The Old Vicarage

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We found the service was safe and good standards of care was being provided to people living at The Old Vicarage. The manager and staff team demonstrated considerable action had been taken in response to our last inspection findings, to achieve an improved score and return to compliance with the breaches of the regulations in relation to safe care and treatment, including medicines management, and safe staffing levels.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s lived experiences of care was positive, with opportunities to give feedback. People and their relatives confirmed any feedback or concerns provided were acted upon to influence changes and improvements to their own care and that of the wider service. For example, people and their relatives told us about individualised meals and menu planning completed between the kitchen staff and people living at the service to ensure they had access to meals they enjoyed as well as meeting their individual nutritional and dietary needs and preferences. From reviewing people’s care records and speaking with staff, we identified examples of collaborative management and assessment of risks between staff and external health and social care professionals. For example, when supporting people’s with changes in their health needs and conditions. This achieved positive outcomes for people.

Staff told us they discussed incidents, accidents, safeguarding concerns, compliments and complaints and these were used as learning and development opportunities. Staff told us culture and morale within the staff team had greatly improved since the current manager had started in post. People’s relatives had also noticed positive change, and gave feedback that, “The atmosphere, staff morale and genuinely the place seems lit up now!!!”

We observed there to be an open and honest culture within the service, with staff feeling able to share feedback, and learning from accidents, incidents, safeguarding concerns, compliments and complaints received.

People newly admitted to the service were supported to cope with the transition between being in hospital or living in their own home, to moving into an unfamiliar environment, to ensure they settled in and felt welcomed. People and their relatives told us about how the staff encouraged people to spend time in their bedrooms and in communal areas to ensure they got to know other people and the staff team. We observed clear arrangements in place in preparation for accepting a new admission to the service on the day of our visit. The bedroom was welcoming, the staff team were briefed and ready for the person when they arrived, which all made the admission happen smoothly.

Leaders and staff talked about the processes in place when assessing, and accepting new people to the service, including those staying for short periods of respite care. Changes to the pre-admission assessment process had been made to ensure wherever possible, the service could be confident they could meet the person’s needs, and their admission would not impact on the standards of care for the existing needs of those people already living at the service.

People’s relatives gave positive feedback regarding the transition process, their involvement with the pre-admission assessment process, as well as involvement with ongoing care plan review meetings where people had been living at the service for some time.

Staff and leaders had a clear plan of approach for ensuring they could meet the assessed needs of people moving into the service, and greater oversight of each person’s care needs to ensure they considered any potential impact of all new admissions in relation to staffing levels and skill mix.

People were protected from the risk of harm and abuse and felt comfortable raising concerns with staff and leaders as required. This was confirmed by people’s relatives who told us they felt their loved ones were well cared for, but if incidents occurred the manager kept them well informed and provided reassurances around actions being taken in response.

Overall, staff demonstrated clear understanding of safeguarding and internal reporting processes within the service, with an expected tendency to defer to the manager or deputy manager for completion of formal reporting processes.

The manager had an open-door policy, and as such ensured staff, people and relatives felt comfortable speaking with them or their deputy manager. The manager was also working with the staff team to upskill and empower members of the team to take on additional roles, responsibilities and overall recognise individual accountability, including in relation to the handling of safeguarding concerns.

We identified some areas of the service’s internal processes required further development to ensure consistent reporting of accidents and incidents meeting the safeguarding threshold were being reported to the local authority and to CQC. We were assured that appropriate action was taken in response to those accidents and incidents, therefore did not find evidence this had an overall impact on the standards of care provided. We found the manager and deputy open to our feedback and quick to implement changes in response to our feedback.

People’s care records contained detailed, individualised plans to mitigate and manage risks. These were formed collaboratively with involvement from people, relatives and external health and social care professionals where appropriate. Where people had specific risks with areas of their care which staff needed to monitor, these were clearly identified within their care records, to ensure management plans were in place for example around malnutrition, experiencing constipation or having a catheter and recognising potential infection risks. We received positive feedback from external healthcare professionals around escalation of risk information by staff, to source timely medical intervention and advice. This was also confirmed from feedback received from people’s relatives.

Staff and leaders demonstrated familiarity with people’s individual care and support needs and assessed risks. Staff gave examples of how they worked with external health and social care professionals to support people for example, known to be at risk of neglecting their personal hygiene standards and living environment, to encourage acceptance of support from staff with washing, dressing and tidying their bedroom.

We observed the morning shift handover meeting, and found the level of detail, and risk information discussed and handed over between shifts assisted staff with the management of individual risks and changes in support needs.

Processes were in place for the auditing and oversight of care records and daily notes, to ensure key risk information was accurately reflected, and updated as people’s needs, and risk profiles changed.

People lived in a clean, well maintained care environment. The older part of the service had areas which required ongoing refurbishment or repair. We spoke with a person residing in this section of the service who raised no concerns with their bedroom and were content with the care received. People’s own bedrooms were personalised, with the option of having items of personal importance, including pieces of furniture brought into the service. People’s relatives told us about the condition and cleanliness of the care environment. They stated, “Well-maintained and safe environment. Always kept at a good temperature.” Overall, people told us the cleanliness and maintenance of the care environment was felt to have continued to improve under this manager.

We liaised directly with the head of maintenance, who was able to share details of the refurbishment schedule of works for the service, as well as ongoing health and safety monitoring arrangements in place.

We observed the condition and cleanliness of the care environment to be of a good standard throughout the new building, and communal areas of the service. We observed some rooms and areas of the older part of the building to be in need of repairs and refurbishment, with the possibility of some bedrooms being decommissioned as no longer suitable for people with specific needs due to size e.g. to accommodate items of equipment, or the lack of full ensuite facilities. The manager told us they were in the process of reviewing all bedrooms to determine which ones were no longer fit for purpose, they also showed us examples of bedrooms being renovated at the time of our visit, which we saw were being completed to a high standard.

Audits and checks were in place to ensure housekeeping standards throughout the service were completed to a high standard. The kitchen had been awarded a 5-star food hygiene rating earlier this year, and we observed the kitchen to be clean and well organised during our inspection visit.

People were supported by sufficient numbers of suitably trained staff during the day and overnight. People confirmed, and we saw their needs to be responded to in a timely way, for example during meal times, and when using the call bell system in place. People’s families told us they felt the core staff team to now be stable, with less use of unfamiliar agency staff, which they felt had previously had an impact on aspects of their loved one’s care. Relatives identified the ongoing benefits of having a consistent staff team, particularly for those people living with dementia. Relatives told us, “No staffing level worries, staff are trained and competent. I see consistent staff and far fewer agency staff.”

Staff told us there were sufficient numbers of staff on shift, and this had improved under the current manager. Due to a COVID-19 outbreak at the time of our inspection, staff were covering additional shifts when needed, and this was well coordinated, to ensure staff still had rest days. The manager had clear plans in place for adjusting staffing levels, and recruitment arrangements as the number of people living at the service steadily increased. Safe recruiting processes were in place to ensure staff recruited to work at the service were suitable to care for vulnerable people.

We observed staff to respond in a timely manner to call bells, or requests for assistance from people or their colleagues. Staff were observed to regularly check on people seated in communal areas of the service, as well as those spending time in their bedrooms.

Arrangements were in place to plan staffing rotas ahead wherever feasible, to allow staff time to coordinate coverage of gaps, prior to needing to request agency use.

People were protected from the risk and spread of infection. At the time of our inspection, the service was experiencing a small COVID-19 outbreak, and this was found to be contained and well managed to protect against further spread. Staff and visitors had access to personal protective equipment, and there was clear signage to alert visitors prior to entering the service. People with a history of developing urine and chest infections had clear prevention and management plans in place to maintain their health and well being. The service was visibly clean and tidy throughout, and additional touch point cleaning was in place to assist with the management of the outbreak. We received positive feedback from people’s relatives regarding the standards of cleanliness within the service, and the handling of situations such as a COVID-19 outbreak.

Staff had access to personal protective equipment and training to ensure they understood how to reduce the risk of the spread of infection, through good infection, prevention and control practices.

We observed staff to be well presented, adhering to the provider’s dress code policies in relation to working bare below elbow, with no jewellery or painted nails which could impact on maintaining good standards of hand hygiene.

The service had infection, prevention and control audits, policies and procedures in place which staff demonstrated they understood and implemented into their daily ways of working.

People were receiving their medicines as prescribed. People’s medicines were stored securely to protect them from the risk of harm and ensured the efficacy of the medicines was maintained. Where people required medicines on an as required basis (PRN), clear written guidance was in place to ensure staff knew when to administer these medicines. We received positive feedback from the GP surgery in relation to the management plans in place for people’s care and support, including in relation to reviews of their medicine management plans.

Staff understood people’s individual support needs in relation to the management of their medicines. Staff received training and regular reviews of their competencies to ensure they maintained the required skills and knowledge to keep people safe. Staff were aware of internal and external reporting processes to follow in the event of a medicine administration error. We observed part of a medicine round during our site visit. Staff demonstrated familiarity with people’s individual preferences on how they wished to take their medicines. We observed safety measures to be followed throughout the round.

Systems and processes were in place to monitor for any administration or recording errors and ensure these were identified and acted upon in a timely way. Staff demonstrated familiarity with the provider’s medicine management policies and procedures.