Archived: The Old Vicarage

Updated 6 January 2016

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.

This inspection took place on 17 November 2015, and was unannounced. The inspection was completed by an inspection manager and one inspector.

Prior to the inspection we looked at information we held about the service and used this information as part of our inspection planning. We also received feedback on the service from a representative of the local authority commissioning team.

We spoke with six people who used the service. We also spoke with two members of the crisis management team currently employed by the home, the deputy manager, cook, kitchen assistant, a senior care worker and a care worker. We also spoke with a visiting social worker.

We looked at three people’s care records, the systems for monitoring staff training and two staff recruitment files. We looked at other documentation such as quality monitoring, questionnaires, accidents, incidents and safeguarding records and maintenance records. We saw records of compliments and complaints records, people’s food /fluid charts and repositioning chart for those deemed at risk of poor skin integrity and medication administration records.

Updated 6 January 2016

This unannounced comprehensive inspection at The Old Vicarage was carried out on 17 November 2015. The Old Vicarage is a care home that provides accommodation and personal care to up to 22 older people, some living with early stage dementia. It is registered to not provide nursing care. There were 16 people living at the home at the time of this visit. There are internal and external communal areas, including dining and lounge areas and a garden for people and their visitors to use. The home is made up of three floors which can be accessed by stairs and a lift.

There was no registered manager in place during this inspection. An external management team was in place to oversee the running of 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.

There was a failing by the provider to conspicuously display the ratings from the previous inspection carried out in January 2015 in the home and on their website for people and visitors to view.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. Where people had been assessed as lacking capacity to make day-to-day decisions, applications had been made to the local authorising agencies. Staff demonstrated to us that they respected people’s choices about how they wished to be supported. However, not all staff were able to demonstrate a sufficiently robust understanding of MCA and DoLS to ensure that people would not have their freedom restricted in an unlawful manner.

Plans were put in place to reduce people’s identified risks, to enable people to live as independent and safe a life as possible. Arrangements were in place to ensure that people were supported with their prescribed medication. Complete and accurate records of people’s prescribed medication were not always kept. People’s prescribed medications were not always disposed of in a timely manner when they had expired.

People, where needed, were assisted to access a range of external health care professionals and were assisted to maintain their health. Staff supported people to maintain their links with the local community to promote social inclusion. People’s health and nutritional needs were met. People at risk of malnutrition and dehydration had records in place to monitor their food and fluid intake. However, these records did not provide enough detail or guidance for staff of the amount of fluid a person deemed at risk should be given and encouraged to drink each day.

People who used the service were supported by staff in a caring and respectful way. Care and support planning documentation had recently been revised as part of the on-going service improvement plan. These care and support plans prompted staff on any assistance a person may have required and monitor people’s assessed care and support needs. Records showed that there was still some work to be done to improve these documents to give detailed guidance for staff. Work was also being carried out to make care and support plans more ‘individual’ to the person being supported.

People and their relatives were able to raise any suggestions or concerns that they had with the management team and staff and they felt listened to.

There were pre-employment safety checks in place to ensure that all new staff were deemed suitable to work with the people they were supporting. There were enough staff to provide safe care and support. Staff understood their responsibility to report any poor care practice.

Staff were trained to provide care which met people’s individual care and support needs. The standard of staff members’ work performance was reviewed through supervisions. This was to make sure that staff were confident and competent to deliver this care.

The management sought feedback about the quality of the service provided from people and their relatives through the setting up of meetings and sending out questionnaires. Staff meetings took place and staff were encouraged to raise any suggestions or concerns that they may have had. Quality monitoring processes to identify areas of improvement required within the service were formally documented in the service improvement plan with action taken recorded.

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.