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Inspection carried out on 31 August 2017

During a routine inspection

The Old Vicarage is an old stone house adapted for use as a care home. The home is situated over two floors and there is a lift and stair lift available for access to the first floor. The home is registered for fifteen people who require accommodation and personal care. It is set in its own grounds in the village of Hornby in the Lune Valley between Lancaster and Kirkby Lonsdale. The home is close to local shops, churches and public houses. At the time of our inspection visit, there were thirteen people residing at the home.

There was a registered manager 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.

The service was last inspected on 04 October 2014 and was rated overall as good. We had rated the service as ‘Requires Improvement’ under the safe and responsive domain. This was because improvements were required to ensure staff were suitably deployed and activities were considered for people who lived at the home.

At this inspection, carried out in August 2017, we found all improvements had been made and the service was meeting the fundamental standards. The registered manager had reviewed staffing levels to ensure there were suitable numbers of staff on shift to meet the needs of the people who lived at the home. People told us staffing levels met their needs. Staff were not rushed and had time to sit with people.

In addition, staff had been deployed to ensure people had the opportunity to take part in activities on a daily basis. People and relatives told us activities took place. We saw evidence of activities occurring during our inspection visit.

We reviewed systems in place for managing medicines. We found good practice guidelines were implemented when administering regularly prescribed medicines. However, documentation relating to ‘as and when’ medicines was sometimes unclear. We have made a recommendation about this.

People and relatives told us staff had the required skills and knowledge to provide effective care. The registered manager maintained a training matrix so that training could be planned effectively. Although training was provided we noted staff did not always receive refresher training to ensure their skills were up to date. We have made a recommendation about this.

We looked at fire evacuation procedures at the home. Whilst procedures were in place these were not always fully documented to show all risks had been considered. We have made a recommendation about this.

People told us they felt safe at the home. Procedures were in place to protect people from harm. Staff told us they had received training in this area and were able to describe abuse and their responsibilities for reporting this.

The registered manager assessed individual risk and developed risk assessments to minimise the potential risk of harm to people during the delivery of their care. Care records showed they were reviewed and any changes were recorded. Risk was suitably managed.

We reviewed staff records. Suitable recruitment checks were in place to ensure staff recruited possessed the correct characteristics and experiences for working with vulnerable people.

We looked around the building. We found it was hygienic and suitably maintained. We reviewed documentation relating to health and safety at the home and found suitable maintenance checks had been carried out.

People and relatives spoke positively about the quality of service provided. They praised the caring nature of staff, constantly referring to them as ‘kind’ and ‘caring.’ We found there was a warm and welcoming atmosphere at the home. People repeatedly described the home as homely and described it as a home from home.

We received positive feedback about the qual

Inspection carried out on 07 October 2014

During a routine inspection

We inspected The Old Vicarage on the 7th October 2014. This was an unannounced inspection which meant the staff and the registered provider did not know we would be inspecting the home.

The last inspection was in November 2013. This was undertaken to check that the home had made improvements with their management of medicines and supporting people with their consent to care and treatment. At that inspection the registered provider was found to be compliant.

The Old Vicarage can accommodate up to 15 people, who require nursing or personal care and who are elderly. The home is not registered to care for people with dementia. At the time of our visit the home was fully occupied.

The Old Vicarage is an old stone house, adapted for use as a care home. The house is a listed building and is set within its own grounds in the village of Hornby in the Lune Valley. Hornby is situated between Lancaster and Kirkby Lonsdale. It is close to local shops, churches and public facilities. The Old Vicarage is served by its own drive and there is car parking available outside the home for visitors.

The home had a registered manager in place. A registered manager is a person who has registered with the Care Quality commission to manage the service. They share the legal responsibility for meeting the requirements of the law; as does the registered provider.

We spent time in the communal areas of the home, including the lounge and dining areas. This helped us to observe the daily routines and gain an insight into how people`s care and support was managed.

The staffing levels in the home were not sufficient to meet the assessed needs of people who used the service. We saw that not enough staff were available to assist people living over busy periods of the day. There was only one call bell in the lounge. This meant people had limited means of summoning assistance should they require it. We found staff did not have sufficient time to monitor and support people adequately. You can see what action we told the provider to take at the back of the full report.

We found there were suitable arrangements in place to protect people from the risk of harm and abuse. All staff we spoke with, including the cook and the cleaner had undertaken safeguarding vulnerable adults training. Our discussions with staff showed us they understood their responsibilities to protect people from the risks of abuse. They all consistently told us they were aware of what actions to take if they had any suspicions of abuse. People we spoke with told us they felt safe. One person told us, “Everyone is kind and helpful, there are people around and they are very good. I know there are other people about. The whole atmosphere is there are people around me. A second person told us “I never think about it, the general feeling is there’s always someone around.” People we spoke with were positive regarding the care they received. One person told us, “I would say they are more than outstanding. I could recommend this place to the queen". One person we spoke with was very complimentary regarding the responsive care and attention they had received from staff.

In the care records we looked at, we saw the home had safeguards in place for people who may have been unable to make decision about their care. This included a pre assessment and various risk assessments. Records showed us people had been supported to understand their care plan and people had signed their consent to their care and support.

The service had policies and guidance in place in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLs) The MCA and DoLs provide legal safeguards for people who may be unable to make decisions about their care. The registered manager told us that they had not been required to make any applications to the Local Authority. She told us that she was aware of who to contact should she be required to make a referral in the future. Our discussions confirmed she was aware of her responsibilities with regard to this legislation

We looked at the management of medicines within the home. We found there were appropriate arrangements in place to safely manage and administer medicines. We observed people were supported to take their medicines and be supported with their underlying health conditions. The registered manager and staff told us they were very well supported by the local doctors and healthcare team. The staff at the home were developing Advanced Care Planning to support people with their end of life wishes.

Staff told us they felt very well supported by their registered manager. They told us they had opportunities to undertake relevant training and personal development. The registered manager also spoke highly of her staff team and told us how much she valued their support. The staff team we met had all worked for a long time at the home. There was not a high staff turnover.

During a check to make sure that the improvements required had been made

We found that the provider had taken appropriate action to ensure that staff adhered to policies on safe handling of medicines.

Inspection carried out on 18 October 2013

During an inspection to make sure that the improvements required had been made

When we last inspected the Old Vicarage in August 2013, we found they were non-compliant with two outcomes. We asked the provider to submit an action plan telling us how they were going to improve. This follow up inspection was to check on progress. Last time we inspected, we found no evidence that people had consented to their care. We saw that this had now been rectified and people signed to say they had seen and approved their care plans.

Last time we found that people were not adequately protected against the risks associated with medicines. This time we found a great many improvements had been made to the storage of medication, including purchasing a trolley. We were told that staff had been advised on proper procedures for administering medication and that the managers were checking these were followed. Despite this, we found there were still some slippages in standards, which the manager accepted as in need of tightening up.

Inspection carried out on 14 August 2013

During a routine inspection

At our last inspection in April 2012, we found the Old Vicarage compliant with all of the outcomes we inspected, except for outcome 8 which is the safe management of medicines. At this inspection we followed up to check if the provider was now administering medication safely. We also talked with residents, looked at care plans and other documents, and observed care. We found the home had had some refurbishment since our last visit. There were also some new residents. On the day we visited there were 12 people in the home. The atmosphere was pleasant and welcoming. We saw that staff worked well with people, and spoke pleasantly with them. Although there was no cleaner on duty on the day we visited, the rooms we saw were clean. Some upgrading of washing facilities was in progress following a local authority audit. This would make them more hygienic. We found that management systems for ensuring quality continued to be informal but that there was evidence that people were listened to and improvements were being made. We looked at the home�s systems for ensuring consent was obtained for care people received. We found that there was no evidence for this. We also found that there was a continuing failure to store and administer medication safely.

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