The Old Vicarage

The Old Vicarage is located in the Somerset countryside and is a residential care home that can accommodate up to 26 people. The service was providing personal care to 23 older people at the time of our inspection.

People's experience of using this service:

People were safe and protected from the risk of harm and abuse. Staff had received safeguarding training and there were policies and procedures to guide staff on what to do if they had concerns. Staff were recruited safely and there were sufficient staff to meet people's needs. People received their medicines as prescribed. The service was clean and tidy but some infection control arrangements needed reviewing.

The provider acted within the law when people lacked capacity to make their own decisions or when they were deprived of their liberty. Staff were unclear as to people’s legal rights. People's health and nutritional needs, including religious observances, were met and understood by staff. Staff received induction, training and supervision to ensure they understood people’s care needs.

People and their relatives described staff as kind and caring. We saw staff were patient and friendly, and people's privacy and dignity was maintained. Staff supported people to communicate their needs effectively. Staff were aware of the need for confidentiality and personal records were held securely.

People had their needs assessed and care plans developed to guide staff in providing people with the care and support they wanted. The initial assessments required more detail to be recorded. The care plans were updated when people's needs changed. The care plans highlighted what people could do for themselves and included a social profile, which indicated their important relationships, previous interests and work. People could remain at The Old vicarage for end of life care. The provider was responsive to complaints and concerns.

The service was well-led; there was an open and supportive culture. People who used the service and their relatives knew the registered manager's name and found them very approachable. There was a quality monitoring system to ensure any shortfalls in the service were identified and improved. People could make suggestions in meetings and surveys. The management team had developed good working relationships with other people and agencies.

The service met the characteristics of good in all areas; more information is in the full report.

Rating at last inspection:

At our last inspection, the service was rated "good." Our last report was published on 1 September 2016.

Why we inspected:

This inspection was part of our scheduled plan of inspection to check the safety and quality of care people received.

Follow up:

We will continue to monitor the service to ensure that people receive high quality care. Further inspections will be planned in line with our scheduled programme of inspections.

The Old Vicarage is registered to accommodate a maximum of 26 people and specialises in providing care to older people. Twenty people can be accommodated in the main house, and there are six bungalows in the grounds where people can enjoy a more independent lifestyle. Staff are on duty 24 hours a day. The Old Vicarage is registered as a care home service without nursing. At the time of the inspection there were 25 people using the service.

The last inspection of the home was carried out in January 2014. No concerns were identified at that inspection. There is 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 living at The Old Vicarage told us they were very happy with the care and support provided. They said the manager and staff cared about their personal needs and preferences. One relative said, “We can’t fault the home, it is well run, I have worked in many care homes and think this is one of the best in Somerset, it is hard to fault it”. Another relative said, “Excellent home, the staff are friendly, nothing is too much trouble”. One person said, “They [staff] take the time to get it right”.

People were supported by sufficient numbers of staff who had a clear knowledge and understanding of their personal needs, likes and dislikes. Staff took time to talk with people during the day and saw their roles as supportive and caring, but were also keen not to disempower people. People valued their relationships with the staff team and felt that they often go ‘the extra mile’ for them, when providing care and support.

People were supported by staff who had undergone an induction programme. The registered manager told us they felt their induction process was good. They explained all new staff completed the care certificate if they did not have a qualification in care. The care certificate is a set of standards that social care and health workers should follow in their daily working life. After staff had completed their induction training they were able to undertake further training in health and safety issues and subjects relevant to the people who lived at the home.

Staff received regular one to one supervisions. Supervisions were an opportunity for staff to spend time with a more senior member of staff to discuss their work and highlight any training or development needs. They were also a chance for any poor practice or concerns to be addressed in a confidential manner.

Care plans were personalised to each individual and contained information to assist staff to provide care in a manner that respected their needs and individual wishes. Risk assessments which outlined measures to minimise risks and keep people safe were held in people’s care plans.

People’s care plans also held “life story books” and dignity questionnaires. Staff discussed how the story books had enabled them to understand more about the “whole person” and their life ensuring they were supporting people to live in an enabling and caring environment

The home was commencing the Gold Standards Framework (GSF) award. The GSF is a comprehensive quality assurance system which enables care homes to provide quality care to people nearing the end of their life. The provider told us within their PIR, “Commencing the Gold Standard Framework for Care Homes earlier this year has provided us with validation of our good practice but also highlighted areas around End of Life Care that we can develop to ensure that we continue to strive to provide the best possible outcomes for our residents”.

There were many thank you cards and complements about the care people received. One card said, “It was an immense comfort to us to know how well and thoughtfully mum was being cared for. You soon discovered her personality and treated her accordingly, we are so grateful. Having mum stay with you until the end was another blessing and meant so much to us as well as mum. The kindness and warmth with which you treated all of us never went unnoticed and was greatly appreciated too. You do a truly wonderful job”.

The mealtime experiences were seen as positive for people living in the home. Throughout the day, snacks and hot and cold drinks were offered to all. If people wished alcoholic beverages, these were provided. One person told us, “I love a glass of wine with my dinner, I always get one.”

Safe systems were in place to protect people from the risks associated with medicines. Medicines were managed in accordance with best practice. Medicines were stored, administered and recorded safely.

People were supported to access external health professionals, when required, to maintain their health and wellbeing. Staff monitored people’s health and ensured people were seen and treated for any urgent or long term health conditions. One health professional visiting the home told us, “We never have any concerns here, the staff always follow our instructions. We all love coming here, the staff listen and follow our guidance.”

There were quality assurance systems in place to monitor care, and plans for on-going improvements. Audits and checks were in place to monitor safety and quality of care. If specific shortfalls were found these were discussed immediately with staff at the time and further training could be arranged if necessary.

The registered manager told us about their values which were communicated to staff. The registered manager told us of the importance of honesty, being open and transparent and treating people who used the service and staff as individuals. They told us they had an open door policy in which people who used the service and staff could approach them at any time.

The registered provider had a system in place for responding to people's concerns and complaints. People and relatives told us they knew how to complain and felt assured that staff would respond and take action to support them. People and relatives we spoke with did not raise any complaints or concerns about the service.