The Lakes

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.

The Old Vicarage is a residential care home registered to provide accommodation and personal care for up to a maximum 30 older people. At the time of our inspection there were 26 people using the service.

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

People told us they felt comfortable and happy living in the home. Whilst the environment had a satisfactory standard of cleanliness, the provider had failed to implement robust infection prevention and control measures. In both lounges, people who had tested positive for coronavirus were sat alongside people who had tested negative with no social distancing. This put people at high risk of being infected. Lateral flow test devices had been left on the desk in the office, some showing a positive result. In addition, we were not asked for evidence of a negative test or our vaccine status on entry into the home. The registered manager was not able to come to the home due to a period of self-isolation after testing positive for Covid-19. However, they gave the staff immediate instructions to address this situation over the telephone.

The staff confirmed they had completed training on safeguarding vulnerable adults. There was a safeguarding policy and procedure, available to all staff in an electronic format. On looking at records, we noted the provider had carried out an investigation following allegations of abuse; however, they had not reported the allegations to the local authority in line with safeguarding vulnerable adults’ procedures. This meant the local authority had no oversight of the investigation.

Individual risks had been assessed and recorded as part of the electronic care planning system. However, environmental risk assessments had not always been carried out and there was no risk assessment seen to assess and manage an outbreak of coronavirus. The provider sent us a copy of the risk assessment after the inspection.

On a tour of the premises we noted instances of unfinished work. The visitors’ pod had been removed for urgent drainage work; however, we were given assurances this would be reinstated the week after the inspection.

There were sufficient staff deployed to meet people’s needs and we observed caring interactions throughout our visit. On looking at two staff files, we noted there were gaps in the recruitment records. The registered manager told us this issue would be addressed.

People and relatives were complimentary about the leadership and management of the home. Whilst the registered manager and provider sent us evidence of their checks, we found shortfalls during the inspection in several aspects of the service. People were consulted about their daily care; however, they had not been invited to complete a satisfaction survey during 2021 and there was evidence of only one residents’ meeting in September 2021.

The provider and registered manager gave assurances they would make the necessary improvements to the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at the last inspection

The last rating for this service was good (published 9 June 2018).

Why we inspected

We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about infection prevention and control practices and the management of the home. 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. This included checking the provider was meeting COVID-19 vaccination requirements.

We inspected and found there was a concern with infection prevention and control arrangements, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence the provider needs to make improvement. Please see the safe and well-led sections of this full 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.

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 required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the management of infection prevention and control and safeguarding allegations as well as the governance of the service.

You can see what action we have asked the provider to take at the end of this full report.

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 work alongside the provider and 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.

The Old Vicarage is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The Old Vicarage accommodates up to 30 older people. The home is in a quiet residential area in the village of Ireleth and is within walking distance of local shops, the train station and the bus stop. The home is on two floors and there is a stair lift to provide access to the first floor. There is a secure garden area with seating for the people living there. At the time of the inspection there were 25 people living there.

There was a registered manager at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they were satisfied with the way the home was run and the care they received. We were told by one person who lived there, “Any requests I have made, the staff have tried to fulfil.” We observed that staff were kind and considerate and that people who lived in the home were at ease with care staff. Relatives were welcomed in the home and raised no concerns about care with us.

We found staff had been recruited safely and were being trained and supported to carry out their roles. Staff spoken with and records seen confirmed training had been provided to enable them to support people who lived in the home. Systems were in place to give staff the opportunity to discuss their work. Staffing levels were seen to be sufficient to meet the needs of people who lived at the home.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These and individual care plans had been kept under review and updated when necessary to reflect people's changing needs. We found people had access to healthcare professionals and their healthcare needs were met.

Health and safety records were in place and regular checks and servicing had been undertaken. Arrangements were in place for contingency planning for foreseeable emergencies and for moving people in the event of fire. Accidents and incidents were recorded.

People who lived in the home told us they were happy with the variety and choice of meals being provided and that there was always a choice.

People had their medicines managed safely, and received their medicines in a way they chose and preferred. Staff who administered medicines had been trained and assessed as competent to do so.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Systems were in place to deal appropriately with any complaints or concerns raised about the service. The registered provider had put systems in place to monitor the quality of the service and to develop services and make on-going improvements.

Further information is in the detailed findings below.

The records we needed to check did not necessarily relate to people's views. Therefore at this visit we did not ask people to specifically comment upon the outcome we looked at.

During this visit we found that the provider had made the further improvements, that they told us they would, to the home's processes for gaining and recording consent. We found that the records on people's choices about daily matters, long term care preferences and ability to make decisions were being assessed, reviewed and updated. This meant that the information about how people needed or wanted to be supported with making choices, what their individual decisions were and who had legal authority to act for them were made clear.

We could see that information had been gathered about people's preferences at the end of life or if their physical condition changed. We saw where people did not want to discuss this aspect of care that had been respected.

The first of these related to the provider's systems to identify the possibility of people being placed at risk of abuse and to prevent this occurring. During this visit we found that the provider had put systems in place and was now complying with the standard.

The second standard that had not been met related to the arrangements for gaining people's consent about their care and welfare. During this visit we found that the provider had made some improvements to the home's processes for gaining consent and how this was recorded. However there were inconsistencies in the application of the home's processes. In two instances there was a lack of information about the way that people's choices had been discussed and consent obtained.

We were told "Care is not bad at all, good." We did not receive any negative comments about the standard of personal care received, the food served, the cleanliness of the home or the staff approaches and support. People told us the food was "good" and told us that they were always given a choice and asked what they liked and wanted. We saw the food choices on the menu board along with the days planned activities.

People we talked with confirmed that they got up and also went to bed when they wanted and had their meals when and where it suited them. On our walk around the building we saw that the home was clean and tidy and that people had been able to personalise their rooms with their own pictures and personal items.

During our visit we found that people had not always been well supported to be involved with decisions about their care and welfare and that poor internal communication had delayed processes intended to promote people's best interests.