The Vicarage 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 Vicarage is a large Victorian property that has been extended and adapted into a care home for older people. Bedrooms are located on the ground and first floor and storage and the laundry are located in the basement. There is one lounge and two dining rooms. The Vicarage is registered to provide accommodation for up to 30 older people and is situated in the Audenshaw area of Tameside.

At the time of our inspection there were 28 people living at the Vicarage.

This inspection was carried out over two days between 21and 22 May 2018. Our initial visit on 21 May was unannounced.

We last inspected The Vicarage in January 2017. At that inspection we rated the service as good in the caring domain and requires improvement in safe, effective, responsive and well-led. The overall rating for the service was requires improvement. At that inspection we found regulatory breaches of three Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These previous breaches related to the safe management of medicines, the safe management of premises and equipment, staff training and induction, and ineffective governance of the service. Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve the key questions to at least good.

The service had a registered manager in place. 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 this inspection we identified repeated breaches of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also identified breaches of three further regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The total of six breaches related to a lack of person-centred care, poor infection control, keeping people safe, staff numbers, medicines, dignity and respect, safety of the building and equipment, incorrect diets, complaints, staff training and induction and inadequate governance of the home. You can see what action we told the provider to take at the back of the full version of the report.

We identified three breaches of the Care Quality Commission (Registration) Regulations 2009. These were a failure to notify us of death of service users and other incidents at the home and a failure to display previous inspection ratings.

We made one recommendation to ensure the home’s décor is more dementia friendly.

The home did not provide person-centred care and people were not involved in planning their care. People did not have keys to their rooms and a ‘bathing schedule’ was in place. Activities were only provided twice per week and people were not offered any personalised activities.

We found poor cleanliness and infection control practices throughout the inspection. The home was malodorous and the laundry system used at the home posed a potential risk to people through cross contamination.

Accidents and incidents were recorded; however, no action had been taken to analyse trends or mitigate further risk to people.

Up-to-date risk assessments were not always in place for people or the building.

Medicines were not always stored or managed safely. Staff had not had their competencies checked to ensure medicines were administered safely.

People were not always treated with dignity and respect.

Staff did not always use safe moving and handling techniques when assisting people.

People’s movement aro

This inspection took place on 26 October and was unannounced.

Our last inspection to the service took place on 30 September 2014 and the registered provider was compliant with the regulations in force at that time.

The Vicarage is a large Victorian property that has been extended and adapted into a care home for older people. The Vicarage is registered to provide accommodation for up to 30 people. There is wheelchair access to the service and parking is available at the front of the property. At the time of our inspection there were 25 people using the service.

The registered provider is required to have a registered manager and the manager in post was registered with the Care Quality Commission (CQC) in 2013. 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 premises required health and safety work completing to ensure that they met the regulations for fire safety. Some areas of the premises were not well maintained and did not maintain standards of hygiene appropriate for the purpose for which they were being used.

The recording, administration and return of medicines was not being managed appropriately in the service. We saw no evidence that people did not receive their medicines as prescribed, but this was not well recorded.

The registered provider failed to notify the CQC about Deprivation of Liberty Safeguard applications which had been authorised by the supervisory body. We have written to the registered provider about this separately from this report.

We found that the induction and training programme for staff was not robust. People and relatives told us they found the staff to be friendly, helpful and approachable and we observed good interactions between people using the service and staff during our inspection.

Quality assurance and record keeping within the service needed to improve. There was a lack of auditing within the service. We saw evidence that care plans, risk assessments, food/fluid charts and end of life plans were not always accurate or up to date. This meant that staff did not have access to complete and contemporaneous records in respect of each person using the service, which potentially put people at risk of harm.

The environment within the service was comfortable, clean and homely, but it was not particularly designed to be dementia friendly. As 76 percent of people using the service lived with dementia, improvements could be considered regarding the dementia design aspect whenever the service is refurbished or redecorated. We have made a recommendation around this in the report.

People were able to talk to health care professionals about their care and treatment. People could see a GP when they needed to and they received care and treatment when necessary from external health care professionals such as the District Nursing Team or Diabetic Specialists.

People had access to adequate food and drinks and we found that people were assessed for nutritional risk and were seen by the Speech and Language Therapy (SALT) team or a dietician when appropriate. People who spoke with us were satisfied with the quality of the meals.

People were treated with respect and dignity by the staff. People and relatives said staff were caring and they were happy with the care they received and they had been included in planning and agreeing the care provided. People had access to community facilities and most participated in the activities provided in the service.

People and relatives knew how to make a complaint and those who spoke with us were happy with the way any issues they had raised had been dealt with. The registered manager had investigated and responded to the five minor complaints that had been received in

We undertook this inspection visit as a result of information we had received suggesting the staffing levels were inadequate to provide safe care to people. We had also received information that people were being put to bed at night and got up in the morning to suit staff needs rather than personal choice.

The inspection was undertaken by one inspector who visited the home at 06:30 am. We talked to staff and people who used the service. We also looked at records, observed staff interactions with people who used the service and talked with the registered manager.

We considered the evidence collected and addressed the following question, is the service safe?

Below is a summary of what we found. Please read the full report for the evidence supporting our summary.

Is the service Safe?

Staffing was provided at a level which enabled people’s needs to be met.

Staff interactions with people who used the service were seen to be calm and relaxed. People were protected from abuse or poor treatment.

Personal protective equipment (PPE) was provided to minimise the risk of cross infection.

This inspection was to follow up on our previous inspection when we had found that The Vicarage Residential Care Home was not compliant with the standard relating to keeping accurate records securely.

We did not speak with people living in the home about this standard. We spoke with the provider who is also the registered manager and with other staff.

We found that in all of the areas that we identified on our last visit the provider had acted to remedy the problems.

We therefore found that the service was now compliant with this standard.

We found that the majority of people living in The Vicarage were not able to communicate effectively due to dementia or similar conditions. Those who were able to express themselves indicated that they were satisfied with the care they were receiving. We observed the care offered by staff and found a warm and caring atmosphere within the home.

We spoke with four sets of visitors. All of them visited their relative in the home on a regular basis. They all spoke highly of the quality of care which their relative was receiving. One said: "We're very happy. He's well looked after. He's safe. Staff are caring." Another said: "All the staff are good. They really do look after her."

We found that the variety and quality of food provided was high. One person said: "It's good the food. I can't fault it." Another said they had just had a "good lunch". One relative stated that if a person wanted another helping it was always provided.

We found that the home was meeting the outcomes we looked at in this inspection, except for the outcome relating to record keeping, where we found inadequate systems and determined that action was needed.

We looked at the care people received and found that they were well cared for and consistently supported with their needs. We observed that people were supported in a dignified and timely way by the staff. We also saw that staff were courteous and positively engaged with individuals.

We looked at the care records and found that assessments and care plans were in place. We saw that they were regularly reviewed to make sure that people’s needs were met.

We toured the communal areas and some of the bedrooms and found that all areas were comfortable and well furbished.

We also looked at staff support and training. We saw the staff records and found the staff were well trained and there were good systems in place to ensure they were well supported in their work.

We found that the provider had effective systems in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

People told us they were happy with the service they received at The Vicarage. They told us that staff were kind and would do anything to help them. Comments from people included:

"The day staff are lovely, I can tell them if I have a problem and they do their best to help me."

"I think it is lovely and peaceful here. There are people to talk to and the staff are very good. I know I can tell them if I was worried about anything."

"As far as I'm concerned its excellent here and I have a lovely room, it's just like a flat. Most of the staff are friendly especially the day staff. I don't have much to do with the night staff."