The Lakes

Updated 26 July 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 one inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

The Old Vicarage 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 is a care home without 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.

Inspection activity started on 8 June 2023 and ended on 26 June 2023. We carried out unannounced visits to the service on 8 and 22 June 2023. Some information we needed to look at in relation to the safety of the service was not available at these visits. We arranged to return to the home on 26 June 2023 to look at the information. We contacted staff and people’s relatives between 13 and 19 June 2023 to gather their views.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

Most people who lived in the home were living with dementia and were not easily able to share their views with us. We spoke with four people who lived in the home and observed how staff interacted with people. We also spoke with the registered manager, administrator and with 2 members of staff. We looked around the accommodation.

We reviewed a range of records. This included 4 people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and training. We also reviewed records relating to the management of the service. We contacted 8 people’s relatives and 6 staff to gather their views.

Updated 26 July 2023

About the service

The Old Vicarage is a residential care home providing accommodation and personal care to up to 30 people. The service provides support to older people and people living with dementia in one adapted building. At the time of our inspection there were 27 people using the service.

People’s experience of using this service and what we found

Although people said they felt safe, risks to people’s safety had not been managed effectively. Some actions required to ensure people were protected against the risk of infection had not been completed. Although staff were trained in how to identify abuse, the provider had not always followed robust procedures when allegations were raised with them. There were enough staff to support people. People received their medicines safely.

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.

Systems to monitor the quality and safety of the service were not effective. The registered manager did not have oversight of important information about the safety of the service. The registered manager had not always used feedback received to improve the quality of the service. The provider was aware of their responsibilities under the duty of candour. Staff worked effectively with other services to ensure people received the support they needed.

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 requires improvement (published 24 February 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, although we found some improvements had been made, the provider remained in breach of regulations.

The last rating for this service was requires improvement (published 24 February 2022). The service remains rated requires improvement. This service has been rated requires improvement for the last 2 consecutive inspections.

Why we inspected

We carried out an unannounced focused inspection of this service on 25 January 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve infection prevention and control, safeguarding people from the risk of abuse and the governance arrangements at the service.

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 of safe 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 remained requires improvement. 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.

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.

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.

Following our inspection the provider made improvements to their infection prevention and control procedures, the processes for protecting people from abuse and the systems to monitor the quality and safety of the service.

Enforcement

We have identified breaches in relation to managing risks to people’s safety, protecting people from abuse and monitoring the quality and safety of the service at this inspection.

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 work alongside the provider and local authority to monitor progress.