Options The Old Vicarage

About the service

Options the Old Vicarage provides accommodation and personal care for up to 8 people who have a range of needs including autism, mental health needs and/or learning disabilities. There were 6 people using the service at the time of this inspection. The provider has a range of registered care services including several adult social care services across the country.

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

The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

Right Support

People who used the service were supported by caring and dedicated staff to exercise their choices and remain as independent as possible. The staff worked in a highly person-centred way, knew people’s individual needs and how to meet these. The staff were supported by the management team to work together and find creative ways to promote learning and for people to develop new skills. People told us they were very happy and had meaningful and fulfilling lives. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The staff worked in a holistic way and always focused on people’s strengths to help ensure they could meet the needs of all the people, regardless of how complex these were. The registered manager had implemented a system whereby people and their representatives were involved in the planning of their care and support and care plans were based on the individual according to their choices and wishes. People were supported to pursue their interests and achieve aspirations and goals. The staff had used people’s individual strengths to build meaningful relationships between them. This included teaching each other skills and knowledge. People took part in a wide range of social activities of their choice.

Staff supported people with de-escalation techniques when they became anxious or agitated, which prevented them from restraining people. The environment had been developed to benefit and meet the individual needs of people. Staff enabled people to access specialist health and social care support in the community. People received their medicines safely and as prescribed.

Right Care

The staff provided kind and compassionate care and people told us they felt respected, valued and happy. Staff protected and respected people’s privacy and dignity. People’s individual wishes and needs were met by staff who were well trained and supported, and put people’s needs at the centre of everything they did.

Staff received training in safeguarding adults and understood how to protect people from poor care and abuse. People were supported to improve their skills and learn new ones. This meant one person had been able to move on to a more independent service and was thriving. The registered manager had worked with each person to develop a comprehensive range of communication methods so they understood their needs fully. They ensured the staff had a full understanding of these and responded to these appropriately.

Right Culture

People, relatives and staff told us the culture of the service had gone from strength to strength and this was evident. People’s quality of life and their health had greatly improved and this was attributed to the service’s culture of improvement and inclusivity. The registered manager and staff worked with people to empower them to lead happy and meaningful lives. The provider’s ethos and values were shared by all and this had contributed to a happy staff team who enjoyed their work and felt appreciated. This meant people received good quality care and support.

The management supported staff to receive regular training so they could understand best practice in relation to the range of needs people with a learning disability and/or autistic people may have. This meant people were empowered and received compassionate care that was tailored to their needs. Staff were happy working at the service and enjoyed their jobs, so turnover was low. This resulted in people being supported by regular staff who knew them well. This contributed to a consistent support which people benefited from. The provider enabled people and those important to them to work with staff to develop the service.

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 17 August 2021).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained good based on the findings of this inspection.

Follow up

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

Options the Old Vicarage provides accommodation and personal care for up to eight people who have a range of needs including autism, mental health needs and/or learning disabilities. There were seven people using the service at the time of this inspection. The provider has a range of registered care services including several adult social care services across the country.

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

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 safe, responsive and well led, the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture

Right support:

• The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

Right care:

• People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent. The staff supported people in a person-centred way and respected their privacy, dignity and human rights.

Right culture:

• Staff were responsive to people’s individual needs and knew them well. They supported each person by spending time with them and listening to them. They ensured that each person felt included and valued as an individual. People were engaged in meaningful activities of their choice. They were consulted about what they wanted to do and were listened to.

There were systems and processes in place to protect people from the risk of harm. Risks to their safety and wellbeing were appropriately assessed and mitigated. The environment was clean and hazard-free. There were robust systems in place for the prevention and control of infection and the staff followed these. People received their medicines safely and as prescribed.

People who used the service and their relatives were happy with the service they received. Their needs were met in a personalised way and they had been involved in planning and reviewing their care. People said the staff were kind, caring and respectful and they had developed good relationships with them.

People's needs were assessed before they started using the service and care plans were developed from initial assessments. People and those important to them were involved in reviewing care plans. There were systems for monitoring the quality of the service, gathering feedback from others and making continuous improvements. The provider worked closely with other professionals to make sure people had access to health care services.

Staff were happy and felt well supported. They enjoyed their work and spoke positively about the people they cared for. They received the training, support and information they needed to provide effective care. The provider had robust procedures for recruiting and inducting staff to help ensure only suitable staff were employed.

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 24 August 2018). We also carried out a focused inspection on 14 July 2020 but did not change the rating. At this inspection, the service remains good.

Why we inspected

The inspection was prompted in part due to whistleblowing concerns received about the management team. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, responsive and well-led sections of this full report.

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.

We reviewed the information we held about the service. No 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.

The overall rating for the service has not changed. This is based on the findings at this inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values 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.

There were systems and processes in place to protect people from the risk of harm. There were enough staff on duty to meet people’s needs. Checks were carried out during the recruitment process to help ensure only suitable staff were employed.

The provider was aware of their responsibilities and had acted in accordance with the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

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.

People were supported by staff who were suitably trained, supervised and appraised.

The staff on duty were caring and treated people with dignity and respect. They understood how to communicate with people effectively and in line with their care plans.

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 24 August 2018).

Why we inspected

We undertook this targeted inspection because we had received information which could indicate a negative culture in the home that might have a detrimental effect on the welfare of people using the service. A decision was made for us to inspect and examine those risks. The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to follow up on a Warning Notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective, caring and responsive sections of this full report.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Options 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.

Options the Old Vicarage provides accommodation and personal care for up to eight people who have a range of needs including autism, mental health needs and/or learning disabilities. There were seven people using the service at the time of this inspection. The provider had a range of registered care services including several adult social care services across the country.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values 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.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Staff were passionate about supporting people to achieve their full potential. They invested time to developing ways to work with individuals to help them improve their quality of life. Their dedication resulted in people making improvements including some leaving the service to become independent.

There were systems and processes in place to protect people from the risk of harm. There were enough staff on duty to meet people’s needs.

Checks were carried out during the recruitment process to ensure only suitable staff were employed.

There were arrangements in place for the safe management of people’s medicines and regular checks were undertaken to ensure this remained safe.

The premises were clean and the provider had effective systems to protect people by the prevention and control of infection.

The provider was aware of their responsibilities and had acted in accordance with the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

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.

People’s nutritional and healthcare needs had been assessed and were met.

People were supported by staff who were suitably trained, supervised and appraised.

Staff were caring and treated people with dignity and respect. Care plans addressed each person’s individual needs, including what was important to them, and how they wanted to be supported.

People were involved in undertaking activities of their choice. People were cared for in a way that took account of their diversity, values and human rights.

People who used the service were young and although their own end of life wishes were not discussed, staff supported them to understand and deal with bereavement.

People living at the service and their relatives told us that the management team was approachable and supportive. People and their relatives were supported to raise concerns and make suggestions about where improvements could be made.

The provider had effective systems in place to monitor the quality of the service and ensure that areas for improvement were identified and addressed.

The registered manager kept themselves informed of developments within the social care sector and cascaded important information to the rest of the staff team. This helped ensure that staff were informed and felt valued.

Options The Old Vicarage provides support and accommodation for up to eight people who have a range of needs including, autism, mental health needs and/or learning disabilities. There were seven people using the service at the time of this inspection.

The last inspection of this service took place on 4 July 2017 when we identified two breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The issues were relating to safe care and treatment (Regulation 12) and the good governance of the service (Regulation 17). At the previous inspection we found that there was missing risk assessments on one person's care file and inaccurate information in another person's care records. Also the quality assurance systems had not included audits on people's care and daily records to ensure they were available, up to date and written in a person centred way.

Following the inspection in July 2017 the provider sent us an action plan in which they told us that improvements would be made by 24 September 2017. At this inspection we reviewed the actions identified in the action plan and we found improvements had been made.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 'Options The Old Vicarage' on our website at www.cqc.org.uk.

Since the last inspection information about people's needs and the risks to themselves and/or others was available to view. The information we saw was up to date and informative. Documents had been dated and signed so it was clear when they had been written or reviewed.

Improvements had also been made to the temperature of the room where medicines were stored. We saw it was cooler and the temperatures taken were within an appropriate range, as previously the room had been warm. Staff had also been assessed to administer medicines safely.

During the inspection the registered manager informed us that the kitchen fire door was not in good working order. The registered manager sought to resolve this and two days after the inspection we saw evidence that the door had been fixed and afforded the necessary protection as a fire door.

The registered manager had implemented an audit of people's care records since the last inspection. This check had been carried out monthly and included viewing daily records to ensure they were appropriate and person centred. The audit enabled the registered manager to follow up on any issues and be confident that staff had the information they needed to safely support people.

Following the inspection in July 2017 the service was rated Requires Improvement overall with the key questions, ‘Is the service safe?’ and ‘Is the service well–led?’ rated as Requires Improvement. Following the inspection in October 2017 the ratings for the Safe and Well-led key questions have been changed to Good with the service now given an overall rating of Good.

The last inspection took place 27 and 28 April 2015 when we rated the five key questions we asked of services and the service was rated ‘Good’.

Options The Old Vicarage provides support and accommodation for up to eight people who have a range of needs including, autism, mental health needs and/or learning disabilities. There was one vacancy and therefore there were seven people using the service at the time of this inspection. One person was on social leave.

The provider had a range of registered care services including several adult social care services across the country.

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.

Although on one person’s care file there were risk assessments in place, on another person’s file there were none to inform and guide staff about the potential risks faced by the person using the service and/others.

There were quality checks in place. However, these were not that effective because they had not identified the issues we found during the inspection. In addition the provider did not ensure appropriate and complete records were maintained about the care people received and about the management of the service.

We found two breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which related to safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of the report.

People received the medicines they needed safely. Staff received medicines training but were not formally assessed, in between the training, to ensure they continued to be competent to carry out this task. We were informed that a competency assessment would be introduced to ensure staff continued to understand their role in administering medicines to people using the service.

Although people’s care records included people's needs and preferences and were individualised, some of the language used in the daily records was not appropriate or informative and did not reflect people in a dignified manner.

Feedback from people using the service, a relative and staff we spoke with was positive about the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the systems in the service supported this practice.

There were checks and systems in place to check the fire procedures and ensure that equipment protected people in the event of a fire.

Staff knew how to report any safeguarding concerns. There were safeguarding policies and procedures in place to inform and guide staff what to do if they had a concern that a person using the service was at risk of abuse.

Staff continued to receive support through one to one and group meetings. They also received an annual appraisal of their work. Training on various topics and refresher training had been arranged that were relevant to staff member's roles and responsibilities.

There were sufficient numbers of staff working to meet people’s needs. The registered manager had been in post for several years and regularly worked alongside staff on shift so that they could see how the service met people's needs.

Recruitment checks were carried out to make sure staff were suitable to work with people using the service.

People had access to the health care services they needed and their nutritional needs were being met.

There was a complaints procedure, which was also available in a pictorial version for people who responded to pictures more than words.

Staff had an awareness of what to do if people needed to be assessed using the Deprivation of Liberty Safeguards assessments. The staff team supported people to make choices, whilst balancing the presenting risks to the person and/or others.

People who use the service were assessed prior to their admission into the home. This was to ensure their needs could be met. People were supported to gain independent daily living skills, such as preparing meals or communicating their needs more effectively. Staff followed people's individual care plans and risk assessments which recorded people's particular needs and any potential risks. Where possible, people were involved in the development of their care plan and their views were taken into account.

The staff team supported people with a wide range of needs, for example some people understood commands and activities if they were presented using pictures and/or photographs, whilst other people needed minimal support and guidance.

Medicine systems were in place to ensure people received their prescribed medicines. People, where able, were also supported to self administer their medicines. One person told us 'I know what medicines I take and the reason why I take them'. Another person said 'I know the medicines keep me well'.

There were sufficient numbers of staff working in the home to support people effectively and safely. One person commented 'I know I can always find a member of staff if I want to talk to them'.

Staff received on-going support, supervision and training to carry out their roles.

There were systems and audits in place to check and review the quality of the care being provided in the home.

People were supported in promoting their independence and community involvement. People attended a local college that provided them with the opportunity to develop and learn skills that promoted their independence. In addition the two staff we spoke with confirmed various activities were on offer in the evenings and week-ends, such as going to the cinema and the pub. People told us that if they could go out without staff support, then this was encouraged to help them gain confidence and social skills with other people.

One professional told us the staff were 'motivated, professional and knowledgeable'. Another professional said the staff team 'empowered' the people living in the home and could work with the different challenges that might present them when supporting people with complex needs.

One professional told us that, 'the team actively listen and talk with the person'. In addition, the two staff we spoke with and the two relatives confirmed that the people living in the home were capable and willing to voice their concerns or raise a complaint if they needed to. The three people we asked also said they felt comfortable talking with staff if they had a concern or complaint.