Archived: Vicarage Court Nursing Home

The service was registered to provide nursing care for up to 39 people. At the time of our focussed inspection 31 people were using the service.

The service did not have a registered manager. 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.

The focus inspection was carried out to see if the provider had made improvements required to keep people safe. We found no improvements had been made. The overall rating for this service is 'Inadequate' and the service is in 'special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, it will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration if they do not improve. This service has been kept under review and, if needed, urgent enforcement action could be taken.

The inspection was also prompted in part by a notification of an incident following which a service user died. This incident may be subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident.

However, the information shared with CQC about the incident indicated potential concerns about the management of risk. This inspection examined those risks.

Since this inspection a decision has been made that people have moved and will continue to move out of this service.

People using the service were not supported safely. We saw people had not received safe care and treatment as risks to people were not managed in a safe way. People were exposed to risk as they did not receive the correct wound care they required. People did not always receive their medicines as prescribed; the systems that were in place to monitor medicines within the home were not effective in identifying concerns and placed people at risk. Equipment within the home was not maintained or tested to ensure it was in correct working order which meant people could not receive the support they required. People and relatives raised concerns with staffing levels within the home.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The service was registered to provide nursing care for up to 39 people. At the time of our inspection 35 people were using the service.

The service did not have a registered manager. 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.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, it will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

People did not always receive their medicines as prescribed; there were no systems in place to monitor stock levels within the home. Risks to people were not managed in a safe way. People were offered an inconsistent approach for management of their behaviours as there was no clear guidance in place for staff to follow. We saw no evidence after incidents had occurred that action had been taken to reduce the risk reoccurring. We could not be sure people were protected from potential abuse. When potential safeguarding incidents had been recorded we did not see these had been reported in line with the provider’s procedures. The provider did not have suitable recruitment procedures in place and people and relatives felt staffing could improve.

People did not have care and support that was responsive to their needs as pressure management and weight loss was not appropriately managed within the home.

People were not always treated in a dignified way as staff were rushing to complete tasks. People were not always offered choices. People felt there could be more to do and the home lack stimulation. Food was served cold to people at breakfast time.

The systems in place were not always effective in identifying shortfalls and information was not used to drive improvements within the home. When action was needed to reduce risks it was not always taken.

We saw the provider offered an inconsistent approach to capacity assessments and best interest’s decisions. Staff did not demonstrate an understanding of DoLS and risk assessments had not been completed while authorisation considered.

People received access to health professionals and were happy with the staff that supported them. People were encouraged to remain independent and make decisions how to spend their day. Staff received an induction and training that helped them provide support to people. People and relatives knew how to complain and any complaints received had been responded to in line with the provider’s procedure. The provider was displaying their rating in line with our requirements.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The service was registered to provide accommodation and nursing care for up to 39 people. At the time of our inspection, 38 people were using the service. Accommodation is on two floors and on both floors there are communal areas.

There was no 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.

Risks to people were not always managed to ensure people were supported in a safe way. When people had behaviours that may challenge, there were no management plans in place for this and staff offered an inconsistent approach. Some people were not protected from potential abuse as accidents and incidents were not always investigated or reported appropriately.

The provider had not always notified us about all significant events within the home. There were some systems to monitor the quality of the service. However, we could not be sure these systems were effective to bring about improvements.

When people were unable to consent, capacity and best interest decisions had not always been completed. We found when capacity assessments had been completed they were often unclear. When people were being restricted unlawfully it was unclear which people had been referred to the local authority for assessment. There were no assessments in place to show how people were being supported in the least restricted way whilst these applications were being considered. People told us they were not involved with reviewing their care and we did not see that care was reviewed as and when required.

We could not be sure people were receiving adequate fluids as there was no guidance in place stating how much people should receive. The food that was served to people was not always warm. When people needed support from other professionals referrals had not always been made in a timely manner. People were not always supported in a kind and caring way and conversations were based on tasks. People were not always offered the opportunity to participate in activities they enjoyed.

There were enough staff available to people and they did not have to wait. People told us staff knew them well and staff received training and an induction that helped them to support people. People’s privacy and dignity was upheld. People were encouraged to be independent and make choices about their day. The provider had a system in place to ensure staff were suitable to work within the home.

People told us they were offered choices at mealtimes and they were also happy with how they received their medicines. We saw people were encouraged to remain in contact with people that mattered to them and visitors felt welcomed. People knew how to complain and when complaints had been made the provider had responded to them in line with their procedure.

Staff told us they were happy with the new manager and the changes they were making. The provider sought the opinions of people who used the service.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Below is a summary of our finding based on our observations, speaking to people who used the service and visitors, the staff supporting them and from looking at records. We considered our inspection findings to answer the questions we always ask –

Is the service safe?

Some people cannot make decisions because of frailty or ill health. Professionals and relatives were involved in making decisions to ensure they were in the person’s best interests.

The service placed people at risk because of unsafe handling of medication, so people did not always receive their medicines as prescribed and intended. We have asked the provider to tell us how they are going to improve their service in relation to medication practices.

We were aware that concerns regarding the safety of some people who used the service had been referred to the local authority for further investigation. The investigations had not been concluded at the time of our inspection.

Is the service responsive?

Regular reviews of people’s care took place and included people and their representatives.

If people’s needs changed the service sought the appropriate support from other agencies.

Is the service caring?

People who used the service told us that the staff were good and they were satisfied with the care and support provided. We saw that staff in attendance were caring and polite in their interactions with people.

Is the service effective?

Everyone had a care plan which informed staff how to meet people’s needs. Assessments included the needs for specialist equipment, mobility aids and dietary requirements.

People had access to a range of health professionals when they required them. Action was taken by the staff when recommendations and advice from the specialists had been given.

Is the service well led?

The service had a system to assure the quality service they provided. The way the service was run was regularly reviewed.

People told us the new manager was supportive, approachable and welcoming.

We found that staff were knowledgeable about how to prevent people being put at risk of abuse. Two of the staff we spoke with told us about a safeguarding incident that occurred a few months ago that had not been reported to us properly. We have taken action to ensure that the authorities have been informed.

We found that the home was clean and tidy throughout. There was no malodour anywhere in the home. One relative we spoke with told us: 'There is never any smell here'. People's personal rooms were clean and fresh.

We had some concerns about medications and the way these were managed. However, the acting manager was able to show us the action plan they had been working through since their recent audit. We could see that they had identified most of the issues we had concerns about and had taken steps to improve.

We found that the service undertook a range of quality and maintenance monitoring to ensure the quality of the service provided to people. We saw a number of notices inviting relatives and people who lived at the service to attend an upcoming 'residents and relatives' meeting.

At this visit we spoke with nine people who lived at the home and six visitors to the home. We also spoke with four members of staff, the deputy manager and registered manager.

The people we spoke with who lived at the home told us that they were well looked after and happy. One person told us: "There are some things I like a particular way, and they remember to do that for me".

Care plans were well organised and the home had captured the life stories of the people who lived there.

Procedures for working with other providers had been revised and there was evidence that the home had dedicated policies in place for staff to follow for both planned and unexpected events.

People said that they were well looked after and very happy at the home. One resident told us, "I have been very comfortable here and I am very pleased with the care I receive".

A relative told us, "The care is really good my relative can be very difficult sometimes. We always find that she has been well looked after.

We had concerns about the way care was consistently planned and recorded and in planning for foreseeable emergencies.

We had concerns about the way information was shared with other providers in planning for their involvement in the care of people who lived at the home.