• Care Home
  • Care home

Archived: The Old Vicarage

Overall: Good read more about inspection ratings

Vicarage Lane, Tilmanstone, Deal, Kent, CT14 0JG (01304) 611241

Provided and run by:
Mrs R Elango & Mr P Elango

Important: The provider of this service changed. See new profile

All Inspections

3 June 2019

During a routine inspection

About the service: The Old Vicarage is a service for older people which can support up to 39 people. There were 34 people at the service when we inspected, some of whom are living with dementia.

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

People’s experience of using this service:

People and their loved ones told us they were happy living at the service. Staff were kind and compassionate, they knew people well and had a good understanding of their support needs.

Staff had the training and support they needed to carry out their roles. A relative told us, “Staff have a great understanding of dementia and that means I know my loved on is safe.”

The provider visited the service regularly and spoke to people and their loved ones to ascertain if there were any concerns. Action was taken to address any issues raised and resolve any complaints. Regular audits were completed by the manager and provider to monitor the quality of care. Incidents were not reviewed to identify themes or trends, this is an area for improvement.

People’s care plans and risk assessments were detailed. They gave staff the guidance they needed to meet people’s needs safely and in the way they preferred. The provider and manager told us they were going to develop the care plans to ensure they were as person centred as possible. Some care plans would benefit from additional details about people’s lifestyle choices.

People told us the food was nice and they always had a choice. Food was prepared in a way which met people’s health needs. Medical professionals were contacted as necessary if people became unwell. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported to give feedback and suggest new activities or meals for the menu. These suggestions were taken on board. Members of the local church visited regularly and activities designed for those living with dementia were offered.

Rating at last inspection: Good (Published 09 December 2016)

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor the service.

31 October 2016

During a routine inspection

This inspection was carried out on the 31 October 2016 and was unannounced.

The Old Vicarage provides care for up to 39 older people some of whom may be living with dementia. On the day of the inspection there were 30 people living at the service. The Old Vicarage is located in the village of Tilmanstone. It offers residential accommodation over two floors and has two communal areas together with a conservatory on the ground floor which is also used as a dining area. There is a secure garden at the rear and side of the premises.

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.

We carried out an unannounced comprehensive inspection of this service on 24 and 25 September 2015 and The Old Vicarage was rated ‘Requires Improvement’. We issued requirement notices relating to safe care and treatment, fit and proper persons employed, person centred care, good governance, staffing and duty of candour. We asked the provider to take action and the provider sent us an action plan. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. Improvements had been made and the provider had complied with the breaches but we found some other areas that still needed improvement.

One person did not have personalised guidance in place for when staff should administer medicine to help them when they were stressed or anxious. The registered manager wrote these guidelines on the day of the inspection and staff read and signed them to show they understood what they said. Staff had identified on the morning of the inspection that one person had not been getting their medicine at the correct time. They contacted the pharmacy and were told that the person should not suffer any ill effects. Staff had sometimes hand written people’s medicine administration records (MARs). These were not signed by two staff members to confirm that they had been checked and were accurate. We have recommended that the provider reviews their medicines policies and procedures.

Staff knew how to recognise and respond to abuse. The registered manager was aware of their responsibilities regarding safeguarding and staff were confident the registered manager would act if any concerns were reported to them.

Staff completed incident forms when any accident or incident occurred. The registered manager analysed these for any trends to see if any adjustment was needed to people’s support. Risks relating to people’s health and mobility had been assessed and minimised where possible. Regular health and safety checks were undertaken to ensure the environment was safe and equipment worked as required. Regular fire drills were completed.

There was enough staff to keep people safe. Staff were checked before they started working with people to ensure they were of good character and had the necessary skills and experience to support people effectively.

Staff had the induction and training needed to carry out their roles. They had received training in people’s healthcare needs. Staff met regularly with their manager to discuss their training and development needs. They had received training in topics relating to people’s needs?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. DoLs applications had been made to the relevant supervisory body in line with guidance.

People were supported to eat and drink healthily. Staff had sought advice and guidance from a variety of healthcare professionals to ensure people received the best care possible. Staff followed guidance and advice given by health care professionals. Some people’s health had improved on moving to the service.

People and their relatives said that staff were kind and caring. Staff knew people well and their likes and dislikes formed part of their care. People were supported to dress how they wished and wear jewellery and perfume when it was important to them. People were treated with dignity and respect.

Staff were responsive to people’s needs. Detailed assessments were carried out before people moved into the service. People’s care plans were reviewed monthly by staff to ensure they reflected the care and support people needed.

People took part in a variety of activities within the service. People participated in pumpkin carving and listened to music on the day of the inspection. People and their relatives told us musicians and entertainers regularly visited the service to perform. There was a complaints policy in place and people’s relatives said they knew how to complain if they needed.

Staff and relatives told us they thought the service was well led. Staff told us they were well supported by the registered manager and there was an open and inclusive ethos within the service. The registered manager told us that, “The resident was at the forefront of everything.”

The registered manager was experienced in working with older people and providing person centred care. The CQC had been informed of any important events that occurred at the service, in line with current legislation.

The registered manager regularly carried out audits to identify any shortfalls and ensure consistent, high quality, personalised care. People’s relatives, staff and other stakeholders were regularly surveyed to gain their thoughts on the service. These were collated and analysed and the results were displayed within the service so everyone could read them.

24 & 25 September 2015

During a routine inspection

This inspection took place on 24 and 25 September 2015 and was unannounced. It was carried out by an inspector 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.

The Old Vicarage provides care for up to 39 older people some of whom may be living with dementia. On the days of the inspection there were 39 people living at the service. The Old Vicarage is located in the village of Tilmanstone. It offers residential accommodation over two floors and has two communal areas together with a conservatory on the ground floor which is also used as a dining area. There is a secure garden at the rear and side of the premises.

There was a registered manager working at 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 and associated Regulations about how the service is run. The registered manager was supported by a deputy manager.

Although people told us they felt safe, risk assessments to support people with their daily lives were not detailed enough to show how the risks should be managed safely and kept to a minimum. The assessments also lacked guidance for staff to support people with their mobility and nutrition and skin care. This left people at risk of not receiving interventions they needed to keep them as safe as possible.

People were satisfied with the care and support they received. Everyone had a care plan. The contents, information and quality of care plans varied. Care plans did not record all the information needed to make sure staff had guidance and information to care and support people in the way that suited them best and kept them safe. When people’s needs changed the care plans had not been updated to reflect the changes. Care plans did not record all the information needed to make

sure staff had guidance and information to care and support people in a person centred way.

If people were unwell or their health was deteriorating the staff contacted their doctors, district nurses or specialist services but this was not always done as quickly as it should be.

Accidents and incidents had been recorded and action had been taken to reduce the risks, however these were not analysed to identify any patterns or concerns to reduce the risk of them happening again.

Recruitment processes were in place to check that staff were of good character to work with people living at the service. Not all the safety checks that needed to be carried out on staff, to make sure they were suitable to work with people had been completed.

Some people received medicines ‘when required’, like medicines for pain or medicines to help people remain calm. There was no guidance for staff to tell them when they should give these medicines and the effects of the medicines people received was not being monitored.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). At the time of the inspection the registered manager had applied for a DoLS authorisation for some people who were at risk of having their liberty restricted. They were waiting for the outcome from the local authorities who paid for the people’s care and support. Not all mental capacity assessments had been completed to assess if other people needed to be considered for any restrictions to their freedom and how they were involved in planning their care. All the people using the service needed to have their mental capacity assessed to make sure consideration was given to any possible restrictions to their freedom. We have made a recommendation about the registered manager seeking advice about making sure everyone has the appropriate mental capacity assessments in place to meet their individual needs.

When people were unable to make important decisions for themselves, relatives, doctors and other specialists were involved in their care and treatment and decisions were made in people’s best interest. Mental capacity assessments and decisions made in people’s best interest were recorded.

People told us that they felt safe living at The Old Vicarage. Staff had received safeguarding training and they were aware of how to recognise and protect people from the risk of abuse. Staff knew about the whistle blowing policy and said they could raise any concerns with the registered manager, the provider or outside agencies if needed.

There were sufficient staff on duty to meet people’s needs. Staff received induction training and there was an on-going training programme. The training programme did not include some of the specialised training staff needed to make sure people received the care and support to meet their individual needs.

The service’s policy and procedures stated that staff should have one to one meetings every six to eight weeks with the registered manager or the deputy manager. Staff were receiving support from the registered manager or deputy manager through one to one meetings but the frequency of the meetings were not in line with the policies and procedures. Yearly appraisals were being held to make sure staff had the opportunity to develop and identify their training needs and develop their skills and knowledge but not all staff had received an appraisal in the last year. There were regular staff meetings so staff could discuss any issues and share new ideas with their colleagues to improve people’s care and lives.

Improvements had been made to the environment and there was an on-going plan to make sure the improvements continued. Checks on the equipment and the environment were carried out and emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do.

People told us that they enjoyed their meals. The meal portions were plentiful and people had a choice of food and drinks they wanted. If people were not eating or drinking enough their food and fluid intake was monitored. Some of the records for this were not clear. If needed a referral was made to a dietician or their doctor and food supplements were available so people were kept as healthy as possible.

People and relatives told us the staff were kind and respected their privacy and dignity. People were offered choices on a daily basis. Staff were familiar with people’s likes and dislikes such as if they liked to be in company or on their own. Staff knew what food people preferred and supported people with their daily routines. People were involved in activities which they enjoyed.

Staff were attentive and the atmosphere at the service was calm and people appeared comfortable in their surroundings. Staff encouraged and involved people in conversation as they went about their duties, smiling and chatting to people as they went by. When people became anxious or restless staff took time to sit and talk with them until they became settled.

Staff supported people to go where they wished within the service. The people and their relatives attended regular meetings to discuss the service and their care.

The complaints procedure was on display. It was assessable and available to visitors but not easily available to people living in the service, People, their relatives and staff knew how to complain and felt confident that if they did make a complaint they would be listened to and action would be taken.

There were quality assurance systems in place. Some audits and health and safety checks were regularly carried out but some checks had not been done. The registered manager had not identified and taken action to make sure the systems used by the service were checked regularly and that shortfalls were identified and improvements made. The service had sought feedback from people, their relatives and other stakeholders. However, their opinions had not been analysed to promote and drive improvements within the service.

The registered manager is required by law to notify the Care Quality Commissions (CQC) of incidents that occur at the service. The registered manager had not notified CQC of some of the incidents that had happened at the service like safeguarding issues and serious injuries.

We received mixed information about the management of the service. The CQC had received concerns about the management approach from various sources. On the day of the inspection people, relatives and staff told us that the management team were supportive and approachable.

When we last inspected The Old Vicarage Residential Home in November 2014 a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 were identified. At this inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

19 November 2014

During a routine inspection

This was an unannounced inspection carried out on 19 November 2014.

The Old Vicarage is a privately owned care home without nursing in Tilmanstone near Deal. It is registered for up to 39 older people, some of whom may be living with dementia. At the time of our inspection there were 32 people living at The Old Vicarage. It has a large conservatory and garden, is close to local amenities and has public transport links.

The service is run by a registered manager who was present on the day of our inspection. 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.

Staff understood how to protect people from abuse. They had been trained in safeguarding people and were able to tell us how they would recognise signs of abuse. They understood how to report any concerns of poor practice or abuse and knew about the provider’s whistle-blowing policy.

There was a risk that people may receive unsafe or inappropriate care. Risks were identified and documented but it was not always clear what monitoring should be done or what action staff should take to reduce risks to people. Staff did not follow best practice when supporting people to have ‘as required’ (PRN) medicines, such as, pain relief.

The registered manager and staff understood the Mental Capacity Act (MCA) 2005 and ensured decisions made for people without capacity were only made when this was in their best interests.

There was a risk that people’s rights were not being protected by arranging for an assessment to be carried out which would test whether or not they were being deprived of their liberty and whether or not it was done so lawfully. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Registered Manager understood when an application should be made and how to submit one if a person’s liberty was restricted. The registered manager was aware of the Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. The registered manager was in the process of reassessing people with a view to completing DoLS applications. No DoLS assessments had been completed and no applications had been completed and sent to the local authority since the Supreme Court Judgement.

People and their relatives told us that they were happy with the standard of care at The Old Vicarage and that they had been involved with the planning of their care. People were treated with dignity and respect and staff encouraged people to maintain their independence. People’s needs were assessed and people received the support they needed. Care plans contained personalised information about how each person preferred to be supported and included an assessment of what they could do for themselves. Staff knew people well and had good relationships with people and their relatives.

The design and layout of the building met people’s needs and was safe. The atmosphere was calm, happy and relaxed.

People were supported by sufficient numbers of staff with the right mix of skills, knowledge and experience. There was a training programme in place to make sure staff had the skills and knowledge to carry out their roles. Staff were respectful, kind and caring.

There were systems in place to monitor the quality of the service and feedback was encouraged from people, their relatives and visiting health professionals. The registered manager analysed the findings to identify any patterns or trends in order to improve the service.

People were offered a choice of healthy food and drinks and were supported to have a balanced diet to meet their nutritional needs. People were supported to see healthcare professionals, such as, GPs, dentists and chiropodists.

Staff told us that there was an open culture and that they felt supported by the registered manager and the deputy manager. Staff, people and their relatives told us that there had been improvements at The Old Vicarage since the registered manager had been employed.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

16 April 2014

During a routine inspection

We used a number of different methods to help us understand the experiences of people who used the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. These included observing the interactions between people and staff. We also spoke with the registered manager, staff and relatives.

There were 31 people using the service at the time of our inspection. We observed how people reacted and responded to see if people indicated they were happy, bored, discontented, angry or sad.

Since our last inspection on 26 June 2013 a new manager and assistant manager had been recruited. One relative told us, 'I wasn't very impressed when my relative first came here. But since this manager has been here, well, what a difference. People are doing more for themselves. It is really nice to see the changes including the dining room tables being moved around so that people can talk to each other'.

We saw records to show how people's health needs were supported and that the service worked closely with health and social care professionals to maintain and improve people's health and well-being.

We found that people were supported to be able to eat and drink sufficient amounts to meet their needs. Staff allowed people to eat at their own pace and did not appear to rush people.

Systems were in place to monitor the service that people received to ensure that the service was satisfactory and safe.

Records were kept securely and could be located promptly when needed. We found that records were accurate and up to date.

The previous registered manager at the service, Christine Bradshaw, no longer works at The Old Vicarage but has not yet deregistered with CQC.

26 June 2013

During a routine inspection

There were 31 people using the service. Some of the people living in the home were unable to tell us about their experiences. We observed interactions between people and the staff. A few people and their relatives told us that they liked the home and the staff were polite, respectful and caring. They said they were satisfied with the service.

Some people and their relatives told us that they thought they received the care and support they needed to remain well and healthy. However, we found that although people's needs were assessed, care and treatment was not always planned and delivered in line with their individual care plan. Some care plans had not been updated and completed when a care need or a risk was evident. This meant that staff had no guidance to follow about how to support people's needs and reduce potential risks.

At the time of the inspection we saw that all levels of staff were very rushed. Staff, people who use the service and relatives felt there was not enough staff on duty at certain times of the day. The provider took immediate action to address this issue and increased the staffing levels at the service.

One person said, 'They are always running around everywhere. They get to you when they can'.

Staff did not always receive the training support and supervision to undertake their roles effectively and safely.

There were no effective systems in place for checking the quality of the service received by people.

11 April 2012

During a routine inspection

Many of the people using the service had complex needs which meant they were not able to tell us their experiences. We used a number of different methods to help us understand the experiences of people using the service. These included using the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

People who use services said or showed us that the staff treated them with respect and supported them to raise any concerns they had. They said or showed us that they received the health and personal care they needed and that they were comfortable in their home.

One person said, 'I have been here 20 years, It is as good as anywhere'. A visitor said, 'The home are very accommodating and the staff are very caring'.