Background to this inspection
Updated
4 February 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
There were six inspectors involved in the inspection process with a maximum of three inspectors on site at any one time.
The inspection was carried out over four days. The team consisted of inspectors from adult social care, hospitals and the children’s team.
Inspectors spent three days on site at the service and telephone calls to staff were made over four days by inspectors who were not on site.
Service and service type
Vestige Healthcare (Dudley Port) 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 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.
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. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.
During the inspection
We spoke with four people who used the service and two relatives about their experience of the care provided. We spoke with 22 members of staff including the nominated individual (who is also the provider). The nominated individual is responsible for supervising the management of the service on behalf of the provider. We spoke with the chief operating officer, the director of commercial operations, the manager, deputy manager, nursing staff, senior care workers, care workers, a consultant psychiatrist, an occupational therapist, an assistant psychologist, and the chef.
We reviewed a range of records. This included six people’s care records and multiple medication records. We looked at four 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
4 February 2021
About the service
Vestige Healthcare (Dudley Port) is a is a short stay service providing treatment for disease disorder and injury, diagnostic and screening procedures and accommodation and nursing care to nine people. People living at Vestige can be aged 16 to 65 and may have a diagnosis of learning disabilities or autistic spectrum disorder, mental health difficulties or misuse drugs and alcohol. The service can support up to 16 people, with a main house accommodating 14 people and two small houses on site accommodating one person each.
People’s experience of using this service and what we found
People did not feel safe. People were being physically restrained without sufficient care pans and risk assessments. People were at risk of harming themselves and there was no risk mitigation to prevent this happening. The environment was unsafe. Medicines were not managed safely. There was a lack of awareness of safeguarding children. There were poor infection control practices in relation to COVID-19.
The provider failed to ensure there were sufficient systems and processes in place to enable them to have oversight of the service. Audits failed to identify significant concerns we picked up. People and staff did not feel listened to by the management team.
People were being physically restricted without the correct legal authorisation. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
People said they did not want to live at the home. People had no choice in what they ate. Peoples nutritional needs were not considered. People gave mixed reviews about whether staff knew them well. People did not feel there was enough for them to do and felt bored.
Staff and people did not feel able to express their views about the care provided. People did not receive dignified or respectful care. People did not receive person centred care.
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 was not person-centred and did not promote people’s dignity, privacy and human rights. The ethos, values, attitudes and behaviours of leaders and care staff did not ensure people using services lead confident, inclusive and empowered lives. This was impacting on people wellbeing.
During the inspection the provider told us they were hoping to seek alternative placements for some people and some people had undergone assessment for new placements. During and after the inspection other people were assessed for new placements.
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 (published12 November 2020) and there were multiple breaches of regulation. The service remains rated inadequate. This service has been rated inadequate for the last two consecutive inspections. The provider was asked to become complaint with the regulations after the last inspection. At this inspection not enough improvement had been made and the provider was still in breach of regulations.
Why we inspected
The inspection was prompted due to concerns received relating to the environment being unsafe, poor infection control practices relating to COVID-19 and the management of risk, in particular about behaviours that can challenge.
We served warning notices to the provider on 28 August 2020. We required the provider to make improvements to governance systems, safeguarding and safe care and treatment. We reviewed the warning notices and found the provider had not complied with them and continued to need to make improvements. Please see the all sections of this full report. 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 safe care, governance, safeguarding, consent, dignity and person-centred care at this inspection.
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 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.
The overall rating for this service is ‘inadequate’ and the service remains 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.