Background to this inspection
Updated
4 January 2023
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 Act.
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
The inspection was carried out by 1 inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
The Old Vicarage 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.
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was no registered manager in post. The new manager planned to register with CQC and the provider was supporting them to do so.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service. 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 (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all of this information to plan our inspection.
During the inspection
We spoke with 7 people, 1 relative and 6 staff, including the manager, director, care staff and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We contacted 2 external professionals via email.
We observed interactions between staff and people. We reviewed a range of records. This included 4 people's care records and medication records. We looked at 2 staff files. We reviewed a variety of records relating to the management of the service, including policies and procedures, training records, meeting minutes.
Updated
4 January 2023
About the service
The Old Vicarage is registered to provide accommodation and personal care to a maximum of 36 older people, including people who live with dementia. At the time of the inspection there were 32 people living at the home.
People's experience of using this service and what we found
People’s care plans were in place and up to date but needed more person-centred detailed to make them more effective. Systems and procedures were not always consistent in identifying areas for required improvement, particularly in medicines administration and recording.
Some medicines recording practices needed improvement and the provider responded to feedback immediately.
Audits had not identified all of the issues we found on inspection and systems were not fully in place to robustly analyse all aspects of the service. We have made a recommendation about this.
There were enough staff to support people and staff had received appropriate training. People were kept safe from the risk of abuse. The provider managed infection prevention and control safely.
Governance and auditing arrangements had not identified the service as a closed culture. Previously staff had felt unable to speak up, although recognised the positive work done by the provider to improve the culture recently.
The service had no registered manager at the time of inspection. The provider had recruited a new manager and they planned to register with CQC. They were completing relevant training.
The manager and staff demonstrated a strong understanding of the service and people who used it.
Staff worked hard to ensure people’s needs were met and they felt comfortable and safe.
The provider had reviewed safeguarding and whistleblowing policies and procedures to ensure they were understood. Staff now knew they could raise any concerns they had. The provider had worked well recently with external partners to ensure people’s safety when concerns were raised.
The environment was well maintained and clean. The new manager had responded well to advice from infection prevention and control specialists. Utilities, safety and fire equipment were regularly checked.
Staff were recruited safely. There were competence assessments and themed supervisions in place to support the safe delivery of care. Staff worked hard to ensure the service did not rely on agency staff, meaning people received a continuity of care.
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.
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 21 June 2018)
Why we inspected
This inspection was prompted by a review of the information we held about this service. We undertook a focused inspection to review the key questions of safe and well-led only.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.