The Old Vicarage

Updated 23 August 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.

This was a targeted inspection to check whether the provider had met the requirements of the Warning Notice in relation to Regulations 13(Safeguarding) and 17(Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Inspection team

This inspection was carried out by 2 inspectors.

Service and service type

The Old Vicarage Care Home is a ‘care home’. People in care homes receive accommodation, nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Old Vicarage Care Home 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 manager in post, whose registered manager application was granted approval following this inspection.

Notice of inspection

This inspection was unannounced.

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

We spoke with 3 people who used the service and 8 members of staff. This included 1 senior and 3 care staff; a cook, a cleaner, an administrator, a maintenance person. We were assisted by the registered manager and the nominated individual for the provider. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We looked at 7 people’s care plans, 4 people’s medicines records and a range of management records. Such as, safeguarding, staff communication and meeting minutes; policies, care and environmental safety audits; external fire authority and buildings control reports.

After the inspection

We continued to seek information from the provider to validate evidence found and looked at further quality assurance records.

Updated 23 August 2023

About the service

The Old Vicarage is a residential care home providing personal and nursing care for up to 24 people. The service provides support to older people, people with dementia and people with sensory impairment or physical disability. At the time of our inspection there were 23 people using the service.

The home is close to the centre of Bakewell and set in its own grounds. It is one building with a lounge, dining room, conservatory and garden. Twenty-two of the 23 bedrooms have en-suite facilities. Two of the bedrooms are shared accommodating 2 people.

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

People were not always protected from avoidable harm. Actions recorded as taken following safeguarding incidents were found not to be in place and lessons were not learnt so incidents reoccurred. Known risks had not always been mitigated. For example, when a person had suffered a fall, we found no actions had been taken to investigate the cause or to review the person’s needs. Risks identified in the service’s fire safety risk assessment review from March 2022 had not been addressed.

The provider was not consistently working within the principles of the Mental Capacity Act (MCA). We found a locked door which restricted a person’s access to their bedroom. People’s needs had not always been thoroughly assessed prior to them joining the service. Managers did not ensure staff had regular supervisions.

People’s dignity was not always promoted. Relatives told us about issues they had encountered with the laundry and how family members were often found wearing other people’s clothes. We observed staff treating people well with care and kindness. However, we found the provider’s systems and practices did not always support this as not all risks had been mitigated to ensure people were safe.

The provider had not actioned all improvements since our previous inspection. We found ongoing issues with safeguarding and governance systems. We found improvements were in place for supporting people to follow interests; an activities coordinator provided a range of activities. People had the opportunity to participate in activities in a group or on a one to one basis with staff.

The quality assurance and governance arrangements in place were not robust. Systems and processes were not effective in actioning findings from medicine and mealtime audits in a timely manner, so shortfalls identified continued to reoccur.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

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

Rating at last inspection

The last rating for this service was requires improvement (published 16 April 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 12 November 2019. 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. This inspection was carried out to follow up on action we told the provider to take from the last 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.

The overall rating for the service has remained requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive 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 monitor the service and will take further action if needed.

We have identified breaches in relation to safeguarding people from abuse and improper treatment, governance and management oversight at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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. We will continue to monitor information we receive about the service, which will help inform when we next inspect.