Archived: The Old Vicarage

At our last inspection we found breaches of legal requirements. This was because the service was unsafe, there were unsafe staffing levels to meet people’s needs, records were incomplete and unavailable. There were poor quality assurance systems in place. Notifications were not always being made when required and the provider was not accurately registered with us.

Following our last inspection we imposed a condition on the provider’s registration. This was because people were at risk of receiving unsafe and inadequate care. Each month the provider had provided a report of the quality assurance systems in place including any action taken or planned.

At this inspection we found improvements had been made to ensure the service was safe, had sufficient staff, records were accessible and quality assurance systems were in place although some shortfalls found during this inspection had not been identified. Improvements were still required to submission of all notifications and the provider was not accurately registered with us.

The Old Vicarage 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.

The Old Vicarage accommodates up to 19 people in one building and is registered to provide accommodation for persons who require nursing or personal care. At the time of the inspection there were 17 people living at the home.

At the time of the inspection there was no registered manager in post. We had received an application and this was being processed. We will monitor this progress. 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 were not always protected from the risk of cross contamination and infection control. Due to poor practices being followed relating to handling laundry, the use of personal protective equipment, lack of liquid hand soap and disposable hand towels.

The provider was not accurately registered with us to reflect the organisation responsible for operating the service. An application had been submitted and we are monitoring the outcome.

The home’s quality assurance system was not always identifying shortfalls found during this inspection. This related to a missing incidents and accident forms and notification to CQC. People having no recorded air mattress setting in place, poor practice relating to infection control, the infection control risk assessment not being up to date or being followed by staff. The home’s quality assurance policy also required confirmation of all systems in place at the home and when they are undertaken.

People were supported by staff who had received training, supervision and an annual appraisal. Staff were able to demonstrate their knowledge and they knew people well.

People had care plans that were personalised and risk assessments identified risks and what actions had been taken to minimise the risks. Personal evacuation plans were in place and confirmed people’s individual support needs.

Medicines were administered when required and safely. People were supported by staff who had checks undertaken prior to being employed at the service.

People felt supported by staff that were kind and caring. Staff demonstrated privacy by shutting people’s door and knocking before entering.

People could have visitors and friend’s at various times during the day. The home had activities that people could access if they wished and local schools would visit from time to time.

People felt able to complain and various compliments had been received by thankful relatives.

The management the home was accessible and approachable and staff felt well supported and the home made referrals when people’s needs changed.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

We found two breaches of Regulations in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

The Old Vicarage is registered to provide personal care and accommodation for up to 19 older people. It is not registered to provide nursing care; if this is required it may be provided by the community nursing team. On inspection, there were 17 people registered to live at the service but one person was in hospital.

A registered manager was appointed to manage the service. 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 registered provider and manager had failed to ensure people were adequately protected from accidental harm. There were no systems in place to stop people burning themselves on the heaters. The hot water was known prior to this inspection to have been reading in excess of the 44oC maximum recommended temperature. Windows were not being restricted to the recommended maximum opening of 100mm. During the inspection we were informed a person had been seriously hurt after coming into contact with one of the heaters. These concerns are currently being investigated. The registered provider and manager were requested to take immediate action to protect people and this action has now been completed.

The registered provider and manager had failed to notify CQC about serious matters affecting people who live at The Old Vicarage, such as serious injury. Prior to the inspection our records showed there had been no information about significant injuries between 2014 and 2016. These are matters registered people are required to tell us about. These have been sent in retrospectively.

There were not enough staff to meet people’s needs safely. Systems were also not in place to make sure there were enough staff. During the day and night time there were insufficient staff to meet people’s needs safely or in a timely way. At night time, those people who needed two staff to assist them safely either received assistance from one member of staff (placing the person and themselves at risk of harm) or alternatively they had to wait until the following morning when a second member of staff was available. We requested the registered provider and manager took immediate action to address the staffing at night and review the day time staffing. The provider did not commit to the increased staff numbers but said that staffing would be reviewed

Staff told us they felt they could approach the registered manager and could suggest changes in how the service was run but did not feel they were heard. Staff told us they had spoken about the staffing to the registered manager and in staff meetings but they had not been listened to.

People had risk assessments in place in line with the risk of falling, skin breakdown, malnutrition, and being moved by staff. These were updated at monthly intervals and linked to their care plans. There were no risk assessments in place in respect of people’s individual needs where they were at an increased risk. For example, there were no risk assessments in place for people at risk of choking. People’s accidents were collated and reviewed for the individual but there was no whole home assessment of these falls and accidents to see if learning could take place.

Staff were trained in how to meet people’s needs in the event of a fire; a contingency plan was in place and a place of safety in the community identified. People had personal emergency evacuation plans (PEEPs) in place. However, there was no evacuation equipment in place and remedial action identified in a fire risk assessment in September 2015 had not been carried out. We have referred these concerns to the fire service to review.

Medicines were administered by staff trained to complete this task. Staff competency was being checked to ensure they understood the training and were maintaining safe practice. All medicines were stored safely and securely. People had their medicines as prescribed and records of this were kept in their Medicine Administration Record (MAR). An audit was completed but there was no check of amounts of medicines to ensure these were accurate. We have recommended the registered provider and registered manager ensure the management of medicines is in line with the current guidance.

The service was clean and people told us they were happy their rooms were kept clean. Not all staff had been trained in infection control. We identified that infection control practices were not always being followed. We have recommended the registered provider and manager review the latest infection control guidance to ensure the policy and practice reflects this.

Remedial work had taken place since the last inspection to address the concerns about the maintenance of the service that was placing people at risk. The registered manager had systems in place to ensure the equipment was safely maintained.

People’s needs were assessed before they moved into the home and care plans were drawn up, giving staff information about their general needs. Care plans were personalised, explaining how people wanted staff to assist them with personal care tasks. However, the plans did not provide sufficient detail about people’s health needs such as dementia, diabetes or heart conditions. End of life care had not been planned and their wishes had not been recorded. This meant people could not be certain they would receive the care they needed or wanted at the end of their lives.

Activities were provided for people to take part in. This depended on the availability of staff to have time outside of the tasks that needed completing. A recent residents’ meeting had requested more one to one time with staff. Staff told us they were restricted by time in meeting this request.

The recording of people’s capacity and their ability to consent to their care and treatment had improved since the last inspection. Staff had received training in Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and described how people’s needs should be met if they lacked capacity or had a DoLS assessment requested. Assessments had been carried out to identify any aspects of people’s lives where they did not have capacity to consent. Staff supported people to make decisions and give consent where possible, although this had not always been recorded clearly. The registered manager agreed to review this and make sure the records were clear.

We could not be certain that staff had received sufficient training to meet people’s needs safely because there were significant gaps in the training records. Staff who started in 2016 had not had safeguarding vulnerable adults training, for example. We spoke with the registered manager who acted promptly to ensure staff training needs were identified, planned and recorded.

People using the service said they felt safe. Staff were knowledgeable about safeguarding people and keeping them safe from abuse. Staff were recruited safely. People and their relatives felt the staff were caring. All staff we spoke with worried about not being able to be as caring as they would like due to there not being enough staff. Staff were observed being respectful in the way they spoke with people and spoke kindly and patiently to people when this was needed. People were spoken to with politeness and staff told people what they were doing before they did it.

People’s need to have enough to eat and drink were met. People said they had enough to eat and drink. People had fresh jugs of water or juice in their rooms or available through the day. People were provided with drinks when they wanted them. People could choose what they wanted to eat and were complimentary about the food and the portion sizes. People who were at risk of weight loss were referred to specialist health professionals for assessment and support and staff followed any guidance they received.

People’s health needs were met. They could see a range of health professionals and their GP as needed. They had regular appointments with chiropodists, opticians and dentists.

People knew how to complain and raise a concern. People and their family were asked their view of the service. People said they attended resident meetings. Questionnaires were sent out to be completed by people, family and professionals once a year. The feedback for the one completed last time was very positive.

We found breaches of the regulations. You can read the action we have told the registered manager and provider to take at the back of full report.

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

We spoke with eight people who lived in the home, six members of staff and observed staff interactions with people in the communal areas. This enabled us to gain an understanding of people's experiences, and how the service was delivered.

Overall comments were positive from people living in the home. Comments included, 'I get a choice of what I want. Staff are very good here, we had ice creams yesterday to help keep us cool'. 'We go to bed and get up when we like'. 'I am here for a short break but I hope to come and live here soon'.

People appeared very relaxed around staff and were interacting in a positive manner. Everyone we spoke with told us they knew how to make a complaint and who to contact, if they were unhappy. One person told us 'I never have any reason to complain but I know who to tell'.

Staff told us they felt they delivered a high standard of care to people living in the home. They also stated they were well supported and trained by the management team. One member of staff told us 'Hand on heart it is the best place I have ever worked. Training and support is great'. Another person told us ' I have had more training in four months than I had in a whole year in my last job'.

At the time of our inspection there were 19 people living at The Old Vicarage. During our visit we looked at records and documentation relating to how people's care was delivered.

We spoke with six people who live in the home, four members of staff and one visiting relative. This enabled us to gain an understanding of people's experiences, and how the service was delivered.

Overall comments were positive from people living in the home. Comments included; 'It's lovely I have the choice to have my main meal in my room if I want'. 'They look after us well, they always do their very best'. 'food is very nice I am very comfortable here'. One visiting relative told us 'it's lovely here I can't wait to move in!'

People appeared very relaxed around staff and were interacting in a positive manner. Everyone we spoke with told us they knew how to make a complaint and who to contact, if they were unhappy. One person told us "the staff are good to us, I would have no hesitation to raise any concerns with them".

We spoke with four members of staff who told us they felt they delivered a high standard of care to people living in the home. They also stated they were well supported and trained by the management team.