The Old Vicarage

The Old Vicarage is a residential care home providing personal care for up to 10 adults with a learning disability or autistic spectrum disorder. At the time of our inspection there were eight people using the service. Accessible, single room accommodation is provided within a large adapted domestic style ‘house’, including a range of communal facilities and level access to a well kept garden.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

People’s experience of using this service and what we found

The provider's governance arrangements, were now effectively operated, to consistently ensure timely decision making and risk mitigation for the quality and safety of people’s care. Related records were accurately maintained. A range of service improvements had been sufficient to rectify breaches we found at our last inspection in October 2021, with regard to safe care and treatment and governance. The provider now needs to demonstrate service improvements are fully embedded, proactively ensured and sustained.

Effective remedial measures were now implemented to fully ensure safe staffing, medicines and measures for the prevention and control of infection and cleanliness at the service. People were protected from the risk of harm or abuse when they received care from staff.

Right Support: People were now fully supported to have maximum choice and control of their lives. The provider was able to consistently demonstrate that decisions made for people's care and daily living arrangements, were lawful, least restrictive and in people's best interests.

Right Care: Care was person-centred and promoted people’s dignity, privacy and human rights.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensured people using the service led confident, inclusive and empowered lives.

Systems to regularly seek the views of people, relatives and staff and ensure effective partnership working with relevant authorities for people’s care were improved and sufficient. Feedback from this was now used to inform, improve or enhance people’s care experience when needed.

Staff were kind, caring, trained and supported. They knew people well, understood their role and responsibilities for people’s care and had good relationships with them and their families.

Staff were responsive, to ensure people's access to relevant external health professionals when needed and consistently sought to provide care in a personalised way. All parties we engaged with for the purposes of the inspection were happy with the management, leadership and culture of the service, along with the arrangements for people’s care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 24/12/2021) and there were breaches of regulation. The provider completed an action plan following the last inspection, to show what they would do and by when to improve safe care and treatment. At this inspection improvements had been made and the provider was no longer in breach of regulations. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection to ensure good governance; to check the provider had followed their action plan to rectify the breach regarding safe care and treatment, which we found at our last inspection in October 2021, and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led, which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections, even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Old Vicarage [care home] on our website at www.cqc.org.uk

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Old Vicarage is a residential care home providing personal care to for up to 10 people adults with learning disabilities or autistic spectrum disorder. At this inspection there were nine people accommodated and receiving personal care. The home is one adapated building over two floors, with an accessible external garden and car parking. Bedrooms are mostly single accommodation, with one shared double occupancy room. Communal lounge, dining, bathing and toilet facilities are also provided.

People’s experience of using this service and what we found

The registered persons had failed to operate effective governance systems, to consistently ensure the quality and safety of people’s care and timely improvement when needed. Management audits, risk assessments and safe systems checks were not consistently operated or ensured.

Accurate and complete records, were not always maintained for the quality and safety of people's care, related decision making or in relation to person's employed and the management of the regulated activity.

Formal systems were not operated, to seek and act on feedback from relevant persons, on the service provided at The Old Vicarage for the purposes of continually evaluating and improving such services. Effective partnership working with local authority care comissiones was not consistently ensured for people’s care and best interests.

Staffing arrangements were not always effectively determined or ensured. Systems for staff induction, deployment, supervision and relevant competency checks, were not always fully ensured or effectively determined, against nationally recognised practice guidance for people’s care. Staff training updates were not always proactively ensured in a timely manner. Management remedial actions for staff training updates had been recently identified and agreed by external commissioning partners with the registered manager. Consultation had commenced with local authority care commissioners to review and agree additional staffing, to support people's increased access local community services of their choice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of whether the service was safe and well led, the service was not able to demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture. This was because the model and purpose of care and related staffing arrangements were not reviewed or fully identified against the principles, to ensure they were being met.

We found people’s choice, independence and rights were not always fully ensured or effectively maximised in line with the principles, for people’s access and participation in activities they enjoyed or aspired to, within their local community. Otherwise, people were often supported to have choice and control of their lives and staff often supported them in the least restrictive way possible, in their best interests. However, the policies and systems in the service did not always fully ensure this.

We were mostly assured of the provider's arrangements for the prevention and control of infection, including for COVID-19. However, the provider's management checks to fully ensure this, were not effectively operated to fully ensure continuous safe practice. People's medicines were now overall safely managed. People received their medicines when they should.

People told us they felt safe and were happy living at the service. Relatives were also satisfied with the management of the service and the care provided. All spoke positively about the manager and staff, who they said were approachable kind, caring and supportive.

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 December 2018).

Why we inspected We received concerns in relation to the management of medicines, staffing, governance and record keeping at the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No further areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections, even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe and Well Led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

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

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The inspection took place on 12 November 2018 and was unannounced. The Old Vicarage is a care home that provides accommodation with personal care and is registered to accommodate ten people. It provides a service to younger adults with a learning disability and complex needs.

The accommodation was within a large old house. There was a communal dining area and two lounges. Each person had their own room and there were two communal bathrooms. There was an accessible, but secure garden on site. At the time of our inspection ten people were using the service.

The Old Vicarage is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care service was registered before we introduced Registering the Right Support, this is a set of guidance which has been developed and designed in line with the values that underpin best practice. The provider reflected these values to include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At our last inspection in June 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. However, we have made a recommendation in relation to the provider looking at best practice in this area.

People were safe and staff knew how to protect them from the risk of harm. Risk assessments had been completed and guidance provided to reduce the risk. Medicines was managed safely. Lessons were learnt from events and incidents.

There were sufficient staff to support the people’s needs and the staffing levels were flexible to accommodate appointments or events. When staff were recruited the appropriate steps had been taken to ensure they were safe to work with people. Staff received training for their role and ongoing support from the registered manager.

Health care was managed for people to ensure good health and wellbeing. People enjoyed the meals and were able to participate in deciding the choices they received. Care plans were detailed and include all aspects of people’s choices and preferences.

People enjoyed the atmosphere of the home. They could personalise their own spaces. Staff had established relationship with people and provided care which was kind and compassionate. People’s privacy was respected and individual dignity observed.

Complaints had been addressed and the information on this subject and others was available in easy read formats to assist people to receive information in a way they could understand. People’s views had been considered and their choices used to shape the care being delivered.

Audits had been completed to reflect aspects of the home and where improvements were needed to be made. The provider had sent us notifications and they had displayed their rating at the home and on the website.

Further information is in the detailed findings below

The service is registered to provide residential care for up to 10 people who have a learning disability or who are on the autistic spectrum. At the time of our inspection 10 people were using the service.

There is a requirement for The Old Vicarage to have a registered manager and a registered manager was in place. 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.

Risks to people’s health were identified and well managed, however hospital passports were not always in place for those people who needed them. Records had not always been made for when medicines, such as creams prescribed for use, ‘as and when required’ had been administered. In addition, guidelines as to when these creams were needed and the best methods of administration were not in place. Other medicines were seen to be managed and administered safely.

Staff recruitment practices were followed to ensure people were safe to work at the service, however not all staff had been asked about their health prior to starting their employment. Checking people’s health in relation to the role they are to be employed in is a recruitment requirement.

People knew how to keep safe and to tell staff and their families if they were worried or upset. This showed the provider had taken steps to reduce the risks of abuse to people. In addition, staff had training on how to safeguard people and care plans and risk assessments considered what actions were required to keep people safe.

The registered manager understood the principles of the Mental Capacity Act (MCA) 2005 and care plans supported how to support people’s decision making. Policies were in place to follow if a person lacked the capacity to make a specific decision, however a system to record capacity assessments should they be needed was not established. The registered manager confirmed shortly after our inspection they had put in place a system to record any capacity assessments in relation to decision making should this be required in the future. People’s consent was obtained prior to staff providing any care and support.

People had healthy, nutritious food and drink and received effective care for any health conditions. They had access to a range of specialist health professionals as and when required.

Staff cared for people with kindness and supported their dignity and independence. People’s views were sought and respected and people were involved in planning their own care.

People received personalised and responsive care as staff understood their needs and preferences. People contributed to their care planning and were asked for any complaints or feedback at regular meetings.

The registered manager was clear on their role and responsibilities and was supported by an established and supportive staff team. Staff were motivated and understood their roles and responsibilities. Systems were in place to check on the quality and safety of services provided.

We found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan

The home was clean and tidy. There were systems in place to reduce the risk and spread of infection.

Appropriate arrangements were in place to ensure that people received their medicines. Medicines records were in place and had been completed accurately. People's medicines were kept securely.

Staff members received appropriate support. We noted that some training was out of date but the registered manager was in process of arranging further training updates for staff.

No complaints had been received by the provider in the twelve months prior to our visit. There was a complaints system in place and details of this were displayed in the home.

We found that the provider had up to date advice and guidance available to staff on the identification of abuse and actions to be taken in the event of any allegation of abuse.

Training certificates showed that all staff working in the home had completed a course on the safeguarding of vulnerable adults.