Vicarage Court Care Home

We found the following examples of good practice.

We observed systems and processes in place, in line with guidance, to ensure visitors to the home did not introduce and spread Covid-19. All visitors, including professionals were subject to a range of screening procedures, including showing evidence of vaccination and a negative lateral flow test before entry into the home was allowed.

Staff followed government guidance in relation to personal protective equipment (PPE). We saw all staff were wearing face masks. Hand sanitiser and PPE was readily available throughout the service. The home had sufficient supplies of PPE.

All staff and people living at the home were being Covid-19 tested in line with current guidance. Appropriate processes were in place should anyone display any symptoms of Covid-19.

The care home was clean, well maintained and odour-free. There were cleaning schedules in place.

Staff supported people’s social and emotional wellbeing. Alternative forms of maintaining social contact were in place including video calls. The home had made adaptations to create a visitors’ ‘pod’ to allow partitioned visiting without having to enter the care home. At the time of our inspection the home had briefly paused some family visits as a precautionary measure as some staff had tested Covid positive. Visiting was due to resume in line with guidance.

All staff had undertaken training in infection prevention and control (IPC) and PPE.

Policies and audits relating to infection prevention control, including coronavirus were up-to-date. We saw that regular IPC audits had been undertaken and the home had actioned the findings of the audits.

Vicarage Court is a care home providing personal and nursing care to younger disabled adults and people aged 65 and over, including people living with dementia. The service can support up to 80 people in one adapted building over three floors. At the time of this inspection there were 63 people living at Vicarage Court.

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

People, their relatives and staff comments about staffing levels were mixed. We saw there were busy times during the day of the inspection when people had to wait to receive support from staff. For example, at meal times some people had to wait for support to eat their meal. We have made a recommendation the provider and registered manager consider the comments made by people and staff and take into account our observations when calculating staffing levels and the deployment of staff during busy times. During the inspection the registered manager and provider agreed they would review staffing levels and the deployment of staff.

Medicines were stored safely and securely. People received their medicines as prescribed. Further guidance for staff on the use of as and when required (PRN) medicines was being developed.

The provider had effective recruitment procedures in place to make sure staff had the required skills and were of suitable character and background. Staff understood what it meant to protect people from abuse. They told us they were confident any concerns they raised would be taken seriously by the registered manager.

Staff were provided with an induction, relevant training and ongoing support to make sure they had the right skills and knowledge to support people. People told us they enjoyed the food served at Vicarage Court, which we saw considered their dietary needs and preferences. People were assisted to maintain their health by being provided with a balanced diet and supported to access a range of health and social care professionals.

Staff understood the requirements of the Mental Capacity Act 2005. 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.

Positive and supportive relationships had been developed between people, their relatives and staff. People told us they were treated with dignity and respect and we saw this throughout the day of the inspection.

There was a range of activities available to people living at Vicarage Court. People were supported to engage in activities that were important to them. There was an up to date complaints policy and procedure readily available to people. People, their relatives and staff told us the registered manager and provider were approachable and responsive to any issues raised.

There were effective systems in place to monitor and improve the quality of the service provided. Safety and maintenance checks for the premises and equipment were in place and up to date. The provider had policies and procedures which reflected current legislation and good practice guidance.

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 3 August 2018). At this inspection we found improvements had been made and the service is now rated good.

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.

Vicarage Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Vicarage Court can accommodate up to 80 people, in a single, adapted building which contains units for residential and nursing service users, younger people with disabilities and people living with dementia. At the time of our inspection there were 61 people using the service.

There was a registered manager in post when we inspected the home. 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.

People told us they felt safe living at Vicarage Court Care Home, which was clean and well-maintained. We saw staff were recruited safely and deployed in sufficient numbers to meet people’s needs, although some staff said they would like to have more on each shift to increase the amount of time they had to socialise with people. Medicines were managed safely, and staff and the registered manager had a good understanding of how to report accidents and incidents including concerns about potential abuse. Risks associated with care and support were well managed, although we have made a recommendation about the quality of records on the electronic system.

Staff had the training and support they needed to be effective in their roles, including a formal induction for newly recruited staff. 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. We found staff were knowledgeable about people’s needs and preferences.

Nutrition and hydration were well managed, and we observed a pleasant mealtime experience on the day of our inspection. Although we received some mixed feedback about meals, we saw the registered manager consulted people on what they wished to see on the menus, and observed people could ask for alternative meals if they wished.

People received support to access health and social care professionals when needed, and there were systems in place to ensure people were supported if they needed to be admitted to hospital. The environment in the Forget-Me-Not dementia support unit required some adaptation in order to improve its suitability for people living with dementia, however the registered manager and provider had already recognised this and were preparing to act.

We observed people and staff had good relationships, and there was good, caring practice in the home, including ensuring people’s rights, privacy and dignity were respected.

There were systems in place to ensure staff had access to information about people’s up to date needs and preferences, and the provider was working to involve people more in the processes of reviewing care. Staff were confident in their ability to provide end of life care when needed, however some electronic care plans lacked detail about people’s wishes in this area.

There was a varied programme of activities available in the home led by knowledgeable and enthusiastic staff, however people gave very mixed feedback about this and we did not see a high level of activity on the day of our inspection. People told us they would feel confident in raising concerns and complaints, and we saw there were processes in place to ensure these were responded to appropriately.

Feedback about leadership in the home was good, and we saw there was a robust approach to measuring, monitoring and improving quality in the service which took the views, opinions and diverse needs of people and staff into account.

Vicarage Court provides nursing and personal care for up to 70 people with a specialist facility for people with dementia. On the days we inspected there were 54 people living in the home with 22 of whom were people living in the facility for people with dementia, and a further 14 received nursing care.

The registered manager had retired a week before the inspection A new manager had been appointed and was in process of registering with the CQC, and there had been a transition period between the registered manager retiring to ensure an effective handover with the new home manager. They were in the process of registering and were available on both days of the inspection. 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.

People and relatives all told us they felt safe. Staff demonstrated what signs of abuse to look for and how to respond if any such concerns were noted.

Staffing levels were reflective of people’s needs which meant people were responded to quickly. We observed high levels of communication between staff when they were responding to call bells which helped efficiency of support further. All necessary checks had been carried out prior to employment of new staff. Although there were some issues with the recording, we found medication was administered, stored and recorded correctly.

We had concerns around moving and handling practice and documentation as not all staff appeared confident with assisting people to move and there was a lack of clarity as to how some people were to be supported if they had variable mobility. We spoke with the manager and registered provider about this who agreed to action immediately. We confirmed improvements were actioned with further training being provided and amended documentation implemented.

Staff had access to regular supervision and training. They were encouraged to develop in their roles and the home promoted learning. This was evidenced through individual and group supervisions alongside regular staff meetings for all staff.

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.

Most support with nutrition and hydration was improved form the previous inspection as people had choices of drinks and meals, and any preferences were known and met. However, the deployment of staff occasionally meant a lack of supervision for people needing this at mealtimes and some care records did not indicate the required food consistency for people even though kitchen staff did provide this correctly.

Positional changes were offered to most people on a regular basis and were recorded accurately.

Care staff demonstrated a high level of commitment to supporting people, being responsive to their needs and emotions and acknowledging distress with kindness and patience. People were involved in reviews of their care wherever possible and their wishes regarding end of life care had been noted where discussed.

There was a range of activities throughout each day, both for groups and individuals and the home had plenty of resources to engage people. We saw much higher levels of interaction than previously and this added to the positive atmosphere in the home.

Care records reflected people’s needs and aided staff to build a good picture of someone through their health and social care needs.

Complaints were handled by the manager promptly and with a thorough investigation ensuring lessons were learnt if necessary.

The quality assurance process had developed since the previous inspection and we saw evidence of effective communication and instructive meetings to assist staff in care delivery. However, the quality assurance system had failed to identify areas where practice was not meeting best practice such as around moving and handling, medication and mental capacity assessments.

You can see what action we told the provider to take at the back of the full version of the report.

At the last inspection in November 2013 we found the home was non-compliant and in breach of regulation 9 which relates to people's care and welfare. The provider sent us an action plan which showed improvements would be made by 30 April 2014. At this inspection we checked these improvements had been made.

Detailed findings

At our inspection we gathered evidence to help us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found.

Is the service safe?

We found the service was not safe. Although, people told us they felt safe in the home we had concerns about staffing levels, the maintenance of the building and how accidents and incidents were managed. Staff had a good understanding of the safeguarding procedures and felt confident any concerns reported would be addressed. However, we found accidents and incidents which had caused harm or injury to people were not always fully investigated or reported, when necessary, to safeguarding. As a result of this we notified the safeguarding team at the local authority.

Although many parts of the building were well maintained, we found people who used the service were being put at risk as some parts of the premises and equipment were not being maintained.

Feedback from staff and our observations showed there were not always enough staff on duty to meet people's needs and keep them safe.

Is the service effective?

The service was not always effective. Most staff received regular training and support, although one staff member's recruitment checks and induction training had not been completed before they started working in the home. Some staff working with people living with dementia had not received any training in dementia care. This meant people were at risk from staff who did not have the skills and knowledge to meet their needs.

People said they did not enjoy the food, choices were limited and people were not always supported to eat and drink enough to maintain their health.

Is the service caring?

The service was not always caring. People spoke positively about the staff and described them as 'lovely', 'caring' and 'very good'.

Some staff interactions were positive and we saw people benefitted from these staff who were quick to respond and compassionate. Other staff were task orientated and did not pick up or respond to people's needs, which meant people were ignored.

Is the service responsive?

The service was not always responsive to people's needs. Care records did not always show the most up-to-date information about people's needs, preferences and risks to their care. We found improvements had not been made as stated in the provider's action plan.

We were told a variety of activities were available for people, however we saw little evidence of these or information about the activities on offer. People told us there was very little to for them to do

Is the service well led?

The service was not always well led. Although quality assurance systems were in place, these were not always effective. This meant risks were not always identified, monitored and addressed and learning from incidents and accidents was not used to improve the quality of the service.

There were 48 people living in the home on the day of our inspection, of which seven people were in the process of being transferred onto the new dementia unit. During our visit we spoke with three people who lived in the home and four visiting relatives. We spoke with the two owners, the registered manager and a sample of care staff. We reviewed four people's care records and spoke with two visiting health care professionals. We left comment cards following our visit to gain feedback on the service and received 7 responses which were all complimentary.

One relative said, 'Staff handle residents with great patience. I like the friendly atmosphere and I think there is a caring attitude here. I have seen staff paying good attention to residents even when they didn't know I was listening.'

We reviewed four people's care records and found detailed care plans had been developed from information gathered at assessment. However, we found instances where changes had taken place during the month, but the care plan had not been amended to reflect the change. We spoke about this with the manager who told us she had carried out a care plan audit since she started in post. The analysis of the findings indicated there were gaps in documentation. She provided us with an action plan of how this was to be addressed to ensure care records were maintained to a high standard.

The staff worked well with other agencies and were proactive in ensuring that people with dementia received all the care and support they required from the appropriate agency. A health professional confirmed the home utilised other professionals and external agencies appropriately to ensure people's needs were met.

Appropriate measures were in place to ensure the quality and safety of the service. However, the provider may find it useful to note that the environment of the home required further development and consideration of best practice guidance for people with dementia.

We used a number of different methods to help us understand the experiences of people using the service including talking to people and observing the care provided. We spent time with people and we observed staff being friendly and warm towards people. We observed that staff and service users had positive relationships and we saw some light hearted banter. People appeared relaxed and comfortable with their surroundings; with staff and the activities they were engaged in. We saw that staff supported people to make choices about their daily living.

We spoke to people who use the service and they told us that they had been included in decisions about what care and support they received and when this would be available.

One person said 'the staff are wonderful here, we are treated really well, nothing is too much trouble'. A person's relative said 'when I leave here I know my relative is well cared for and I can trust the staff to look after them properly'.

We spoke with two members of staff who were able to demonstrate a good understanding of the needs of the people who lived at Vicarage Court. They told us that they were well supported by managers of the home and there were good opportunities for training.