Archived: The Old Vicarage

The Old Vicarage is registered to provide accommodation for up to six adults with learning disabilities who require personal care and support. On the day of the inspection there were six people living at the home. There was a registered manager in post. 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.

Relatives told us they felt people living at the home were safe. Staff understood their responsibilities in keeping people safe from harm, and knew how to report any concerns. There were enough staff to support people living at the home, and staff had the right level of knowledge, skills and experience. Staff received training that was relevant to their role. The provider had effective recruitment processes in place and carried out appropriate checks on staff before they were able to start supporting people. People received their medicines as prescribed and systems to manage medicines were effective.

People were asked for their consent before care was provided. People’s care and support was planned in a way that did not restrict their rights and freedom. People enjoyed the food and were supported to have enough to eat and drink. People were supported to access healthcare professionals when required and staff understood the importance of following direction given by other agencies.

Relatives told us they felt their family members were supported by staff who were kind and caring. Staff understood people’s individual needs and preferences and people’s privacy and dignity was respected. People were supported to develop and maintain their independence.

People were supported to take part in activities that interested them. Where people’s needs changed, staff took action to ensure people received care that was appropriate to meet their needs. People’s relatives felt confident to complain if they were unhappy and there was a system in place for handling complaints.

Relatives and staff expressed confidence in the registered manager and felt they were listened to when they gave feedback. People felt able to express their views and opinions. There were systems in place to manage the quality of the service and regular audits were carried out which were effective in improving standards of care.

We completed an inspection previously in September 2013, where we found the provider was not meeting the regulations and some improvements were needed. After the inspection, the provider sent us an action plan. This told us the action the provider would take and by what date.

At this scheduled inspection we checked whether required improvements identified at the last inspection had been made and looked at other essential standards. We found the provider had made the required improvements and was meeting the regulations..

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People are treated with respect, they were offered choice and their consent was sought by staff before they provided care or support. One person said about the service, 'It's alright'. Safeguarding procedures are robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduces the risks to people and helps the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). This is legislation that makes provision relating to persons who lack capacity, and how decisions should be made in their best interests when they do. No DoLS applications had needed to be submitted. Staff had been trained to understand when an application should be made, and in how to submit one. This means that people should be safeguarded as required.

We saw that there was sufficient staff to ensure people's care needs were met, and that staff were supported so that they had the qualifications, skills, experience and support they required. This helps to ensure that people's needs are always met.

Is the service effective?

People's health and care needs were assessed with them, and other professionals contributed towards information in their plans of care. Specialist needs had been identified in care plans where required. We saw that care plans reflected assessments and observations that staff carried out and recorded; this relating to people's day to day preferences. A relative we spoke with said they had been involved in care planning previously but not recently. One relative told us they had been involved in meetings where they, 'Were told what the home planned to do', but had had not received feedback since. The manager told us before we spoke with relatives that they were looking to improve relative's involvement with the home.

People's needs were taken into account with the layout of the service enabling people to move around freely and safely. Visitors confirmed that they were able to see people in private and that they could, as one we spoke with told us, 'Just drop in on them to see if everything is alright'.

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 looked comfortable in the presence of staff and we saw that they were comfortable approaching them. We saw staff responded readily to any verbal or non-verbal request for assistance from people.

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

Is the service responsive?

People completed activities in and outside the service regularly. The home has its own transport, which helps to keep people involved with their local community.

A relative we spoke with said that if they raised an issue the manager was responsive. They said the service, 'On the whole not too bad, just little blips'.

We saw that the staff were aware of how to observe to see if people were dissatisfied with the service. We saw there were systems to monitor people's behaviours so as to identify how staff could improve responses to incidents. Relatives we spoke with were not always aware of the provider's complaints procedure but knew how to raise a complaint through partner agencies. We heard that any issues raised had been responded to and the manager was approachable and would listen. The manager told us that any concerns they had received since our previous inspection had led to safeguarding referrals. These had been investigated by Wolverhampton City Council with the provider's support. This meant that concerns related to people's safety were dealt with appropriately.

Is the service well-led?

The service involved external healthcare professionals to ensure people received the care that they needed, for example people had recently seen a dentist and dental hygienist to promote their oral health.

The service has a quality assurance system; records seen by us showed that significant identified shortfalls were addressed promptly. There were some areas where audits could be more robust, one of these partly addressed by the manager before the inspection was completed. We did see that quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

We met and spoke with five people who lived at the home, two relatives and three staff as well as the acting manager who was appointed a few months prior to this inspection.

We saw people were relaxed with the staff. They were comfortable approaching them if they needed anything. We saw staff were responsive when people made verbal or non-verbal requests to them. Relatives told us they were happy with the care and support people received at the home. One said the person was, 'Perfectly happy' there but, 'Could do with a bit more activities'. The manager was aware these needed improvement and was developing these. We saw people's needs were assessed and staff showed a good understanding of what people's needs and preferences were. People's health care needs were not always followed up with external health care professionals.

We saw there had been an improvement in the way staff responded to people's behaviours that challenged them with a decrease in restrictive behaviour management techniques and improved monitoring.

The provider had systems in place for the monitoring of service quality. These were not used by the home meaning that issues that presented a risk to people may not always be identified.

Two relatives we spoke with told us that they were happy with the care and support people received at the home. They said that they were kept up to date and, 'Communication was first class' and that they were,' Very satisfied' with the care people received. This meant that people's relatives had confidence in the service people received.

We saw people's needs were assessed and staff showed a good understanding of what people's needs and preferences were. We saw people with staff during the inspection and saw that they were relaxed in their presence. We saw staff take time to sit and talk with people so that they were involved in the support they received.

People were provided with a choice of suitable food and drink that reflected their preferences.

The provider responded appropriately to any allegation of abuse, although systems for monitoring restraint were not robust enough.

The provider had taken steps to provide care in an environment that was suitably designed for the needs of people that lived there.