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.