Archived: Old Vicarage Nursing Home

Updated 25 January 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.

Two inspectors and a specialist nurse advisor completed this unannounced inspection on 9 October 2017. We had not requested that the provider should complete a provider information return (PIR) on this occasion. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We gave the provider time during the inspection to update us on any information they wished to share.

We used a range of different methods to help us understand people’s experiences. People had varying levels of communication and most were unable to speak with us at length; so we observed the care and support staff provided in the communal areas of the home. We spoke with two relatives about their experience of the care that the people who lived at the home received.

We spoke with the nurse, the manager, the care co-ordinator and seven care staff. We reviewed care plans for eleven people to check that they were accurate and up to date. We also looked at the systems the provider had in place to ensure the quality of the service was continuously monitored and reviewed to drive improvement.

Updated 25 January 2018

We inspected Old Vicarage Nursing Home on 9 October 2017 and it was unannounced. The home was previously inspected on 11 January 2017 and had been rated ‘good’ overall with improvements required to keep people safe from harm. This inspection was brought forward and prompted in part by the failings of the provider’s other service. The concerns we had at that location resulted in us taking urgent action to close the service. We found that there were similar concerns at this location and that the provider had not put measures in place to protect people from the same failings. There was no learning evident from the provider’s previous failings nor any new systems implemented to ensure that there was not a repetition of the concerns.

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.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Old Vicarage Nursing Home provides nursing care and support for people, some of whom are living with dementia. It is registered to provide care for 30 people and at the time of our inspection 26 people were living at the home.

Risks to people’s health and wellbeing were not adequately assessed and managed leaving people at risk of harm. Where risks had been identified the provider did not always take action to remove or minimise the risks. Changes to people’s health were not always responded to by referring them to healthcare professionals. Some people did not receive enough support with eating and drinking. Staff did not always have the skills to be able to support people effectively and the provider did not have a system in place to routinely assess their competence.

Medicines were not always managed or administered to people as prescribed. The recording was not always clear to ensure that staff knew how to administer them. The systems in place to monitor the risks associated with medicines were not effective in highlighting errors and concerns.

There was not a registered manager 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. There was a manager but they were only available to support the home on a part time basis and did not have the systems in place to have a good oversight of concerns. Staff did not receive leadership and support to know their responsibilities well. They did not receive adequate training to be able to support people effectively. They were not always deployed well to ensure that they could meet people’s needs in a timely manner.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible. Some people were not enabled to make their own choices because their communication needs had not been met. When people did not have the capacity to make their own decisions best interest decisions were made on their behalf but they were not always followed.

People’s dignity and privacy were not always upheld and they were not always spoken to kindly. Their preferences were not always planned for and when their needs changed their care was not always reviewed.

People were not always protected from harm and abuse because incidents were not fully investigated and staff did not always recognise potential safeguarding concerns.

People’s care plans were not always altered to reflect a change in their support needs and so did not assist staff to provide a personalised service. Opportunities to pursue hobbies and interests were limited for some people.

Complaints were managed in line with the provider’s procedure.

We found breaches of 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. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.