The Old Vicarage Care Home was inspected on the 31 October 2018 and the 2nd November 2018 the first day of the inspection was unannounced. The Old Vicarage Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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 Care Home is registered to accommodate a maximum of 35 older people, including older people who may be living with dementia. Accommodation is provided on two floors. A passenger lift is available. There is a communal lounge, a separate dining area and an enclosed garden.
At our last inspection in August 2017 the service was rated as ‘Requires improvement’. We identified a breach of Regulation 12 of the Health and Social Act Care Act 2008 (Regulated Activities) Regulations 2014. We found people could not be assured that medicines were managed safely as staff trained in medicines were not always available and infection control practices did not protect people from the risk and spread of infection. We also noted a breach of Regulation 18 of the Health and Social Act Care Act 2008 (Regulated Activities) Regulations 2014 as staff were not consistently available to meet people’s needs and staff were not always well rested. In addition, we identified a breach of Regulation 17 of the Health and Social Act Care Act 2008 (Regulated Activities) Regulations 2014 as care records were not always completed with up to date information about people’s individual needs. In addition, the audit systems in place had not identified the concerns we had found on inspection and if people raised concerns, these were not always continuously followed through and reviewed. We took regulatory action and served requirement notices for these breaches of legal requirements. We asked the registered provider to take action to make improvements to the areas we identified. The registered provider sent us an action plan which indicated improvements would be completed by November 2017.
At this inspection in October and November 2018 we found medicines were not always managed safely. For example, we found people could not be assured they would receive their medicines in a safe way, or when they needed them. This was a breach of Regulation 12 of the Health and Social Act Care Act 2008 (Regulated Activities) Regulations 2014.
You can see the action we told the provider to take in the full version of the report.
At this inspection in October and November 2018 we found the home had transferred paper care records to a computer based system. Records we viewed showed the care and support people required to meet their needs, however this was sometimes difficult to find. We have made a recommendation regarding this.
Relatives told us they were consulted and involved in their family members care. People we spoke with confirmed they were involved in their care planning if they wished to be and staff treated them kindly and with respect. Documentation we viewed did not consistently record people’s consent or involvement. We have made a recommendation regarding this.
Records related to the food people had eaten and the times they had bathed or showered were not consistently accurate, the manager and regional manager told us they had identified this as an area for improvement. Staff told us the manager discussed this with them to improve the record keeping at the home.
We found improvements had been made to manage the risk and spread of infection. We found the home was visibly clean and checks were carried out to ensure the environment remained hygienic.
We reviewed recruitment records to check staff were safely recruited. Staff told us recruitment checks were carried out prior to starting employment at the home. We noted one recruitment record did not contain a full employment history of a staff member. We discussed this with the regional manager and the manager. The regional manager could demonstrate how the service had changed its working processes to ensure this did not happen again.
Audits carried out by the manager and the regional manager had identified where improvements were required and action plans were in place to ensure steps were taken to improve the service provided.
The service sought feedback from people who lived at the home, relatives and visitors to identify what the home did well and what needed to improve. A notice board within the home displayed the findings of the feedback given and the action the home had taken.
People told us they did not have to wait for help and we timed two call bells which were answered promptly. We observed staff were patient and did not rush people when they supported them. Staff told us they considered the home was busy at times, but they could meet people’s needs promptly. Rotas we viewed showed staff had their rota arranged so they had adequate rest days and did not work excessive days in a row.
At the time of the inspection visit there was a no manager in place who was registered with the Care Quality Commission. 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. There was a manager at the home who was supported by a deputy manager.
Staff told us and we saw documentation which evidenced staff attended training to enable them to maintain and update their skills. We also saw evidence and staff confirmed, they had regular supervision with their line manager to discuss their performance. The manager explained that in the last 12 months, a new staff team had started work at the Old Vicarage Care Home and appraisals were being planned.
People were asked to express their end of life wishes. Documentation was available to plan this area of people’s care if people wanted to share their needs and wishes.
People told us they had access to healthcare professionals and their healthcare needs were met. Documentation we viewed showed people were supported to access further healthcare advice if this was appropriate. People and relatives told us they were happy with the care at support provided at The Old Vicarage Care Home.
People told us they had a choice of meals to choose from and they enjoyed the meals provided. We observed the lunchtime meal. We saw people were given the meal of their choice and were offered more if they requested it. Staff were available to help people if they needed support.
Staff we spoke with knew the needs and wishes of people who lived at the home. Staff spoke fondly of the people they supported and said they cared about them and their wellbeing. Staff were gentle and patient with people who lived at the home and people told us they felt respected and valued.
Staff we spoke with were able to describe the help and support people required to maintain their safety and people who lived at the home told us they felt safe.
Staff told us they were committed to protecting people at the home from abuse and would raise any concerns with the registered provider or the Lancashire Safeguarding Authorities so people were protected.
There was a complaints procedure available at the home. People we spoke with told us they had no complaints, but they if they did these would be raised to the manager or staff.
People told us there were a range of activities provided to take part in if they wished to do so. People told us they were asked if they wanted to take part in activities and if they declined, their wishes were respected. Staff told us they reminded people of the activities available.
The manager demonstrated their understanding of the Mental Capacity Act 2005. People told us they were enabled to make decisions and staff told us they would help people with decision making if this was required. People were supported to have maximum choice and control in their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
Relatives we spoke with told us they were could speak with the manager if they wished to do so and they found the manager approachable.
This is the fifth time the service has been rated Requires Improvement.
Further information is in the detailed findings below.