We carried out a review of the data available to us about The Old Vicarage on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The Old Vicarage, you can give feedback on this service.
The Old Vicarage is a residential care home providing personal and nursing care to up to 30 people. The service provides support to people with physical disabilities, mental health support needs and older people, including those living with dementia. At the time of our inspection there were 15 people using the service. The home accommodates people over 3 floors, however, only 2 were being used at the time of inspection.
People’s experience of using this service and what we found
Significant improvements had been made in the service since our last inspection which reflected positively on people's experience. The management acknowledged further improvements were required to ensure these improvements were embedded and sustained.
A new manager had been in post since November 2022. We received consistent positive feedback on the management of the service and that improvements were ongoing. The provider demonstrated a commitment to continuous learning and was working towards an improvement plan, sharing progress with relevant stakeholders. Effective monitoring systems and quality checks were now being completed. Where action was required to improve people’s safety and experience at the service, this was carried out. People and staff had opportunities to be engaged in the running of the service and felt listened to.
Medicines were safely stored, administered and managed. People received their medicines as prescribed and staff followed best practice guidance for safe administration. Risks to people were assessed and there was enough guidance for staff to support people safely. There were enough staff to meet people’s needs, and spend time engaging with them. People felt safe using the service because the manager and staff understood how to recognise, report and investigate potential abuse. Lessons were learned when things went wrong, and effective action was taken to keep people safe.
People’s holistic needs were comprehensively assessed and regularly reviewed using evidence-based tools. Staff worked well together and referred to relevant health care professionals appropriately, so people achieved good outcomes in relation to their health and well-being. Staff were suitably trained to carry out their role. The premises and equipment were safe and met people’s needs.
People were supported to have maximum choice and control of their lives and staff 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 and update
The last rating for this service was inadequate (published 12 October 2022) and there were breaches of regulation. 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 improvements had been made and the provider was no longer in breach of regulations.
This service has been in Special Measures since 12 May 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.
Why we inspected
We carried out an unannounced focused inspection of this service on 30 March 2022 and there were breaches of regulation. CQC issued the provider with warning notices in relation to regulation 12 (safe care and treatment) and regulation 17 (good governance). We followed up with an unannounced focused inspection on 16 August 2022 to check whether the warning notices had been met and found the provider remained in breach of legal requirements. We met with the provider after the last inspection and they completed an action plan to show what they would do and by when to improve safe care and treatment, staffing and governance.
We undertook this focused inspection to check whether the warning notices we previously served in relation to regulation 12 and regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We also checked whether the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to good. This is based on the findings at this inspection.
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.
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 nursing home providing personal and nursing care for up to 30 people. The service provides support to older people, people with physical disabilities and people with mental health needs including those with dementia. At the time of our inspection there were 20 people using the service. The home is split over three floors, with people’s bedrooms located on each. There are communal lounges and dining spaces.
People’s experience of using this service and what we found
People did not always receive their medicines as prescribed. We found some people had missed their required medicines and accurate medicine administration records (MAR’s) were not always maintained. Systems in place to calculate safe staffing levels were not always effective. Lessons were not learned when things went wrong. Improvements were required to ensure policies were followed and records of accidents, incidents and safeguarding concerns contained the necessary information. Overall, the home was clean, and staff were observed to follow safe Personal protective Equipment (PPE) practice, however cleaning schedules were not always completed to evidence required cleaning to reduce the risk of infection had been carried out.
Oversight was not always effective. Legible, complete and accurate documentation was not always maintained. Action to mitigate risks was not always taken. People and their relatives were not supported to feedback into the running of the service and improvements were required to ensure people were supported to achieve good outcomes. There was a new management team in place since the last inspection and staff reflected positively on this and felt supported in their roles. The service worked collaboratively with a range of professionals.
People’s risk assessments were not always effectively reviewed after significant events. We found some assessments did not always provide consistent guidance for staff. Staff were suitably trained and supported in their roles. People were supported to maintain a healthy weight and have plenty to eat and drink. Referrals to relevant professionals were made when concerns were identified.
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 and update
The last rating for this service was inadequate (published 20 May 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, governance, staff training and consent to care and treatment. At this inspection we found the provider had made some improvements and were no longer in breach of some regulations, however remained in breach of regulations relating to safety and governance.
Why we inspected
We carried out an unannounced focused inspection of this service on 30 March 2022. Breaches of legal requirements were found.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective and well-led which contain those requirements.
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.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service is inadequate. This is based on the findings at this inspection.
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 safety, governance and staffing at this inspection.
Please see the action we have told the provider to take at the end of this report.
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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Special Measures
The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the 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 is a nursing home providing personal and nursing care to up to 30 people. The service provides support to older people, people with physical disabilities and people with mental health needs including those with dementia. At the time of our inspection there were 25 people using the service. The home is split over three separate floors and has two communal lounges and a dining space.
People’s experience of using this service and what we found
There were shortfalls in the way the service was led by the provider. The delivery of high-quality care was not assured by the leadership, governance or policies in the service Audit systems failed to highlight the concerns we found during the inspection.
Risks to people were not always identified, assessed or managed effectively. We found documentation to guide staff on how to support people was either not in place or inconsistent, which placed people at risk of receiving unsafe care. Accurate and contemporaneous records were not completed of people’s daily care.
Medicines were not managed safely. People did not always receive their prescribed medicines and records in relation to medicines were not always completed in line with best practice guidance. Effective action had not been taken to address issues with medicines management.
People were not always referred to healthcare professionals when required. We saw people had lost weight within the service but no records of consultations with the dietician or GP. Healthcare advice was not always followed, meaning people were at risk of further health deterioration.
The provider had not ensured all staff were up to date with the training they needed to carry out their role effectively.
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.
Staff did not always answer call bells quickly, meaning people had to wait for their care and support needs to be met.
People, relatives and staff had opportunities to feedback and felt involved in the running of 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
The last rating for this service was good (published 22 June 2019).
Why we inspected
We received concerns in relation to moving and handling practice, staff training, inaccurate care records, infection prevention and control, staffing and the management of people’s nursing care needs. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.
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.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
The overall rating for the service has changed from good to inadequate based on the findings of this inspection.
We have found evidence that the provider needs to make improvements. Please see the safe, effective 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.
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 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 identified breaches in relation to safety, governance, staff training and consent 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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Special Measures
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.
About the service:
The Old Vicarage Care Home (Long Eaton) Limited is a care home that provides personal care for up to 30 people. The accommodation is established in an old rectory containing bedrooms on three floors, each floor has toileting and/or bathing facilities. There are two communal lounges on the ground floor which are also used for dining. At the time of the inspection there were 29 people using the service.
People’s experience of using this service:
There were not always enough staff to support people when they required this, as the lounge was often unsupervised. . . Some equipment used in the home was not able to be cleaned to reduce the risk of possible infections.
There was a friendly atmosphere and relatives felt welcomed. People’s medicine was managed safely, risks had been reviewed to ensure ongoing learning. When people required equipment to move there was guidance provided, which staff followed.
People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.
Staff had received training to support their role and in developing their skills when they were promoted. People enjoyed the meals and their weights were monitored.
When people required health care this was provided in partnership to ensure the best outcome for the person’s wellbeing. This was reflected in the consistency of the staff group. Staff were provided with training and felt supported by the registered manager and the senior team.
People told us they enjoyed the company of the staff and had established positive relationships. When care was delivered this was done with dignity and respect, ensuring people’s views were considered.
The care plans provided sufficient information to ensure people’s needs and preferences had been considered. They were reviewed to reflect any changes. Signage around the home was in place and further consideration was being made to reflect other information could be shared. Some activities were planned and further consideration about how to achieve meaningful engagement was being developed.
Any complaints had been acknowledged and addressed. Notifications had been received to reflect events at the service. The rating was displayed at the home and on the providers website. Audits were in place to reflect on how to drive improvement, along with people’s views.
Rating at last inspection: Good (Published October 2017)
Why we inspected: This was a planned inspection based on the rating at the last inspection which was Good. At this inspection we identified that improvements were required in the Safe domain, however the overall rating remains ‘Good.’
Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
This inspection visit was unannounced and took place on 25 October 2017. This was the first inspection since the provider registered with us in May 2017. The service was registered to provide accommodation for up to 29 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection 28 people were using the service.
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.
People were supported to make choices and when required decisions had been made in people’s best interest. Any restrictions had been referred to the authorising authority. There were sufficient staff to support people’s needs and staff had undergone a range of checks to ensure they were suitable to work in the home. Staff felt supported by the manager and they were provided with suitable training for their role.
People had established positive relationships with the staff and they respected people’s choices and offered a range of choices in relation to their daily living. Staff maintained people’s privacy and dignity at all times. Staff had received training and the provider had invested time to expand the staff knowledge in end of life care which was provided in a dignified and respectful way.
People enjoyed the meals on offer and people’s dietary needs had been considered. Any concerns had been referred to health care professionals for guidance. People received regular drinks and had the opportunity for snacks or an alternative from the set menu.
The manager and provider completed a range of audits to support the improvements within the home. Improvements to the environment had been made; some of this was following feedback from the relatives and people using the service.
Medicines were managed safely and administered in line with people’s prescriptions. Referrals had been made to health care professionals and people had access to a range of health care professionals to maintain their health needs.
The care plans covered all aspects of people’s care and their preferences. There was a clear process in place to cascade information about the service and the needs of people. People were able to choose how they spent their time and were encouraged to join activities. Any complaints had been addressed and responded to.
The manager understood their responsibility of registration with us and notified us of important events that occurred at the service; this meant we could check appropriate action had been taken.