The Old Vicarage

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had developed a positive learning culture where incidents, accidents and near misses were used as opportunities to improve care and support. At the previous assessment, monitoring and trend analysis had not always been effective due in part to frequent management changes. This had significantly improved.

The home now benefited from a stable and consistent management team who maintained effective oversight of incidents, accidents and safeguarding concerns. Records demonstrated incidents were reviewed promptly, root causes were considered and appropriate actions were implemented to reduce the risk of recurrence.

Managers completed regular analysis of incidents and trends, which had enabled them to identify themes, share learning and make improvements to practice. Staff were encouraged to reflect on incidents, contribute to learning and work collaboratively to improve outcomes for people.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Since the last assessment, the service had strengthened its oversight of risk associated with people accessing the community, transport arrangements and periods of transition between activities and services.

Risk assessments were comprehensive, regularly reviewed and reflected people's current needs. Staff demonstrated they understood the support people required and followed agreed guidance. Lessons learned from previous incidents had been embedded into practice, which resulted in improved planning and safer outcomes for people.

The management team had reviewed previous incidents involving community access and vehicle safety and introduced additional controls and monitoring. Staff understood their roles and responsibilities and were able to explain how they maintained people's safety whilst respecting their independence and choices.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found staff had a good understanding of people’s personalised risks and safeguarding needs. People had a staff member who was assigned as their key worker and safeguarding risks were reviewed at a monthly meeting between people and their key worker. This meant staff were able to build trusting relationships with people. Staff, relatives and professionals told us communication had improved significantly and they felt concerns were listened to and acted upon in a timely manner.

People, and those important to them where appropriate, were involved in decisions about managing risks associated with their care and support. Risk assessments were person-centred and balanced safety with people's rights, choices and independence.

Relatives told us communication had improved and they felt involved in discussions about changes to people's needs and support arrangements. One relative said, “Previously I was never involved, but since the new [registered] manager arrived, we discuss things and I am always included.” Staff demonstrated a good understanding of individual risks and the strategies in place to reduce these. Care plans provided clear guidance that enabled staff to support people consistently.

Since the last assessment, improvements in management stability and workforce consistency had resulted in greater continuity of support for people. This helped ensure staff were familiar with individuals' needs, preferences and risk management strategies.

People were supported in environments that were safe, well maintained and suited to their needs. Environmental risks were assessed and monitored regularly, with timely action taken where concerns were identified.

Regular health and safety checks were completed, including fire safety systems, equipment maintenance and environmental audits. Personal Emergency Evacuation Plans (PEEPs) were up to date and provided staff with clear information about how to support people safely during an emergency. The provider had strengthened governance arrangements around environmental safety, which identified actions needed and these were monitored through to completion and reviewed for effectiveness.

During the assessment we observed upgrades and maintenance being carried out by trades people. The management team had ensured people safety and considered their sensory needs during these works to ensure people did not suffer increased anxiety or distress in the environment.

People were supported by sufficient numbers of suitably skilled and experienced staff. Staffing arrangements were planned and organised effectively to ensure people's assessed needs, including any requirements for enhanced supervision or one-to-one support, were consistently met. Recruitment processes remained robust, with appropriate pre-employment checks undertaken before staff commenced work. Newly recruited staff completed a structured induction and received ongoing training and competency assessments to ensure they to provided safe care. At the previous assessment, concerns had been identified regarding the deployment of staff. Since then, the provider had reviewed staffing systems and implemented improved oversight arrangements. Records demonstrated staffing levels were maintained, and staff were deployed appropriately to meet people's needs safely.

People were not always fully protected from the risk of infection because risks associated with animal husbandry within the service had not been fully assessed or managed.

The home environment was clean, well maintained and visibly hygienic. Staff demonstrated a good understanding of infection prevention and control practices and were observed using personal protective equipment (PPE) appropriately and in line with current guidance. Cleaning schedules were in place and completed regularly, and there were effective arrangements to maintain the cleanliness of the service.

However, during the assessment we identified that chickens were being kept within the outdoor area of the home. People using the service were encouraged to participate in caring for the chickens, including feeding them and helping to clean and maintain the enclosure. Whilst this provided meaningful engagement and promoted people's independence and wellbeing, the provider had not fully considered the potential infection prevention and control risks associated with keeping poultry on site. For example, there were no specific risk assessments, care plans or infection control guidance in place to identify and mitigate the risk of infections that could be carried and transmitted by chickens. This meant there was limited assurance that risks to people, staff and visitors had been appropriately assessed and managed.

We discussed this with the management team during the inspection. They responded positively to the feedback and took immediate action to address the concerns. The provider began developing individual risk assessments and care planning documentation to ensure appropriate control measures were implemented. This included consideration of hand hygiene, use of protective equipment where necessary, safe cleaning arrangements, supervision levels and monitoring of people's contact with the animals.

People received their medicines safely and as prescribed. Significant improvements had been made since the previous assessment, where concerns had been identified regarding medicine errors and the effectiveness of competency processes.

The provider had strengthened medicine management systems, including enhanced training, regular competency assessments, increased management oversight and improved auditing processes. Records demonstrated medicine errors had reduced and where issues were identified these were investigated promptly, with learning shared across the staff team.

Staff responsible for administering medicines were knowledgeable about people's individual requirements, allergies and preferences. Protocols for "as required" medicines contained clear guidance to support safe and consistent administration.

Auditing processes provided managers with assurance that medicines were managed safely and any emerging issues had been identified and addressed promptly. One relative said, “There had been no incidents or mistakes since the new [registered] manager took over, [name] now receives their medicines correctly and I feel they are safe.”