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The Old Vicarage Outstanding

The provider of this service changed - see old profile


Inspection carried out on 27 March 2018

During a routine inspection

The inspection took place on 27 March 2018. The inspection was unannounced and carried out by one inspector.

We last visited the service in December 2015 where we found a breach of the regulation relating to good governance. We rated the service as good. Following the inspection, the registered manager sent us an action plan stating what action they were going to take to improve.

At this inspection in March 2018, we found that action had been taken and the provider was meeting all the regulations we inspected against. In addition, the registered manager and provider had introduced a number of changes and had further developed the service. We rated the caring and responsive key questions as outstanding which meant the overall rating for the service is outstanding.

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. The Old Vicarage accommodates 18 people over two floors. Some of the people living at the home had a dementia related condition. There were 17 people living at the home at the time of the inspection.

There was a registered manager in place. 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 that staff were exceptionally caring. We observed kind, caring and thoughtful interactions between staff and people. Staff were highly motivated and committed and spoke with pride about the importance of ensuring people's needs were held in the forefront of everything they did. People, relatives and staff were able to give numerous examples about how staff went "above and beyond" to meet people's needs.

The service was extremely responsive. People and relatives described the responsiveness of staff as "Outstanding." Staff found inclusive ways to meet people's needs and enable them to live as full a life as possible. A creative activities programme was in place to help meet people's social needs. There was a complaints procedure in place and people knew how to complain.

People told us that they felt safe at the service. There were no ongoing safeguarding concerns. Medicines were managed safely. Checks were carried out to ensure that prospective staff were suitable to work with vulnerable people. There were sufficient staff deployed. Staff carried out their duties in a calm unhurried manner.

Staff told us, and records confirmed that training was available. There was an appraisal and supervision system in place and all staff told us they felt supported.

People's nutritional needs were met and they had access to a range of healthcare services.

Action had been taken following our last inspection with regards to monitoring the quality and safety of the service. Audits and checks were carried out to monitor the service. Our observations and findings on the day of our inspection confirmed that the provider now had an effective quality monitoring system in place. Staff were very positive about working at the home. We observed that this positivity was reflected in the care and support which staff provided.

We had been informed of all notifiable events at the service.

Inspection carried out on 13 and 20 November 2015

During a routine inspection

The inspection took place on 13 November and was unannounced. We carried out a second announced visit to the service to complete the inspection on 20 November 2015.

A new provider took over the service in January 2015. This was our first inspection of the service under the new provider.

The Old Vicarage provides accommodation and personal care and support for up to 18 older persons, some of whom are living with dementia. There were 16 people living in the home at the time of the inspection and one person was receiving respite care. The home also provides day care for up to five people. We did not inspect the day care service since it was out of scope of the regulations.

A new manager had been appointed five weeks before the inspection. Since the inspection took place, the manager has now been registered with the Care Quality Commission (CQC). People, relatives and staff spoke positively about the new 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 and associated Regulations about how the service is run.

People told us they felt safe. There were safeguarding policies and procedures in place and there were no ongoing safeguarding concerns. This was confirmed by the local authority’s safeguarding adults officer. Staff knew what action to take if abuse was suspected.

People said they liked living at the service and that it was homely. We saw that overall, the building was well maintained although the décor in some areas was in need of updating. Cleaning schedules and infection control procedures were in place. We found that the premises were clean and there were no malodours. Equipment had been regularly serviced and maintained.

There was a system in place for the safe management of medicines. Medicines were stored in different areas of the home. The manager told us of her plans to centralise the storage of medicines.

People, staff and relatives told us there were enough staff to meet people’s needs. This was confirmed by our own observations. Staff told us that safe recruitment procedures were followed. We noted that records did not always evidence that recruitment procedures had been followed. The manager told us that she would address this.

People spoke highly of the staff who supported them and said they felt well cared for. There was a training programme in place and a new e learning training package was in the process of being introduced. Staff were trained in safe working practices and to meet the specific needs of people who lived at the Old Vicarage. The newly appointed manager had carried out supervision with all staff and was in the process of implementing a new appraisal system which she planned to complete by the end of the year. A plan was in place to ensure appraisals were completed when due. We saw that people were treated respectfully and that staff were knowledgeable about the people they cared for.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure that people are looked after in a way that does not inappropriately restrict their freedom. The manager had submitted DoLS applications for authorisation to the local authority.

People told us that they were happy with the meals provided at the home and were supported to meet their nutritional needs. New menus were in the process of being implemented. Special diets were catered for and people enjoyed their meals and were appropriately supported by staff.

People and their relatives told us that staff were caring. Staff responded kindly to people and treated them with respect. People told us they were supported to be as independent as possible and received help whenever they needed it. We observed that staff knew people well and had a good understanding of their individual needs.

People were supported to maintain their hobbies and interests. An activities coordinator was employed and a varied activities programme was in place. We saw planned and spontaneous activities taking place.

There was a complaints procedure in place. The manager told us that no complaints had been received. Feedback mechanisms to obtain the views from people, relatives and staff were being introduced by the new manager but were not in place. There were no satisfaction questionnaires or evidence of meetings with relatives or other relevant persons since the new provider took over. Some audits had been completed and a new detailed annual quality monitoring audit system had been developed but not yet implemented.

We found that although staff told us that the correct checks were carried out before they started work; records did not always evidence all the necessary recruitment information.

The provider’s statement of purpose was out of date and did not contain details of the new provider.

CQC had not been notified of authorisations to deprive three people of their liberty. These had been granted under the previous provider and registered manager and have now been forwarded.

An incident involving the police had not been notified since the new provider took over. This has now been forwarded.

We found one breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. (Good governance). People and their representatives can see what action we told the provider to take at the back of this report.