The Old Vicarage Care Home

The Old Vicarage Care Home is a care home providing accommodation in one adapted building, for up to 44 adults who require personal care. At this inspection, there were 34 adults receiving care at the service.

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

The registered provider’s accountability and oversight arrangements were not wholly effective, to consistently ensure timely and sustained service improvement when needed. Action had recently commenced to rectify this. A range of management, staffing and care improvements were either recently made or in progress. However efficacy was not yet demonstrated, as the improvements were either not yet fully embedded, or demonstrated as sustained and ongoing for people’s care.

There was no registered manager for the service and a history of high manager turnover. Recruitment had commenced to address this, and suitable interim management arrangements were confirmed. Overall staff understood their role and responsibilities for people’s care, but remedial measures recently introduced for their supervision and support where not yet wholly assured.

People, relatives and staff were somewhat confident in the management of the service, following the recent appointment of a deputy manager. However, most held reservations due to the high manager turnover and the impact previously experienced from this in relation to staffing, complaints and concerns handling.

For the most part, the provider was able to demonstrate effective partnership working, information handling and communication with external professionals, agencies, authorities and other care providers when needed for people’s care. Action was taken to notify us of important events when they happened at the service, although this was not always without delay.

Complaints and concerns, including those raised by staff, were not always effectively handled and responded to in a timely manner. Remedial management action had commenced to rectify this, to help inform and improve people’s care when needed.

People were protected from the risk of harm or abuse at the service. Overall, risk management strategies for people’s care, environment and emergency contingency planning, were effectively informed and understood by staff. The service was suitably adapted and designed to promote people’s safety, choice and independence.

People’s medicines were safely managed to ensure people received them when they should. We were assured the provider was meeting with requirements and nationally recognised government guidance, concerned with the prevention and control of infection, including COVID-19. People, relatives and staff were confident people were safe when they received care within the service.

Staff were trained and safely deployed for people’s care. 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 from kind, caring staff who knew people well, how to communicate with them and had good relationships with people and their families. Nationally understood care values were promoted and understood by staff. This help ensure people’s equality, rights, independence and choice in relation to their care and daily living arrangements.

People were effectively supported to maintain or improve their health and nutrition. People received care from staff who were trained and informed to provide this in accordance with the law and nationally recognised care standards, including end of life care principles.

The provider was meeting the accessible information standard, to enable people to agree their care and daily living arrangements within the service in a way they could understand.

Overall, people received timely, individualised care, which they and their families were happy with at the time of this inspection. People’s equality characteristics were taken account of, to help enhance their care and daily living experience.

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 October 2017).

Why we inspected

The inspection was prompted in part due to concerns received about the quality and safety of people’s care in relation to staffing and management arrangements at the service. A decision was made for us to inspect and examine those risks.

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.

We have found evidence that the provider needs to make improvements. Please see the Effective and Well Led sections of this full report. You can also see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The provider followed safe arrangements and procedures, in line with nationally recognised guidance and the law, for the prevention and control of infection at the service. This included, to ensure safe admissions, visiting, testing and isolation arrangements for COVID19 when needed.

Relevant equipment, facilities and accessible information was provided, to support safe entry, social distancing, hand hygiene and use of personal protective equipment. Individual risk assessments were undertaken, to ensure safe support for people and staff who may be clinically vulnerable.

The environment and care equipment were visibly clean and kept in a good state of repair and renewal.

Staff were effectively deployed, supported and informed to ensure safe arrangements for the prevention and control of infection and cleanliness at the service.

We found the following examples of good practice.

¿ The provider had completed an environmental audit and replaced carpets and flooring in communal areas; handrails and door frames had been sanded and re-stained to ensure these could be cleaned effectively.

¿ The cleaning regime had been reviewed and new systems were in place to evidence where cleaning had taken place and where action needed to be taken urgently.

¿ A visitor’s cabin had been installed in the garden to enable relatives to visit people safely.

¿ The service had enough personal protective equipment (PPE) for staff to use and a supply was kept in each person bedroom.

¿ Testing was completed weekly for staff and monthly for people where needed. Visitors arrived early enough so they could have a rapid test for COVID-19 along with their temperature taken.

¿ Staff felt there was enough staff to support people in the home and the staff team worked closely to provide support to each other.

At our last inspection on 8 and 9 June 2015 the service was found to require improvement relating to the management and recording of certain medicines. .At this inspection we found the necessary improvements had been made.

A registered manager was in post and present on the day of the inspection. 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.

There were policies and procedures in place to assist staff on how keep people safe. There were sufficient staff on duty to meet people’s needs; Staff told us they had completed training in safe working practices. We saw people were supported with patience, consideration and kindness and their privacy and dignity was respected.

People received care and support from staff who were appropriately trained and confident to meet their individual needs and they were able to access health, social and medical care, as required. There were opportunities for additional training specific to the needs of the service, such as diabetes management and the care of people with dementia. Staff received one-to-one supervision meetings with their line manager. Formal personal development plans, such as annual appraisals, were in place.

People’s needs were assessed and their care plans provided staff with clear guidance about how they wanted their individual needs met. Care plans were person centred and contained appropriate risk assessments. They were regularly reviewed and amended as necessary to ensure they reflected people’s changing support needs.

Thorough recruitment procedures were followed and appropriate pre-employment checks had been made including evidence of identity and satisfactory written references. Appropriate checks were also undertaken to ensure new staff were safe to work within the care sector.

Medicines were managed safely in accordance with current regulations and guidance by staff who had received appropriate training to help ensure safe practice. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals, where necessary.

The service was clean, well maintained and readily accessible throughout. There were quality assurance audits and a formal complaints process in place. People were encouraged and supported to express their views about their care and staff were responsive to their comments. Satisfaction questionnaires were used to obtain the views of people who lived in the home, their relatives and other stakeholders.

We received information between April and July 2014 about a number of incidents that had been, or were still being, investigated by the Local Authority under safeguarding procedures.

This is a summary of what we found.

Is the service safe?

We found people were not having their capacity to make decisions assessed consistently and their consent to care and treatment was not being obtained consistently. We also found people subject to a Deprivation of Liberty Safeguards were not being properly supervised.

We found that the service had had a high number of incidents referred for investigation under Derbyshire County Council safeguarding procedures. This meant people's safety was not always being maintained.

Medicines were prescribed and given to people appropriately but were not always kept safely.

Is the service effective?

External health care professionals we spoke with were complimentary about the care provided by the service; one told us 'It's a really nice home. There are no problems with carrying out instructions' and another said 'The senior carers seem to be 'on the ball'.

We found care records were incomplete, reviews were not up to date and some issues had not been followed up. This meant the records maintained by the service were not always adequate and there was the potential for people to receive inappropriate care.

Is the service caring?

Some people we spoke with were complimentary about the care; one person said 'It's a beautiful home', another said 'I like it here' and a relative told us 'The staff are very friendly and helpful'. However, another person using the service told us 'I am not happy about the way I am looked after. No one takes the time to understand what I am saying'.

Our observation of people's care found that most staff were caring and helpful but we saw that where people had cognitive impairments, those who were less able to communicate received less attention.

Is the service responsive?

People we spoke with told us that they liked the staff and told us they received the right support. One person said 'They're really careful making sure I don't slip in the shower'.

We received mixed feedback about the availability of staff. One person told us they did not have to wait long for assistance. However, a relative told us 'Staff are run off their feet. Buzzers are taking ten minutes plus to be answered'. Our observation during this inspection visit also showed us that there were periods in the communal lounges when no staff were around and we found one person who was at risk of falls walking around unsupervised upstairs asking for assistance. This indicated there were insufficient staff on duty and requests for assistance were not always responded to in a timely manner.

People we spoke with told us they would go to the manager if they had any concerns about the service although some people said they had not received a copy of the formal complaints procedure. We found complaints received a written response and people could be sure their concerns were properly addressed.

We found staff received health and safety training and training related to care. This meant they received appropriate training to work safely.

Is the service well led?

We found there were issues relating to record keeping and responding to care and welfare issues that indicated the provider was not aware of potential problems affecting people's health, welfare and safety.

We spoke with three people who live at the care home. They told us that: “I am quite happy, thank you. I’ve got everything I need, and the staff are very friendly.” Another person said: “They are making it better, have you seen the workmen? I do like to see what’s going on, and it’s all very busy. I think it should be very nice when it’s finished.” A third person said: “I’ve got a very nice bedroom, I like to go outside to see the birds, they have had little ones recently, and we went out to see them.”

We carried out a Short Observational Framework for Inspection (a SOFI) during this inspection visit. This involved us sitting in the dining room and observing for an hour over the lunch period. This enabled us to see how the staff spoke with people who live at the home, and how they offered help and support. This observational technique is also very useful for identifying issues relating to privacy, dignity and respect. Our observations showed that people were treated with respect, and that staff had good relationships with the people who live at the care home. We saw staff offering support and encouragement in a pleasant, friendly and helpful manner.

We found that staff had been provided with information and guidance about safeguarding and the reporting of any concerns.

The provider's staff training matrix showed that appropriate arrangements were in place to ensure all staff receive training in safeguarding and the Deprivation of Liberty Safeguards (2005). This helps to ensure that people are protected from the risk of abuse or unlawful restraint.

We saw that where possible, people had been involved in the assessment of their needs and the writing of their care plans. We spoke with the relatives of three people and one relative we spoke with told us how they are regularly involved in reviewing their relatives care. People’s care plans had been regularly reviewed with changes being made where necessary.

Not all of the staff in the home had received training in safeguarding or the deprivation of liberty safeguards (DOLS). Two of the staff we spoke with had limited understanding of safeguarding and how they would report any concerns.

Staff members were being supported in their roles and were having regular supervision sessions with the home manager or their line manager. One of the relatives we spoke with told us, “the staff are welcoming and friendly, they seem happy and they stay which is good, I have seen a few new faces but not many.”

The provider was regularly seeking the views of people living in the home, relatives and staff members. Most recently a survey had been completed on activities available within the home.