Archived: The Old Vicarage

The Old Vicarage is a care home that provides personal care for up to 16 adults who have mental health needs or a learning disability. At the time of our inspection 12 people were living at the service. Accommodation was provided for 8 people within the Old Vicarage building, with self-contained flats located in the adjacent building, St Mary’s House.

People’s experience of using this service and what we found

We have made a recommendation to talk with people about their end of life wishes.

Quality assurance audits were completed, any issues identified were reviewed and action plans completed to ensure improvements were made. However, we found that although areas for improvement were identified these had not always been addressed.

The provider had not ensured that staff had completed their mandatory training, this included infection control training during COVID-19.

People told us they were happy with the care and support they received. Improvements had been made to peoples care plans to guide staff, although further work on care plans is in progress.

The staff team, people and a relative were positive about their experiences at the service. The locality manager was supporting the home in the absence of a registered manager. Staff understood safeguarding and how to keep people safe and the importance of reporting any concerns.

Staff understood their roles and felt supported by the management team. Recruitment practices were robust and included appropriate checks by the provider.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. This service was able to demonstrate how they were meeting how they were meeting some of the underpinning principles of right support, right care, right culture. People’s care and support was person centred with each person having a key worker to discuss their goals and support their interests and promote their independence with appropriate support.

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 requires improvement (published 12 June 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve governance systems. At this inspection enough improvement had not been made and the provider was still in breach of regulation 17.

The service remains requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions in Safe, Effective, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions to keep people safe and to hold providers to account where it is necessary to do so.

We have identified breaches in relation to regulation 17 Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Systems and processes did not always ensure people risks were managed and quality monitoring had not ensured identified actions were completed.

Please see the action we have told the provider to take at the end of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Old Vicarage on our website at www.cqc.org.uk.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

People’s experience of using this service:

Quality monitoring systems had failed to identity and drive improvement in areas we identified as requiring improvement. Systems and processes were not established or effective in seeking feedback from relevant persons to monitor and improve the service. This meant the service was in breach of Regulation 17 of the Health and social Care Act 2008 (Regulated Activities) Regulations 2014.

Risks to people’s safety were not always robustly responded to or managed.

Medicines were managed safely.

The home environment was clean and met people’s needs.

Improvements were needed regarding the training and support of staff in relation to people’s specific needs, such as managing behaviour that may challenge.

The care provided was not always in line with recommended guidance or legislation. For example, the service was not always working in accordance with the Mental Capacity Act 2005.

People were happy with the food provided and staff supported them to access health care services.

Staff were kind and caring. They supported people to be as independent as possible.

People did not always have access to their care plans and they were not always provided in accessible formats.

Improvements were required in supporting people to access and participate in their interests and hobbies.

People felt able to complain. Their complaints were listened to and action was taken.

Staff worked well together as a team but communication with people, relatives, and professionals required improvement.

Rating at last inspection: Good; published on 15 November 2016.

Why we inspected: This was a planned inspection based on the rating of the service at the last inspection.

Enforcement See end of full report for action we told the provider to take.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

The inspection took place on the 28 and 29 September 2016 and was unannounced.

The Old Vicarage provides care and support for up to 17 people. The Old Vicarage is a home which supports people who have mental health needs. The home comprised of two buildings, a period property offering accommodation over two floors and a purpose built block called St Mary’s comprising of self-contained flats.

There was a registered manager in place. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. During this report the registered manager will be referred to as the manager.

Some important safety checks relating to water temperatures and some equipment used in the building had not been carried out for some time.

There were some systems in place to monitor the quality of the service. However, not all of these were robust. In some areas the manager and the provider did not have an oversight on elements of the service provided.

People benefited from being supported by staff who were safely recruited and well trained. Staff felt supported in their work by the manager. There was consistently enough staff to safely meet people’s individual needs. Staff understood how to protect people from the risk of abuse and knew the procedure for reporting any concerns.

Staff knew and understood the needs of people living at the Old Vicarage. People received care which was person centred, the manager and staff knew the people they supported.

Staff received yearly appraisals. Staff also had regular supervisions. The manager observed practice and was involved in the daily running of the service.

Staff told us they were happy working at the Old Vicarage. Staff were committed and dedicated to the service. They assisted people with kindness. People’s dignity and privacy was maintained and respected. People were treated as individuals. People’s wishes and what was important to them was promoted by staff and the manager.

The Care Quality Commission (CQC) is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The service was depriving some people of their liberty in order to provide necessary care and to keep them safe. The service had made applications for authorisation to the local authority DoLS team. The service was working within the principles of the MCA. The manager and the staff had a good knowledge of the MCA and DoLS.

People’s care plans contained important, relevant and detailed information to assist staff in meeting people’s individual needs. People’s needs were regularly reviewed and monitored.

People were supported to maintain good health and wellbeing. The service responded proactively to changes in people’s health and their wellbeing.

The service encouraged people to maintain relationships with people who were important to them. People benefited from being supported to do what they wanted to do. People experienced a variety of individual and group events. People were supported and given opportunities to explore their interests. The service encouraged people to be independent and to fulfil their goals.

There was a positive and open culture at the Old Vicarage. The service was welcoming and friendly.

Care records included individualised risk assessments and care plans. One person said that Hollybrook House was 'A very good, safe, place. Service is excellent.' A staff member emphasised that care plans were written and care delivered 'with people's own choices in mind.'

Each care record contained a 'healthcare professional record' where the person's contact with health professionals was recorded. A 'healthcare passport' had also been prepared for each person, to be sent with them if they needed an urgent admission to hospital.

The provider had constructed a new laundry room for people living in Hollybrook House. A new carpet had been fitted on the stairs and landing of the main house and bathrooms and communal areas had been repainted. Three en-suite rooms were being developed in the house by combining existing smaller rooms.

One person told us that staff were 'first class' . Staff members told us that they received feedback and support, although there was no appraisal timetable in place. The provider monitored the quality of care and took steps to deal with any issues that were identified. We noted that a system of audits was used to assist in quality monitoring.

When they had been asked where they would like to go for their annual holiday, one person said that they had been amazed when they were told that it was their choice and that they could go wherever they wanted.

We were told by one person that their key-worker helped them get things sorted very quickly. For example, when their medication needed reviewing or if they had any issues with their health or care.

One person said: "The only thing I have to complain about here is where we do our laundry. First of all we get our washing ready, then we have to find a member of staff to go across with us but then you never know whether there are any empty machines. If they're all being used, it means that you have to take your washing back and then do the whole process over again later. It sometimes takes a long time and it does get really frustrating."

We observed the atmosphere in Hollybrook House to be calm, relaxed and comfortable and noted staff chatting and interacting with people in a pleasant and cheerful manner.

One person we spoke with said they knew how to make a complaint or raise any concerns. They also told us that they felt they were listened to and that any concerns were taken seriously by staff.