The Old Vicarage Care Home

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.

We found the following examples of good practice.

The registered manager had introduced a system for ensuring all professional visitors had been vaccinated.

Staff worked hard to ensure they did not rely on agency staff, reducing the impact on people who used the service.

Further information is in the detailed findings below.

The Old Vicarage is a ‘care home’. People in care homes receive accommodation and 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.

The Old Vicarage is registered to provide accommodation and personal care to a maximum of 36 older people, including people who live with dementia.

We last inspected The Old Vicarage in December 2016. At that inspection we found the service was in breach of its legal requirements with regard to Regulation 11 and Regulation 17 of the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve to at least good in the areas identified. These included with regard to where people lacked capacity to consent the provider had not always acted in accordance with the Mental Capacity Act 20015. Robust quality assurance systems were not in place and records did not provide an accurate account of the care people received.

At this inspection we found improvements had been made so the service was no longer in breach of its legal requirements. Staff had an understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves. Records were in place that reflected people's care and support requirements and they were regularly reviewed to ensure they remained accurate. The home had a more effective quality assurance programme to check the quality of care provided.

A registered manager was 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.

Due to their health conditions and complex needs not all people were able to share their views about the service they received.

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.

People and staff told us they felt safe and there were enough staff on duty to provide safe and individual care to people. People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

Risk assessments were in place and they identified current risks to the person. Staff knew the people they were supporting well.

People said staff were kind and caring. Limited activities and entertainment were available to keep people engaged and stimulated. We saw staff did not always interact and talk with people. We have made a recommendation about training about person-centred care.

Appropriate training was provided and staff were supervised and supported.

People received a varied and balanced diet to meet their nutritional needs. People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. Systems were in place for people to receive their medicines in a safe way.

A complaints procedure was available. Staff and relatives said the management team were approachable. People had the opportunity to give their views about the service. There was consultation with people and family members and their views were used to improve the service. People had access to an advocate if required.

At our last comprehensive inspection of the service, in March 2015, we found the service was in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, namely Good Governance. We returned to the service in September 2015 and found the provider had made improvements to meet legal requirements.

A registered manager was 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.

People and their relatives told us they felt safe living at the home. Staff had undertaken training in how to respond to safeguarding issues and concerns and were able to describe to us the correct processes to follow. We saw where concerns had been raised these had been shared promptly with the local authority safeguarding team.

Accidents and incidents had been monitored and analysed. Risks had been assessed and where possible action had been taken to reduce the likelihood of the risks occurring again.

People, their relatives and staff told us there were enough staff to meet people’s needs. We saw staff were able to respond to people’s requests quickly. Robust recruitment procedures had been followed.

Medicines were managed appropriately.

Staff training was up to date. The manager monitored essential training to ensure any refresher courses were booked before training expired.

The principles of Mental Capacity Act 2005 (MCA) were not always followed. Some people had capacity assessments completed which were not decision specific. Where decisions had been made on people’s behalf, documentation had not been completed to evidence that their capacity had been assessed or that the decision was in the person's best interests.

Where restrictions on people’s liberty were in place to keep them safe, applications had been made to the local authority to grant Deprivation of Liberty Safeguards.

People told us the food on offer was plentiful. A choice of food was available at every meal and food was on offer throughout the day. However, we found records relating to people's nutritional needs and food and fluid intake had not always been completed.

People spoke highly of the staff team. Through our observations we saw staff were friendly and treated people with respect.

Care records were personalised and contained specific information so staff could provide people with consistent care.

People's needs and their plans of care were regularly assessed, however, we noted on some occasions advice from healthcare professionals had not been incorporated into care plans.

People provided us with mixed feedback about the activities on offer. We observed people enjoying a reminiscence session, but one person told us they would like to go on more trips out of the home. The registered manager told us she was trialling different staff shifts so staff had more time to focus on activities.

People and staff were positive about the leadership in the home. Staff described the improvements they had seen in the home. Staff told us they were proud to work at The Old Vicarage.

The provider did not have a robust system in place to monitor the quality of the service provided. Whilst a schedule of audits was carried out regularly, they had not identified or addressed the shortfalls which our inspection highlighted.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the need for consent and good governance. You can see the action we have told the provider to take at the back of the full version of this report.

We found care was planned and delivered in a way that was intended to ensure people's safety and welfare, though review of their care could be improved. Each person's needs, including risks, had been assessed and care plans were in place. Care plans were not being routinely reviewed but were reviewed when people's care changed or their needs altered.

We found people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We saw there were effective recruitment and selection processes in place because appropriate checks were undertaken before staff began work. Staff had been recruited who had suitable qualifications and experience to provide care to people.

We found people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard with some further planned opportunities for staff development still to be put in place.