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Inspection carried out on 16 May 2016

During a routine inspection

This unannounced inspection was carried out on 16 and 17 May 2016. At our last inspection on 1 October 2014 the service had met all of the standards we had inspected against .

The Old Prebendal House provides residential and nursing care for 34 older people in the Oxfordshire area. The home is located in a rural area of Oxfordshire. On the day of our inspection 31 people were living at the service.

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.

People were supported by staff that were not always appropriately trained. The records showed that the provider had not ensured that staff had received up-to-date training in the areas such as moving and handling equipment, fire awareness, safeguarding or infection control. However when we spoke with staff they demonstrated good knowledge about these elements of training. We have made recommendation regarding staff training and training updates.

People told us they felt safe. Staff were confident that if they reported any concerns regarding people’s safety, health or welfare to the registered nurse or to the registered manager, these would be acted upon immediately.

Medicines were stored safely. Records relating to medicines were completed in line with the provider’s medicines policy.

On the day of our inspection there were sufficient numbers of staff deployed to support people safely and effectively. Thorough recruitment practices and appropriate pre-employment checks ensured that staff were of a suitable character to care for people. Staff were supported through regular supervisions and appraisals.

Risks to people had been identified, assessed and were managed safely. Staff understood the signs of potential abuse and what action they needed to take if such suspicion arose. There were sufficient numbers of staff employed to meet people's needs and the service followed safe recruitment practices. People's medicines were managed and administered safely.

Thorough recruitment practices and appropriate pre-employment checks ensured that staff were of a suitable character to care for people. Staff were supported through regular supervisions and appraisals.

Management and staff understood and followed the principles of the Mental Capacity Act 2005 (MCA). The MCA provides the legal framework for acting and making decisions on behalf of individuals who lack the mental capacity to make particular decisions for themselves. The MCA also requires that any decisions made on behalf of a person who lacks capacity are made in the person's best interests. People were able to make decisions concerning everyday aspects of their lives themselves, which helped them maintain their independence.

People were involved in the planning of their care and staff provided support that met people’s needs and maintained their independence. The provider sought support from relevant healthcare professionals to maintain people’s health.

Care plans were reviewed regularly on an annual basis and, reviews of people’s care were carried out and if people’s needs changed, people’s care plans were amended accordingly. Staff were familiar with the contents of people’s care plans and knowledgeable about people’s individual needs, backgrounds and preferences. Individual risk assessments were in place and provided information about how to manage any of the identified risks to people.

The service had a complaints policy in place. People who use the service were made aware of the complaints procedure. They told us they knew how to make a complaint and who to complain to, should such a need arise.

People were given the opportunity to contribute to the enhancement of the service by providing feedback on its management at residents’ meetings.

The service had systems in place to assess the quality of the service. However, the systems had not always been effective and had failed to identify the training issues highlighted in the report. The registered manager addressed the issue immediately and introduced new audits on the second day of our inspection. However to ensure improvements were made we have asked the provider to send us an action plan.

Inspection carried out on 1 October 2014

During a routine inspection

This inspection took place on 1 October 2014 and was an unannounced inspection which meant the staff and provider did not know we would be visiting. The service had met all of the outcomes we inspected against at our last inspection on 18 October 2013.

The Old Prebendal House provides residential and nursing care for 34 older people in the Oxfordshire area. The home is located in Shipton under Wychwood, Chipping, Norton Oxfordshire. On the day of our inspection 34 people were living at the service.

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.

People told us they felt safe. Staff told us, and training records confirmed that staff received regular training to make sure they stayed up to date with recognising and reporting safety concerns. Records confirmed the service notified the appropriate authorities where concerns relating to abuse were identified.

Risks to people were managed and reviewed. Where risks to people had been identified risk assessments were in place and action had been taken to reduce the risks. Staff were aware of people’s needs and followed guidance to keep them safe while maintaining their freedom.

The service ensured staff had the necessary skills to support people through, induction training, ongoing training and regular supervision. Staff told us they understood their roles and responsibilities and received the support they needed. One nurse said, “My manager is very supportive.” Records confirmed staff received appropriate support.

People received their medicines as prescribed. Medicines were stored securely and accurate records maintained.

People were involved in the planning of their care and staff provided support that met their needs and maintained their independence. The service sought support from relevant healthcare professionals to ensure people’s needs were met.

The registered manager and staff were aware of their responsibilities under the Mental Capacity Act 2005 (MCA) which governs decision-making on behalf of adults who may not be able to make particular decisions themselves, and Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of people by ensuring if there are any restrictions to their freedom and liberty these have been authorised by the local authority as being required to protect the person from harm. Records confirmed people who lacked the capacity to consent were supported in their best interests.

People we spoke with told us that they enjoyed the meals provided. We saw the staff were kind and where appropriate, provided the support people needed with eating and drinking. People told us they enjoyed activities at the home. Comments included; “There’s plenty to do, I am never bored,” “I go out on all the trips. My family comes on some as well.”

People we spoke with made many positive comments about the care provided at the service. People’s comments included; “It is really good here, the care is superb,” “There is a happy atmosphere here, it’s lovely.” Staff took the time to speak with people as they supported them.

People we spoke with knew how to complain and there was a complaints procedure in place. Records showed complaints were dealt with compassionately and in a timely fashion.

The service had systems to assess the quality of the service provided in the home. Learning was identified and action taken to make improvements. These systems ensured people were protected against the risks of unsafe or inappropriate care.

People knew who the registered manager was and told us they were approachable. Comments included; “I can always talk to them, they always have time for me,” “I think the manager leads the staff very well, they are always about the place.” This helped to promote a clear, open culture around the home.

Inspection carried out on 18 October 2013

During a routine inspection

We spoke to six people who used the service, to a family member and to three members of staff. We reviewed care plans, risk assessments, daily records of care and staff files. We saw that people were treated in a dignified, respectful way. People told us that they exercised choice in their care and that their independence was supported.

One person told us, of their move to the home, "I've been very lucky." Another person who used the service said "I can't think of anywhere better." A relative we met said of the home that "I find it very warm and welcoming." Care plans we reviewed were current, personalised and reflected individual needs. Risk assessments were appropriate and had been reviewed regularly. Family members were involved in care planning. A nurse told us "What I like is how involved the relatives are."

The service had established policies and procedures for safeguarding vulnerable adults and used the Oxfordshire Safeguarding Adults procedures. Staff we spoke with could identify types and signs of abuse and knew the reporting procedure to follow if they had any concerns.

Staff received training which they valued. We saw that a range of training and development opportunities were available. Staff were supervised regularly and had an annual appraisal.

We saw that the provider had pathways in place to assess and monitor service quality, including meetings for residents and questionnaires on personal care, daily living and catering.

Inspection carried out on 5 March 2013

During a routine inspection

A new manager had taken up their post a month prior to our visit. They were currently going through registration with us at the time of our visit. Therefore the registered manager's name does not appear on this report.

We spoke to five people who used the service and all of them told us that they were treated with respect and dignity at all times. Staff addressed people as they wanted to be addressed and we saw evidence of this throughout our visit. During our observation we saw excellent communication between staff and people who used the service. It was respectful and courteous at all times, but also friendly and caring.

The care files were current, fit for purpose and reflected people’s individual needs. Care plans and risk assessments were in place and reviewed on a regular basis. Nutritional assessments had been completed and reviewed. The staff took particular care to offer activities specifically tailored to each individual. As an example one person’s passion was gardening. They had helped develop a garden to grow vegetables for the kitchen.

We also spoke to five people who told us. “I have only been here a short time, but the staff are very good and they look after me very well”. “I like it here, I like the other residents, I like the staff and I like the building. I am quite happy here”. “The staff make me feel happy”. “I have been here 13 years and I am well looked after”. “It’s magnificent here, fully meets all my expectations”.

Reports under our old system of regulation (including those from before CQC was created)