The Old Vicarage

About the service: The Old Vicarage provides accommodation for up to nine adults with a learning disability and/or autism. On site there is the main house which has four bedrooms, the bungalow which has three bedrooms and the stables which has two bedrooms. At the time of the inspection eight people were living at The Old Vicarage.

People’s experience of using this service:

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways; People were supported to take reasonable risks to enable them opportunities to lead a full life. People made decisions about what they ate and drank. People spent their day as they preferred were supported to take part in social activities of their choice, both in and out of the home to enhance their well-being

Clear plans were in place to promote positive behaviours and safeguard people from injury when they became anxious. Staff understood their responsibilities to safeguard people and were clear on reporting any concerns. People were supported to take their medicines in a safe way. Recruitment checks were undertaken, to determine the suitability of new staff and protect people that used the service. The risk of people acquiring an infection, was minimised as infection control procedures were in place and followed.

People were supported as needed, to ensure their preferences and dietary needs were met. Where people were unable to independently make specific decisions regarding their care; assessments were undertaken to determine the support they needed with these decisions. This ensured people were supported to have maximum choice and control of their lives and were supported in the least restrictive way possible. People and their representatives were involved in their care to enable them to receive support in their preferred way. Healthcare services were accessible to people with staff support as needed, and they received coordinated support, to ensure their preferences and needs were met.

Information was available in an accessible format to support people’s understanding. People maintained relationships with their family and friends and were encouraged to give their views about the service. This included raising any concerns they had. There were systems in place to monitor the quality of the service and drive improvement.

More information is in the full report below.

Rating at last inspection: Requires Improvement (report published 13 March 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection we saw that improvements have been made.

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

We previously carried out a responsive inspection in April 2017 following concerns from local authorities and a whistle-blower about the quality of care provided. A whistleblower is a worker who reports certain types of wrongdoing. In April 2017, we rated The Old Vicarage as Inadequate, and issued the provider with a notice of decision to impose conditions on their registration at The Old Vicarage. As a result, this service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The Old Vicarage is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at on this inspection. The Old Vicarage is a Georgian property near Ironville, with a large secure garden area. People live in three separate buildings, which share a secure courtyard and garden space. The Old Vicarage is registered to provide accommodation for nine people who require nursing or personal care. The service does not provide nursing care. At the time of our inspection there were seven people living there. The Old Vicarage supports younger people who have diagnoses of moderate to severe learning disabilities and other complex healthcare needs.

The service is required to have a registered manager. 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. At the time of our inspection the manager was not registered but was going through the process to become registered. The manager is now registered.

People were not consistently kept safe from the risks of avoidable harm and abuse. People were not consistently kept safe from risks associated with their health conditions. The provider could not be assured safe recruitment practices were in place.

The premises were kept clean, which minimised the risk of people acquiring an infection whilst using the service. People were kept safe from risks associated with the environment. Medicines were stored, documented, administered and disposed of in accordance with current guidance and legislation.

People were not consistently supported to maintain their health. There was a lack of clear information in people’s records to evidence how their health needs were being monitored and met. Staff knew what action was needed to ensure people received care they needed, but there was a risk that these actions were not undertaken in a timely way.

People’s needs and choices were assessed and care delivered in a way that helped to prevent discrimination. People received care from staff who had skills and training to support them.

People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The provider followed the requirements of the Mental Capacity Act 2005 (MCA), and people were protected from care practices that were overly restrictive and unlawful. People were kept safe from the risks associated with physical restraint. People were supported to have sufficient to eat and drink.

People and relatives were positive about the kind and caring attitudes of the staff team. People were encouraged to communicate in ways which suited them. People’s dignity, privacy and choices were respected by staff. Staff understood how to keep information about people's care confidential, and knew why and when to share information appropriately.

People and relatives were given information about raising concerns and making a complaint. However, there was no clear process in place for the provider to ensure concerns or complaints raised by people or relatives were managed consistently.

People were encouraged to express their views and wishes in relation to their daily lives. However, people were not consistently supported to participate in designing or reviewing their care. People received personalised care that was responsive to their needs. They were supported by staff who understood their needs and followed their care plans. People were supported to communicate effectively by staff who understood their verbal and non-verbal communication.

The governance of the service required improvement. The provider had not appropriately notified the Care Quality Commission of all significant events as they are legally required to do. Quality assurance processes to ensure people’s care was safe were not consistently implemented or effective. Relatives and staff were positive about how the service was managed. Staff felt supported by the provider and manager to deliver care well. Staff understood their roles and responsibilities, and demonstrated their knowledge and understanding of people's physical and emotional needs.

We found one breach of the Care Quality Commission (Registration) Regulations 2009. Full information about CQC's regulatory response is added to reports after any representations and appeals have been concluded.

We previously carried out a comprehensive inspection of the service in February 2016, when The Old Vicarage was rated as Good. Following concerns from local authorities and a whistle-blower about the quality of care provided, this comprehensive unannounced inspection was carried out.

People were not kept safe from the risks of avoidable harm and abuse. People were not kept safe from the risks associated with unsafe physical restraint. Risks associated with the environment were not reduced and mitigated. Information about people’s care needs in an emergency were not up to date or easily accessible. Medicines were not stored securely.

Staffing levels were not consistently sufficient to ensure people received the care and support they were assessed as needing. The provider did not always undertake pre-employment checks to ensure prospective staff were suitable to work with people receiving care.

People were at risk of harm because staff did not have training to help them to understand how to effectively support people’s health and care needs. The provider could not assure themselves that staff had training and skills to meet people’s needs.

People were at risk of being physically restrained when this was not proportionate or in their best interests. There were no effective safeguards in place to ensure physical interventions used were minimal and reasonable. The provider was not working in accordance with the Mental Capacity Act 2005, and people were at risk of care that was overly restrictive and unlawful.

People’s health action plans were not kept updated with information about health appointments and outcomes. There was a risk that essential information would be lost and not shared appropriately, and people would not receive the healthcare they needed. The provider could not demonstrate that people were supported to maintain their health.

Staff spoke in a caring way about the people they supported, but this was not consistently reflected in their actions or language. People were not consistently supported to participate in designing or reviewing their care. People’s confidential care records were not kept securely.

People did not receive personalised care that was responsive to their needs, preferences and aspirations. People were not supported to communicate effectively. There was no effective system in place for people or relatives to share their concerns and contribute to improving the service.

The service was not managed well. There were failures to meet the fundamental standards in relation to safe care practices and staff recruitment processes, insufficient staffing levels and staff training, planning and delivery of people’s care, and following relevant legislation. Systems and processes in place did not identify learning from incidents and mitigate any future risks to people. Quality assurance processes to ensure people’s care and the service environment were safe were not effective. CQC registration requirements were not being met.

The Old Vicarage had a registered manager, and they were present during 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.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to these concerns found during inspection is added to reports after any representations and appeals have been concluded.

We found one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The Old Vicarage is a Georgian property near Ironville with a large secure garden area. The location has the main house and a purpose built bungalow. The home is registered to provide accommodation for persons who require nursing or personal care. The service does not provide nursing care. At the time of our inspection there were seven people living there. Four people were living in the main house, and three people lived in the bungalow. The Old Vicarage supports younger people who have diagnoses of moderate to severe learning disabilities and other complex healthcare needs.

There was a registered manager in post at the time of our inspection, and they were present during the inspection visit. 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 protected from the risk of avoidable harm. The provider took steps to minimise the risk of harm or potential abuse.

People’s care records contained enough information to enable staff to support them to be as independent as possible. Care records showed risks to people’s health, safety and well-being had been identified and plans were in place to reduce or eliminate risk.

We found people were cared for by sufficient numbers of staff who were suitably skilled, experienced, and knowledgeable about people’s needs. The provider took steps to ensure checks were undertaken to ensure that potential staff were suitable to work with people needing care. Staff were knowledgeable about how to recognise if people were at risk of abuse, and what steps they should take to protect people from avoidable harm.

Appropriate arrangements were in place to assess whether people were able to consent to their care. The provider was meeting the legal requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DOLS). This ensured that legal safeguards were in place to protect people who could not consent to aspects of their care.

The systems for managing medicines was safe, and staff worked in cooperation with health and social care professionals to ensure that people received appropriate care and treatment in a timely manner.

People were supported to be as involved as possible in their care planning and delivery. The support people received was tailored to meet their individual needs, wishes and aspirations. People were supported to maintain contact with family and friends who were important to them, and relatives praised staff for their kind and caring attitudes.

Systems were in place to monitor the quality of the service provided and ensure people received safe and effective care. These included seeking and responding to feedback from people and their relatives in relation to the standard of care. Regular checks were undertaken on all aspects of care provision and actions were taken to improve people’s experience of care.

People we spoke with were very positive about the provider and the care provided. One person whose relative used the service told us 'We absolutely think its top notch', another commented that their child had 'come on leaps and bounds since they been there'. One relative described the home as 'One of the top quality ones'. We found that support and behaviour plans, and risk assessments were specific to the person and updated on a regular basis.

We found that the provider had accurate records of medication and that all staff were up to date with training in this area. There were protocols in place for people who had medication that was given as 'as required'.

Staff were up to date with mandatory training in key areas such as safeguarding and first aid. There was evidence that staff had also completed additional training such as understanding the Mental Capacity Act 2005.

We saw that appropriate checks had been made to ensure that the premises were safe.

The provider had not received any complaints since our previous inspection and had a procedure in place for dealing with any complaint.

Although the people we spoke to had limited verbal communication they were all able to indicate that they liked living at The Old Vicarage. We found that people using the service and their relatives were involved in discussions about their needs and care. One relative told us the 'staff are fantastic. I can't fault them.' We found that people were always treated with respect.

We found there was a good level of communication and contact between staff and people using the service. Care and daily routines were centred around people's individual needs and preferences. A relative told us their family member 'is doing really well at The Old Vicarage. The place is excellent.'

People were protected from the risk of abuse, staff knew how to raise any concerns. We found that people had been assessed as to whether they could make decisions about the care and treatment they receive.

We found there was a clear and up to date recruitment procedure in place that was followed by the service. This meant that people were cared for, or supported by, suitably qualified, skilled and experienced staff.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained. We found the provider had clear and effective systems in place relating to record keeping.