About the service:

The Old Vicarage is a ‘care home for 22 male adults with acquired or traumatic brain injury, or other neurological conditions. 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 is one of six adult social care locations at Glenside which also has a hospital that is registered separately with CQC. Glenside Manor Healthcare Services is not close to facilities and people may find community links difficult to maintain.

Each of the services is registered with CQC separately. This means each service has its own inspection report. The ratings for each service may be different because of the specific needs of the people living in each service. While each of the services are registered separately some of the systems are managed centrally for example maintenance, systems to manage and review accidents and incidents and the systems for ordering and managing medicines. Speech and Language, psychology physiotherapy and occupational staff cover the whole site. Facilities such as the hydrotherapy pool are shared across the whole site.

One adult social care location (Pembroke Lodge) is currently closed as there were ongoing and continual issue with the provision of heating and hot water.

The hospital is also currently closed due to flood caused by a major water leak. People from the hospital were transferred at short notice to some of the adult Social care locations. Works to repair the fabric of the hospital building are currently underway. The Old Vicarage was temporarily accommodating four people from the hospital. We reviewed aspects of these peoples care and support in line with the expectations of their inpatient status.

The provider notified us of the temporary arrangements for hospital patients while refurbishments take place. However, The Old Vicarage will not be correctly registered with CQC if these arrangements become long term. The provider will need to submit applications to CQC to register appropriately if the closure of the hospital continues.

People’s experience of using this service:

The service was rated Requires Improvement at the comprehensive inspection dated June 2018. The rating for the focus inspection undertaken on the 7 November 2019 remained the same.

• People were placed at risk from poor management. We found systemic overarching poor management systems and improvements were not prioritised. Quality assurance systems were in place but the improvement plans were not adequate. There had been sudden and persistent changes of senior managers. A lack of regulatory response from the provider. Poor recruitment procedures, lack of investment with equipment and maintenance of the property. The morale of the staff was low and they were reluctant to give feedback because of fear of reprisals.

• Areas of the home were not clean and there were repairs outstanding. The staff told us the response from the maintenance team was not prompt.

• Care plans and risk assessments were in place on how to manage risk. The staff knew people’s individual risks and the action needed to minimise the risk. There were people whose brain injury had triggered changes in their behaviour. Care plans gave detailed guidance on how staff were to manage situations when people used extreme behaviours to express their emotions.

• Protocols on the administration of medicines prescribed to be taken “when required” were not detailed on how staff were to identify signs of anxiety. Risk assessments did not give staff guidance on the preventative measures to take for people that smoked.

• Medicine records were signed by staff to show they had administered medicines. A record of medicines no longer required was maintained which the supplying pharmacist signed to evidence receipt of the medicines for disposal.

• The staff we

We undertook an unannounced focused inspection of Old Vicarage on 7 November 2018. After the comprehensive inspection dated 6 and 7 June 2018 we received concerns in relation to staff not having appropriate checks before starting employment, language barriers of staff, poor working and living conditions for staff working as agency staff. Concerns were also raised about the competency of staff undertaking maintenance checks and lack of equipment across the Glenside Manor site. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those concerns. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Old Vicarage on our website at www.cqc.org.uk.

The team inspected the service against two of the five questions we ask about services: is the service well led and safe. This is because the service was not meeting some legal requirements.

No risks, concerns or significant improvement were identified in the remaining Effective, Caring and Responsive through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

The Old Vicarage is a care home for 22 male adult’s with acquired or traumatic brain injury, or other neurological conditions. 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 is one of six adult social care locations at Glenside Manor which also has a hospital that is registered separately with CQC. Glenside Manor Healthcare Services is not close to facilities and people may find community links difficult to maintain. Each of the services is registered with CQC separately. This means each service has its own inspection report. The ratings for each service may be different because of the specific needs of the people living in each service. While each of the services are registered separately some of the systems are managed centrally for example maintenance, systems to manage and review accidents and incidents and the systems for ordering and managing medicines. Physiotherapy and occupational staff cover the whole site. Facilities such as the hydrotherapy pool are shared across the whole site.

A registered manager was in post. 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.

At the previous inspection dated June 2018 we found a breach of Regulation 12 – safe care and treatment. We asked the provider following the inspection to tell us how they were going to meet this regulation. The provider failed to report on the actions to meet Health and Social Care Act 2008, its associated regulations, or any other relevant legislation. At this focus inspection we found other parts of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were not being met.

The CQC formally requested under Section 64 of the Health and Social Care Act 2008 to be provided with specified information and documentation by 16 November 2018. We received some of the information requested but not all.

Quality assurance systems were inadequate. Audits were not robust and did not provide an accurate assessment of the quality of care delivered. Action plans were not developed to drive improvements. The CQC was not notified of accidents and incidents reportable under the Care Quality Commission (Registration) Regulations 2009: Regulation 18.

People

At the inspection dated 14, 15 and 20 June 2017 we rated this service as Requires Improvement. We found a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider wrote telling us the actions they were taking to make improvements. At this inspection we found improvements were made to meet Regulations 9.

This inspection took place on the 6 and 7 June 2018 and was unannounced on the 6 June 2018. The operations director and staff were aware of the visit that took place on the 7 June 2018.

The Old Vicarage is a ‘care home for 22 male adult’s with acquired or traumatic brain injury, or other neurological conditions. 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.

A manager was in post and was in the process of applying to register as manager with CQC. ‘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 raised concerns with the operations director about the number of locations the proposed manager will have and how a management presence will be maintained. The operations director told us a deputy manager’s post was introduced and they will provide day to day presence at the home. The deputy manager told us the current manager maintains good lines of communication between the home and the operations director.

There were systems in place to assess, monitor and mitigate risks relating to the health, safety and welfare of people who used the service. Documents were developed from the audits undertaken which showed how the provider was meeting their own targets. While audits were undertaken to assess how standards of care were being met the findings from this inspection had identified other areas for improvement. However, there were areas identified at this inspection that had not been prioritised for improving. For example, risk assessments action plans, care plans lacked guidance to staff and following incidents and accidents a review of needs was not triggered

Some risks were assessed but lacked action plans on how to minimise the risk. Individual risks included people with a history of falls, mobility needs, and malnutrition. Moving and handling risk assessments were detailed on each movement, the aids and equipment used and the number of staff needed. The staff we spoke with had attended training in moving and handling.

There were people who at times placed themselves and other at risk of harm. The management of behaviours policies were not always followed. The appendices attached on developing behaviour plans were not used. Members of staff described how they managed these situations but guidance was not detailed on how staff they were to manage these levels of anxiety. Information of aggression was reported in the daily notes but senior staff were not always aware of incidents. Analysis of behaviour charts have no impact on devising behaviour management plans

Incidents of aggression were not analysed for those people that expressed their anxiety through behaviours that were difficult to manage. A review of the risk assessment was not triggered following incidents. There was little evidence of learning from incidents and staff may take aggression towards them as usual during the working day instead of devising plans to prevent situations from escalating. Without specific guidance for reference the actions of the staff were open to their interpretations as the same staff were not on duty each day. This meant without detailed guidance a consistent approach was not always possible.

The rota showed ther

This inspection took place on the on the 14, 15 and 20 June 2017 and is part of the Glenside Manor Healthcare Services Limited. This was the first inspection for The Old Vicarage. At this location 22 male adults can be accommodated with acquired or traumatic brain injury, or other neurological conditions. At the time of the inspection there were 18 people living at the service.

A registered manager was in post and had been recently employed. ‘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.’

The people we spoke with made positive comments about the care delivered by the staff. They said they felt safe living at the home, the food was good and there were choices of meals at mealtimes. People attended residents meetings where their views about the service were gained. They told us their healthcare needs were met and they had access to internal healthcare professionals. People told us how verbal and aggressive behaviours were managed by the staff.

The staff said they attended training that ensured they had the skills and knowledge needed to meet people’s needs. However, staff showed a lack of insight into people’s needs and how to develop relationships with people living with dementia. We noted staff used outdated language when they discussed people and in the recording of people’s needs. Comments from staff about the importance of developing relationships were not always person centred. Staff did not have an understanding of the person and what was individual about them. While training was available to staff on person centred care and to meet the needs of people living with dementia not all staff had taken the opportunity to develop their skills and knowledge in this area.

Care plans were variable and were not always person centred. People were not involved in the development of their care plans and did not participate in their review meetings. Behaviour management plans were in place and the quality of the information was variable. Staff recorded incidents of aggression on Patient Observation (OS) charts which showed behaviour management plans were not consistently followed. There was no evidence that the charts had been analysed and the care plan reviewed following an incident. We were shown the charts to be introduced and will provide more detailed information for staff to identify triggers. We were told the new formats will allow for analysis of frequent behaviours.

There were systems in place to assess, monitor and mitigate risks relating to the health, safety and welfare of people who used the service. Documents were developed from the audits undertaken which showed how the provider were meeting their own targets and identified business development plans with areas for improvements. While audits were undertaken to assess how standards of care were being met the findings from this inspection had identified other areas for improvement. We found the care plan audit had not identified the terminology used by staff to document events and that care plans were not person centred.

We found there were areas of the home that were not maintained to an acceptable hygiene standard. We found there were repairs needed in bedroom and lift. Link infection control staff had identified shortfalls in hygiene standards. However the Health and Safety audit had not identified the same areas of poor hygiene and in need for improvement.

Members of staff attended training in safeguarding of vulnerable adults from abuse. The staff we spoke with knew the types of abuse and the actions they must take for allegations of abuse.

Some risks were assessed and staff knew the actions they must take to minimise the risk to the person. Risk assessments were in place