Archived: Vestige Healthcare (Dudley Port)

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.

Vestige Healthcare (Dudley Port) is a short stay service providing personal and nursing care, treatment for disease, disorder or injury and/or diagnostic and screening procedures to 12 people with Learning Disabilities and Mental Health needs. The service can support up to 16 people.

Vestige Healthcare (Dudley Port) accommodates 10 people in one purpose-built building and has a further two houses adjacent to the main building that accommodates a further two people.

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

People were not protected from the risk of abuse. Records held relating to both physical and chemical restraint did not provide assurances that restraint was being completed safely and only when absolutely necessary. Chemical restraint is the use of medication to control or subdue behaviour. Due consideration had not been given to principles under the Mental Health Act Code of Practice in relation to restrictive practices for one person.

Risks to people’s health, safety and wellbeing were not consistently assessed. Key pieces of information relating to people’s care and treatment needs were not recorded. There had been no consideration for what support people may need if there were a deterioration in their mental health and their needs could no longer be met at the service.

Medicines were not always managed in a safe way. Sufficient guidance for the use of ‘as and when required’ medicines was not always available and there was no oversight of the use of these medicines. There was a risk of medication errors due to a poor understanding of legal responsibilities and documentation not being accurate and up to date.

Systems in place to monitor quality of care had failed to identify the areas for concern we found at this inspection.

The provider had risk assessed the use of personal protective equipment in relation to COVID-19. Based on the risk assessment, the decision had been made not to follow the national guidance as this had a negative effect on people’s mental health.

Although there was a high usage of agency staff, people reported that they knew their staff team and had sufficient numbers of staff available to support them.

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 12 March 2020)

Why we inspected

We received concerns in relation to the management of risks; particularly around behaviours that can challenge. As a result, we undertook a focused inspection to review the key questions of Safe and Well Led only.

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 Safe and Well Led sections of this full report. 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 Vestige Healthcare (Dudley Port) 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 keeping people safe, and the managerial oversight 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 continue to monitor information we receive about the service until we 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 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.

About the service

Vestige Healthcare (Dudley Port) is a residential care home providing personal and nursing care to three people with needs associated to their Mental Health at the time of the inspection. The service can support up to 13 people.

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

There remained no registered manager in post. Although systems to monitor quality were in place, these had not been applied consistently. People had been given opportunity to feedback on the quality of the service.

Risk assessments were not consistently clear about the level of risks to people and were not always followed by staff. Action had been taken to ensure safeguarding incidents were reported and investigated. There were sufficient numbers of staff to support people and medicines were managed safely.

People had not always been supported to access healthcare services as required. No new admissions to the service had taken place but the provider was implementing systems to ensure assessments were robust. People were supported to have their dietary needs met.

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.

People told us staff were kind and caring. People were given choice and had their dignity and independence respected.

People’s care records held personalised information about them and staff knew people well. People were able to access activities that were meaningful to them. Complaints made had been investigated and resolved.

Rating at last inspection and update: The last rating for this service was Inadequate (published 25 July 2019) and there were four breaches of regulation. Since this rating was awarded the provider had changed the name of the service from Oak House to Vestige Healthcare (Dudley Port). At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 22 July 2019. 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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

About the service

Oak House is a care home providing personal and nursing care to people who may have learning disabilities or care needs relating to their mental health. The service can support up to 16 people. We inspected this service on four dates between 15 May and 4 June 2019. On the first two days of inspection, there were 13 people living at Oak House. On the third day of inspection, there were 12 people receiving support from the service and on the fourth day of inspection, there were eight people receiving support.

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 were not safeguarded from abuse as allegations of abuse were not always investigated or referred to external agencies. Risks to people were not consistently well managed and left people at risk of harm. People’s individual needs had not always been met by the right number of staff with the required competencies and skills.

Staff had not received the training and support they needed to support people effectively.

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. Timely action had not been taken where people had gained significant weight. People’s access to the provider’s in-house therapy team had been inconsistent.

People were supported by staff who were caring, but the provider’s systems and processes did not support them to consistently display their caring values. People were given some choices but did not consistently involve people in decisions around their care. People were not always treated with dignity.

People were supported by staff who knew them well. However, this knowledge of people’s likes and dislikes had not been reflected in care records. People had access to activities, but these had previously been restricted due to the numbers of staff available for people. People’s concerns were not always acted upon.

The systems and processes in place had not supported the provider to identify where areas for improvement were needed. This meant that risks to people’s safety or incidents that left people at risk of harm were not identified or acted on by the provider. People and staff’s concerns about the service had not been acted upon. The provider had not acted on their duty of candour and shared information where incidents had occurred.

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 Good (Published 01 November 2017)

Why we inspected

The inspection was prompted in part by notification of a specific incident in which a person using the service died. This incident is currently subject to an investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident, indicated concerns about the management of risks to people’s health and safety. This inspection examined those risks.

We have found evidence that the provider needs to make improvements. Please see the ‘Is the service Safe?’ 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 have identified breaches in relation to keeping people safe, responding to allegations of abuse, supporting people in line with the Mental Capacity Act and monitoring the care provided 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 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.

Oak House provides residential accommodation and support for up to 16 adults with mental health needs. At the time of our inspection visit, 12 people were living there. At our last inspection, in May 2015, the service was rated Good. At this inspection, the service remained Good.

There was no registered manager in post. The operations manager was acting as interim 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. However, a new manager had been recruited and was due to commence in post a few days after our inspection.

People continued to receive care that made them feel safe and where possible were supported to manage their own medication. Staff understood how to protect people from abuse and harm. Risks to people were assessed and guidance about how to manage these was available for staff to refer to/follow.

People continued to receive effective support from staff with a sufficient level of skills and knowledge to meet their specific needs. People were not unduly restricted and were enabled wherever possible to have maximum choice and control of their lives. People were assisted to access appropriate healthcare support and take an adequate diet.

The care people received was provided with compassion. People were supported to express their views and be involved as much as possible in making decisions about their support needs. Staff supported people to exercise choice, independence and control, wherever possible. People’s diverse needs were recognised and staff enabled people to access the activities they wished to be involved in.

The provider had effective systems in place to regularly review people’s care provision, with their involvement. People’s care was personalised to them and care plans contained information about the person, their needs, lifestyle choices and cultural needs. Care staff knew people’s individual needs and goals. People were able to speak openly with staff and tell them if they were unhappy or wanted to make a complaint.

The service continued to be well-led, including on-going checks and monitoring of the quality of the service. People and staff were positive about the leadership skills of the management team in place. Arrangements were in place to obtain people, staff and the local communities views about the service.