Archived: Vaughan House

Updated 18 November 2020

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.

Inspection team

This inspection was carried out by two inspectors.

Service and service type

Vaughan 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 did not have a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We announced the inspection 20 minutes before we entered the building to establish the provider’s policy regarding COVID-19 infection control procedures for visitors.

What we did before the inspection

We sought feedback with the local authority and their safeguarding team. We spoke with the provider to understand what they were doing in relation to the recent concerns, this included speaking with the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We used all this information to plan our inspection.

During the inspection

We spoke with four people who lived at Vaughan house, the acting manager and the operations manager. We looked at people’s risk assessments, care plans, personal behavioural support plans, ‘activity’ charts and food menus. We also looked at staff recruitment checks, medication administration records, and we completed many observations of staff interactions with each other and the people at the home.

After the inspection

We spoke with the operations director, five care staff, three relatives and the managing director. We reviewed incident reports, evacuation plans, safety records, maintenance records and recent audits by the provider.

Updated 18 November 2020

About the service

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.