The Old Vicarage

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 questiongood. At thisassessmentthe rating has changed torequires 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 people’s safe care and treatment.

This service scored 62 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Systems were in place to support the timely reporting and recording of safety incidents and events. The management team understood the importance of reviewing incidents to learn lessons when things went wrong.

The management team shared information with the staff team when things went wrong, to encourage continuous development and reduce the risk of incidents recurring.

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.

Whilst staff and leaders knew people well, care records were not always complete or reflective of people’s current needs. This placed people at risk of incorrect or incomplete information being shared with other healthcare professionals or services, such as during transfers to hospital. There was a risk this could impact the continuity and safety of people’s care and treatment.

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

Staff knew how and when to raise concerns and felt confident these would betaken seriously. Information was available to people and their relatives in relation to identifying and reporting concerns of a safeguarding nature.

The management team had thorough and well organised records relating to historic and ongoing safeguarding investigations. There was a strong emphasis on keeping people safe, and the service made appropriate external referrals where necessary. Every person and relative we spoke with told us they felt safe living at The Old Vicarage.

The service made Deprivation of Liberty Safeguards (DoLS) applications where necessary. If people were subject to DoLS, information was included within their care records.

The provider did not 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.

Risks relating to people’s care were not always reflected within care records. For example, for one person at very high risk of experiencing a fall, their care plan reflected the need to wear supportive and well-fitting shoes. We observed this was not always the case during our site visits. We spoke with the management team about this, who took action to assess the situation.

Not everyone identified as being at high risk of developing a pressure ulcer was receiving appropriate support with repositioning, which had been identified as necessary to reduce risk. Although staff were aware of the need for preventative action, this was not consistently reflected as happening in care records. This meant there was not always assurance that people were being effectively supported to manage and mitigate the risk of pressure ulcers developing.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Systems were in place to manage risks relating to the environment, such as regular audits, a reporting process and daily checks.

The service was supported by a maintenance manager who demonstrated in depth knowledge about the health and safety requirements for the service. They worked in partnership with the management team to identify, monitor and minimise risk relating to the building and care environment.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staff were well trained and demonstrated in depth knowledge of their roles. Staff had completed a variety of training courses alongside competency assessments to monitor their practice.

Most staff had received regular supervisions and appraisals, and the manager had plans in place to further build on support in place for staff. As the manager was newly appointed, they were receiving regular support from a senior manager.

Most people and their relatives felt staffing levels were appropriate. When asked whether they felt there were enough staff members on duty, one person’s relative said “Yes, I think so. There always seems to be carers around”. However, some people felt busier times such as at meal times and weekends would benefit from additional staff. Another relative told us, “I feel they sometimes need more staff on at weekends, this is not a criticism of the staff as the care they provide is very good”.

The service used a dependency tool coupled with their own observations to ensure staffing levels were suitable to meet people's needs. We observed people to receive care in a timely way, and people were not rushed.

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.

The care home is a converted period building, which also has a newer extension. The older part of the building would benefit from refurbishment to ensure it is able to be cleaned to a high standard. For example, following a roof leak and subsequent roof replacement, there are several walls which require attention. These surfaces cannot currently be cleaned effectively. When we raised this, the provider shared with us their plans to redecorate and replaster the walls.

When discussing cleanliness, relatives we spoke with told us “I don’t think the older part of the building is as clean as the newer extension”. Another said, “I feel sorry for the cleaners, there is a lot to do here”.

We also found some poor practice, such as bowls people used to wash with stored on top of open toilet seats and commodes.

However, staff received training in infection prevention and control. Furthermore, audits, spot checks and policies were in place to support and encourage good practice.

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.

Medicines were well managed and people received their medicines in line with the prescriber’s instructions. We saw that where a person’s medicines had recently been changed, the service had worked in partnership with the prescriber to monitor the effectiveness of the new medicine.

Audits were undertaken regularly and were effective at identifying concerns and driving improvements. When medicines errors had happened, they had been identified and managed in line with the provider’s policy and best practice guidelines.