The Old Vicarage

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We found the service was effective, with good standards of care and support being provided to people living at The Old Vicarage. The manager and staff team demonstrated considerable action had been taken in response to our last inspection findings, to achieve an improved score and return to compliance with the breaches of the regulations in relation to person-centred care and consent to care and treatment.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s ongoing care and support needs were being thoroughly assessed and kept under regular review. This ensured guidance and information available for staff to follow was accurate and in date. People and their relatives told us they were involved in the reviews of their care plans to ensure their needs and wishes were reflected. Feedback received was supported by our findings from reviewing people’s care and support plans, including for those newly admitted to the service. We received positive feedback from people’s relatives regarding improvements to standards of assessment, review and risk mitigation now in place under the current manager. This offered people and their relatives’ greater levels of assurance in relation to ensuring changes in their needs were identified and addressed in a timely way.

Staff and leaders demonstrated clear understanding of peoples assessed and ongoing care and support needs and wishes. The care provided was personalised and people were kept at the centre of decision making. Staff gave examples of timely onward referrals made to external health and social care professionals where changes in need and risk presentation were identified. We observed staff to demonstrate clear knowledge and understanding of people’s care and support needs and risks, this was reflected in the feedback and discussions we observed during the morning shift handover meeting.

The manager was clear what people’s level of assessed needs were in relation to whether they could offer people respite care or longer-term placements. They completed thorough pre-assessment placements before accepting any new admissions and were clear what staffing levels they needed to have in place before being able to accept increases in the number of admissions to the service.

People’s care needs were assessed in line with recognised tools and recognised best practice. For example, in the monitoring of people’s weight, skin integrity, diagnosed conditions such as diabetes, and in working collaboratively to support provision of end of life care. People’s care records and staff interactions we observed reflected recognised the use of assessment tools and best practice in relation to the care provided to people, including those living with long-term conditions.

Staff were familiar with recognised guidance, for example in relation to the management of people’s dietary and nutritional needs, and approaches used to reduce the risk of choking and aspiration. Staff and leaders gave positive feedback in relation to their working relationships with external health and social care professionals, as well as the GP surgery. We received positive feedback from the GP surgery working with the service, in relation to their approach to collaborative working, and timely referrals to ensure changes in people’s medical support needs were closely monitored and responded to in line with best practice.

Policies and procedures in place contained links to information and resources to support staff and leaders to deliver evidence-based care and support.

People were supported by a cohesive, established staff team, familiar with their individual needs and wishes. People received support from external health and social care professionals as required to ensure their care needs were met holistically. We observed staff with varying roles and responsibilities to work together to provide care and support to people.

Staff told us they felt part of a well-supported team, who felt confident to work as part of the team or autonomously. Staff with varying roles were encouraged to feedback suggestions on way to develop and continue to improve the service. The manager and deputy were both clear about their leadership roles within the service, but also empowered staff to develop and take on new roles and responsibilities to further individual development. The manager and deputy were observed to thank staff and value their contributions to the shift, supporting to maintain positive morale and leading by example.

People’s relatives told us they felt the staff worked as a supportive team, to ensure the needs of their loved ones were fully met. Relatives told us they felt the manager and staff team were open to suggestions, they stated, “They take everything on board, very open to suggestions of how to improve.”

Work between the independent consultancy team, manager and deputy had been implemented to improve working relationships within the staff team, but also with people and their relatives. Improvements in communication were identified as a particular concern, and the manager and deputy demonstrated clear commitment to addressing and continuing to improve approaches.

People were supported with the management of their health and long-term conditions. People were able to regularly access GP visits, and we received confirmation from people and their relatives that timely action was taken if staff identified any concerns regarding people’s health presentation. The kitchen team worked closely with people to tailor menus to ensure people enjoyed meals which met their personal preferences, but also any specialist dietary or health requirements. We received positive feedback from people’s relatives and external health and social care professionals regarding the support and arrangements in place to ensure people maintained their overall health and wellbeing. One relative told us, “Staff assess their food and drink intake and they tell me. My loved one has put on weight since being admitted.” Another relative stated, “The food is lovely, and they have tried to build them up and give choices with the option to have something else. It smells lovely. Good portion sizes.” People were encouraged to eat and drink regularly throughout our inspection visit. People had access to additional snacks where needed to increase their calorie intake. Food was made from fresh and was appetisingly presented.

Staff confirmed arrangements were in place for the ongoing monitoring of people’s health, weight and well being. The manager gave an example of where they supported people to access health services to address hearing loss, and the significant and positive impact regaining hearing, particularly when living with dementia had on those individuals.

Processes were in place to monitor people’s day to day health and well being, but also to aid the assessment process if a person’s medical presentation was felt to have changed, so this information could be passed onto emergency services or the GP to aid decision making and prioritisation of urgency.

People’s daily care and support needs were kept under regular review, and timely changes, such as the implementation of equipment, or completion of external referrals were made to improve overall care outcomes. People received additional monitoring and oversight where they experienced a fall or episode of being unwell. Staff proactively checked on people’s welfare throughout our inspection visit, to ensure they could respond to their wishes and requirements in a timely manner.

Staff gave examples of working collaboratively with external health and social care professionals to jointly monitor people’s care and support needs, and access specialist services, such as palliative care teams to ensure people received best standards of care, and pain management. We received feedback from the GP surgery to confirm the staff made timely referrals to request assistance and reviews for people where they identified changes in their care needs, or health status.

Recognised monitoring tools were in place, and their use established within staff practice, for example where people had experienced a fall and possible head injury.

People were supported to be fully involved in decision making processes. In line with the principles of the Mental Capacity Act (2005) (MCA), staff supported people in the least restrictive ways possible and made decisions in their best interests where appropriate. We observed staff ensuring people could make informed decisions and choices over their daily lives. Staff were observed to take time to ensure options were given, and people did not feel rushed to make decisions.

People’s relatives were clear staff gave people maximum choice and control, to ensure they remained in control of their daily lives. One relative told us, “When we visit, we see that the staff knock on doors, they offer choice and options, loved one can do what they want, the staff are respectful of their wishes.”

Staff received regular training and updates in relation to the MCA, deprivation of liberty safeguards and how to implement this legislation into their practice. Policies and procedures were also in place.