Background to this inspection
Updated
17 July 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
This was a focused inspection to check on specific concerns we had from our previous inspection.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection control outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was completed by one inspector.
Service and service type
The Old Vicarage is a care home. People in care homes receive accommodation and personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service did not have a manager registered with the Care Quality Commission. This means that the provider was legally responsible for how the service is run and for the quality and safety of the care provided. The provider has a manager who has applied to CQC to become the registered manager for this service.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We reviewed information we requested from the provider to show the improvements they had made where a breach had been identified at the last inspection. We sought feedback from the local authority. We contacted other professionals for their feedback. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
We spoke with one person who used the service, a relative, three staff and the locality manager. We reviewed two people’s care records. We looked at two staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures.
After the inspection
We continued to seek clarification from the locality manager to validate evidence we found.
Updated
17 July 2021
About the service
The Old Vicarage is a care home that provides personal care for up to 16 adults who have mental health needs or a learning disability. At the time of our inspection 12 people were living at the service. Accommodation was provided for 8 people within the Old Vicarage building, with self-contained flats located in the adjacent building, St Mary’s House.
People’s experience of using this service and what we found
We have made a recommendation to talk with people about their end of life wishes.
Quality assurance audits were completed, any issues identified were reviewed and action plans completed to ensure improvements were made. However, we found that although areas for improvement were identified these had not always been addressed.
The provider had not ensured that staff had completed their mandatory training, this included infection control training during COVID-19.
People told us they were happy with the care and support they received. Improvements had been made to peoples care plans to guide staff, although further work on care plans is in progress.
The staff team, people and a relative were positive about their experiences at the service. The locality manager was supporting the home in the absence of a registered manager. Staff understood safeguarding and how to keep people safe and the importance of reporting any concerns.
Staff understood their roles and felt supported by the management team. Recruitment practices were robust and included appropriate checks by the provider.
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.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. This service was able to demonstrate how they were meeting how they were meeting some of the underpinning principles of right support, right care, right culture. People’s care and support was person centred with each person having a key worker to discuss their goals and support their interests and promote their independence with appropriate support.
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 12 June 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve governance systems. At this inspection enough improvement had not been made and the provider was still in breach of regulation 17.
The service remains requires improvement. This service has been rated requires improvement for the last two consecutive inspections.
Why we inspected
This was a planned inspection based on the previous rating.
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 in Safe, Effective, Responsive and Well-led which contain those requirements.
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. This is based on the findings at this 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.
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 discharge our regulatory enforcement functions to keep people safe and to hold providers to account where it is necessary to do so.
We have identified breaches in relation to regulation 17 Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Systems and processes did not always ensure people risks were managed and quality monitoring had not ensured identified actions were completed.
Please see the action we have told the provider to take at the end of this 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.
Follow up
We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.