The Old Vicarage

The Old Vicarage is a residential care home providing accommodation and personal care for to up to 16 people. The service provides support to older people some of whom live with dementia. At the time of our inspection there were 13 people using the service.

People’s experience of the service and what we found:

People and their relatives told us they felt safe and were positive about the service, however, we found risks to people's health and well-being were not managed robustly. Practices did not always promote good infection, prevention and control.

Medicines were not always managed safely for people living at the service.

There were enough staff to meet people’s needs and staff were recruited safely.

Not everyone was supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests as the provider had not ensured all requirements under the Mental Capacity Act (MCA) and authorisations under the Deprivation of Liberty Safeguards were fully met.

Some areas of the home were in need of refurbishment. Improvements could be made to the environment to support people living with dementia.

Care was not always person-centred and did not promote people's dignity, privacy and human rights.

Systems to monitor and improve the quality and safety of the service were not always effective. The provider had not always sent us statutory notifications which is their legal responsibility to do so for notifiable incidents. Policies and procedures were not always in line with current legislation and guidance. The registered manager informed us they were looking at introducing a new quality assurance system.

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 this service was Good (published 8 September 2019).

Why we inspected

We undertook this inspection due to the length of time since our last comprehensive ratings inspection. We undertook a focused inspection to review the key questions of Safe and Well-led. During the inspection we found there was concerns with the environment, storage of confidential information, dignity and respect, so we widened the scope of the inspection to include Effective and Caring. For the key question not inspected, Responsive, we used the rating awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘All inspection reports and timeline’ link for The Old Vicarage on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to management of risks, medicines management, dignity, safeguarding and good governance.

Please see the action we have told the provider to take at the end of this report.

Follow Up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At the last inspection on 12 May 2016, the service was rated Good. At this inspection we found the service remained Good, as the service continued to meet all relevant fundamental standards.

People continued to be supported in a safe way and were protected from avoidable harm and abuse. Risks to people were managed in a way that protected them and kept them safe from harm. Staff were aware of the risks people faced and the action required to minimise the risk and keep people safe. People were supported safely and their needs were met by sufficient numbers of staff. People told us there was always enough staff to support their needs and respond to them in a timely manner. People continued to receive their medicines safely.

People told us they had confidence in the abilities of staff to meet their individual needs. Staff received training and support that was specific to the people they supported. They were encouraged to undertake any training that was relevant to their role and felt supported and valued as part of a team. People were supported by staff to make their own decisions. When people lacked mental capacity to take particular decisions, staff took the required action to protect people's rights and ensure people received the care and support they needed. People’s dietary requirements were assessed and people were provided with sufficient food and drink.

People continued to receive support from staff who were kind, caring and compassionate. Staff were respectful of people’s privacy and dignity. People were listened to and felt able to voice their opinions and were involved in decision-making about their care and support they received.

People received care and support that was responsive to their needs. People’s care and support was tailored to meet people’s individual needs and preferences. People continued to be involved in activities and stimulation of their choice. People knew how to complain if they needed to and were confident any concerns would be addressed seriously by the registered manager.

People were cared for by a team of staff that were well-led. There were systems in place, which continued to monitor and assess the quality of the care provided. The home had been involved in forging links with the local community. They had become the local collection point for people in the village to collect their medicines.

The Old Vicarage provides accommodation and personal care to up to 16 older people some of whom are living with dementia. At this inspection 13 people were living there.

A registered manager was in post and present during our inspection. 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 were safe as staff had been trained and understood how to support people in a way that protected them from danger, harm and abuse. Staff had access to care plans and risk assessments and were aware of how to protect people from harm.

There were enough staff to support people and to meet their needs. The registered manager had systems in place to ensure additional support was provided when needed. The registered manager completed appropriate checks on staff before they started work to ensure they were safe to work with people.

People received their medicine from staff who were trained to safely administer these and who made sure they had their medicine when they needed it. The registered manager completed checks to ensure staff followed safe practice when assisting people with their medicines.

People received care from staff who had the skills and knowledge to meet their needs. Staff attended training that was relevant to the people they supported and adapted to meet their specific needs. Training was provided in a way that adapted to staff learning preferences. Staff were supported by the provider and the registered manager who promoted an open and transparent culture.

Staff provided care and support which was personalised and respected people’s likes and dislikes. People took part in activities they liked and found stimulating. People felt involved in the day to day running of the home and were kept up to date with changes and developments. People’s independence was encouraged and staff respected their privacy and dignity.

People were supported by staff who knew them well and had good relationships with them. Staff made sure people were involved in their own care and information was given to them in a way they could understand. People were involved in decisions about their day to day care. When people could not make decisions for themselves staff understood the steps they needed to follow to ensure people’s rights were upheld.

People had a choice of food to eat and could choose alternatives if they wished. People had access to healthcare when needed and staff responded to any changes in need promptly.

People and staff felt able to express their views and felt their opinions mattered. The provider and registered manager undertook regular quality checks in order to drive improvements. The provider engaged people and their families and encouraged feedback. People felt confident they were listened to and their views were valued.

This is a summary of what we found-

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints and concerns. This reduced the risks to people and helped the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people were be safeguarded as required.

The service was safe, clean and hygienic. One person said, "My clothes are always clean and they clean my room every day'.

The registered manager produced the staff rotas which took people's care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people's needs were always met.

Procedures were in place for the management of medicines. Staff administering medicine had received regular training. This meant that people were protected against risks associated with the unsafe use and management of medicines.

Is the service effective?

People's health and care needs were assessed. Specialist dietary, mobility and equipment needs had been identified in care plans where required. Some people did not always understand what a care plan was but expressed that staff helped them in the way they wanted.

People's needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. A call system was available throughout the home to enable people to request help. The premises were not suitable for people with significant mobility needs.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, 'Staff will always help', 'They [staff] are brilliant' and 'I am very happy here, I have no complaints'.

People using the service, their relatives and friends completed an annual satisfaction survey. This information had been analysed to identify areas for improvement.

People's preferences, likes, dislikes and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

We saw staff respond quickly to meet people's needs. This was also confirmed by people we spoke with. People had the opportunity to engage in a range of activities.

People knew how to raise a concern or make a complaint if they were unhappy. People told us that they had no complaints and were happy with the care they received.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. Staff expressed 'It was like one big family" and 'Home from home.'

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continually improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

The manager was also one of the providers. They lived on site and worked in the home regularly and so were able to monitor the quality of the service first hand. People were very complimentary about how caring the manager was.

There were effective leadership systems in place to manage the care service and monitor health and safety risks. Work continued to improve the environment and people were now safer because fire prevention systems had been upgraded.

The daily routines were relaxed and we saw that people were given choices throughout our visit, such as what they would like to eat, and what they would like to do.

People's health needs were being met with the support of the local doctors and other health professionals. People told us that they felt safe and were confident that they could approach the manager with any concerns.

There were systems in place to support staff and provide them with ongoing training relevant to their role.