The Old Vicarage

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care,treatmentand support achieved good outcomes and promoteda good qualityof life, based on best available evidence.

At our last assessment we rated this key questiongood.At thisassessmentthe rating hasremainedthe same.This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 63 (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 make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

People’s care needs were assessed before they moved into The Old Vicarage. Where information available at the point of this assessment was limited, care plans sometimes said additional information would be added as staff got to know the person. However, this information was not being added to care records in a timely way. For example, we saw that for one person who was at very high risk of developing a pressure ulcer, information relating to their risk factors had not been entered within their care record despite them having lived at the service for 2 months. This meant that effective preventative actions had also not been implemented.

Where people’s needs had changed, these had not always been recorded in care records in a timely way. For example, one person had been using a device which undertakes continuous blood sugar monitoring. Their care plan was inconsistent as to whether the person was or was not continuing to use this device.

We raised these inconsistencies with the management team, who told us about their plans to review and update peoples care records to ensure accuracy.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Evidence-based care and treatment was not consistently delivered to people. For example, one person living with dementia experienced periods of distress resulting in them presenting as upset and frightened. Upon reviewing the person’s care record, there was no guidance for staff on how to best support this person with their emotional needs. Whilst staff responded to the person in a timely way, and attempted to provide reassurance, this had little effect. Recognised guidance indicates that people living with dementia who experience distressed behaviours should have an individualised behavioural support plan in place to improve quality of life and ensure consistent, appropriate staff responses.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The management team at the service gave examples of how they worked with internal and external teams and services to ensure people received care which was joined up. We saw evidence that referrals had been made to appropriate services such as dementia support teams, GP’s and district nurses in a timely way. The service had recently worked with the GP to undertake a review of each person medicines together.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

The manager told us how they encourage people to live healthier lives through remaining as independent as possible and promoting a healthy balanced diet. We asked people and their relatives how they found the food. One person indicated to us with hand gestures that they were satisfied with the food. A relative told us, “If there is nothing on the menu that [relative] fancies, they can ask for an alternative and they will provide it”. People spoke highly of the catering team, and told us, “The cook is very good”.

The cook demonstrated in-depth knowledge of people’s dietary requirements, including those which were health related, and was passionate about supporting people to live and eat well.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and

consistent, or that they met both clinical expectations and the expectations of people themselves.

The service had systems in place to monitor aspects of the service such as falls, medicines errors and safeguarding concerns. The manager undertook a monthly review of these to monitor outcomes and drive improvements. However, daily monitoring of care being delivered was not always effective. The manager told us that senior care staff monitor and review that people have received care in line with their care plans, however we found several examples where omissions of care had not been identified through this system, such as repositioning. The manager investigated this and provided us with their plans to improve care and outcome monitoring.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff and managers demonstrated good knowledge around mental capacity and the need to seek consent before care is provided. Staff received training in mental capacity and consent and were able to talk confidently about it. A staff member told us, “We always ask [for consent] before we start, [and] for example would you like a bath or shower”. Another staff member described how for one person who is non-verbal, they have grown to know how they indicate consent through their body language.

Where people lacked capacity to make specific decisions, best‑interest decisions were made in accordance with relevant legislation. These decisions were clearly recorded within peoples care records, with people appropriate representatives involved in the process.