The Old Vicarage

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We were not assured that people living in the service had their needs assessed regularly. People were not involved in decision making and choices about their lives. Care plans were generic and lacked person-centred information. We found 2 breaches of the legal regulations, these were, person-centred care and need for consent. The provider did not have systems in place to monitor feedback from people, staff and relatives. Records were not clear and completed fully when health professionals visited the home. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. Mental capacity assessments did not meet the mental capacity act requirements. They did not evidence that information had been offered in an appropriate format for the individual and that more than one attempt had been made to support people to decide themselves.

This service scored 25 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives were not involved in care planning. People’s views had not been sought and surveys had not been offered to relative ad people to gain their views.

Staff told us that online training was not enough to be able to support peoples individual health needs. We asked staff what person centred care meant to them, one person said “We do what the individual wants, maintaining independence and how they want to be supported”.

The provider did not have systems in place to review and monitor feedback from people and relatives. Care plans were generic, this meant that peoples needs, preferences and wishes may not be met.

We received mixed views from people about the food provided. One person said ““I’m quite a fussy eater. They make me omelettes.” Another person said “The food could be better, I chose fish pie today and it was mostly mash with 3 small pieces of fish in it. Lunch comes around 12:15pm to 12:30pm and then you can wait for up to an hour for dessert. Surely most want to finish their meals in a reasonable time frame." One person was at risk of falls, they required specialist seating to reduce this risk, referrals were made but they were not followed up. Therefore the person was left at risk with their needs not being met.

One staff member said “When we are short staffed, people get up later, this pushes things back and then people are low on fluids. Not everything gets documented on the PCS system as we have not received training.”

The PCS system generated fluid intake totals for people, however the provider had put no measures in place to review or monitor these totals, this left people not receiving adequate fluids. At the time of the assessment all people on fluid watch were given a daily target of 1500mls, however there was no documentation to explain how this target had been agreed. Protocols were not in place to support staff if fluid intakes were not met.

People were supported with visits from external professionals arranged by staff. One person said “Yes. The chiropodist cuts my nails and I’ve seen Specsavers here and have got new glasses.” However another person said “I did ask about my glasses a few weeks ago. I need new glasses and they said they’d sort it out, but I haven’t heard anything.”

Staff were aware of how to make contact with external professionals and services but they were unable to tell us about individuals pathways and how people were being supported with this.

Health care professionals who visited the home told us “Prior to reviewing patients, the manager informed me of some concerns they had been having with a patient and asked me for advice and to see if I was able to discuss the issue with the patient. After reviewing the patient, I updated the manager of my findings. The senior carer was able to provide me with the information I needed about the patient, including recent weight, mobility status, continence status and if they had any concerns with pressure areas.’’

Referrals were made to district nurses where concerns were identified, however other referrals were not followed up appropriately and in a timely manner, this increased the risk further to people.

Relatives and people were not involved in care plan reviews as they wished to be. One relative told us they requested a keyworker meeting, once arrange they attended. The relative requested and set the goal for their family member to be supported to walk around the home more often. The care plan was not revised with this information, the person was not supported with this and has now lost the ability to weight bear and walk.

Staff enquired with GP to support a person with a health issue, GP advised to take observations. The service is unable to evidence these were completed therefore further health concerns may be increased.

Records were not clear and lacked detail around health professionals visiting the home, numerous gaps were found in the records and outcomes were not documented from visits.

Relatives and people have not been included in care plan reviews or offered surveys for feedback. One relative said “We are categorically not involved with care plans, we have been promised 3 times with (manager) and emailed (Nominated Individual) to gain access to the care plan, we have just gained access today and there are inaccuracies.”

Staff were unable to tell us about individuals pathways and how people were being supported with this.

Records were not always completed with end to end information, therefore systems were not effective in collating accurate information required for external health professionals. The provider did not carry out their own analysis of these records.

People told us that staff are kind and caring and respectful. One person said “They look after me”. People were not supported to be involved in their assessments around mental capacity.

Staff were observed to be gaining consent from people when support eating at lunchtime. Staff told us they had received training in the Mental Capacity Act 2005 (MCA 2005). One staff member said “I feel confident in applying it and make sure I promote independence”. However we found mental capacity assessments to contain conflicting information around their abilities. We also found that assessments were completed within few minute of each other.

Mental capacity assessments did not meet the mental capacity act requirements. They did not evidence that information had been offered in an appropriate format for the individual and that more than one attempt had been made to support people to decide themselves. Relatives and people had not been included in this process. We found that mental capacity assessments have been completed at inappropriate times, that they had been completed within a few minutes of each other. For example, mental capacity assessments for ‘medicines administration’, ‘living at The Old Vicarage’ and ‘having routine checks’ were all completed in 13 minutes.