Archived: The Old Vicarage

Updated 31 March 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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 30 October and 11 November 2014 and was unannounced.

The team consisted of a lead inspector and two other inspectors on the first day of the inspection. An inspection manager and one inspector completed the second day of the inspection. Before the inspection we reviewed the information we held about the service, including notifications. The provider is required by law to make notifications about some events happening in the home, such as serious accidents, abuse and deaths. We also received information from the council’s quality monitoring team, infection control team and safeguarding team in east Norfolk.

During the inspection we looked around the home, talked to four people using the service and four of their relatives. We spoke with two staff, the manager and the provider of the service.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We checked how people were supported at each stage of their care and treatment. We reviewed four people’s care records, medication records, records relating to the premises, training records and recruitment records for two staff.

Updated 31 March 2015

The inspection took place on 30 October and 11 November 2014 and was unannounced.

Our last inspection of this service was on 14 July 2014 and followed up concerns from previous inspections. We found that there were continued breaches of legal requirements for care and welfare of people using the service. There were also breaches of legal requirements for infection control, safety and suitability of premises and assessing and monitoring the quality of the service. The provider met with us on 1 September 2014 and told us how they were going to improve. At this inspection, we checked to see whether improvements had been made and found that they had not.

The service must have 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. We took action to cancel the registration of the former manager in September 2014 because improvements had not been made to comply with regulations. At present there is a manager in post who is not registered.

The Old Vicarage provides accommodation and personal care for up to 24 older people. On the first day of this inspection there were seven people living in the home. On the second day, there were four people in residence.

People’s safety was compromised in a number of areas. Staff knew that they needed to report any concerns about abuse. However, allegations were not always properly responded to and there had been instances of neglect. People’s safety was also compromised because of hazards in the environment and poor infection control. Their medicines were not always stored securely and administered properly.

There were enough staff on duty to meet people’s needs and to respond promptly to people’s requests for assistance.

People did not always receive care which met their needs. Action was not taken promptly to secure advice when people’s needs changed significantly and care plans were unclear about specific individual needs. People did not always receive sufficient nutrition and hydration for their needs.

Long standing staff had access to training including in the Mental Capacity Act (MCA) 2005. The manager understood the need to make an application under the MCA Deprivation of Liberty Safeguards where someone’s liberty had been restricted. However, staff were not receiving supervision or regular assessments of their competence to support people effectively and safely. New staff did not receive proper induction training to support them in their roles.

People or their relatives were not encouraged to express their views about care and treatment. Although people felt that staff were caring we received mixed views about this from relatives. Half of them felt that some staff were not patient with people. We saw some interactions that were caring and compassionate and others where staff did not engage with people. We found that people’s privacy was respected.

The service was not responsive. It did not respond to changes in people’s needs promptly and people’s social interests and hobbies were not taken into account. One person said they got bored and relatives said that there was nothing going on for people. People and their relatives were not clear about how to make a complaint. Two relatives felt that concerns were not properly addressed with staff being defensive if they raised anything.

Leadership of the home was poor. There were no effective systems in place to monitor the quality of the service and identify where improvements were needed. There had been a lack of action to address shortfalls identified at previous inspections.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what these are at the back of the full version of this report. Where we have identified a breach of a regulation during inspection which is more serious, we will make sure action is taken. Where providers are not meeting essential standards, we have a range of enforcement powers we can use to protect the health, safety and welfare of people who use this service (and others, where appropriate). We have taken action to cancel the provider’s registration.