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Inspection carried out on 12 December 2017

During a routine inspection

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.

Inspection carried out on 8 December 2016

During a routine inspection

This inspection took place on 8 December 2016 and was unannounced. The Old Vicarage provides accommodation, nursing and personal care for up to 28 people. On the day of our inspection 15 people were using the service who had a variety of needs associated with dementia and physical health conditions.

The service had 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

People were protected from the risk of abuse and staff had a good understanding of their roles and responsibilities if they suspected abuse was happening. The registered manager shared information with the local authority when needed.

People received their medicines as prescribed and the management of medicines was safe.

Staffing levels were sufficient to support people’s needs and people received care and support when required.

People were encouraged to make independent decisions and staff were aware of legislation to protect people who lacked capacity when decisions were made in their best interests. We also found staff were aware of the principles within the Mental Capacity Act 2005 (MCA) and had not deprived people of their liberty without applying for the required authorisation.

People were protected from the risks of inadequate nutrition. Specialist diets were provided if needed. Referrals were made to health care professionals when needed.

People who used the service, or their representatives, were encouraged to contribute to the planning of their care. Although some care records did not always contain enough information to assist staff manage their care. Staff did have the knowledge they required to give care and the registered manager provided further information following the inspection to show the care records had been updated.

There was lack of regular social activities in the service and number of people told us they were often sitting with long periods with nothing to do.

People were treated in a caring and respectful manner and staff delivered support in a relaxed and considerate manner. People also felt they could report any concerns to the management team and felt they would be taken seriously.

Systems to monitor the quality of service provision were in place.

Inspection carried out on 22 April 2015

During a routine inspection

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.

Inspection carried out on 16 April 2013

During an inspection to make sure that the improvements required had been made

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

At our last inspection of the home we identified areas of concern and asked the provider to take action and provide us with information about how the areas of concern were to be addressed.

Prior to our visit we reviewed all the information we had received from the provider and other agencies. During the visit we spoke with people who used the service, members of the staff team and the manager. We also looked at records. These included care plans, records of meetings and information about how the service operated.

We saw that people were cared for in a clean, safe environment.

We saw that the provider had sought the opinions of the people who lived at The Old Vicarage and taken their views into account in delivering care and support. People were involved in decisions about their care. One person said, "Staff are keen to find out details of my wants, if any."

Records we looked at and staff we spoke with confirmed they had received training aimed at improving and maintaining the level of care and support provided to people. Staff told us they felt well supported and had the opportunity to raise any issues through staff meetings and supervision sessions with a manager.

Inspection carried out on 17 December 2012

During a routine inspection

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time

Due to the complex needs of some of the people who used the service we used a number of different methods to help us understand their experiences when we undertook our visit.

Prior to our visit we reviewed all the information we had received about the service. During the visit we spoke with two people who used the service. We also spoke with three members of the staff team and the manager. We also looked at records. These included care plans, records of meetings and information about how the service operated.

The people we spoke with who lived at the home said they were happy with the care and support they received and felt it was delivered in a safe way. They told us that staff offered them choice.

We found that the manager had been in post for a short while. She told us she had identified issues that needed to be addressed.

We identified concerns regarding people's choices about their care, the number of staff available to support people at the home, staff training and support, the suitability of premises and equipment and record keeping.

The local authority had conducted an audit of the service in October 2012 and had identified similar issues.