The Vicarage Residential Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Good. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to staffing as we were not assured staff were recruited in a safe way and there were concerns about the deployment of care staff and how this impacted on their ability to provide person-centred care.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

There were processes and policies to support a learning culture. However, we found these were not always effective. For example, completed audits and checks did not identify issues we found during this assessment such as concerns around fire safety. Where actions plans were in place we were not assured these were robust. The provider also had failed to improve outcomes for people following findings from our last assessment. We found people were still not receiving care that was tailored to their individual needs or in line with their personal choices and wishes.

People and their relatives told us, they felt they could raise concerns and knew who to speak to if needed. People knew who the manager was and they told us they felt relaxed to speak to them. Staff felt comfortable to raise concerns and felt these would be acted upon.

One relative told us, “The communication I think is good, but I would have no problem speaking to them[staff] if I had a problem.” One staff member told us, “If I raise concerns they [management] respond effectively.”

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

We found risks such as fire safety concerns or environmental risks were not identified as a part of provider’s internal quality assurance and had potential for serious harm. We told the registered manager about it, and they implemented an action plan to address these concerns.

People’s individual risks were identified and included in their care plans and there was appropriate risk mitigation in place. One relative told us, “My loved one had a fall a while ago and was taken to hospital, they fell out of bed and since then staff put a side on their bed and a mat on the floor and adapted it to them.”

People and their relatives were included in making decisions about their care. For example, during our visit there was a care review carried out to address one person’s poor diet intake, and it was agreed that food delivery was to be organised to meet both person’s dietary and cultural requirements.

The provider worked well with people and healthcare partners to understand what being safe meant to them and how to achieve that. Staff concentrated on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People told us they felt safe. One person told us, “I feel very safe here.” One relative told us, “I have no worries at all, it gives me a piece of mind knowing my loved one is safe here.” Staff had overall good understanding of how to keep people safe. However, staff did not always know who to contact if they had to escalate concerns and were not always aware of internal safeguarding policies. Following our feedback the registered manager had spoken to all the staff to remind them of the procedure of reporting safeguarding concerns. Staff received safeguarding training.

The provider worked with the Mental Capacity Act 2005. People’s capacity was assessed when required and staff understood their duties under the Act.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

There were policies and procedures in place to protect people from avoidable harm and abuse. However not all the policies were acted upon, and environmental risk assessments were not always robust and being followed by staff. For example, the Fire Safety Policy relating to the completion of the fire risk assessment which was out of date. During the assessment we found concerns regarding how fire safety was managed by the provider which impacted on both people and staff safety. For example, we found a number of people’s bedrooms were not closing properly which could impact on how effectively fire was contained when it occurred. We told the provider about this, and they developed an action plan to address these concerns.

People and their relatives told us they could raise concerns and knew who to speak to. There were evidence of service reviews taking place to enable people and their relatives to discuss changes in people’s care. Staff had a good understanding of people’s individual risk. However we saw instances where staff did not support people’s independence and discouraged positive risk taking. For example, during our visit we saw one person who wanted to stand up and mobilise. However, staff member repeatedly told this person to sit down.

People’s care plans included information about people’s risks and these were overall detailed and regularly reviewed.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

During the assessment we identified number of concerns regarding people’s immediate environment as well as concerns regarding fire safety. For example, we saw furniture in people’s bedrooms were not anchored to the walls. Some of the high-risk rooms where equipment was kept were not locked. People’s rooms were not always maintained safely. For example, in one person’s bedroom their call bell was pulled out of the wall exposing wires which could potentially lead to serious harm. Furniture and fittings in most rooms were tired and worn and required attention. Some of people’s bedrooms door were not shutting properly not only impacting on people’s privacy but also posing a risk in the event of fire.

During our visit we observed people who required assistance with their moving and handling had only one sling available. Therefore, if this sling was in the wash there was no sling available for person to use if they needed to be transferred. Some of the slings were in poor working condition which could result in harm or injury when used.

Following our feedback the registered manager took an action to resolve some of the identified areas of concern. For example, following a visit from the Fire Service they arranged for the full fire risk assessment to be completed as this was out of date, arranged for furniture to be anchored to walls although this did not include all areas of risk and property maintenance work was ongoing. The provider bought some new slings for people, and a full check of existing slings was arranged to ensure these were safe and fit for purpose.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development.

Staff did not always work together well to provide safe care that met people’s individual needs.

The provider did not always follow safe recruitment practices. Staff references were not always appropriately sought prior to their employment and DBS (criminal checks) were not always completed. Gaps in the employment were not always followed up and staff right to work was not robustly checked. Staff health risks were assessed. However, these were not always detailed.

There was very little evidence staff’s professional development was encouraged, and we were not assured that appropriate training oversight was in place. We were told staff completed the Care Certificate (this is a set of fundamental standards for new health and social care workers in the UK, ensuring they have the core knowledge and skills to support people assessed through theory and practical assessment in the workplace), but we saw no evidence staff completed this. Staff were provided with mandatory training on supporting people with Learning Disability and Autism. We were not assured staff had the right skills and knowledge to support people with complex needs. For example, we saw one person diagnosed with a learning disability getting distressed in the communal area. However, staff did not know how to provide reassurance to this person and reduce their distress. Staff were provided mostly with online training and had few opportunities to attend face to face learning sessions. One staff told us, “I had a lot of training, mostly online and one moving and handling face to face.” Staff competencies were checked and reviewed. For example, regarding supporting people with their medicines. One staff member told us, “They[management] assess us to see if we need anything further.”

Staff received supervision and appraisals. One staff member told us, “I had my appraisal before my supervision.”

We received positive feedback about staff from people. People and their relatives told us, staff were kind, knew them well and treated them with respect. One person told us, “The carers are good, and they look after you well.” Another person told us, “They try to look after me as best they can, I don’t have any complaints.” However, both people and staff raised their concerns regarding staffing levels. One person told us, “I don’t think there is enough staff about.” One staff member told us, “Normally at night there is just 2 staff, and I believe we need more it’s not enough. Some residents are 2 staff to 1 and if we are attending to a resident and then the buzzer goes off, we need an extra hand because we might be in the middle of personal care and we cannot just run off like that.” Some of the care staff was also completing cleaning tasks and were involved in kitchen duties which was taking them away from their caring duties. We also observed kitchen duties were not always covered and, on some days, people were not offered hot meals. One person told us, “There is a menu for meals but when you get here [dining room] you don’t get the food.” Another person told us, “Food is ok, but you don’t get a choice though.”

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

There were policies and procedures in place regarding infection control in place however these had not always been followed. For example, regarding effectiveness of cleaning measures. Some areas of the home were dated and in a need of decorating which could impact on the effectiveness of the infection control measures. We saw staff members undertaking cleaning tasks. However, these were not always effective. For example, one person was incontinent in the communal lounge and staff only cleaned the floor and left the chair out until we pointed this out to them. In one of the communal bathroom there was urine on the floor which has not been cleaned.

Staff had access to the PPE (Personal, protective, equipment) such as aprons and gloves and knew how to use these. We saw a staff member encouraging people to clean their hands by handing wet wipes and supporting them. The provider worked with the local Infection control and prevention team. Internal infection control audits were completed but these did not identify issues we found during this assessment.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

There were policies and procedures in place to support how medicines were administered. People’s care plans overall contained a good level of information regarding their medicines and support required.

People received their medicines on time and when they needed them. One person told us, “Cares give me my medicines and I take them.” During our visit we saw a staff member asking one person if they were in pain and needed any painkillers and when they said yes, staff gave them medicines promptly.”

Staff received medicines training, and we saw their competencies assessed. Staff had a good understanding and knowledge regarding supporting people with their medicines, and this included spotting and addressing any medicines errors.

When people required support with their PRN medicines (PRN medicines are medicines not required on a regular basis, such as paracetamol) there was guidance in place which informed staff of when and how to administer these medicines.

People’s medicines were not always stored correctly. Some of the medicines such as people’s creams did not have legible labels in place and on some of the medicines there was no label placed at all. We told the Deputy Manager about this, and they took prompt action to address this.

People’s medicines were regularly reviewed. For example, we saw people’s medicines were reduced and stopped when these were no longer needed in consultation with the medicalprofessional. People and their relatives did not raise any concerns with us regarding how their medicines were managed and administered.