The Old Vicarage

The Old Vicarage is a residential care home located in an adapted house over two floors. Some bedrooms are accessible on the ground floor, and some upstairs. There are communal areas and a garden.

The service provides personal care and accommodation for up to nine people who have learning disabilities and additional needs. Eight people were living at The Old Vicarage at the time of the inspection. This is larger than current best practice guidance, however, the size of the service was mitigated by the fact that it fitted into the residential area and other homes in the area were of a similar size.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People were safe and protected from avoidable harm or abuse at The Old Vicarage. Policies, procedures and checks were in place to protect people and staff. Risk assessments were in place, and the environment was clean and met people’s needs. Plans were in place to redecorate some areas of the building.

There were enough staff to meet people’s needs. Safe recruitment and selection procedures were in place and staff received induction and training to ensure they had the skills and knowledge to effectively support people. Some staff had not had supervision as frequently as the provider required, but this was being addressed and all told us they felt well supported.

People's medicines were administered as prescribed and managed safely by competent staff. People accessed routine and specialist healthcare services as required, and were supported to eat and drink enough to maintain a balanced diet which met their needs.

People were well supported and treated with dignity and respect. They were involved in decision making where possible. People and their relatives were positive about staff.

People had care plans which were personalised and identified what was important to them. Care plans gave guidance to staff about what people could do for themselves and how best to provide support. Records were being developed to ensure people’s preferences were respected in the event of serious illness or death.

People were supported to participate in a range of activities. A plan was in place to further develop more activities which were meaningful for the individual. People were supported to develop and maintain relationships with family and friends.

The service was well run and staff felt supported by the management team to provide high quality care. Checks and audits were carried out regularly to review quality and performance. Action plans enabled the provider to monitor changes and improve care for people.

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 service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support usually focused on them having opportunities to gain new skills and become more independent.

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 15 March 2017)

Why we inspected

This was a planned inspection based on the previous rating.

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.

There was a registered manager for the services. 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 were helped to stay safe because the provider had systems that helped reduce risks to them. People were supported by enough staff to keep them safe and to reduce the risks of them experiencing harm. Staff were well trained about how to provide safe care. The staff knew how to protect people if they had any concerns about their safety or wellbeing.

People were helped by staff to manage and receive their medicines safely. People were properly supported to stay healthy. They were also well supported to have positive relationships in their life. Each person had a detailed care plan in place and these were produced with people and their relative’s involvement. Care plans showed how each person’s’ care and support needs were met Care plans were reviewed regularly. This was to ensure they were up to date and reflected people’s full range of care and support needs.

The staff were kind and caring and the communication we saw between people and staff were warm and friendly in nature. The staff understood that part of their role was to promote people’s independence and encourage them to take part in activities they enjoyed. People told us they liked going out for example to visit family and take part in a range of social events.

Staff felt they were supported in their work and they also felt the management were supportive. The quality of care and service that people received was checked and monitored. This was to make sure it was safe and suitable for them.

People were supported with their range of day to day needs by a team of staff who were well trained and properly supported and supervised in their work. The staff were able to go on regular training courses and felt developed and supported in their roles. This helped the staff to improve and develop their skills and competencies when they supported people at the home .The staff felt positive about working as a team and they felt there was usually a good morale and team spirit among them.

The visions and values of the organisation were understood and put into practice by the team. The staff showed how they followed these visions and values in their work. They included providing personalised care, treating people as unique individuals and encouraging independence.

The Old Vicarage provides accommodation and personal care for up to 10 people with a learning disabilities. At the time of our inspection there were nine people using the service.

A registered manager was in not post at the time of our inspection. 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 previous registered manager had left in November 2015. A manager was in post at The Old Vicarage who was currently completing their registration process with the Commission.

Training in challenging behaviour had not been completed. This placed both the staff and people living at the service at risk.

The provider had not ensured that current medicines information was available for trained staff despite being previously advised. People’s photographs within their medicines folders were undated which had also been previously highlighted by a pharmacist in July 2015 as requiring action. Incidents and accidents were recorded however staff had inconsistently recorded matters.

During interviews with staff, we found that staff knowledge in relation to the Mental Capacity Act 2005 was variable. The service had not consistently completed best interest decisions for people when required.

Staff received support through training and supervision. People were supported with meals and drinks when required. People were involved in choosing their meals. Where needed, the service had made referrals to healthcare professionals and health plans were in place.

The manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the mental capacity to consent to treatment or care and need protecting from harm.

People felt safe and told us they had a good relationship with the staff. People’s identified risks were recorded and risk management guidance was available. There were sufficient numbers of staff on duty and staff knew their responsibilities in relation to safeguarding. Staff recruitment procedures were safe and the environment and equipment was tested and serviced to ensure it was safe.

People said the staff at the service were kind. People had a keyworker to provide personalised support and we observed that interactions between staff and people were positive. People had their privacy respected and staff we spoke with understood the people they cared for well.

The service was responsive to people’s needs. People, their relatives or representatives were involved in care planning and reviews. The care plans we reviewed were person centred and contained unique information about people and how to meet their needs. People were given key information about the service. There were activities people could participate in if they chose. The provider had a complaints procedure and system in operation.

People knew who the manager was and who to approach if they had any concerns. Staff told us they were happy with their employment and felt supported by the manager. There were systems in operation to communicate key messages to staff. People had the chance to express their views and opinions.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

At the time of our inspection there were nine people living in the home. We observed the care being provided to people in the communal areas of the home and examined the care documentation and supporting records. We spoke with two people that used the service who were able to tell us of their experiences and we spoke with three members of staff to gain their understanding of how they met the needs of people living in the home.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, the staff supporting them and looking at records.

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

Is it safe?

Staffing was maintained at safe levels. During our inspection people's needs were responded to in a timely manner. Staff received training in safeguarding adults.

Safeguarding procedures were in place and staff understood their role in safeguarding the people they supported. Staff had a good understanding of who they needed to contact should they have any concerns around people's welfare.

People who used the service were cared for by staff who knew how to protect them from the risk of abuse. The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (Dols). The senior member of staff confirmed no one currently living in the home was subject to such an application. However relevant staff had been trained to understand when an application may be required. This meant that people were safeguarded from abuse.

Is it caring?

People were supported by sensitive and attentive staff. One person we spoke with told us 'lovely I am very happy'. We saw that care staff showed patience and gave encouragement when supporting people. We spent time in the communal lounge observing interactions between staff and people that used the service.

The observations we made demonstrated staff supported people in a calm unhurried manner, using communication methods conducive with their individual assessed needs.

Staff communicated with people in a way that supported them. Not all people living in the home used verbal communication methods. We viewed 'your voice' meeting minutes which demonstrated the methods used to gain people's opinions on the care they received. For example people were asked if they were happy with the care they received and the people that supported them. One person gave a thumbs up, another person tapped a picture to indicate yes and another person screamed with excitement when asked.

Is it effective?

We found people's health and care needs were assessed with them and reviewed regularly. Care plans provided guidance for staff to follow to ensure people's individual specific needs were met. Care plans were reflective of people's current level of need.

Specialist dietary, mobility and equipment needs had been identified in care plans where required. People also had supplementary files that held detailed information about their health needs and detailed any changes. This information travelled with the person when they visited health professionals and if they had a hospital admission. One person told us their keyworker met with them on a monthly basis and this was evidenced in people's files.

It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew them well.

Is it responsive?

People received co-ordinated care. We saw evidence in people's care plans that demonstrated people had been visited by their GP and other health care professionals. For example, people's files held information and advice sought from the district nurse team in relation to end of life care. Records demonstrated they visited on a regular basis.

Is it well led?

A stable management team was in place. We were told the manager was approachable and staff we spoke with felt supported by the whole management team.

People that used the service, their relatives and external professionals completed a satisfaction survey once a year. The senior person told us if any concerns were raised these would be addressed promptly and people were encouraged to raise any concerns or worries on a daily basis and at residents meetings called 'your voice'. Minutes we viewed confirmed this.

Throughout our inspection we saw that staff engaged positively with people in a calm and relaxed manner. People were observed moving freely around the home and taking part in 'activities of daily living'. For example one person was being supported to do their ironing and risk assessments were in place to support this person safely.

People that we spoke with told us they were very happy living in the home and felt safe. People's comments included; 'I'm happy here I like X she's my keyworker'. 'I go on holiday, I've been to Spain'. 'I can choose what to do I get lots help'. " I have friends here".

We asked staff what it was like to work at the Old Vicarage and comments included; " its ok here we get support from the management team and we are asked for our feedback', 'training is good but I wish we had more classroom style training and not so much computer style'. Another person told us 'I get regular supervision and X is always available for advice and support".

The provider had systems in place to monitor the quality of the service and completed regular audits on the service that people received.