CQC report explained · a nursing home
What the CQC found at The Vicarage Nursing Home
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, March 2018
Rated Good, improved from Requires Improvement; inspectors found safe, kind and personalised care, with some records and staff knowledge still needing attention.
Inspectors made an unannounced visit on 14 December 2017. They spoke with people living at the home, relatives and staff. They observed care and reviewed care, medicines and management records.
All five areas were rated Good: safe, effective, caring, responsive and well-led. Inspectors found enough staff, safe medicines practice, suitable training, kind relationships and care that was tailored to people's needs.
The home had improved since the November 2016 inspection, when it was rated Requires Improvement. The earlier concerns about moving and handling and recording best-interest decisions had been addressed well enough for the overall rating to become Good.
There were still some areas to follow up. Not all end-of-life wishes had been recorded, some staff could not explain people's Deprivation of Liberty Safeguards, and most bedroom memory boxes were empty.
Safe moving and handling
Staff worked confidently and safely when helping people move. They recognised when someone was tired and changed the support offered.
“We observed safe moving and handling practices throughout our visit and staff recognised people's individual mobility support needs.” from the report
Kind relationships
Inspectors saw staff spending time with people, listening to them and supporting them with patience and respect.
“We saw positive and caring interactions between staff and people, and it was clear that staff had built good relationships with people and their relatives.” from the report
Personalised care
Staff understood people's individual needs, preferences and communication methods. Activities and support were adapted for people living with dementia.
“People's care and support was personal to them and their individual needs.” from the report
Quality monitoring
Managers used audits, incident records, observations and meetings to monitor the home and plan improvements.
“There were effective quality assurance systems in place to monitor care and plan on-going improvements.” from the report
End-of-life wishes
needs fixingThe report says people's wishes for end-of-life care were recorded, but this was not complete for everyone. Ask how this is now checked and updated.
“People's wishes for their end of life care were recorded in their care plans. However, we did see that this was not always completed.” from the report
Staff knowledge of legal safeguards
needs fixingNot all staff could explain why Deprivation of Liberty Safeguards were in place or whether conditions applied. The manager said checks were being carried out.
“Staff were aware of who was subject to a DoLS authorisation but not all staff could tell us why these were in place or if they had conditions attached.” from the report
Empty memory boxes
minorMost memory boxes outside bedroom doors were empty. These were intended to help people living with dementia recognise their rooms and support reminiscence.
“Although memory boxes were in place outside each person's bedroom door, most of these were empty.” from the report
- 01How do you make sure every person's end-of-life wishes are recorded, reviewed and shared with the right people?
- 02How are staff told why a person's Deprivation of Liberty Safeguards authorisation is in place and what conditions apply?
- 03Have the empty memory boxes outside bedrooms been completed, and how are they used to support people living with dementia?
- 04How many agency staff are currently working at the home, and how do you make sure they know each person's needs?
- 05What is the current outcome of the manager's application to become registered with the CQC?
This was an unannounced inspection of the overall service, covering all five CQC questions and both the accommodation and care provided. This explanation was written from the published report of 28 March 2018 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, December 2016
The Vicarage Nursing Home is rated Requires Improvement; care was kind and personalised, but inspectors found unsafe moving practices and gaps in mental capacity safeguards.
Inspectors visited without notice on 7 and 9 November 2016. They spoke with people living at the home, relatives, staff and a healthcare professional. They also checked care records, medicines records, incident records and quality checks.
The home had improved significantly since its previous inspection, when it was rated Inadequate and placed in special measures. Staffing, medicines management, care planning, activities and quality monitoring had improved. However, inspectors saw staff use an unsafe lifting technique, despite training and a different technique being set out in the person's risk assessment.
The service was rated Good for caring, responsive care and leadership. It was rated Requires Improvement for safety and effectiveness. Staff were caring and people received personalised support, but some staff did not understand the Mental Capacity Act or the legal safeguards around restrictions on people's freedom.
More reliable staffing
Staffing arrangements had improved. Inspectors saw enough staff available to meet people's needs, and staff did not appear rushed or overwhelmed.
“At this inspection, people's relatives, and staff themselves, told us there had been a significant improvement in the staffing arrangements at the home over recent months.” from the report
Kind and respectful care
Staff knew people well and treated them warmly. Inspectors saw positive interactions and did not see people waiting too long for help.
“Staff responded to people in a warm and respectful manner, and took interest in what people had to say to them.” from the report
Personalised support and activities
Care plans included people's needs and preferences. The home offered individual and group activities linked to people's interests.
“People were offered a varied programme of activities, which took into account their personal backgrounds, interests and preferences.” from the report
Improved medicines management
The home had introduced an electronic barcode system and written guidance for medicines given when needed. Inspectors found the medicines systems reflected good practice.
“The systems and procedures in place reflected good practice, and were designed to ensure people received their medicines safely.” from the report
Unsafe moving technique
seriousInspectors saw two staff members use an inappropriate lifting technique during a transfer. This went against the person's risk assessment and could have caused injury.
“The use of this technique put both the person and the staff involved at risk of injury.” from the report
Weak understanding of legal safeguards
seriousSome staff did not understand the Mental Capacity Act or which people were lawfully subject to restrictions. Staff were also unclear about conditions attached to authorisations.
“Staff were unaware of who was being lawfully deprived of their liberty, and any conditions that must be complied with for this to continue.” from the report
Best-interest records were not reliable
needs fixingFor people unable to decide about flu vaccinations, best-interest meetings had not been arranged. The home manager could not find records of some other best-interest meetings.
“We were not assured that best interest meetings were being appropriately conducted and recorded, in the event that people were unable to make a particular decision for themselves.” from the report
No registered manager
needs fixingThere was no registered manager at the time of the inspection, although the home manager had applied to become registered.
“There was no registered manager in post at the time of our inspection.” from the report
- 01How do you now check that staff use the correct moving and handling technique for each person?
- 02What training have all staff completed on the Mental Capacity Act and Deprivation of Liberty Safeguards?
- 03How are best-interest meetings arranged and recorded, including decisions about medical treatment?
- 04Which people currently have a Deprivation of Liberty Safeguards authorisation, and what conditions must staff follow?
- 05Has the home manager now become the registered manager?
This was an unannounced inspection covering all five key questions; the report compares the findings with the previous inspection on 24 February 2016. This explanation was written from the published report of 24 December 2016 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 Vicarage Nursing Home
5 rated inspections over 3 years: the service has improved, from Requires improvement to Good.
- March 2018Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2016Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- May 2016Inadequatedown from Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- February 2016Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- July 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- July 2013
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- August 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 31 January 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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