chatting and engaging with them. There was a lack of social events taking place. People’s interests, dreams and ambitions were not developed and promoted at the home. Real plans to support people to achieve what was important to them were not made and reviewed.

Some of these issues constituted breaches in the legal requirements of the law. There were five breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of the report.

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

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

The service provides accommodation and personal care for up to ten people with learning disabilities and autism. At the time of our inspection, there were eight people using the service.

The home has 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 & Social Care Act and associated regulations about how the service is run.

People were kept safe and staff understood how to report any concerns to the relevant agencies. Risk assessments had been completed to identify any risks to people and implement control measures to help keep them safe. When people demonstrated any behaviour which may have impacted negatively on others this was managed safely through robust guidance and consistent approaches from staff. The service employed enough staff to meet people’s needs and recruitment procedures were followed correctly. Medicines were managed safely and people’s healthcare needs were identified and met.

People enjoyed a varied menu and had enough to eat and drink. People and their families were actively involved in care and support planning, and were supported to achieve positive, person-centred outcomes. Their dignity and privacy was respected.

Staff were knowledgeable and positive about the people they supported. Interactions between staff and people using the service were caring, and people had a key worker system in place to help to meet their individual needs. Staff received a range of training which enabled them to carry out their roles effectively. They were supported through an on-going program of supervision and appraisal.

People using the service and their relatives spoke highly of the management team, although staff sometimes said they did not always feel valued or listened to. The service had robust systems in place to monitor the quality of people’s care, with regular audits by senior management. People and staff were given opportunities to contribute towards the development of the service through regular meetings.

During this inspection, we gathered evidence against the outcomes we inspected to help answer our five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with staff and looking at records.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

We looked at care records for four of the 10 people living in the home or using the service at the time of this inspection. Overall, we found that improvements had taken place in respect of people's care records, but further work was required to enhance the quality of these records and ensure they were fit for purpose. A new manager had been appointed since our last inspection who demonstrated a good understanding of how to go about bringing care records up to the required standard. He told us that training and one to one sessions had been planned for the following week, to support staff in completing this work.

At our last inspection of Vaughan House, we found that people were not being cared for in an environment that was adequately maintained. This was because some parts of the home were tired, damaged or in need of repair. During this inspection we found that extensive work to improve the building and facilities for the people living in the home was well underway. This demonstrated that the provider had taken appropriate steps to improve the environment for people living in the home and promote their safety and wellbeing.

However we did identify concerns with regard to the home's cleanliness and infection control systems on this occasion. This meant that people living in the home were not living in a clean and pleasant environment. We brought this to the attention of the new manager who told us immediate steps had been taken to address our findings.

Is the service effective?

Through the course of the inspection we observed staff responding to people's needs and requests in a timely way.

A number of different events occurred during the inspection that placed the staff on duty under pressure. We noted that they consistently worked well together in the best interests of the people living in the home. They were calm at all times and spoke appropriately to people, taking the time to explain to them what was going on. It was clear from our observations and from speaking with staff, that the team worked well together.

Is the service caring?

We observed some positive interactions between staff and people living in the home and it was clear that staff knew people well and how best to meet their needs.

Is the service responsive?

We observed people's requests being met in a timely way. For example one person asked for their medication after lunch and this was provided.

On another occasion someone needed support with personal care. Staff acted quickly to address their needs to ensure their comfort and wellbeing. The same person's care plan recorded that they did not like loud noises. Renovation works were taking place in the home on the day of our inspection and a member of staff took swift action to address this with one of the builders, requesting that they complete the work when the person went out for the afternoon.

Is the service well-led?

A new registered manager was in place who demonstrated a good understanding of their role and the improvements required to move the service forward in terms of concerns raised by us during this, and our last inspection of the service.

We did not plan to assess the home's systems for monitoring the quality of service provision at Vaughan House during this inspection. However, our findings from this inspection have shown that the provider did not have adequate arrangements in place to identify, assess and manage risks relating to the health, welfare and safety of people living, working or visiting the home.

For example, we found concerns with the quality of care records relating to people living in the home. Following our last inspection of the home on 23 April 2014, we reported that the home had been without a permanent manager for some time. There was evidence on this occasion that this had impacted on staff, as there had been a lack of clear and consistent direction and support for them regarding updating people's care plans and risk assessments. A new manager had been appointed who had begun to address the deficits with care records, but there was no evidence of any managerial oversight in respect of updating or monitoring the quality of these records prior to him starting. This meant that people using the service had been at risk of not having their assessed needs met adequately during this period.

We also found concerns on this occasion in respect of the home's cleanliness ' specifically with regard to offensive odours found in two areas of the home. Although the new manager took swift action in response to our findings, we were concerned that these had not been identified and dealt with adequately by the service prior to our inspection. This raised concerns about the home's monitoring systems for maintaining a clean and appropriate environment which facilitates the prevention and control of infections.

When we visited Vaughn House on the 23 April 2014, we gathered evidence to help us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We observed people were treated with respect and dignity and there were good interactions between people and staff. People looked relaxed in the company of the staff and were able to approach them if they needed advice and support.

The home ensured that staffing numbers were adequate to safeguard the health, safety and welfare of people who lived there.

Records relating to relating to people's care and treatment and other records required to protect their safety and well-being were appropriately maintained and held securely.

We found that some areas of the premises were not well maintained. This meant that people were not protected against the risks associated with unsafe or unsuitable premises.

Is the service effective?

Staff told us that people had access to an advocate if required. There was a notice displayed in the home to remind staff how to access the local advocacy service. This meant that when required people could access additional support.

We found that people's care plans and risk assessments were not written in enough detail to ensure people's identified needs were adequately met and they were protected from the risk of harm. The interim manager had identified the need for improvement and had started making arrangements for staff to be appropriately trained in writing person centred care plans.

We found that people's health care needs were kept under regular review. They had access to health care professionals such as the GP, psychiatrist dentist and optician. This meant that people were supported to keep healthy and well.

Is the service caring?

We observed staff talking to people in a kind and respectful manner and addressed them by their preferred name. Staff enabled people to be part of the local community and regularly accompanied them to the local leisure centre and pubs.

Staff spoken with were able to describe how they ensured people's dignity and privacy were promoted. People spoken with were confident that staff respected their privacy and dignity.

Is the service responsive?

We found that people were supported to express their views and be actively involved in making decisions about their care treatment and support. Regular one to one meetings and unit meetings took place. One person said, 'We have meetings to discuss meal plans and choose what we want to eat. The menus are changed weekly.' Another person said, 'At the last meeting we asked for new cushions for the lounge and a coffee table. The manager said that we are going to get them soon.' It was evident that suggestions made by people were addressed.

Is the service well led?

Staff spoken with said that they felt supported by the interim manager and were provided with regular staff meetings. At these meetings they were able to raise questions and make suggestions relating to the provision of care. This meant that staff felt supported and well-led.

The home ensured that the complaints procedure was available in a suitable format to meet people's diverse needs. Arrangements were in place to monitor complaints, accidents and incidents. This meant that lessons were learnt from mistakes, incidents and complaints investigations to ensure improvements with the service delivery.

We spoke with three people who used the service, three staff members and the manager.

People spoken with said that staff supported them to maintain their bedrooms to an appropriate standard. They also said that staff assisted them with their medicines and ensured that their medicines were reviewed regularly by the GP. One person said, 'I always get my medicines daily.'

We found that the home had reviewed its medication system to ensure that people's medicines were recorded, handled and administered safely. Also the home's infection control systems had been revised to ensure that people were cared for in a clean, hygienic environment.

A relative of a person who used the service described staff as, 'caring and ever so kind.'

We found that people's medicines were not administered safely and they were not protected against the risks associated with the unsafe use and management of medicines. The service did not have an effective system in place to ensure that standards of cleanliness and hygiene were appropriately maintained. Staff supervision and appraisal was not consistent.

We observed that people were offered support at a level which encouraged independence and ensured that their individual needs were met. There was a relaxed atmosphere in the home and people were at ease in the company of the staff supporting them. The staff were friendly and polite in their approach and interacted confidently with people.

We noted that people were encouraged to express their views and were involved in planning their care and making decisions about their support and how they spent their time. Some people were out at day centres at the time of our visit, and others were involved in carrying out tasks to support their personal development. One person said "I'm the representative for everybody here", and they talked about the range of activities and entertainment that were available to them.

Within the care files we saw that care documentation had been signed by the individual to confirm their involvement and agreement with their particular care needs.