We carried out a review of the data available to us about Old Vicarage Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Old Vicarage Care Home, you can give feedback on this service.
We found the following examples of good practice.
The staff were following up to date infection prevention and control guidance to help people to stay safe. The providers organisation kept staff up to date through on-line training and the registered manager spoke to staff to update them. The registered manager and deputy manager ensured staff understood why every measure was in place.
The registered manager worked with the housekeeping team and care staff team to ensure infection prevention and control measures were followed.
The providers training department provided training to ensure staff knew how to keep people safe during the COVID-19 pandemic. The registered manager ensured staff had access to additional support, included contact by phone and one-to-one meetings, with any emotional support needed in response to the pandemic.
Staff supported people to occupy themselves whilst maintaining their safety. Staff were providing additional one to one activities to people in their rooms and visited them frequently. People who preferred to spend their time in communal areas were supported to this whilst maintaining physical distancing.
Staff helped people to stay in touch with family and friends through phone and video calls. Visitors could also book appointments to visit people in a safe way.
The registered manager was communicating with people, staff and family members regularly to make sure everyone had an understanding of precautions being taken, and how to keep people safe.
The Old Vicarage is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The Old Vicarage Care Home accommodates up to 20 people in one adapted building. On the day of the inspection 11 people were living in the home.
A manager was employed to manage the service locally. They were in the process of registering with the commission. 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.
When we completed our previous inspection 8 and 10 April 2015 we found concerns relating to how people’s mental capacity was assessed and people’s care plans not always being reflective of their needs. At our last comprehensive inspection in December 2017 the service was rated requires improvement overall. We issued the provider with a requirement notice, which identified the areas to be improved. This was because the provider had not used learning from a previous inspections to improve people's records and capacity assessments and their systems to monitor records had not identified issues. Following the inspection, we were sent an action plan which set out the actions the provider was going to take. At this inspection we found the provider had made the improvements and were no longer in breach of the regulation.
At this inspection improvements had been made. People had mental capacity assessments in place when required. People’s records now provided detail about their health needs. However some further action was required to clarify the specific support people needed and to detail any related needs. We have made a recommendation about this. Governance systems had also been improved and regular checks and audits had highlighted areas where improvements were required.
People told us they felt safe using the service. There were risk assessments in place to help reduce any risks related to people’s care and support needs. Staff had been recruited safely and had received training in how to recognise and report abuse.
People received support from staff who cared and had the skills and knowledge to meet their needs and knew people well. People and their relatives spoke positively of the staff and the support provided. People received their medicines safely and on time. They told us they could see a GP when they wanted or needed to.
Care plans detailed people’s wants, needs, preferences, likes and dislikes and this information was known to staff. Staff used their knowledge of people to help ensure their diverse needs were met. Alternative methods of communication, were available and staff were aware of what equipment or support people needed to communicate successfully. People and relatives had a variety of ways they could raise concerns or ideas about the service and these were encouraged.
There was a positive culture within the service. Staff told us they enjoyed working there and felt supported by the manager and the provider. The manager was in the process of making some changes to improve the service and staff members told us they felt positive about these.
At the last inspection, the service was rated Requires Improvement in Effective and Responsive.
At this inspection we found the service was Requires Improvement in Effective and Well Led.
Why the service is rated Requires Improvement:
People did not always have guidance in place for staff to meet their health needs. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; however records did not always reflect this clearly. The manager told us they would review people’s records to ensure they reflected people’s needs and promoted people’s human rights.
The provider had systems in place to monitor the quality and safety of the service, however these had not identified gaps in people’s records highlighted during the inspection; even though these were also identified at the previous inspection. The manager and provider sought people's views to make sure they were involved in any changes within the home.
People received safe care and support from staff who had been recruited safely and received training on how to keep people safe. Medicines were administered safely and staff understood how to minimise risks to people. The environment was monitored to identify and reduce any potential risks to people.
People were supported by staff who received training and supervision and knew them well. Staff used their knowledge of people to help ensure their diverse needs were met. Staff protected people’s privacy and dignity and showed respect and compassion for people.
People enjoyed the food available and their environment was adapted to meet their needs. People knew how to complain and the manager endeavoured to resolve any concerns people had as soon as possible.
People’s care plans showed how they liked to be supported and people were enabled to keep themselves physically and cognitively stimulated, according to their preferences.
We found a breach of the regulations. You can see what action we told the provider to take at the back of the full version of the report.
Further information is in the detailed findings below.
This was an unannounced inspection on 8 April 2015 and 10 April 2015.
Old Vicarage Care Home is part of Torcare Limited and is one of three care homes, which Torcare Limited own and operates.
Old Vicarage Care Home provides accommodation for up to 20 older people, who require support in their later life or are living with dementia.
There were 16 people living at the home at the time of our inspection. The home is on two floors, with access to the upper floors either by stairs or a lift. There are shared bathrooms, shower facilities and toilets as well as a shared lounge and dining area.
We last inspected Old Vicarage Care Home in September 2014. At that inspection we found the service was meeting all the essential standards that we assessed.
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.
People told us they were well supported by staff who were kind and caring. Through their interactions, the registered manager and staff showed respect and consideration for people. People’s friends and families were welcomed by staff. People’s privacy and dignity was maintained by staff by ensuring curtains and doors were closed when people were supported with personal care. We found people did not have a lock on their bedroom door which would provide them with privacy if they wished and security of their belongings when out of the room. The registered manager had not recognised this but told us she would ask people if they would like a lock and install them as requested.
People told us they had no concerns but were confident if they did they could speak with the registered manager and with staff. People were encouraged to give feedback about the care and support they received and their feedback was valued and used to make changes. The registered manager valued feedback and complaints to help improve the service. External health and social care professionals were complimentary about the staff and the care home.
People told us they felt safe. People were protected from abuse because staff had been trained to recognise abuse, and were confident to whistleblow about poor practice. Staff were confident they would be listened to and that any concerns raised would be taken seriously. Safe recruitment procedures were in place. Staff underwent the necessary checks which determined they were suitable to work with vulnerable people, before they started their employment. People told us there were enough staff. The registered manager regularly reviewed the staffing levels in line with people’s individual care needs to help ensure there were always sufficient and appropriately skilled staff available.
People, when appropriate, had been assessed in line with the Deprivation of Liberty Safeguards (DoLS) as set out in the Mental Capacity Act 2005 (MCA) and applications had been made by the registered manager as required. However, care plans did not always detail information about people’s mental capacity.
People received an individual approach to their care and people’s care plans detailed information about their personal histories to help staff get to know people and help promote engaging conversations. People told us there were social activities, but some people told us they would like more to do and to be offered the chance to get out and about more.
People were protected from risks associated with their care, and documentation was reflective of people’s individual needs. People’s care plans were reflective of the care being delivered, however information about how to support people with diabetic care and tissue viability was not always documented. People were involved in their care, however were not aware of their care plan.
People’s personal confidential information was stored securely; however, people’s care plans were not always locked away and staff were observed to talk about people’s individual care needs in front of another person.
People told us the meals were nice and people were offered choices. The chef told us she was passionate about making sure people enjoyed the meals and welcomed both positive and negative feedback. People’s nutrition was monitored but the registered manager had not identified other alternatives to weigh people if they could not stand on scales, but told us she would seek immediate advice from external health professionals.
People’s medicines were managed safely and, where possible, people’s independence with their own medicines was promoted. The registered manager had a monitoring system in place however some recording discrepancies demonstrated the system was not always effective. People were supported to maintain good health through regular access to healthcare professionals, such as GPs, social workers, and district nurses.
Staff told us they felt well supported and the registered manager offered and encouraged training opportunities. Staff were expected to complete an induction and partake in supervision and appraisals to help them reflect on their practice and ongoing development.
The registered manager was knowledgeable about people, and took a hands-on approach to the management of the care home. The registered manager told us she was well supported and met regularly with her line manager. Staff told us the registered provider was interested in investing in the care home, for example had they had recently upgraded some bedrooms and purchased a new cooker.
There were quality assurance systems in place. Incidents were recorded and analysed. Learning from incidents and concerns raised was used to help drive improvements. There was a care standards committee, involving people, staff and relatives, which met regularly to discuss relevant topics affecting the care home.
Staff we spoke with were clear that the people they cared for should be treated as individuals and had the right to make their own decisions. One member of staff said 'people have the right to make a choice but if we have any concerns about a person's health we contact their GP'.
People told us that they had very good food and one person said the 'chef is very good'. Another person said 'the food is very nice'. After lunch one person asked the member of staff to pass their 'compliments to the chef'.
Staff told us that they had regular meetings with the manager and if they had any concerns she was very approachable. Staff told us they felt well supported within the home. One member of staff told us that the training 'was brilliant', and another said the training was 'excellent and we get a reminder from the training officer when our training is due'. Staff we spoke to told us how much they enjoyed being at work; one staff member said 'you never hear people say they do not want to be at work today'.
We were supported on this inspection by an Expert by Experience. This is a person who has personal experience of using or caring for someone who uses this type of care
service.
We reviewed all the information we held about this provider. We talked with people who use services and relatives, talked with the staff and talked with visiting health professionals. We checked the provider's records, and looked at three care records of people who use services.
We talked with eight people who lived in the home, we were not able to communicate effectively with everyone due to their physical health needs. We saw people's privacy and dignity being respected at all times. We saw and heard staff speak to people in a way that demonstrated a good understanding by staff of people's choices and preferences. People living at the home were all complementary about the home environment, food, staff and the care they received. Their comments included,
'The food is lovely, they know what I like and what I don't like. I have gained weight since coming here'.
'Anything you don't like ' staff will change it'.
'I can get up when I want to and go back to bed when I am ready'.
'It's my choice if I go out or stay in and my family visit often'.
'All the staff are lovely and the manager and deputy manager are lovely'.
People said that they would feel able to complain if they needed to. We talked to people using the service and staff about how people are kept safe. People told us,
'I feel safe here and that was the most important thing for me'.
'I feel as safe as house here'.
Staff were clear about the actions they would take should they have any concerns about people's safety.
We pathway tracked three people who use the service. Pathway tracking means we looked in detail at the care three people received. We spoke to staff about the care given, looked at records related to them, met with them and observed staff working with them.
We spoke with three visiting health professionals who all confirmed that the staff at the home were helpful.
We looked at medication systems and saw that they are mostly managed in a safe way. The management of prescribed creams is not well managed and the registered manager assured us that this would be addressed promptly.
We found that the home was clean and there were no offensive odours.
We looked at the auditing systems of the service. We found that auditing systems have been put in place and efforts made by the management of the service to monitor and address issues identified.
All of this information helps us to develop a picture of what it is like to live at the Old Vicarage.