About the service:

The Old Vicarage Care Home provides personal care and support for up to 35 older people. At the time of the inspection 28 people were receiving support with personal care.

People’s experience of using this service:

Medicines were not managed safely which placed people at risk of harm.

People told us they received help from staff when they needed this and staff came quickly to support them.

People were enabled to express their views on their experiences of receiving care and support. People were encouraged to share their experiences of living at the home with staff and the management team.

Safe recruitment procedures were used to help ensure prospective employees were of suitable character to work at the home.

People told us they felt safe with staff and staff told us they would report concerns of abuse or avoidable harm to the manager and local safeguarding authorities to protect people.

Rating at last inspection:

At the last inspection the service was rated requires improvement (published 18 January 2019).

The service has been rated requires improvement for the last five consecutive inspections.

Why we inspected:

We carried out this focused inspection to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection in October 2018 had been taken.

Enforcement:

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 have asked the registered provider for an action plan to show how they will make and sustain improvements.

We will liaise with the local authority and clinical commission group to ensure all required actions are completed to ensure the health and welfare of people who live at the home.

The next scheduled inspection will be in keeping with the overall rating. We will continue to monitor information we receive from and about the service. We may inspect sooner if we receive concerning information about the service.

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

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 manage

We carried out an unannounced comprehensive inspection of this service on 19, 26 and 27 April 2017. After that inspection, we received information of concern in relation to lack of confidence in management; poor falls management, risk assessment and care recordkeeping; inadequate personal care; lack of effective infection control measures; insufficient staffing levels and poor training provision; lack of nutritional support; and people’s preferences not being met. As a result, we undertook a focused inspection to look into those concerns. However, we decided to extend this to a comprehensive inspection because we found additional concerns during this focused inspection.

The Old Vicarage provides personal care for a maximum of 35 older people who may be living with dementia or a physical disability. The home is situated in a residential area of Freckleton village close to local shops and other amenities. There is full lift access to both floors to assist people with reduced mobility. Communal areas consist of a lounge, dining room and rear garden.

A registered manager was not in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 last inspection on 19, 26 and 27 April 2017, we rated the service as Requires Improvement. This was because breaches of legal requirements were found. The provider failed to ensure systems were in place to assess, monitor and improve the quality and safety of the service. These had not been established and operated effectively and records were not consistently accurate.

We additionally made recommendations for the provider to further improve people’s safety and welfare. These concerned systems to enhance safe medication recordkeeping, falls management, general risk assessments and staff training. We also recommended the provider developed their person-centred approach to care planning.

During this inspection, we found the provider continued to fail to maintain good governance and oversight at the home. Audits we looked at did not pick up the concerns we found during our inspection. Care records and monitoring systems were poorly organised and the management team failed to store them securely. We noted gaps in care records and people’s documented preferences were not consistently followed. We reviewed the management team’s staffing tool and found it did not always meet the requirements of people’s complex needs. Although people’s feedback was sought, the provider had not always followed identified concerns through. This is a breach of Regulation 17 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Good governance.

You can see what action we told the provider to take at the back of the full version of the report.

Staff told us the management team were supportive in their work and personal issues. They felt a part of the drive to improve the home and were keen about developing the Old Vicarage further.

We found the provider had improved falls assessment and management processes. For example, they introduced new systems, which covered an outline of the accident, body mapping of any injuries and ongoing observation charts. Falls risk assessments were implemented to identify hazards and actions to reduce them. We noted one person’s fall was not properly documented and the management team assured us they would address this through staff training.

You can see what action we told the provider to take at the back of the full version of the report.

We noted staffing levels and skill mixes were insufficient and the deployment of employees was not always effective. For example, people’s meals were disrupted because there were not enough personnel to support them. We observed they ha

This comprehensive inspection was carried out on the 19, 26, 27 April 2017. The first day of the inspection was unannounced.

The Old Vicarage is a residential care home accommodating a maximum of 31 older people including people who are 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 the time of the inspection there was no manager in place who was registered with the Care Quality Commission. There was a manager in place who was in the process of applying to become the registered manager. 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 last inspected The Old Vicarage Care Home in October 2015. We identified a breach in Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Safe care and treatment.) We found medicines were not managed safely.

During this inspection carried out in April 2017 we found improvements had been made and medicines were managed safely. We have made a recommendation regarding best practice and the management of medicines.

Documentation we viewed was not always complete or up to date. We found risks to people were identified, however the action required to maintain people’s safety was not always recorded. In addition, we found care records were not always completed when care was delivered.

This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Good Governance.)

We looked at the auditing systems in place to identify shortfalls at the home and drive improvement. We found checks on medicines and the environment were carried out. We were informed that audits on care records were not currently carried out and during the inspection visit we noted improvements were required within care records. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Good Governance.)

We viewed the accident and incident audit and noted it had not identified if referrals to the local safeguarding authorities were required. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Good Governance.)

We observed care and support being provided in a safe way and people told us they felt safe. One person told us, “I’m being taken care of and I have someone come to my room every day.”

Staff were able to explain the actions to take if they were concerned someone was at risk of harm or abuse. People who lived at the home told us they felt safe. We found a number of falls had occurred at the home and they had not been referred to the local safeguarding authorities. We have made a recommendation regarding this.

We checked to see if people without mental capacity were lawfully deprived of their liberty if this was necessary. We found appropriate applications to deprive people of their liberty were made to the local authorities as required.

We reviewed staff files and found there were processes that ensured staff were suitably recruited. Staff we spoke with confirmed checks had been carried out prior to starting work at the home.

Staff told us they met with the manager on an individual basis to discuss their performance. Staff were complimentary of the training provided and told us further training was being arranged to ensure their skills remained up to date.

We discussed staffing with people who lived at the home. People and their relatives told us staff were often ‘busy.’ During the inspection we saw staff were patient and kind with people who lived at the home. We saw people were supported at a pace

The Old Vicarage is a residential care home accommodating a maximum of 31 older people including older people who live with dementia. Accommodation is provided on two floors. A passenger lift is available. There are several communal lounges, a separate dining area and an enclosed garden.

There were 24 people using the service at the time of the inspection.

At the time of the inspection the service did not have a registered manager in place. However, a new manager had been recruited and intended to apply for registration with the 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.

The last inspection of the service took place on 8 & 13 October 2015. During that inspection we found the service was in breach of a number of regulations relating to person centred care, consent, safe care and treatment, safeguarding people from abuse and improper treatment, meeting nutritional needs, good governance, staffing and recruitment.

We found during this inspection that a number of significant improvements had been made. However, we identified a number of areas where further improvements were required and we still had outstanding concerns about medicines management.

The overall management of medicines was much improved. We found that there were clear medicines records in place for each person who used the service, which included all the required information. We also noted that medicines were now stored in a safe and appropriate manner. However, during the inspection we found that some errors had occurred, which resulted in two people receiving their medicines at the wrong times and another person not receiving some medicine for a period of four days, because the stock had run out. This meant that people did not always receive their medicines as prescribed.

At the last inspection of the service carried out in October 2015, we found that risks to people’s safety and welfare were not always assessed or managed well. We found during this inspection that procedures for risk assessment and care planning were much improved and care workers had a good understanding of the measures required to promote people’s safety. However, we found that people’s individual risk management plans and PEEPS (Personal Emergency Evacuation Plans) could have contained more individualised guidance to further support their safe care and treatment. We made a recommendation about this.

During the last inspection in October 2015, we found that the provider did not always ensure there were adequate numbers of suitably qualified and competent staff on duty to meet people’s needs safely. During this inspection we found there had been much improvement to staff training and that staffing levels were determined in line with the needs of people who used the service. However, some people we spoke with told us they felt they had to wait for assistance at times and we also noted that staff were not always present in some communal areas of the home, such as the lounge. We made a recommendation that the manner in which staff are deployed across the service is reviewed.

We found recruitment procedures were more robust. The provider was able to demonstrate that due consideration was given as to whether applicants were suitably qualified to carry out the role they were applying for and all applicants were subject to a range of background checks to help ensure they were of suitable character. However, further potential improvements to the recruitment processes were needed.

Everyone we spoke with including people who used the service, their families and community professionals felt the home had been much cleaner since the last inspection. People were very satisfied with the standards of

During the inspection we had the opportunity to observe residents and staff providing their support. Residents appeared relaxed and comfortable in their surroundings and seemed to get along well with staff. Some residents were taking part in activities in the communal lounge and others were having quiet time in their rooms, or one of the smaller lounges.

We spoke with three residents who told us they were happy living at The Old Vicarage and said their needs were well met. One resident commented, ‘’ I have no complaints. Everyone is very good to me here.’’ Another told us, ‘’ I am more than happy. I am very well looked after. They (the staff) are all very good to me.’’

We carried out this inspection to ensure that improvements had been made in the areas of infection control, medication management and quality assurance. The manager was able to describe actions she had taken to address the areas of none compliance we identified at our previous inspection. In addition, evidence was available to demonstrate that the improvements had been embedded into the working practices of the service, to help ensure they were maintained.

This inspection was carried out to follow up a warning notice that we issued to the provider in September 2013. The warning notice was as a result of our judgement that the provider did not have adequate arrangements in place to protect people from the risk of abuse.

During the inspection, we examined the actions that had been taken by the provider to comply with the warning notice and assessed the improvements they had made.

We found that the provider had met the requirements of the warning notice. We will be carrying out further work with the service in the future, to ensure that they maintain the improvements made.

During this inspection we were able to speak with eight people who lived at the home. The feedback we received from people was all very positive. People spoke highly of staff and the manager and expressed satisfaction with the care they received. Comments included;

‘’They are brilliant! All great!’’

‘’They look after us so well. I could not ask for anything more!’’

‘’This place is brilliant. They are smashing!’’

‘’I can’t fault it here at all.’’

We assessed a number of areas during this inspection, including how the care and welfare of people was promoted and how people’s medication was managed. We also looked at the arrangements for safeguarding people from abuse and processes for monitoring quality. We found some examples of very good practice. However, we also identified some concerns, particularly in relation to arrangements for safeguarding people from abuse. We have asked the provider to take action to address our concerns and will be carrying out further work to ensure this has been completed.

People who used the service told us they were involved in planning and reviewing their care and said they were listened to. A resident said, “I have a written care plan. The deputy asks me every day if I need anything.”

A relative said, “I am fully involved in decisions about mum’s care.”

People were given appropriate and relevant information to enable them to understand their care and support options and to make informed decisions. A relative told us about a newsletter provided by the manager. They said, “The last newsletter told us about end of life care and important things like the Liverpool Care Pathway. This helps us to make decisions about the care for our relative.”

We found that individual care plans and risk assessments were in place and that individual needs were being met. A relative told us, “My mum has been nursed in bed for a while. She has never had any pressure sores because they use special boots and a mattress and they make sure she is moved every two hours. They also record everything she drinks so that she doesn’t get dehydrated.”

We found that staff were trained and supported to provide safe and effective care to residents.

There was a suitable and sufficient range of equipment in place to safely meet people’s needs and promote their independence.

We spoke with a number of residents during our visit to the home. People we spoke with were very complimentary about the service provided and spoke highly of staff and the manager.

One resident commented ‘’They cannot do enough for you here, nothing is too much trouble.’’ Another person said ‘’This is the best care home there is and that’s the truth!’’

People said that carers treated them with kindness and everyone we spoke with felt that their privacy and dignity was respected. People said they were happy with their care and the way it was provided.

During our visit we saw that some residents were busy taking part in various activities. One resident was having a game of pool, another doing some craft work whilst two people were escorted to have a walk to their local park.

Carers were seen spending time with residents on a one to one basis, chatting quietly. Carers appeared to have plenty of time to spend with residents and the atmosphere was relaxed.

Many of the people we spoke with commented on the activities provided and told us there were lots of ways to spend their time both inside and outside the home. One resident said ‘’We go to a tea dance in Lytham quite regularly, I really enjoy that, especially the music.’’ Another resident said ‘’We go to nice places for lunch, it’s nice to wear a fancy dress and go out.’

During the afternoon a snacks trolley was taken around the home which provided several options for people to choose from for their snacks and drinks. Residents appeared to enjoy this and we saw that carers had plenty of time to assist those who needed it.

We also noted that the home received many visitors throughout the day. Visitors appeared to be welcomed and clearly got along well with staff and the manager. One set of visitors we spoke with told us they were extremely pleased with their relative’s care. They told us ‘’This is the sort of place where they go that extra mile and nothing ever seems too much trouble.’’

The Old Vicarage is a residential care home accommodating a maximum of 31 older people including older people who live with dementia. Accommodation is provided on two floors. A passenger lift is available. There are several communal lounges, a separate dining area and an enclosed garden. The last inspection of the service took place on 5th December 2013. During that inspection the service was found to be compliant with all the area we assessed.

The inspection took place on the 8th and 13th October 2015 and was unannounced.

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 registered manager was not available during the inspection due to a period of extended leave. There were temporary management arrangements in place at the time of the inspection.

We found that risks to the health, safety and wellbeing of people who used the service were not consistently well managed. Staff were not always aware of the risks to people they were supporting. In some cases, we found risks had been assessed but information was out of date and did not reflect people’s current circumstances.

The support of people who did not have capacity to consent to some aspects of their care was inconsistent. The service did not always work in accordance with the Mental Capacity Act or Deprivation of Liberty Safeguards, which meant people’s rights were not always protected.

Processes for planning people’s care required improvement to ensure that people were provided with care that met their individual needs and was in line with their personal wishes and preferences.

Arrangements for the safe management of people’s medicines were not effective. This meant that people were not protected against the risks of unsafe medicines practice.

Infection control practices required improvement to ensure that people who used the service were protected against the risks of infection and were provided with clean, comfortable accommodation.

Recruitment practices were inconsistent and pre-employment checks, required to protect people who used the service, were not always completed. Not all staff felt they had been provided with adequate training and support to carry out the duties expected of them. The induction of new staff was inconsistent and did not ensure they were fully equipped to carry out their roles.

The processes in place to monitor safety and quality across the service were not being effectively utilised at the time of the inspection. An audit schedule was in place but had not been completed for some time. This meant that some areas in need of improvement had not been identified, for example, medicines management.

We received some positive feedback from people who used the service, their relatives and five community professionals. People spoke highly of carers describing them as patient and helpful. People told us they found staff and the acting manager to be supportive and approachable.

People told us they knew how to raise concerns and that they would feel comfortable in doing so.

We saw there were processes in place to determine staffing levels and ensure they were in line with the needs of people who used the service. The acting manager was able to give us examples of increases in staffing levels, which had been arranged in response to changes in people’s needs.

We found the service to be in breach of several regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to safe care and treatment including medicines management, obtaining vaild consent, person centred care, safeguarding, staff recruitment and governance.

You can see what action we have asked the provider to take at the end of this report.