Archived: The Old Vicarage

We found the following examples of good practice:

We noted good practices in areas we considered including the use of and disposal of personal protective equipment (PPE). Staff, management and visitors were using PPE correctly and there were robust procedures in place around the use of PPE.

The provider and registered manager had processes to minimise the risk to people, staff and visitors from catching and spreading infection. These included weekly testing of staff and at least every 28 days for people living in the home. Hand sanitiser and PPE were available throughout the home. There were signs to remind staff, visitors and people about the use of PPE, the importance of washing hands and regular use of hand sanitisers.

Visiting rules and process were communicated effectively to people using the service and their relatives. However, checks and processes around visiting professionals entering the home were not robust enough and the registered manager altered this position during the inspection. This would reduce the risk of professionals unwittingly spreading infection into the home.

Where appropriate, and consistent with infection control rules, ‘socially-distanced domestic' visits had been taking place. We noted the processes around this were in line with local rules and guidance. We noted they were regularly reviewed and adapted to reflect latest guidance and legislation.

We noted the provider had developed a visiting area inside a conservatory attached to the home. This incorporated shielding and isolation processes to ensure visitors and residents were protected.

Infection control policy and people's risk assessments had been completed and revised following the pandemic so that people were protected in the event of becoming unwell or in the event of a COVID-19 outbreak in the home. The registered manager insisted people were tested before admission and consistent with guidance, people were not being admitted to the home at the time of the inspection. This will be reviewed as appropriate and in line with any changes in restrictions. We were satisfied the service, staff, people and visitors were following the rules.

People's mental wellbeing had been promoted by use of social media and hand held devices so people could contact their relatives and friends. Staff had comprehensive knowledge of good practice guidance and had attended COVID-19 specialist training. There were sufficient staff to provide continuity of support and ensure safeguards were in place should there be a staff shortage.

Policies and infection control processes were regularly reviewed when guidance changed. We saw good examples of this that took into account guidance from a wide variety of sources. The registered manager kept abreast of developments and we saw examples of where they had considered new guidance and provided this in a summary to staff in the home.

The home was clean and hygienic. The service had a designated cleaner. All staff had received COVID-19 related supervision and had access to appropriate support to manage their wellbeing should it be required.

The provider had created a policy around the national COVID-19 vaccination programme. Staff and residents were encouraged to participate and were supported appropriately.

Further information is in the detailed findings below.

There was a registered manager in place. 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 service was last inspected on 04 October 2014 and was rated overall as good. We had rated the service as ‘Requires Improvement’ under the safe and responsive domain. This was because improvements were required to ensure staff were suitably deployed and activities were considered for people who lived at the home.

At this inspection, carried out in August 2017, we found all improvements had been made and the service was meeting the fundamental standards. The registered manager had reviewed staffing levels to ensure there were suitable numbers of staff on shift to meet the needs of the people who lived at the home. People told us staffing levels met their needs. Staff were not rushed and had time to sit with people.

In addition, staff had been deployed to ensure people had the opportunity to take part in activities on a daily basis. People and relatives told us activities took place. We saw evidence of activities occurring during our inspection visit.

We reviewed systems in place for managing medicines. We found good practice guidelines were implemented when administering regularly prescribed medicines. However, documentation relating to ‘as and when’ medicines was sometimes unclear. We have made a recommendation about this.

People and relatives told us staff had the required skills and knowledge to provide effective care. The registered manager maintained a training matrix so that training could be planned effectively. Although training was provided we noted staff did not always receive refresher training to ensure their skills were up to date. We have made a recommendation about this.

We looked at fire evacuation procedures at the home. Whilst procedures were in place these were not always fully documented to show all risks had been considered. We have made a recommendation about this.

People told us they felt safe at the home. Procedures were in place to protect people from harm. Staff told us they had received training in this area and were able to describe abuse and their responsibilities for reporting this.

The registered manager assessed individual risk and developed risk assessments to minimise the potential risk of harm to people during the delivery of their care. Care records showed they were reviewed and any changes were recorded. Risk was suitably managed.

We reviewed staff records. Suitable recruitment checks were in place to ensure staff recruited possessed the correct characteristics and experiences for working with vulnerable people.

We looked around the building. We found it was hygienic and suitably maintained. We reviewed documentation relating to health and safety at the home and found suitable maintenance checks had been carried out.

People and relatives spoke positively about the quality of service provided. They praised the caring nature of staff, constantly referring to them as ‘kind’ and ‘caring.’ We found there was a warm and welcoming atmosphere at the home. People repeatedly described the home as homely and described it as a home from home.

We received positive feedback about the quality of food at the home. There was a variety of food on offer and staff were accommodating to people’s individual needs and preferences. Meal times were relaxed. Nutritional and hydration needs were met.

Care records were person centred and reflected the needs of people who lived at the home. We saw evidence these were reviewed on a regular basis or when people’s needs changed.

The registered manager had an understanding of the principles of the Mental Capacity Act and the Deprivation of Liberty safeguards. We saw evidence of capacity being considered within care records.

Resident meetings took place on a regular basis. We saw evidence of people being encouraged to give feedback about the service and areas in which improvements could be made.

People were supported by a stable staff team. This promoted effective and responsive care as people were supported by staff who knew them well. We observed dignity being respected at all times during our inspection visit.

People and relatives had no complaints about the service provided. They told us they were encouraged to raise any concerns and complaints.

People were encouraged to retain their independence. Care plans emphasised the importance of promoting independence and empowering people. People told us this occurred in practice.

The service worked in partnership with other care professionals to meet needs. Health professionals we spoke with said they had no concerns about the service provided and the skills of the staff.

Leadership within the organisation was good. Staff were positive about ways in which the service was managed and the support received from the registered manager.

The registered manager used a variety of methods to assess and monitor the quality of care at the home. These included regular audits of medication, care plans and the environment.

The registered manager was aware of their responsibilities in reporting to the Care Quality Commission.

Last time we found that people were not adequately protected against the risks associated with medicines. This time we found a great many improvements had been made to the storage of medication, including purchasing a trolley. We were told that staff had been advised on proper procedures for administering medication and that the managers were checking these were followed. Despite this, we found there were still some slippages in standards, which the manager accepted as in need of tightening up.

At our last inspection in April 2012, we found the Old Vicarage compliant with all of the outcomes we inspected, except for outcome 8 which is the safe management of medicines. At this inspection we followed up to check if the provider was now administering medication safely. We also talked with residents, looked at care plans and other documents, and observed care. We found the home had had some refurbishment since our last visit. There were also some new residents. On the day we visited there were 12 people in the home. The atmosphere was pleasant and welcoming. We saw that staff worked well with people, and spoke pleasantly with them. Although there was no cleaner on duty on the day we visited, the rooms we saw were clean. Some upgrading of washing facilities was in progress following a local authority audit. This would make them more hygienic. We found that management systems for ensuring quality continued to be informal but that there was evidence that people were listened to and improvements were being made. We looked at the home's systems for ensuring consent was obtained for care people received. We found that there was no evidence for this. We also found that there was a continuing failure to store and administer medication safely.