Archived: The Old Vicarage

Updated 7 February 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 12 and 18 December 2017 and was unannounced. The inspection team consisted of two inspectors and two experts by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service. We were accompanied on the 18 December by a member of the quality monitoring team from the local authority.

The inspection was prompted by information of concern we received from both the local authority and a whistle blower. We used information we had received from and about the service to plan the inspection. This included previous inspection reports and statutory notifications. A notification is information about important events which the provider is required to send us by law. We also sought feedback from the local authority, who commission services from the provider.

During the inspection, we spoke with10 people who lived at the service and four relatives or friends who were visiting. We spoke with the nominated individual (this is a person nominated to represent the provider), one company director, the manager, one senior care worker, one care worker and one agency care worker, a housekeeper and a maintenance person. We also spoke with a healthcare professional who routinely visited the service.

Updated 7 February 2018

This unannounced inspection took place on 12 and 18 December 2017. The Old Vicarage is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single packages under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The Old Vicarage accommodates up to 28 people over two floors. During our inspection 17 people were using the service.

There was no registered manager in post at the time of our inspection; the previous registered manager had left the service in September 2017. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. An interim manager had been in post since September 2017 but had not yet applied to the CQC to become registered manager for the service.

People were not always protected from risks associated with the premises and a number of serious safety risks relating to the environment had not been addressed by the provider. People were not always protected from risks associated with their care and support. People were not always supported by sufficient amounts of staff who knew their needs and staff were not always recruited safely. People could not be assured that the management of medicines was safe. The environment people lived in and equipment used was not always clean.

People’s rights under the Mental Capacity Act (2005) (MCA) were not always protected as people’s mental capacity had not always been assessed robustly and the MCA had not always been applied to ensure that decisions were made in people’s best interests. People could not be assured that staff had the skills and training they needed to meet people’s needs correctly. People did not always get the support they required to eat their meals in a safe way. People had access to health professionals; however, staff did not always work with them to improve people’s health. Information in care plans about the support people required to maintain good health was not always clear. People’s individual needs in relation to the premises they lived in, were not adequately met.

Staff supporting people did not always know their needs and people were not involved with the development of their care plans. People’s privacy and dignity needs were not always met.

People did not always receive personalised care and their care plans lacked up to date key information to assist staff to provide individualised care. There was a lack of personalised end of life planning in place for people. Social activities available for people were limited and were not tailored to people’s individual needs people who spent time in their rooms were at risk of becoming isolated. People’s concerns and complaints were not always recorded and responded to appropriately.

The service was not well led. Systems in place to monitor and improve the quality and safety of the service were not effective and this placed people at risk of harm. Service provision was not robustly monitored and effective action was not always taken in response to serious issues identified. There was a lack of over sight of the service from the provider which had resulted in poor care for people who lived at the service

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

After the inspection visit, further information of concern was received in relation to fire safety. Following this, all people at the service were moved into alternative accommodation. We then issued a notice which proposed to cancel the provider’s registration and at the time of writing this report intend to do this.