The Old Vicarage

Updated 9 August 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 3 inspectors (one of whom specialised in medicines) and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

The Old Vicarage is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Old Vicarage is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 21 June 2023 and ended on 14 July 2023. We visited the service on 21 June 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We reviewed support plans and associated records for 7 people. We reviewed medicine administration and associated records for 14 people, observed medicines being given to people and we spoke with 2 members of staff about medicines. We spoke to 8 people who lived at the service and observed staff delivering care. We spoke with the registered manager, deputy manager, activity co-ordinator and compliance manager.

After the inspection we received further documentation electronically, such as governance audits, supervisions, and minutes of meetings. We spoke with 8 relatives, the head cook, and 1 cleaner. We continued to liaise with the local authority about our concerns following the inspection.

Updated 9 August 2023

About the service

The Old Vicarage is a residential care home providing accommodation and personal care for up to 41 older people. At the time of our inspection there were 39 people using the service.

The Old Vicarage comprises the main home for up to 29 people, and a new building for 12 people. The new building provides spacious rooms, and there were small outside spaces attached to each room. The main home has a dining area which all people had access to and pleasant outdoor areas with seating.

People’s experience of using this service and what we found

Significant improvement was needed to ensure people always received good quality, compassionate, individualised and safe care as a minimum standard.

People were not supported safely. Risks to people were not always robustly assessed and mitigated. Staff did not always have the information they needed to provide safe care because risks associated with people's care had not always been fully assessed. This included for falls, diabetes, and choking. Medicines were not always safely managed. There were not sufficient numbers of suitably skilled staff to make sure that they could meet people's care and support needs. Staff were not always recruited safely.

Infection prevention and control was not well managed. We found the service to be unclean in multiple areas including people’s rooms, the main kitchen, and laundry. Staff were not disposing of PPE safely.

People were mostly supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Further work is needed to ensure mental capacity assessments and best interest decisions are in place for all aspects of people’s day to day care, but work had begun on this.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic. Staff received training in learning disabilities, however, the registered manager was unaware of the statutory guidance.

The service lacked effective leadership and risk management. The provider's systems for monitoring and improving the quality of the service had not been effective, because people were not always receiving a good quality of service and some risks had not been mitigated. This placed people at continued risk of harm.

The provider was responsive to the inspection findings, they told us they were willing to learn, improve and share the actions they would take to address the issues found at this inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 18 May 2019).

Why we inspected

We received concerns in relation to environmental risks, infection control and staffing. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report. The overall rating for the service has changed from Good to Inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Old Vicarage on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, medicines, infection control, staffing, recruitment, governance and reporting procedures at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.