The inspection took place on 19 and 20 November 2014. This was an unannounced inspection. We last inspected The Old Vicarage on 6 November 2013. At that inspection we found the home was meeting the regulations that we inspected against.
The Old Vicarage provides accommodation and nursing and personal care for up to 30 people. Within the past year, the provider has developed part of the premises to provide general nursing care for people. At the time of our inspection there were 19 people living at the home, three of whom were receiving nursing care. The home had 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 Act 2008 and associated regulations about how the service is run.
We found the provider had breached Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This was because some of the upper floor windows did not have suitable window opening restrictors to help prevent falls from the windows. You can see what action we told the provider to take at the back of the full version of the report.
People we spoke with told us they felt safe living at the home. Their comments included, "It's nice," and “Oh yes. If there was anything wrong with me, they would see to it straightaway”.
People’s relatives also felt confident their family members were cared for in a safe way. This was reflected in comments such as, "It's like a home from home. We know she is safe” and "She is pretty safe. The staff are caring".
The staff identified potential areas of risk in respect of people’s care, such as the risk of falls and skin damage, and took steps to reduce the likelihood of such risks occurring.
The staff we spoke with had a good understanding of safeguarding people from harm. They were also clear about how to report any concerns they had. The registered manager fully understood her responsibilities in relation to safeguarding people and kept appropriate records in this regard.
The premises were well-maintained and safe for people and staff to use, apart from the issue we identified with some window opening restrictors. Relatives we spoke with were satisfied with the condition of the home. Their comments included, “There’s no issues. There’s always someone in fixing something. I think I’ll book myself a place,” and “It’s ‘nip-n-clean’. They are always on the go”.
There were sufficient numbers of suitable staff to keep people safe and meet their needs. Relatives we spoke with were also confident about this. Their comments included, “The staff come straight away. The staffing is alright," and “I think it’s alright. There is always someone about if you need them. They’re all nice.” We found there were thorough recruitment procedures in place. This helped to protect people as checks had been carried out on potential staff before a decision was made to employ them.
People’s medicines were managed safely. Staff followed safe procedures which helped ensure people’s medicines were stored correctly, ordered in time and given to them when they needed them. Relatives we spoke with were confident their family members received the help they needed with medicines. Their comments included, “I’ve no worries about medicines,” and “There’s been a 100% improvement since he was in hospital, when he wasn’t getting his tablets. Here they check everything”.
Staff told us they felt supported by the provider, by way of training, supervision and appraisal. This helped them provide effective care for people. Relatives we spoke with were confident the staff team had the skills needed to care for people well.
Staff sought people’s consent before they provided care to them. Staff followed the requirements of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS).
Comments from relatives showed that the service provided effective support to people to provide them with good nutrition and hydration. One relative said, "He's fed well. He looks a lot better." Another relative told us, "The staff help feed her. She has put on some weight. They tried everything. They found out she was anaemic and now she has got her appetite back."
People were supported with their health. A relative commented, "They get the doctor in. The optician and dentist come in too." Another relative told us their family member’s health had improved as a result of the care they received at The Old Vicarage by commenting, "He has never had any infections, which is an improvement." Health care professionals told us the staff took prompt action if there were any concerns about people’s health.
Staff had developed positive, caring relationships with people using the service. People made the following comments about their care: "It's nice"; "They're canny"; "It's alright. They're kind to me"; and “They treat me very well. We have a good laugh together”.
Relatives of people who used the service were confident that the staff team were caring and kind. Their comments included, "Most of the staff are like family. The young ones are very caring. The older ones are too. The staff are compassionate," "They're definitely caring. One person passed away and the staff were so upset. They do get very close to them," and "I think it is great. They're really friendly and they look after him they're always popping in to see him".
Staff showed people respect and dignity and safeguarded their privacy. People were involved in discussions about how they wanted their care to be provided. Health professionals who visited the service felt staff were caring and compassionate. For instance, one commented, “Staff are very caring. The management are very caring and I think that cascades down to the staff. They have some fairly challenging people but the staff see the better side of them. They are exceptionally good.”
People received personalised care that was responsive to their needs. For instance, the staff supported people to have meals in private if this was their preference or have meals at a later time. People and their relatives had been involved in making decisions about how their care would be provided. The staff supported people to participate in a wide range of social activities. A health professional remarked, “They promote a really good, positive lifestyle for people.”
People were encouraged to raise any concerns but the people and relatives we spoke with were very satisfied with the care and none had any complaints.
People were encouraged to share their views about the service and these were acted on. For instance, one relative told us, “When [our family member] wasn't eating, we said she used to like scotch pancakes and yoghurts, and they got these in for her. They do listen."
The service was managed well and the registered manager had overseen improvements in the quality of care. This was reflected in the comments we received from a number of other professionals who had contact with the service. The local authority commissioner of services told us, “We visited just the other day. Everything was fine. They have achieved the Gold Standard in the Council’s Quality Standards. The new owner is improving the premises and there have been no safeguarding issues.” A practice manager from a local GP practice used by some of the people living at the service told us, “We feel there has been a huge improvement in the management and service provided.” A relative put this simply, “It’s great.”