Archived: Old Vicarage Nursing Home

We inspected Old Vicarage Nursing Home on 9 October 2017 and it was unannounced. The home was previously inspected on 11 January 2017 and had been rated ‘good’ overall with improvements required to keep people safe from harm. This inspection was brought forward and prompted in part by the failings of the provider’s other service. The concerns we had at that location resulted in us taking urgent action to close the service. We found that there were similar concerns at this location and that the provider had not put measures in place to protect people from the same failings. There was no learning evident from the provider’s previous failings nor any new systems implemented to ensure that there was not a repetition of the concerns.

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, 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.

Old Vicarage Nursing Home provides nursing care and support for people, some of whom are living with dementia. It is registered to provide care for 30 people and at the time of our inspection 26 people were living at the home.

Risks to people’s health and wellbeing were not adequately assessed and managed leaving people at risk of harm. Where risks had been identified the provider did not always take action to remove or minimise the risks. Changes to people’s health were not always responded to by referring them to healthcare professionals. Some people did not receive enough support with eating and drinking. Staff did not always have the skills to be able to support people effectively and the provider did not have a system in place to routinely assess their competence.

Medicines were not always managed or administered to people as prescribed. The recording was not always clear to ensure that staff knew how to administer them. The systems in place to monitor the risks associated with medicines were not effective in highlighting errors and concerns.

There was not 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. There was a manager but they were only available to support the home on a part time basis and did not have the systems in place to have a good oversight of concerns. Staff did not receive leadership and support to know their responsibilities well. They did not receive adequate training to be able to support people effectively. They were not always deployed well to ensure that they could meet people’s needs in a timely manner.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible. Some people were not enabled to make their own choices because their communication needs had not been met. When people did not have the capacity to make their own decisions best interest decisions were made on their behalf but they were not always followed.

People’s dignity and privacy were not always upheld and they were not always spoken to kindly. Their preferences were not always planned for and when their needs changed their care was not always reviewed.

People were not always protected from harm and abuse because incidents were not fully investigated and staff did not always recognise potential safeguarding concerns.

People’s care plans were not always altered to reflect a change in their support needs and so did not assist staff to provide a personalised service. Opportunities to pursue hobbies and interests were limited for some people.

Complaints were managed in line with the provider’s procedure.

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. 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 Old Vicarage Nursing Home provides accommodation, personal care and nursing care for up to 30 people, some of whom may have dementia or sensory impairment. There were 26 people living in the home on the day of our inspection.

There was 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.

Equipment used to move people was not always used correctly to ensure they were transferred from chair to chair safely. Staff were not able to monitor medicine stock because they had not recorded the number of medicines they received.

Staff understood their role in protecting people from harm and abuse and the action they should take to report any concerns they had. The environment was monitored regularly to ensure it remained safe for people to live in.

People’s choices were recognised by staff who understood how to support them to make decisions when they were unable to do so themselves. There were a sufficient number of suitably recruited staff available to care for people and meet their needs. Staff had access to training and support to improve their knowledge of care and enhance their skills.

People enjoyed the company of staff who respected their privacy and promoted their dignity. People were able to maintain their important relationships, as relatives and friends could visit at any time. Staff understood the needs of people living with dementia and encouraged people to reminisce and talk about their earlier lives. The advice of healthcare professionals was sought when additional advice was required to support people.

Staff knew people well, understood their needs and provided the care and support in a way they preferred because. People’s care plans provided information about people and staff were updated regularly to ensure the care they provided met people’s preferences.

There were clear management structures offering support and leadership to staff. The home had a positive, empowering culture. People and staff were given opportunities to share their views on the way the service was run. Records showed that we had been notified, as required by law, of incidents in the home that could affect the health, safety and welfare of people.

The Old Vicarage Nursing Home provides accommodation, personal care and nursing care for up to 30 people, some of whom may have dementia or sensory impairment. There were 25 people living in the home on the day of our inspection.

There was 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.

When we were planning the inspection we looked at the information we held about the provider including the information they are required to send us by law. On this occasion we did not ask the provider to complete a Provider Information Return (PIR) however we gave them the opportunity to share information with us during our inspection. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

Staff sought people’s consent before they provided care and support. Where people were not able to make decisions for themselves as they may lack capacity, the provider had not always assessed whether people could make these decisions themselves; this meant that some decisions that had been made may not be in their best interests.

Improvements were required to the way medicines and medicine stock was recorded. Staff had received training so that people’s care and support needs were met. When new staff joined the team the provider had introduced the new Care certificate to ensure they developed and demonstrated key skills, knowledge, values and behaviours which should enable them to provide people with safe, effective, compassionate and high quality care.

Staff understood their responsibility to safeguard people from harm and what constituted abuse or poor practice. Where risks associated with people’s health and wellbeing had been identified there were management plans in place to protect people. People’s care needs were planned and reviewed regularly. There were a sufficient number of suitable recruited staff to support people living in a caring environment.

Staff provided care which was kind and compassionate. People were supported to maintain their dignity and their right to privacy was recognised. People were supported to socialise together and maintain relationships with people who were important to them. There was information on raising concerns or complaints displayed prominently. Visitors views on the service was sought and staff felt well supported by the registered manager.

You can see what action we told the provider to take at the back of the full version of the report.

Care plans were being updated and were person centred. We were told that the staff had attended person centred care training the day before our inspection. Staff we spoke with told us how helpful this had been to them.

We saw that people had a positive dining experience and that fresh tablecloths were on the tables at every meal. Meals were hot and people were offered a choice of two hot meals or a lighter meal. One person told us: 'There is plenty and I can choose'.

We saw that the garden had been re fenced to make it a safe and level area for people to enjoy. There were a wide variety of potted plants and flowers, and some of these were sensory plants. One person told us: 'I love to garden'.

We saw that there were sufficient staff to meet the care needs of the people who lived at the home. The manager told us that they based staff numbers on the needs of the people who used the service.

We saw that there was an effective complaints system. Relatives that we spoke with told us: 'I know what the complaints process is here, but have never had to use it'. Another person told us: 'I am very confident that they would deal with any issue straight away'.