The Old Vicarage

The Old Vicarage Care Home is a residential care home providing accommodation and personal care for up to 24 adults who may have dementia, a sensory impairment or physical disability. People are accommodated over 2 floors in 1 adapted building, with a third floor adapted for office and storage space. The home is set within extensive grounds, including well-kept gardens and car parking. At the time of this inspection there were 21 people using the service.

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

The provider demonstrated effective systems and processes to safeguard people from the risk of harm or abuse.

Overall, risks to people’s safety associated with their health condition, environment and any equipment used for their care, were effectively, assessed, monitored and managed.

The provider demonstrated effective governance arrangements for the management and oversight of the service. This helped to ensure the quality and safety of people’s care and any improvements needed.

The provider now needs to demonstrate fully embedded, sustained and ongoing timely service improvement when needed for people’s care.

Rating at last inspection and update

The last rating for this service was requires improvement (published 20 December 2022) and there were breaches of regulation. CQC issued the provider with a warning notice in relation to Regulations 13 (Safeguarding) and 17(Good governance).

The provider completed an action plan after the last inspection to show what they would do and when to improve. At this inspection, we found improvements had been made and the provider had complied with the requirements of the warning notice which related to Regulations 13 and 17.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulations 13 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

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

The Old Vicarage is a residential care home providing personal and nursing care for up to 24 people. The service provides support to older people, people with dementia and people with sensory impairment or physical disability. At the time of our inspection there were 23 people using the service.

The home is close to the centre of Bakewell and set in its own grounds. It is one building with a lounge, dining room, conservatory and garden. Twenty-two of the 23 bedrooms have en-suite facilities. Two of the bedrooms are shared accommodating 2 people.

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

People were not always protected from avoidable harm. Actions recorded as taken following safeguarding incidents were found not to be in place and lessons were not learnt so incidents reoccurred. Known risks had not always been mitigated. For example, when a person had suffered a fall, we found no actions had been taken to investigate the cause or to review the person’s needs. Risks identified in the service’s fire safety risk assessment review from March 2022 had not been addressed.

The provider was not consistently working within the principles of the Mental Capacity Act (MCA). We found a locked door which restricted a person’s access to their bedroom. People’s needs had not always been thoroughly assessed prior to them joining the service. Managers did not ensure staff had regular supervisions.

People’s dignity was not always promoted. Relatives told us about issues they had encountered with the laundry and how family members were often found wearing other people’s clothes. We observed staff treating people well with care and kindness. However, we found the provider’s systems and practices did not always support this as not all risks had been mitigated to ensure people were safe.

The provider had not actioned all improvements since our previous inspection. We found ongoing issues with safeguarding and governance systems. We found improvements were in place for supporting people to follow interests; an activities coordinator provided a range of activities. People had the opportunity to participate in activities in a group or on a one to one basis with staff.

The quality assurance and governance arrangements in place were not robust. Systems and processes were not effective in actioning findings from medicine and mealtime audits in a timely manner, so shortfalls identified continued to reoccur.

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

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 16 April 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 12 November 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve. This inspection was carried out to follow up on action we told the provider to take from the last inspection.

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, effective, caring, responsive and well-led sections of this full report.

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

Enforcement

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 identified breaches in relation to safeguarding people from abuse and improper treatment, governance and management oversight at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Old Vicarage is a residential care home providing accommodation and personal care to 22 people at the time of the inspection. The service can support up to 24 older people, people living with dementia, sensory impairment or physical disability.

The home is close to the centre of Bakewell and set in its own grounds. It is one building with a lounge, dining room, conservatory and secure garden. 22 of the 23 bedrooms have en-suite bathrooms.

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

The manager had taken steps to improve the service and ensured people received safer care. The provider had completed an action plan which stated how they planned to implement improvements set out in the warning notice we served after the last inspection. All the requirements of the warning notice had been met.

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

For example: Rating at last inspection and update: The last rating for this service was requires improvement (published December 2019) and there were multiple breaches of regulation. At this inspection we found improvements had been made.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains Requires Improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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 is a residential care home providing accommodation and personal care to 22 people at the time of the inspection. The service can support up to 24 older people, people living with dementia, sensory impairment or physical disability.

The home is close to the centre of Bakewell and set in its own grounds. It is one building with a lounge, dining room, conservatory and secure garden. 22 of the 23 bedrooms have en-suite bathrooms.

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

Governance and performance management was not always reliable or effective. Accidents, incidents and complaints were not always investigated, and not audited so the registered manager and provider did not identify themes and trends to prevent recurrence.

Safeguarding was not always given sufficient priority. We found some incidents that should have been referred to the local safeguarding authority, but this had not been considered. Improvements had been made to medicine management and medicines were administered as prescribed.

The assessment and management of risk was not always effective. We made a recommendation that the provider reviewed their systems and processes to ensure people were protected from the risk of avoidable harm.

People were not always supported to follow their interests or take part in activities that were relevant to their lifestyles. People’s needs, and choices had been explored and documented but care was not always planned or delivered in a person-centred way.

The physical environment of the home was not designed or decorated to a consistent standard to meet people’s needs. There was a lack of dementia friendly signage to assist people living with dementia to navigate the building.

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.

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

Rating at last inspection

The service has been rated as requires improvement for one previous inspection (published December 2018). At this inspection we found they were in breach of regulations and the overall rating for this service is Requires Improvement again. Providers should be aiming to achieve and sustain a rating of ‘Good’ or ‘Outstanding’. Good care is the minimum that people receiving services should expect and deserve to receive.

We will ask the provider to give us information about how they plan to improve the quality and safety of the service and the experience of people using it.

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

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the governance and leadership of the service, person-centred care and safeguarding people from abuse and improper treatment.

We have served a warning notice against the provider. This means we explained the reasons we found they were not complaint with regulations. We set a time frame of 12 weeks for improvements to be made.

The accommodation consisted of a lounge, dining room and a conservatory and private en-suite bedrooms. There was a large garden at the rear of the property and a gated courtyard for people to sit. The home was on the outskirts of the village of Bakewell but within a short walking distance of local amenities.

The service had a registered manager in place at the time of our 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.

At our last inspection in March 2016 we rated the service, Good. At this inspection we found improvements were now needed and the service is rated as Requires Improvement.

Medicine management systems were not always safe as medicines were not recorded and audited effectively to ensure people had received their medicines as prescribed. Where people needed help to make some important decisions about their care, it was not always clear how each decision was reached and assessments about people’s capacity had not been completed. This meant people were not always supported to have maximum choice and control of their lives. People’s care plans needed to be reviewed to ensure risk were assessed and recorded and reflected how people needed to be supported. Improvements were needed with how the provider responded to concerns and how people received information in an accessible format. Quality assurance systems were in place, however these were not always effective as they had not identified these concerns.

People felt there was sufficient staff in the home to provide care and support when this was needed. The staffing levels had been reviewed to meet people’s support care needs in the evening to ensure people’s safety.

Staff understood their role in protecting people from the risk harm or abuse and the actions they needed to take if they had concerns. People were confident that the staff supported them well and had received training to develop the skills they needed to provide their care. Recruitment checks were made before staff employment to confirm they were of good character and suitable to work in a care environment.

People were happy with the quality of the food and could have food and drinks that they enjoyed throughout the day. People received support from health care professionals to help ensure their well-being was maintained. Health concerns were monitored to ensure people received specialist health care intervention when this was needed.

Staff were kind and caring when supporting people and knew their likes and dislikes. People’s privacy was respected and the staff made visitors feel welcome and were approachable.

We found one breach 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.

This inspection took place 8 March 2016 and was unannounced.

The service is registered to provide accommodation with personal care for up to 24 older people. There were 22 people living in the service on the day of our inspection. The service provides care and support for older people, with a range of medical and age related conditions, including mobility issues and dementia.

At the time of our inspection there was a registered manager in place. 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 included in decision making about their care and support. For people who lacked capacity to consent to their care and support the provider had followed the principles of the Mental Capacity Act (MCA) 2005. The registered manager had applied for approval of any restrictions on a person’s freedom in line with the Deprivation of Liberty Safeguards (DoLS). Staff training in areas relevant to people’s care needs was up to date.

Staff received supervision and support from the registered manager. Staff demonstrated a knowledge of people’s needs. When required, people were supported to have access to health professionals. People were provided with sufficient food and drink that met their nutritional needs.

People received responsive and personalised care. People, and where appropriate their relatives, were involved in planning people’s care and support. People were able and encouraged to maintain relationships with those who were important to them. People were supported to engage in interests and activities.

Staff understood people’s individual needs and encouraged and supported people to remain as independent as possible. People were supported by staff who were compassionate and caring. Staff were mindful of respecting people’s dignity and supporting their privacy.

The registered and staff understood their responsibilities in relation to safeguarding people. The provider’s arrangements helped to ensure staff were safely recruited and fit to provide people’s care at the service. Staffing levels met people’s support needs and requirements.

Risks to people’s health were identified and care plans were in place to ensure any risks were reduced. Any accidents and incidents were recorded and actions taken by the registered manager to reduce risks to people. Records and audits were available to check and monitor the quality and safety of services provided to people.

Systems were in place to ensure medicines were stored, administered and disposed of in a safe way. Senior staff administered medicines and training was provided to ensure their practice was safe. Medicines were managed in line with current legislation and guidance.

The registered manager was regarded as being approachable and supportive. We saw information was available advising of how to make a complaint, raise any concerns or provide suggestions or feedback.