CQC report explained · a nursing home
What the CQC found at The Old Vicarage Nursing Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Risks were not always managed effectively. Medicines records and storage were not always safe, some staff lacked required training, and safeguarding investigations did not always show that lessons had been learned.
- Effective?
- Good
- This question was not rated in this inspection. Inspectors said the service worked within the principles of the Mental Capacity Act, but some staff could not explain best-interest decisions clearly.
- Caring?
- Good
- This question was not rated in this inspection. Some people and relatives said staff were kind and that people felt safe, although feedback about timely support was mixed.
- Responsive?
- Requires improvement
- This question was not rated in this inspection. Inspectors noted that care plans did not always contain accurate or current information about people's needs.
- Well-led?
- Requires improvement
- Quality checks, medicines audits, training records and care plan audits were not always effective. Complaint investigations did not always provide impartiality, analysis or evidence of learning.
What inspectors found, October 2023
The Old Vicarage Nursing Home is Requires Improvement; inspectors found unsafe medicines and risk management, weak oversight and complaints handling, but no evidence of harm.
Inspectors made an unannounced visit on 4 and 5 September 2023. They spoke with people living in the home, relatives, staff and visiting professionals. They also checked care plans, medicines records, staff files, complaints, incidents and management records.
The home was not always managing risks safely. Medicines were not always stored or recorded safely. Some care plans lacked important information, three care staff had not completed mandatory training, and one safeguarding incident was not investigated thoroughly. Infection control was mostly effective, but inspectors found a bad smell and stains and spillages in one area.
The home was not always well-led. Audits did not reliably identify problems with medicines, training or care plans. Complaints and investigations were not always handled impartially or effectively. The home remained rated Requires Improvement, the same overall rating as at the previous inspection published in January 2023.
Staff support
Staff had regular supervision and said they felt supported in their work.
“Staff had regular supervisions and felt supported in their roles.” from the report
Approachable management
People and staff said the manager was approachable and listened to concerns.
“The manager is good, and I would go to them if I ever needed to report anything.” from the report
Infection outbreak planning
Inspectors were assured that the home had arrangements for preventing and managing infection outbreaks, and that staff used protective equipment safely.
“We were assured that the provider was making sure infection outbreaks can be effectively prevented or managed.” from the report
Working with professionals
Staff worked with external professionals, including GPs and social workers, about people's care.
“Staff worked with external professionals which included the GP and social workers.” from the report
Medicines safety
seriousSome medicines were not stored or recorded safely. Records for pain-relief patches and medicine stock counts were incomplete or inaccurate.
“Medicines were not always stored and recorded in a safe way.” from the report
Risk information
seriousSome care plans did not explain clearly how staff should manage risks such as bowel movements or food and fluid intake.
“Care plans did not always contain accurate information about people's risks.” from the report
Staff training
seriousThree care staff were providing care without completing mandatory training, which meant people could be at risk of unsafe care.
“Three members of care staff were delivering care to people without having completed their mandatory training.” from the report
Complaints and investigations
seriousAt least one complaint was handled by the manager it concerned. Investigations did not always show impartial analysis or learning.
“One complaint, which implicated the registered manager, was delegated to the registered manager to respond to the complaint.” from the report
Environment and infection control
minorInspectors found a bad smell in one area, along with stains and spillages on the décor. The home had a plan to replace flooring, repair items and update the décor.
“There was a malodour in 1 area of the care home and stains and spillages on the décor” from the report
- 01What has been done to make sure medicines, including pain-relief patches and topical creams, are stored and recorded safely?
- 02Have all care staff now completed their mandatory training, and how is this checked?
- 03How are care plans being reviewed so they accurately reflect people's current risks and needs?
- 04Who now investigates complaints involving the manager, and how do you show that lessons have been learned?
- 05What action has been completed to improve the area where inspectors found a bad smell, stains and spillages?
This was a focused inspection prompted by concerns about nursing care, medicines, staff training and infection control, and it rated Safe and Well-led only; the other key-question ratings were not given in this report. This explanation was written from the published report of 28 October 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, January 2023
Rated Requires Improvement; inspectors found kind care and enough staff, but gaps in safety records, activities and oversight.
This was an unannounced inspection on 15 November 2022. Inspectors spoke with 11 residents, 3 relatives and 6 staff. They reviewed 10 care plans, medicine records, staff training and how the home was managed.
The home was rated Requires Improvement overall. Safe, Responsive and Well-led were rated Requires Improvement. Effective and Caring were rated Good.
Inspectors found that people did not always receive safe support with prescribed creams, pressure relief, fluids and constipation care. Mealtimes were not always a good experience, activities were limited, and visitors had to book appointments. The home had enough staff, oral medicines were given safely, and people described staff as kind and respectful.
The home was also rated Requires Improvement at the previous inspection in August 2021. Effective and Caring improved from Requires Improvement to Good, but Well-led remained Requires Improvement. The home has been rated Requires Improvement at four consecutive inspections.
Kind and respectful care
People said staff were kind, approachable and treated them with dignity. Inspectors observed sensitive support with personal care.
“People were supported by kind staff who knew them well.” from the report
Enough staff
Inspectors found enough staff to support people in a timely way. Recruitment checks were completed.
“There was sufficient staff to support people in a timely way.” from the report
Health support and consent
People could access health and mental health professionals when needed. Capacity assessments, best-interest decisions and DoLS applications were in place where required.
“People had access to healthcare professionals when they needed them.” from the report
Improved care planning
Compared with the previous inspection, people's needs, choices, culture, religion and preferences were better reflected in assessments and care plans.
“At this inspection improvements had been made.” from the report
Gaps in safety records
seriousRecords did not always show that planned pressure relief and bowel care had been provided or escalated. Ongoing low fluid intake was not always escalated clearly after initial concerns.
“People did not always have support with pressure relief documented.” from the report
Creams not always recorded safely
seriousNursing staff signed for creams applied by other staff, so it was not always clear that creams had been applied as prescribed. The manager corrected this during the inspection.
“Nursing staff were signing for people's cream other staff had administered.” from the report
Limited personalised activities
needs fixingPeople did not always have a range of activities matched to their interests, including people who preferred to stay in their bedrooms.
“People told us they would like more activities on offer.” from the report
Visiting arrangements
needs fixingVisitors were still required to book appointments. The report says relatives found this restrictive and recommends that the provider review the arrangement.
“During our inspection relatives were still required to make an appointment prior to visiting the home.” from the report
Weak quality checks
seriousAudits did not identify several problems found by inspectors. This included gaps in care records, mealtime arrangements, activities and medicine records.
“Systems had not been established to effectively identify where improvements were required to people's care and records and ensure these improvements were made.” from the report
- 01How are you now checking and recording pressure relief, bowel care and fluid intake for each person?
- 02How do you make sure the staff member who applies a prescribed cream records it themselves?
- 03What personalised activities are available for my relative, including if they prefer to stay in their bedroom?
- 04Can relatives visit without booking, and how do you support people's preferences about visitors?
- 05What actions have you taken in response to the Regulation 17 breach, and how do you check that improvements are lasting?
This was an unannounced inspection covering all five CQC key questions, infection prevention and control, the premises and the care provided; the report also compares the ratings with the previous inspection in August 2021. This explanation was written from the published report of 12 January 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of The Old Vicarage Nursing Home
10 rated inspections over 8 years: the service has held its Requires improvement rating throughout.
- October 2023Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
Read what inspectors found at The Old Vicarage Nursing Home →
- January 2023Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
Read what inspectors found at The Old Vicarage Nursing Home →
- August 2021Requires improvementstayed Requires improvementSafe: GoodWell-led: Requires improvement
- October 2020Requires improvementstayed Requires improvementSafe: GoodWell-led: Good
- September 2019Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: GoodWell-led: Requires improvement
- January 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2016Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementResponsive: GoodWell-led: Requires improvement
- May 2016Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- February 2016Inadequatedown from Requires improvementSafe: InadequateEffective: InadequateCaring: InadequateResponsive: InadequateWell-led: Inadequate
- November 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- November 2013
Report published without a new overall rating.
- March 2013
Report published without a new overall rating.
- July 2012
Report published without a new overall rating.
- February 2011
Registered with the Care Quality Commission on 28 February 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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