The Old Vicarage Care Home

We found the following examples of good practice.

The service were allowing limited visiting for those people who were on end of life care or for those people that it was having a detrimental impact on their wellbeing.

Any person entering the building had their temperature taken, washed their hands, completed a health questionnaire and wore full personal protective equipment (PPE).

People were supported by staff in full PPE, whether that person was COVID-19 positive or negative. This was to protect both staff and people living in the service from spreading infection.

The building was clean and free from clutter. The registered manager told us that there was frequent cleaning carried out throughout the day and that night staff carried out additional cleaning of communal areas.

Staff changed into their uniform at work and changed out of it before leaving the premises.

Whole home testing was in place for people, visitors and the staff.

People’s experience of using this service:

• People felt safe living at the service. Risk assessments had been completed to ensure that action was taken to keep people safe. Staffing levels meant that people were safe and they received their care in a timely manner. People received their medication as prescribed. There were systems in place to record, monitor and learn from accidents and incidents.

• Staff had the knowledge, skills and support they required to meet people’s needs effectively. People’s physical, emotional and social needs were identified so staff could meet these. People received support with eating and drinking when needed. People were supported to maintain good health and were supported by or referred to the relevant healthcare professionals.

• People received care and support from staff that were kind and caring. People’s privacy and dignity was protected and promoted. Staff knew people well and what made them happy.

• People received person centred care that met their needs. Most care plans were detailed so that staff knew people’s preferences and how people would like to be supported. Activities were provided according to people’s interests and hobbies. People knew how to make a complaint if needed.

• People’s views had been sought in the running of the service. The provider and registered manager had worked hard to identify where improvements were needed and make them.

Rating at last inspection: Requires Improvement (report published August 2018)

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as scheduled in 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

The service is in a converted vicarage and accommodation is offered on two floors. There are three lounge / dining rooms on the ground floor. There is a passenger lift for access to rooms on both floors at the rear of the property and a stair lift for access to rooms at the front. Outside, a large walled garden provides secluded and sheltered areas for people to sit and walk in.

This inspection took place on 23 and 31 May 2018. The 23 May was unannounced, but we told the provider we would be inspecting on 31 May 2018. On the first day of our inspection there were 16 people receiving care. On the second day of our inspection, 15 people were receiving care. This was the first inspection of the service since it was taken over by a new provider, MD Care Homes Limited, and registered with the CQC on 16 January 2018.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. And one breach of the Care Quality Commission (Registration) Regulations 2009 (part 4). You can see what action we told the provider to take at the back of the full version of the report.

Processes to assess and monitor the quality and safety of the service had not consistently been carried out to inform the provider if the service was operating safely or not. The provider’s systems had failed to identify that they had not always followed their own procedures and failed to identify the issues we found during our inspection. This led to people’s care, welfare and safety being compromised.

There was a lack of clear leadership of the service which did not promote an open, transparent culture with positive values. Staff were unclear of their roles and responsibilities and staff were unsure of what they were accountable for and who they were accountable to. The provider and registered manager had failed to notify CQC of all the incidents they were legally obliged to notify us about. Support and resources needed were not always available to run the service in a way that promoted a holistic approach to people’s care and ensured all people’s needs were being met.

Safe and effective recruitment practices were not always followed. There were not always sufficient numbers of staff deployed to meet people’s needs effectively and in a timely manner. Not all staff had received sufficient induction, training, or supervision in line with the provider’s policy to ensure they had the knowledge and skills to carry out their roles and responsibilities.

Poor monitoring and management of people’s eating and drinking put people at risk of dehydration and malnutrition. Potential risks to people's health, well-being or safety had been identified and assessed. However, the actions were not always followed and had not all been reviewed. Medicine management systems were safe. However, people could not be assured they would receive their prescribed medicines at night because there was no trained staff on duty to give them.

The provider did not ensure the service was run in a manner that consistently promoted a caring and respectful culture. People’s privacy, dignity and independence was not consistently respected and promoted. There was inconsistent support for people to follow their interests and take part in social activities. People were consulted about their care plans, but these had not been updated to reflect changes in people’s needs. People were not always involved in every day decisions about their care.

People did not have access to information on how to complain about the service. People could not be assured their complaints would be satisfactorily addressed.

The service was clean and hygienic. Staff knew how to recognise and report any risks to people’s safety. Staff met people's day-to-day health needs in a timely way and people had access to health care and social care professionals when necessary to maintain their health and well-being.

People’s rights to make decisions about their care were respected. Where people did not have the mental capacity to make decisions, they had been supported in the decision-making process. The service supported people at the end of their life and consulted them and their relatives about their end of life wishes. People were encouraged to maintain and develop new relationships.

This is the first time the service has been rated requires improvement.