The Old Vicarage is a Georgian property near Ironville with a large secure garden area. People live in three separate buildings, known as the main house, the bungalow and The Stables (a modern stable conversion). There is a secure courtyard and garden space shared by all three buildings. The Old Vicarage is registered to provide accommodation for nine people who require nursing or personal care. The service does not provide nursing care. At the time of our inspection there were eight people living there. Four people were living in the main house, and three people lived in the bungalow. One person lived in The Stables. The Old Vicarage supports younger people who have diagnoses of moderate to severe learning disabilities and other complex healthcare needs. We previously carried out a comprehensive inspection of the service in February 2016, when The Old Vicarage was rated as Good. Following concerns from local authorities and a whistle-blower about the quality of care provided, this comprehensive unannounced inspection was carried out.
People were not kept safe from the risks of avoidable harm and abuse. People were not kept safe from the risks associated with unsafe physical restraint. Risks associated with the environment were not reduced and mitigated. Information about people’s care needs in an emergency were not up to date or easily accessible. Medicines were not stored securely.
Staffing levels were not consistently sufficient to ensure people received the care and support they were assessed as needing. The provider did not always undertake pre-employment checks to ensure prospective staff were suitable to work with people receiving care.
People were at risk of harm because staff did not have training to help them to understand how to effectively support people’s health and care needs. The provider could not assure themselves that staff had training and skills to meet people’s needs.
People were at risk of being physically restrained when this was not proportionate or in their best interests. There were no effective safeguards in place to ensure physical interventions used were minimal and reasonable. The provider was not working in accordance with the Mental Capacity Act 2005, and people were at risk of care that was overly restrictive and unlawful.
People’s health action plans were not kept updated with information about health appointments and outcomes. There was a risk that essential information would be lost and not shared appropriately, and people would not receive the healthcare they needed. The provider could not demonstrate that people were supported to maintain their health.
Staff spoke in a caring way about the people they supported, but this was not consistently reflected in their actions or language. People were not consistently supported to participate in designing or reviewing their care. People’s confidential care records were not kept securely.
People did not receive personalised care that was responsive to their needs, preferences and aspirations. People were not supported to communicate effectively. There was no effective system in place for people or relatives to share their concerns and contribute to improving the service.
The service was not managed well. There were failures to meet the fundamental standards in relation to safe care practices and staff recruitment processes, insufficient staffing levels and staff training, planning and delivery of people’s care, and following relevant legislation. Systems and processes in place did not identify learning from incidents and mitigate any future risks to people. Quality assurance processes to ensure people’s care and the service environment were safe were not effective. CQC registration requirements were not being met.
The Old Vicarage had a registered manager, and they were present during our inspection. 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.
We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to these concerns found during inspection is added to reports after any representations and appeals have been concluded.
We found one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.