The Old Vicarage

The Old Vicarage is a family run residential care home providing accommodation and personal care for up to 37 people aged 65 and over. The home is located approximately 2 miles from Bolton town centre. At the time of inspection 34 people were living at the home.

People’s experience of using this service and what we found

People felt safe living at The Old Vicarage. They spoke positively about the care they received, telling us staff were well trained, knew them well and how they wanted to be supported. Staff knew how to identify and report safeguarding concerns, though this was rarely required. Enough staff were deployed to meet people’s needs and keep them safe. A lot of the staff had worked at the home for many years, which ensured continuity in care. Accidents, incidents and falls had been documented along with actions taken. The home was clean with effective cleaning and infection control processes in place.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People and staff spoke positively about the home and how it was run. Each person we spoke with said they would recommend the home to others. People’s views were sought through meetings and annual surveys. A range of systems and processes were used to monitor the quality of the service provided. Action plans were created to help drive improvements. People described the registered manager as “pleasant”, “considerate” and “approachable”. The registered manager attended a number of local groups and meetings regarding both the home and the wider health and social care market, to help drive improvements. The provider offered placements at the home for trainee therapists and professionals to aid their learning about the home and care process. A range of audits and checks were completed to monitor the home and care provided.

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

Rating at last inspection

The last rating for the service was good (published December 2017).

Why we inspected

We undertook this focused inspection to assess whether the current rating of good was still accurate. This report only covers our findings in relation to the key questions safe and well-led, as these were the only key questions inspected. For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has remained good based on the findings at this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Care staff completed activities with people to show them what they looked like in personal protective equipment (PPE). Each staff member wore a picture of themselves on their uniform without PPE, so people knew who they were talking with. This was done to offer reassurance.

Increased strength and balance training was provided for people during the lockdown to help reduce falls and to reduce hospital admissions. This was done in an effort to try and reduce the likelihood of bringing COVID into the home.

Further information is in the detailed findings below.

The inspection took place on 29 August 2017 and was unannounced.

The Old Vicarage is a privately owned care home offering residential care and support for up to 37 people. One of the owners is responsible for the day to day management of the home. It is situated about two miles from the centre of Bolton, and is close to bus routes, shops, pubs and other amenities.

There was 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.

People we spoke with told us they felt safe at the home. There were sufficient, suitably trained staff and the recruitment process was robust. Good staffing levels and low staff turnover helped to ensure staff had good knowledge of people who used the service and could deliver person-centred care. Medication systems were safe and staff were trained in medicines administration.

The safeguarding policy and procedures were appropriate and up to date. Staff had undertaken safeguarding training and demonstrated a good knowledge of safeguarding issues. Staff we spoke with were aware of whistle blowing and assured us they would report any poor practice they may witness. The registered manager was committed to raising the profile of safeguarding within the home and on a wider level.

General and individual risk assessments were in place. Accidents and incidents were recorded appropriately. Health and safety measures were in place and equipment was maintained and serviced as required.

The induction programme was thorough. Training was on-going and refresher courses were undertaken as required. We saw records of regular staff supervisions and annual appraisals.

There were no malodours and the environment was homely, clean and uncluttered. The home had recently had an extension to the premises built and this had been done to a very high standard. There was a good choice of food for all meals and special diets were catered for.

Care plans included relevant health information. Communication between health professionals and the service were documented. The service was working within the legal requirements of the Mental Health Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS).

We observed interactions between staff and people who used the service throughout the day and found them to be kind, courteous and friendly. People’s dignity and privacy was maintained at all times.

A service user guide was in place as well as a statement of purpose. Residents meetings were held regularly.

Care plans included advanced care planning if people had expressed their wishes for the end of their lives. The service endeavoured to respect these wishes and support people to remain at the home if they wished to do so, when nearing the end of their lives.

Care plans were person-centred and included information about people’s preferences, likes and dislikes. Staff communicated well with people who had difficulty with verbal communication and responded quickly to individuals who were unwell.

There were lots of activities and outings arranged by the service. People’s diversity was respected and there were visits to the home from leaders of various faiths.

There was an appropriate, up to date complaints procedure, which was outlined within the statement of purpose. There was a complaints book, but no complaints had been received.

All the people we spoke with felt the service was well run and the management were approachable. Staff observations took place to help ensure their competence remained at the correct level.

Audits were undertaken for issues such as falls, accidents and incidents, medicines, health and safety and feedback from people who used the service and staff. Care files were regularly audited and all audits included actions to address any shortfalls.

The service were committed to being a positive and active part of the wider community and were involved with a number of local initiatives to promote this. People who used the service, that we spoke with, were positive about this interaction and clearly enjoyed participating with the local community.

The service were involved with the National Citizens Service (NCS). This is a government funded initiative supporting community engagement and bringing together schools, businesses and communities. There was clear indication of the positive effects of this interaction on the moods of the people taking part and the initiative served to help keep people at the home integrated with the wider community.

There was evidence that management were committed to supporting staff in delivering an environment and culture focused on the continual improvement and wellbeing of both staff and people who used the service alike.

We looked at a sample of care plans which contained relevant health and personal information. Care plans were reviewed on a monthly basis with changes noted, and we saw evidence of good partnership working.

We spoke with one person who used the service. They said, “I would recommend this home to anyone”. We spoke with three visitors and one told us, “Communication is good, if anything changes they let us know”. Another said, “It has changed my opinion about care homes, I have no concerns”.

We spoke with a number of professional visitors, such as GPs and district nurses, who were all very positive about the home. They told us the home made appropriate referrals, followed instructions well and communicated well with them.

People’s nutritional needs were recorded and dietary needs adhered to. Monitoring charts, such as weights were completed and appropriate referrals made to other services.

Staff were recruited appropriately and were qualified for their roles.

There was a complaints procedure complaints were followed up appropriately. Regular audits were carried out to ensure consistency in the quality of service delivery. People who used the service were consulted and their views and wishes taken on board with regard to service delivery.

We spoke with three people who used the service and they all expressed satisfaction with the care they had received. One person said “All the staff are polite and caring. They look after us very well, they help me with everything.” A visitor at the home told us “visitors are always made welcome and offered food and drinks."

We looked at a sample of five care plans and found them to contain up to date and relevant medical and health information as well as records of care needs. We saw evidence of good partnership working and saw that the records were person centred and individualised to incorporate people’s choices and preferences.

We saw that efficient cleaning regimes were in place and that efforts were made to minimise the risk of infection occurring.

We found that relevant policies and procedures were in place within the home and that staff were aware of them. We saw evidence of a good induction and comprehensive training programme for staff members and encouragement of staff members to continually develop their knowledge and skills.

We saw that there was a complaints procedure in place and noted that complaints were taken seriously and followed up appropriately.