The Old Vicarage Nursing Home

The Old Vicarage Nursing home is a residential nursing home providing care for up to 45 people. The service provides support to older people, people with physical disabilities and people living with dementia. Accommodation is provided across three parts of the building. At the time of our inspection there were 43 people using the service.

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

The provider was unable to demonstrate they were responding effectively to risks and systems in place did not always identify lessons were learnt when things went wrong. Medicines were not always stored and recorded in a safe way. Not all staff received the required training to deliver care safely. Systems and processes in place to safeguard people from the risk of abuse were not always effective.

The service was working within the principles of the MCA, although staff we spoke to were not always able to describe how they would act in people’s best interests when delivering care.

Concerns were found over infection prevention control. However the provider was aware of these concerns and there was an plan in place.

The systems in place to assess and manage the quality and safety of the service were not always effective. The governance systems for investigations and complaints handling were not always effective. The registered manager was approachable. Staff had regular supervisions and felt supported in their roles. The provider understood and met the duty of candour. Staff worked with external professionals which included the GP and social workers.

Rating at last inspection

The last rating for this service was requires improvement (published 11 January 2023).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about people’s nursing care needs, medicines management, staff training and infection control. 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.

The overall rating for the service has remained requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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

Enforcement

We have identified breaches in relation to the safe care people receive, the management of complaints and the overall governance of the service.

We have issued the provider with a warning notice. We will check the provider is taking action to comply with the legal requirements set out in the warning notice.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Old Vicarage Nursing Home is a nursing home providing the regulated activities of accommodation for persons who require nursing or personal care and treatment of disease, disorder or injury to up to 45 people. The service provides support to older people across three different parts of the building, some of whom are living with dementia. At the time of our inspection there were 42 people using the service.

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

People did not always receive support with their prescribed creams safely. Where there were concerns around people's fluid intake there was not always clear escalation plans to share these concerns following the initial concerns being raised with people's GP. People's mealtime experience was poor.

People did not always have support with pressure relief documented. Staff had not followed people's care plans in relation to constipation where there were gaps in people's bowel care records. People did not always have access to a range of activities in line with their preferences. We have made a recommendation in relation to the review of activities.

Visitors to the home were required to book an appointment. We have made a recommendation for the provider to review this to ensure people can have access to visitors in line with their preferences.

Quality assurance tools had not always identified concerns around people's pressure care documentation, fluid escalation and bowel care. Quality assurance tools had not identified where improvements were required to people's access to personalised activities and people's mealtime experience.

People received support with their oral prescribed medicines safely. People were supported by trained staff who knew them well. There was enough staff to meet people's needs in a timely way. People felt able to raise concerns. People were safeguarded from abuse.

People were able to make choices about their food and fluids. People were involved in their care planning. People's preferences were included within their care plans and risk assessments. People's protected characteristics were included within their care files.

People had access to healthcare professionals where they needed them. People were supported by kind and caring staff. People were supported to maximise their independence and in a way which respected their privacy and dignity.

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.

Quality assurance tools were effective at identifying other areas of improvement in the service.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 06 August 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

This inspection was prompted by information we received from external partners about improvements at the home since their last inspection. We completed this inspection to check whether the home’s rating was still reflective of the quality of care they provided.

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 and Recommendations

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 monitor the service and will take further action if needed.

We have taken enforcement action in relation to the oversight of care and documentation at the service.

We have made recommendations about the relative's visiting the service and people having access to personalised activities.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect. We will request an action plan from the provider to show us how they plan to make improvements at the home.

The Old Vicarage Nursing Home is a care home providing personal and nursing care to 38 people aged 65 and over at the time of the inspection. The service can support up to 45 people.

The Old Vicarage Nursing Home accommodates people in one adapted building, over two floors. The building is split into four separate wings, each of which has separate adapted facilities. One of the wings specialises in providing care to people living with dementia and one of the wings supports people on a short-term basis whilst they have a period of assessment.

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

People felt safe and were happy with the care they received. However, we found that some systems required improvement to ensure that issues were identified, and improvements were made when required.

There were enough, safely recruited staff to keep people safe and meet their needs. People’s medicines were managed safely, and lessons were learned when things went wrong.

The registered manager was open and honest and approachable to people and staff. They understood their responsibilities of registration.

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 2 November 2020).

Why we inspected

We received concerns in relation to staffing levels, safety of the building and management of people’s nursing care needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions 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 found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this full report. However, we have found evidence that the provider needs to make some improvement in other areas. Please see the well-led section of this full report.

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

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.

Follow up

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

The Old Vicarage Nursing Home is a care home providing personal and nursing care for up to 45 people

aged 65 and over across two floors. 36 people were living in the service, although one person was in hospital at the time of our inspection.

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

We found that people received safe care because their risks were managed effectively. Risk assessments demonstrated that people’s identified risks had been assessed and were being managed safely and reviewed regularly.

Care plans were personalised and contained detail around people’s care needs.

Medicines were administered safely, and records demonstrated that people had received their medicines as prescribed. Staff medication training and competency checks were up to date.

The quality of the service was monitored by effective governance and audit systems which identified any improvements needed in the service.

The service was clean and free of malodour. There were a number of personal protective equipment (PPE) stations positioned throughout the home and staff wore appropriate PPE. Where new admissions came into the home, they were isolated for 14 days in the isolation wing of the service, in line with guidance.

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

Rating at last inspection

The rating at the last inspection was requires improvement (report was published on 19 September 2019). You can read the report from our last comprehensive inspection by selecting the 'all reports' link for The Old Vicarage Nursing Home on our website at www.cqc.org.uk.

Why we inspected

We received concerns in relation to people's nursing care and how the service was promoting people's

safety. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

Follow up

We did not identify any concerns at this inspection. We will therefore aim to re-inspect this service within the published time scale for services rated requires improvement. We will continue to monitor the service through the information we receive.

The Old Vicarage Nursing Home is a care home providing personal and nursing care for up to 45 people aged 65 and over. 39 people were living in the service, although two of those people were in hospital at the time of our inspection. The service can support up to 45 people across two floors, part of the top floor was dedicated to people living with dementia.

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

People felt safe living in the home, however they were not consistently supported by a caring staff team. We saw people did not always have their choices respected. A number people were unable to reach their call bells when they were in their rooms. Staff were tasked focused.

Risk assessments were in place for people, however, audit documents did not always highlight people’s wound care needs. Medicines were effectively managed and administered safely and protocols were in place.

People had care plans in place which were reviewed and updated which included their support needs. These plans provided staff with information to supporting people living in the home which detailed people's preferences. However, people’s end of life wishes was not consistently sourced or recorded in people’s plans.

Accidents and incidents were monitored to identify trends and address any concerns. Systems were in place to manage infection control, although nurses were observed not wearing gloves when distributing medication, meaning there could be a risk of cross contamination.

People were not always supported to have choice and control of their lives. Although staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the home supported this practice.

People did not always have the choice to choose where they wanted to spend their time and had access to the communal areas and a garden area. However, there were a large number of people spending time in their rooms.

Staff had good relationships with external agencies which supported people to live a healthy life, however, Staff did not always follow professional advice which impacted on people’s health and wellbeing. and guidance for people. guidance was not always followed. Majority of people had their dietary needs assessed and people were seen by professionals to support their needs, although this was not always done in a timely manner.

People were encouraged to participate in activities to ensure they were not isolated, this included a weekly trip to the community centre. Staff were able to have meaningful conversations with people as they had an understanding of people's hobbies and interests.

People that were at the end of life were being supported appropriately. However, people that were not nearing end of life did not always have their advanced wishes considered or recorded.

The provider had a complaints process in place however, people and relatives were unaware of the process.

The provider was aware of their responsibilities and had systems in place to monitor the home and to identify where improvements could be made, however, these were not always effective in identifying improvements to be made.

Statutory notifications had been completed to inform us of events and incidents, this helped us to monitor the action the provider had taken.

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 05 January 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

The Old Vicarage provides accommodation, personal and nursing care for up to 44 people. At the time of this inspection 31 people were using the service.

There was a manager in post who was in the process of registering with us (CQC). 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 were safeguarded from abuse as staff and the manager knew what to do if they suspected abuse and followed the correct safeguarding procedures to keep people safe.

Risks of harm to people were assessed and plans put into place to minimise the risks. Staff knew people’s risk assessments and followed them to reduce the risk and keep people safe.

People’s medicines were stored and administered safely by trained staff. There was sufficient suitably trained staff to keep people safe and meet their care needs in a timely manner.

The principles of The Mental Capacity Act (MCA) 2005 were being followed to ensure people were consenting to or being supported to consent to their care, treatment and support.

Staff received support, supervision and training to be able to be effective in their roles. Staff recognised and responded when people became unwell and sought medical advice from health care agencies. People were supported to maintain a healthy diet and if people lost weight they were referred to their GP for advice.

People were treated with dignity and respect and their right to privacy was upheld. People felt able to complain and confident that the manager would listen and respond.

People received care that reflected their individual assessed needs and reflected their preferences. There were opportunities to engage in hobbies and activities of people’s liking including external entertainment.

The manager had implemented systems to monitor and improve the service. Improvements had been made throughout the service. People and staff respected the manager.

The Old Vicarage provided accommodation and nursing care to up to 45 people. At the time of this inspection 35 people were using the service.

The previous manager had left and a new manager was in post who was in the process of registering with us. 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 were not always safeguarded from potential abuse as the provider was not following the local authority safeguarding procedure by ensuring that all incidents of suspected abuse were reported and investigated.

The provider was still not consistently follow the principles of the MCA 2005 to ensure that people consented to or were supported to consent to their care, treatment and support.

The systems the provider had in place to monitor and improve the service were ineffective as not all the required improvements had been made since our previous inspection and as stated in the provider's action plan.

People were cared for by staff who were supported and trained to fulfil their roles. There were sufficient staff to meet people's needs safely.

People's nutritional needs were met and when their health care needs changed or they became unwell advice and support from other health care professionals was gained.

People's medicines were stored and administered safely. However records relating to reviews of people's medicines were not up to date.

People received care that was personalised and reflected their individual preferences. People were encouraged to be participate in hobbies and activities of their choice.

People and their relative's views were sought on the quality of service they received through regular reviews, meetings and surveys.

The provider had a complaints procedure and people and their relatives knew how to use it. Complaints were managed according to the procedure.

The Old Vicarage provided accommodation and nursing care to up to 45 people. At the time of this inspection 38 people were using the service.

There was a new manager in post who was in the process of registering with us. 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's safety were assessed, however staff did not always follow people's risk assessments to ensure they kept people safe.

The provider did not consistently follow the principles of the MCA 2005 to ensure that people consented to or were supported to consent to their care, treatment and support.

People's nutritional needs were not always met as weight loss was not noticed and acted upon.

People had access to some health care services, however some people would have benefited from referral to other health care agencies for advice and support.

People did not always receive care that met their assessed needs and reflected their preferences.

Systems were in place to monitor the quality of the service and some improvements had been made, however further improvements were required.

Medication was stored and administered safely.

People were treated with dignity and respect and their privacy was respected.

There were enough suitably skilled staff to keep people safe employed using safe recruitment procedures.

Staff felt supported and received supervision and training to support them to be effective in their roles.

Complaints were listened to and acted upon by the new manager. There was an open door policy and people felt they could approach the manager.

The new manager had made several improvements since being in post and acted quickly when issues of concern were identified with them.

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.

The Old Vicarage Nursing Home provides accommodation and nursing care for up to 45 people. There were 43 people using the service at the time of this inspection.

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. We were supported throughout the inspection by the provider's nominated individual.

The provider was not working within the guidelines of the Mental Capacity Act 2005. The MCA and the DoLS set out the requirements that ensure where appropriate decisions are made in people's best interests where they are unable to do this for themselves. People were being unlawfully restricted of their liberty within the service and were not consenting to their care.

People were not protected from the risk of abuse. Incidents of suspected abuse were not reported or investigated.

People's medicines were not managed or administered safely.

People did not always receive the health care support they needed. Staff felt supported and trained however this did not always reflect in their care practices.

People did not receive care that was personalised and reflected their individual needs and preferences.

People were not always treated with dignity and their privacy was not always respected.

People knew how to complain but complaints were not always managed appropriately.

No improvements had been made since our previous inspection and the systems the provider had in place to monitor the quality of the service were ineffective.

Where people were not able to make decisions, capacity assessments were completed and information about why others had made decisions on their behalf had been recorded. This meant people could be confident decisions had been made in their best interest.

Systems were in place to protect people from the risk associated with the unsafe use and management of medicines.

The service had an effective recruitment policy which was followed by staff.

The provider had a number of systems in place to enable them to monitor and assess the quality and effectiveness of the service provided.

We observed that staff responded to people's needs. We checked records which showed people had provided consent to their care and treatment. Where people did not have capacity to give informed consent, we saw how decisions had been made in their best interest.

People received care and support that met their individual needs. Care records were based on people's individual needs. A person who used the service told us, 'The staff are lovely; they can't do enough for you'.

We saw that the home was kept clean. We spoke with staff, people who used the service and their relatives about the cleaning routines and infection control.

We saw from training records we checked and what staff told us that staff had appropriate qualifications and skills to provide care.

There was a complaints system for identifying and dealing appropriately with complaints and comments.