Background to this inspection
Updated
28 October 2023
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 Health and Social Care Act 2008.
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 outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by 2 inspectors.
Service and service type
The Old Vicarage Nursing Home is a 'care home'. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Old Vicarage Nursing Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had about the service. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
During the inspection we spoke with 9 people who lived in the care home and 4 of their relatives. We spoke with 8 members of staff including the registered manager, nominated individual, operations manager, nurses, care staff and agency staff members. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We also spoke with 3 visiting professionals.
We reviewed a range of records. We looked at 4 people's care plans and medicine administration records. We looked at 4 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service were also reviewed, including complaints, compliments, incident records, quality assurance processes and various policies and procedures. We also reviewed the training matrix sent to us by the registered manager.
Updated
28 October 2023
About the service
The Old Vicarage Nursing home is a residential nursing home providing care for up to 45 people. The service provides support to older people, people with physical disabilities and people living with dementia. Accommodation is provided across three parts of the building. At the time of our inspection there were 43 people using the service.
People’s experience of using this service and what we found
The provider was unable to demonstrate they were responding effectively to risks and systems in place did not always identify lessons were learnt when things went wrong. Medicines were not always stored and recorded in a safe way. Not all staff received the required training to deliver care safely. Systems and processes in place to safeguard people from the risk of abuse were not always effective.
The service was working within the principles of the MCA, although staff we spoke to were not always able to describe how they would act in people’s best interests when delivering care.
Concerns were found over infection prevention control. However the provider was aware of these concerns and there was an plan in place.
The systems in place to assess and manage the quality and safety of the service were not always effective. The governance systems for investigations and complaints handling were not always effective. The registered manager was approachable. Staff had regular supervisions and felt supported in their roles. The provider understood and met the duty of candour. Staff worked with external professionals which included the GP and social workers.
Rating at last inspection
The last rating for this service was requires improvement (published 11 January 2023).
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 the provider remained in breach of regulations.
Why we inspected
The inspection was prompted in part due to concerns received about people’s nursing care needs, medicines management, staff training and infection control. A decision was made for us to inspect and examine those risks.
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 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.
Enforcement
We have identified breaches in relation to the safe care people receive, the management of complaints and the overall governance of the service.
We have issued the provider with a warning notice. We will check the provider is taking action to comply with the legal requirements set out in the warning notice.
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 continue to monitor information we receive about the service, which will help inform when we next inspect.