We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask. We also spoke with three of the people living in the service and several staff.Is the service caring?
Is the service responsive?
Is the service safe?
Is the service effective?
Is the service well led?
This is a summary of what we found:
Is the service safe?
People received care and support in accordance with care plans and behaviour support plans in which they or their representatives had been involved. The care plans were regularly reviewed. Incidents were monitored and discussed to amend care where necessary.
Where people had healthcare needs, the home had sought the advice of external healthcare specialists appropriately to maintain their wellbeing and safety. Staff were aware of the health and support needs of the individuals they were supporting.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the home had liaised effectively with the local authority DoLS team and had made applications as appropriate. The manager was aware of a recent Supreme Court judgement relating to 'deprivation of liberty' and planned to contact the DoLS teams in relevant local authorities to agree the way forward.
The people we spoke with told us the service was caring and that they felt safe at The Old Vicarage. Where issues had been raised by people in the home about the behaviour of others, they had been advised how to better deal with any future concerns to keep them safe.
Is the service effective?
We saw that people's needs were well met by a knowledgeable staff team. People's care and health needs had been effectively met. Appropriate external advice had been sought where necessary to maximise wellbeing. We saw that the people supported, enjoyed positive relationships with the staff. They told us the home met their needs effectively and provided them with a fulfilling lifestyle. One person told us they went horse riding, attended college and church and was: 'very happy now.' Another person told us: 'the staff are very good'.
The home had been successful in managing and reducing the level and severity of incidents in situations where people had come from other placements with a history of challenging behaviour.
Is the service caring?
We saw staff working in a caring and respectful way while supporting people. They supported people to make decisions and choices and defused situations effectively and without drama. We saw that staff gave people time to make decisions and choices.
The people we spoke with thought the service was caring. One told us the staff were: 'kind' and added: 'they help me get up for work.' People told us the staff supported them to go to health appointments.
Is the service responsive?
We saw that people's care plans and other documents recorded people's needs and where these had changed. Care files showed that the home responded promptly to any changes and sought appropriate specialist advice where necessary.
Care was provided based on people's known and indicated wishes and preferences and they had been asked their views. People had access to a good range of meaningful activities and to the community.
The people we spoke with all felt that they were involved and consulted and that the service responded to people's needs. One said: 'I am involved in my care plans and reviews.'
Is the service well-led?
We found that the home provided consistent care to people and was well-managed. There were clear lines of managerial responsibility. A range of systems were used to monitor the home's operation and the provider visited the home regularly. Action had been taken to address issues where these were identified. The views of people, their relatives and staff were sought and acted upon.