The Care Quality Commission (CQC) has again rated The Old Vicarage, a care home in Norfolk, as inadequate and imposed conditions on its registration following an inspection in January.
The Old Vicarage, run by Hewitt-Hill Limited, is a residential care home providing accommodation for people with dementia and older people who require personal care. At the time of this inspection, there were 25 people using the service.
This inspection was prompted in part due to concerns CQC had around potential risks in the service, and to check on the progress of improvements they were told to make following their previous inspection when they were first rated as inadequate and placed into special measures.
Following this inspection, their ratings overall, for safety and for how well-led they are have been rated as inadequate again. Ratings for how effective, caring and responsive the service is have dropped from good to inadequate.
The service will be kept under close review by CQC to ensure rapid and widespread improvements are being made, and to keep people safe while this happens. During this inspection, CQC made referrals to the fire service due to concerns about the home’s physical environment, and also to the local authority due to safeguarding concerns.
CQC also imposed conditions on the provider’s registration, meaning they must update CQC monthly on improvements they are making and must ask CQC before admitting residents to the home. Since this inspection, the provider has submitted action plans and enlisted the support of a consultancy to help them improve their service.
Stuart Dunn, CQC deputy director of operations in the east of England, said:
“Our experience tells us that when a service isn’t well-led, this has a knock-on effect to the level of care being given, which is what we found when we inspected The Old Vicarage. At our last inspection we rated leadership as inadequate, and at this inspection we found that the level of care being provided to people had deteriorated further.
“It was clear to us that the service wasn’t well-led. Staff told us there’d been a high turnover of managers and that lack of consistency was impacting on their ability to provide good care. They also told us management hadn’t provided them with effective systems to enable them to provide the best possible care for the people who call The Old Vicarage Home.
“It was very concerning that there wasn’t always a complete record of accidents and incidents, and managers didn’t support staff to learn from them to avoid the same things happening again. For example, two people using the service got into a physical fight when no staff were around, and both were seriously hurt. The same situation had happened before with the same people, but care plans weren’t updated to try and prevent it from happening again.
“The environment wasn’t safe, or meeting people’s needs. We were so concerned about people’s safety in the event of a fire when we visited that we made a referral to the fire and rescue service to support them to address these issues. New signage still wasn’t specific enough to meet the needs of people living there, especially those with dementia. It also wasn’t safe in other ways, with overflowing, unlocked bins filled with clinical waste in an area that people at the home had access to.
“We found care plans and risk assessments were generic and not person-centred. People didn't have access to information about them, in formats that they could easily understand, which meant they couldn’t always make informed decisions and participate actively in their own care planning. People and their relatives also told us they weren't involved in the care planning reviews and weren't given the opportunity to share their views and wishes.
“Staff didn’t consistently support people in a respectful way. For example, someone requested to sit at the table with a chair instead of in their wheelchair during lunchtime. Despite this request, staff brought out their lunch, and just placed it on a table, disregarding their expressed preference.
“We’ve told the home where they must improve, and the home will remain in special measures to keep people safe while these improvements are being made. If sufficient progress hasn’t been made, we will not hesitate to take action to ensure people’s safety and wellbeing.”
Inspectors also found:
- Referrals were made about the risk of falls but weren't followed up, this increased the risk to people experiencing falls
- Medicines weren’t managed safely, with some people not receiving medication that had been prescribed to them
- Pre-employment checks weren't completed appropriately. Disclosure and Barring certificates and references were found to be missing from staff files, which meant that the service wasn’t assuring themselves people were suitable to work with vulnerable people
- There wasn’t a registered manager in post during our site visit
- Staff knew people well but didn’t have appropriate training to fulfil their roles.
However:
- Relatives told us they were able to visit their family member when they wanted
- We observed staff speaking with people in a kind manner.