About the service: Vaughan Lee House is registered to provide accommodation and personal care for up to 30 people. The home specialises in the care of older people. At the time of the inspection there were 28 people living in the home.

People’s experience of using this service:

People received care and support that was safe. The provider had a robust recruitment programme which meant all new staff were checked to ensure they were suitable to work with vulnerable people. All staff had received training in safeguarding vulnerable people.

Risk assessments were in place to identify any risk to people and staff understood the actions to take to ensure people were safe. There were sufficient staff to support people with their daily living and activities

People received effective care and support. Staff demonstrated a clear understanding of people’s needs and received training relevant to their role and the needs of people living in the home. People enjoyed a healthy balanced and nutritious diet based on their preferences and health needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, the policies and systems in the service supported this practice.

The provider had invested in improvements to the property and people had been involved in decisions about décor and changes made to the home. There was a bright warm atmosphere in all areas of the home.

People received care from staff who were kind and caring. Staff always respected people’s privacy and dignity. Staff encouraged people to be involved in their care planning and reviews. People were supported to express an opinion about the care provided and the day to day running of the home.

People received responsive care and support which was personalised to their individual needs and wishes and promoted independence. There was clear guidance for staff on how to support people in line with their personal wishes, likes and dislikes.

The provider looked at innovative ways to support people in maintaining their choice, control and independence. They also supported people to continue to follow hobbies and interests, as well as maintain links with their local community. People were supported to access health care services and to see healthcare professionals when necessary.

People were supported by a team that was well led. The registered manager and provider demonstrated an open and positive approach to learning and development. Everybody spoken with said they felt the manager was open, approachable and the home was well led.

There were systems in place to monitor the quality of the service, ensure staff kept up to date with good practice and to seek people’s views. Records showed the service responded to concerns and complaints and learnt from the issues raised.

Rating at last inspection: At our last inspection we rated the service Good. The report was published September 2016.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained Good overall.

Follow up:

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

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection was unannounced and took place on 30 August 2016

Vaughan Lee House is owned by Ilminister and District (OPW) Housing Society Limited which is a non-profit making charity run by a committee. It is registered to provide care and accommodation for up to 30 people. It specialises in the care of older people.

The last inspection of the home was carried out in August 2015. At that inspection the service was rated as Requires Improvement. We found that improvements were needed because some records were not easily available and others, such as care plans, were not always up to date and reflective of people’s current needs. We also found that staff were not clear about how to make decisions when people lacked the mental capacity to make decisions for themselves.

At this inspection we found improvements had been made.

There is 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 and Social Care Act 2008 and associated Regulations about how the service is run.

The registered manager had only been in post about 8 months but had already started to make improvements. Systems had been put in place to make sure records were available and up to date. A new care plan system had been implemented and the registered manager informed us they planned to expand on this to make sure care plans were comprehensive and person centred.

The provider was committed to continually improving the service offered to people and carried out regular monitoring visits. The registered manager sought people’s views by informal chats and resident’s meetings. Suggestions made by people were acted upon where appropriate.

There were procedures in place to help to keep people safe. These included a robust recruitment process and training for all staff to make sure they were able to recognise and report any suspicions of abuse. People told us they felt safe at the home.

Staff were kind and caring and treated people with respect and dignity. One person said “Kindness is everything and you cannot fault them.” Another person told us “They help me to have a bath and they are so gentle and kind.”

New systems had been put in place to make sure staff had the training they needed to safely and effectively support people. One person said “Staff are properly trained about how to speak to people and how to treat people.”

People had their needs assessed and received care and support in accordance with their needs and wishes. People said they were able to make choices about their day to day lives and were involved in decisions about their care and support.

People received meals in accordance with their needs and preferences. Where people required support to eat and drink this was provided in a discreet and dignified manner.

Staff monitored people’s health and sought advice from healthcare professionals to meet people’s specific needs. People had access to equipment to assist them to maintain their independence and to ensure their comfort.

Staff assisted people to administer their own medicines if they wished to. If people chose not to take responsibility for their medicines they were safely administered by staff who had received specific training.

People were able to take part in activities both at the home and in the local community. There was a mini bus which enabled people to get out and about on a regular basis. One person said “We are very lucky to get out so much. It’s nice to be able to do a bit of shopping and go for a coffee.”

This inspection was unannounced and took place on 25 August 2015.

Vaughan Lee is registered to provide accommodation and personal care for up to 30 people. It specialises in the care of older people. At the time of this inspection there were 28 people living there.

The last inspection of the home was carried out in November 2014. At that inspection we found improvements were needed. Personal risk assessments were not up to date and did not reflect people’s changing needs. We also found that in some situations people were not receiving care in line with their assessed needs. This had led to some people not receiving effective care to meet their pressure area care needs. The quality assurance systems in place to monitor the quality of the service were not robust and had not identified the shortfalls in people’s care or record keeping. At this inspection we found improvements had been made however further work was required to ensure all records were easily accessible and up to date.

At this inspection we found more robust quality monitoring had been put in place but it was too early to establish the effects of this over a period of time.

There is 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 and Social Care Act 2008 and associated Regulations about how the service is run. At the time of this inspection the registered manager was away from the home. The CQC had been informed that the registered manager would be away from the home for over 28 days and interim management arrangements had been made.

The provider had made suitable arrangements to ensure the smooth running of the home in the absence of the registered manager. They had appointed an acting manager and acting deputy manager who were appropriately experienced to manage the service.

Senior staff had an understanding of the legal requirements of making decisions in people’s best interests when they lacked the capacity to make decisions for themselves. However some documentation in respect of this required improvement to ensure it gave evidence that people’s rights were protected. We have therefore made a recommendation that all staff receive training to increase their knowledge in this area.

Risk assessments and care practices relating to people’s vulnerability to skin and pressure damage had been updated and new checking systems had been put in place. This meant people received appropriate care to meet their needs in relation to minimising the risks of pressure damage.

Staffing levels had been increased to ensure they met people’s needs. The increase in staff had originally been met by the use of agency staff but a large number of new staff had been appointed to make sure people were cared for by a consistent staff team. Rotas showed a reduction in the use of agency staff as new staff completed their induction. One member of staff said “The new staff have made such a difference. We now have so much more time to spend with people.”

People lived in a home that was part of the local community and had a homely relaxed atmosphere. One person said “I’ve known the home for years. It was the obvious place to come when I needed it. I’m still part of things.”

People said they were supported by caring staff. One person said “The staff are all very friendly.” Another person told us “The staff are very nice and make sure you are comfortable.” People felt staff had the skills and knowledge to carry out their roles with one person telling us “They’re good at caring for you. They seem well trained, even the new ones.”

People were complimentary about the food served at the home and said there were always choices. One person said “The food is pretty good.” Another person who required a diabetic diet told us “They do special meals and cakes so you don’t miss out.”

People received care and support which was personalised to their wishes and needs. People were able to make choices about all aspects of their day to day lives and staff respected people’s privacy. One person said “I like to stick to my own routines. They know what I’m like.”

People knew how to make a complaint and had confidence that any complaints would be investigated. One person said “I think they’d want to know if I wasn’t happy so I would definitely say something.”

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

This unannounced inspection took place on 4 November 2014.

The last inspection of Vaughan Lee House was carried out in October 2013. No concerns were raised at that inspection.

The care home is registered to provide accommodation and personal care to up to 30 people. It specialises in the care of older people.

There is 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 and Social Care Act 2008 and associated Regulations about how the service is run.

We found improvements were needed to ensure people received care in line with their assessed needs. We identified two people who were not receiving effective care to minimise the risks of damage to their skin. Although these people had care plans which stated the level of support they required there was no evidence people were receiving the assistance needed. The service was not always reviewing and up-dating risk assessments to ensure people received care which was reflective of their current needs and minimised risks to their health and well-being.

We also found improvements were needed to make sure the quality monitoring systems in place were effective in identifying and addressing shortfalls in practice which could affect the well-being of people.

People were very complimentary about the staff who supported them and told us they felt well cared for. Comments included; “Staff are excellent, very caring and polite,” “The staff are patient and they always treat you with respect” and “Staff are kind and polite.”

Staff administering medicines did so safely and always asked the person if they were happy to take them. Some people were prescribed medicines on an ‘as required’ basis for pain relief. We saw that these medicines were regularly offered to people to make sure they remained comfortable. One person said “I get the right tablets at the right time.”

There was a robust recruitment procedure which included checking all prospective employees to make sure they had the right skills and character to work in the home. All new staff completed an induction programme which gave them the basic skills required to carry out their roles. Staff had access to a range of training, including nationally recognised certificated courses, to make sure they had up to date skills and knowledge to support people. One member of staff said “Training is good it makes you think and makes you a better carer.”

There was a range of activities for people to take part in. Activities included in house activity groups and trips out in the home’s minibus. There was an active volunteer group who were able to support people to take part in activities in line with their likes and interests. One person said “I like to pick and choose. There’s no pressure to go to things but I don’t like to miss some things.”

The home was very much part of the local community and there were frequent visits from local people including members of the Vaughan Lee Committee. Visitors were always made welcome and people were able to see personal and professional visitors in private or in communal areas. Visitors we spoke with confirmed there were no set visiting times and they were able to come and go as they pleased.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

This inspection was carried out solely to follow up on the progress being made to address two compliance actions which were made at the last inspection.

At our last inspection carried out in May 2013 we found that there were no systems in place to comprehensively monitor the practices in the home or record keeping.

At this inspection we found that monthly monitoring inspections had become more robust and comprehensive. We saw that reports of the monthly visits still included discussions with people who lived and worked at the home and observation of the premises. Recent reports showed that the committee members who carried out the visits also looked at records and care practices.

All complaints received were fully investigated to make sure any shortfalls in the service were identified and rectified.

Since the last inspection care plans had been reviewed to ensure that they provided up to date information about people’s needs. This meant that staff had appropriate information to enable them to provide care to the people who lived at the home.

The provider may find it useful to note that because information about individuals was recorded in a number of different places it was not easy to see an overall picture of the person’s health and wellbeing. This could lead to changes in a person’s health not being identified promptly which may lead to a delay in treatment.

Vaughan Lee House was a well maintained building set in a residential area of Ilminster. Accommodation was arranged on the ground floor which meant that all areas were accessible to people with all levels of mobility including wheelchair users.

People we spoke with said they made choices about their day to day lives. One person told us “I’m free to come and go as I please and can have visitors at anytime.” Another person said “You are never forced to do anything. You can please yourself up to a point but obviously you have to consider other people.”

People were well dressed and presented which demonstrated that staff took time to assist people with their personal care. We were told that staff assisted people in an unhurried manner and allowed people to maintain independence where possible. One person said “I never feel rushed or that I am nuisance because I am slow with washing and dressing.” A member of staff told us “We have enough staff, you never have to rush anyone.”

We saw no evidence that care plans, incidents or medication practices were audited. This meant that shortfalls may not be identified and addressed in a timely manner.

Each person who lived at the home had a personal file which contained assessments of need and risk. There were also details of how care should be provided. We noted that care plans were not always kept up to date and staff used information in the handover file to inform their practice instead of referring to individual care plans.

People who lived at the home told us that they continued to make choices about all aspects of their daily lives. People said that they were free to decide how they spent their time. One person told us “you can do what you like within reason.” Another person said “it’s all very free and easy.”

People we spoke with were very happy with the care that they received. Comments included; “people are looked after really well,” “I can’t fault the care that I receive” and “nothing could be better.”

People who lived at the home said that they felt safe with the staff who supported them. One person said “I always feel very safe and I know that I can get help with anything.” Another person said “since moving in I have complete peace of mind, everyone is so caring and gentle.”

People said that they were aware that staff were always busy but they never felt rushed. People said that if they rang their bell for assistance staff responded promptly. One person said “if you ring that bell, day or night, they come straight to you.”

People we spoke with said that they would be comfortable to raise any worries or concerns with a member of staff or the manager. One person said “we are always being told not to be afraid to raise anything we aren’t happy with.” Another person told us “I don’t have any complaints but if I did I know the manager would want to sort it out.”

This inspection was carried out to follow up on a compliance action issued at the inspection in March 2011. In March we found that care plans were basic and did not always reflect the persons’ up to date needs and wishes.

At this inspection we found that the care plan format had been changed and each person had a comprehensive up to date care plan.

People spoken with were aware of their care plan and some said that they had been fully involved in writing them. One person said “We all have a care plan, it’s to make sure they have all the information they need about you.” Another person said “They went through all the paperwork with me to make sure I get the help I need.”

Staff spoken with told us that they thought the new care plan format gave them more information and enabled them to provide “very personalised care” to people. Staff said that the care plans were kept up to date and they used them in their day to day work.

People living at the home said that Vaughan Lee House was a happy place to live. They felt that they were able to make choices about their day to day lives and could raise any concerns with a member of staff. One person said “It’s very free and easy, you can ask for anything.”

Everyone was very complimentary about the food, saying that the food was excellent and there was always a choice of meal.

People said that staff were kind and polite. One person said that “Staff know what they are doing.” Some people said that staff were always very busy but everyone agreed that they came quickly if assistance was required.

Many people praised the housekeeping staff and the high standards of cleanliness within the home.

People said that staff assisted them to make and attend appointments with healthcare professionals. Everyone asked was very happy with the care that they received. Some people said that they had been uncomfortable about being assisted with personal care by a person of the opposite gender but all felt the issue had been resolved.

People said that they felt safe at the home and one person said “You can have a talk with staff if you have any problems”.

One person said that they thought the home was “Value for money” and another said “I have no complaints and no regrets about moving here.”