The Old Vicarage

The Old Vicarage is a residential care home providing personal care to up to 21 people in one adapted building. At the time of our inspection there were 18 people using the service. Accommodation is provided on three floors accessed by stairs and lifts. People had their own rooms and access to communal rooms such as a lounge and dining room. People could access a large garden from the ground floor.

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

People, relatives and staff spoke positively about the care received and the management of the home. They appreciated the home was a small, family run service providing people with continuity of care. People and relatives told us there were enough staff available to support them and the staff were caring and helpful.

People’s individual risks had been identified and risk assessments were in place. They were regularly reviewed and amended when needed. People had their medicines as prescribed and where safe to do so people were supported to manage their own medicines. Staff had been trained in safeguarding and understood their responsibilities to report any concerns.

People and relatives told us the home and their rooms were cleaned regularly. We observed the home was clean and smelt fresh. Staff were observed to be wearing appropriate personal protective equipment (PPE) and staff told us they had received training on using PPE safely. The provider told us they had plenty of PPE in stock.

Management had kept in touch with local health protection agencies and kept up to date with government guidance on COVID-19. Updated guidance had been cascaded to staff when needed. People, relatives and staff had received communications throughout COVID-19 on changes and guidance for visiting, PPE and testing. Staff were testing regularly for COVID-19 as per the government guidance.

We observed relatives were visiting indoors and wearing PPE as appropriate. The home also had a large garden which could be used for visiting. The provider had made changes to the garden to provide people with a hard, safe path to use so they could walk around the whole garden area. The registered manager told us this had enabled people to exercise during national lockdowns.

Quality monitoring systems were in place. People, relatives and staff knew who the registered manager and owners were and told us all the management were approachable. Feedback and ideas for improvements were encouraged from everyone and listened to. Action was taken to make improvements where appropriate.

The service worked in partnership with a range of professionals. People were supported to see healthcare professionals in the community or at the home if needed. There were good community links which included religious services and visits for people if they wished.

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 2 February 2018).

Why we inspected

This focused inspection was carried out as part of our inspection schedule. 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.

Follow up

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

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good.

The home continued to ensure people were safe. There were enough suitable staff to meet people’s needs. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. People received their medicines safely and, where possible, were supported to administer their own medicines. People were protected from abuse because staff understood how to keep them safe, including more senior staff understanding the processes they should follow if an allegation of abuse was made. All staff informed us concerns would be followed up if they were raised.

People continued to receive effective care. People who lacked capacity had decisions made in line with current legislation. Staff received training to ensure they had the skills and knowledge required to effectively support people. People told us, and we saw, their healthcare needs were met. People were supported to eat and drink according to their likes and dislikes. 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.

The home continued to provide a caring service to people. People and their relatives told us, and we observed that staff were kind and patient. People’s privacy and dignity was respected by staff and their cultural or religious needs were valued. People were involved in decisions about the care and support they received. People’s choices were always respected and staff encouraged choice for those who struggled to communicate with them.

The home remained responsive to people’s individual needs. Care and support was personalised to each person which ensured they were able to make choices about their day to day lives. People were supported to follow their own activity programmes. These considered people’s hobbies and interests and reflected people’s preferences. People knew how to complain and there were a range of opportunities for them to raise concerns with the registered manager and designated staff.

The home was very well led. People, their relatives and staff spoke very highly about the management and told us they felt the service was outstanding. Staff were highly valued and appreciated and morale was very high. Staff told us they were very well supported and the management went out of their way to help. The registered manager continually monitored the quality of the service and made improvements in accordance with people’s changing needs.

The service met all relevant fundamental standards.

Below is a summary of what we found. The summary is based on our observations during the inspection and from looking at records. We also spoke with five people who use the service, eight members of staff and two relatives of people who use the service. We also requested the provider to send additional information to us after the inspection.

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

Is the service safe?

Care provided by the staff to people was safe and people told us they felt safe living at the care home. Staff were aware of abuse and neglect principles and knew what to do if they suspected that it had occurred. The provider had necessary checks in place to ensure that the premises did not pose a risk to people's health and safety.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications had been submitted, we saw comprehensive policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

It was clear from our observations and from speaking with staff that they had a good understanding of people's care needs and they knew them well. People who use the service and their relatives confirmed our observations. People's health was maintained and protected. People received care that was specific to their requirements.

Is the service caring?

People told us the care staff cared for them professionally. The care home had a person-centred approach in their delivery of care and this was evidenced at the inspection. Care workers who provided care to people ensured people's needs were taken care of, which included checking their needs were addressed. Care staff knew each person at the service as an individual and what their preferences were.

Is the service responsive?

People we spoke with were complimentary of the care provided by The Old Vicarage. We also spoke with some of their relatives who told us care was based on people's health and changes in their conditions. The provider ensured that appropriate interventions were taken where people were at risk because of their health.

Is the service well-led?

The care home had a registered manager who worked with staff to provide management oversight of the care provided. The manager took responsibility for quality and safety that involved risk assessment, care planning and care delivery. This was overseen by the owners of the service. People, relatives and staff could have a say in the operation of the care home, and this was recorded to monitor improvement. There were audits in place and a robust quality system to ensure risks to people and others were appropriately addressed.

We observed staff being caring and responsive to the needs of the people living in the home. This was in keeping with the guidance in people's care and support plans.

We spoke with three people who were visiting family and friends at the home. They told us 'Our relative has recently returned to the home from hospital. We wanted her to come home. This was because we knew that this was the best place for her to be. Staff know mum, they know all of her little ways. Since she has come back she is getting so much better'. Another visitor told us 'The staff are friendly and helpful. I have no worries. I know my friend is in good, safe hands'.

We looked at the care records of four people who used the service. These were comprehensive and detailed the health and social care needs of the person and how any possible risks were minimised. Records were kept under review and were updated when required.

The provider had systems in place for the safe management of medicines.

We found that appropriate recruitment procedures were in place.

People were encouraged and supported to make day to day decisions about their life. For more complex decisions and where people did not have the capacity to consent, the provider had acted in accordance with legal requirements.

The provider and staff were extremely knowledgeable about the practical and emotional support needs of the people in their care. We saw that staff were friendly, caring and professional when supporting individuals at the home.

We found that staff had been trained in a number of areas in order to support the people in their care. Training had included the protection of vulnerable adults, and staff were very clear about what action they would take if they saw or suspected any abuse.

The provider had an effective system in place to regularly assess and monitor the quality of service that people receive.