Background to this inspection
Updated
31 March 2020
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 Care Act 2014.
Inspection team
The inspection team consisted of two inspectors, a member of the medicines team 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
Vicarage House Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received from and about the service since the last inspection. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We spoke with the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We used this information to plan our inspection.
During the inspection
We spoke with ten people who used the service and two relatives about their experience of the care provided. We spoke with six members of staff including the registered manager, clinical lead, and care workers. 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 reviewed a range of records. This included six people’s care records. We also reviewed five people’s medicine administration records. We observed administration of medicines and checked storage arrangements, policies and procedures, medicines audits and records. We looked at three staff files in relation to recruitment, staff supervision and training.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data specifically for moving and handling and staffing rotas.
Updated
31 March 2020
About the service
Vicarage House Nursing Home is a residential care home providing personal and nursing care to 21 people aged 65 and over at the time of the inspection. The service can support up to 32 people.
People’s experience of using this service and what we found
Systems in place to monitor the safety and quality of the service provided failed to identify the shortfalls found in recording of medicine’s and daily records.
The medicines administration records were not always completed effectively. The shortfalls identified included the lack of recording when pain relief patches had been removed and in maintaining safe storage temperatures for medicines. The evidence showed there was a shortfall in the recording of actions taken rather than unsafe practices by staff who had received training and been assessed as competent to safely administer medicines.
People received their medicines in a timely manner and the administration of medicine’s was carried out safely and, in a person, centred way.
Repositioning records had not been completed as required. Repositioning is used to prevent pressure ulcers to people. Food and fluid charts had not been completed to demonstrate when and how much people had been given. We found that people were being repositioned and food and fluids offered regularly however there were shortfalls in recording the information.
People had mixed views about staffing levels in the home. A dependency score based on people’s needs was used to determine how many staff were on duty. However, people said they often had to wait a long time for staff to attend to them. Staff said they felt there were more staff available and that they did not feel rushed. A recruitment programme meant there were more permanent staff and less use of agency staff.
We made a recommendation that the provider looks at ways of deploying staff effectively.
People were 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.
People received care and support that was safe. The provider had a robust recruitment programme and staff had received training in recognising abuse and safeguarding people.
People were supported by a team that was well led. The registered manager demonstrated an open and positive approach to learning and development. Everybody spoken with said they felt the manager was open and approachable
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 8 August 2019).
Why we inspected
We received concerns in relation to the management of medicines and people’s nursing care needs. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from Good to Requires improvement. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvements. Please see the Safe and Well Led section of this report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Vicarage House Nursing Home on our website at www.cqc.org.uk.
Enforcement
We have identified one breach in relation to Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.