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Inspection carried out on 13 August 2019

During a routine inspection

About the service

The Old Vicarage is a care home providing personal care to nine people with mental health conditions, learning disabilities and/or autism at the time of the inspection. The service can support up to 10 people in one adapted building. This is one of three care homes located on one site, within the village community of Baschurch, outside of Shrewsbury.

The service has been developed 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.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 10 people. Nine people were using the service. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by people’s integration into the local and wider community, as well as the planning and delivery of person-centred support. The service needed to ensure that consistent staffing ensured this, as we have noted below. When we visited, staff were not wearing uniforms, which helped to create an atmosphere of partnership working.

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

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used some restrictive intervention practices as a last resort, in a person-centred way. We found that review of restrictive practices, as well as the application of Positive Behaviour Support (PBS) principles to promote proactive support, could at times be improved. We made a recommendation regarding this.

The effective planning and deployment of staff required review to ensure a consistently safe service that was supportive of and flexible around people’s needs. We received mixed feedback around this and made a recommendation.

People told us, or showed us in their own ways, that they felt safe and liked living at The Old Vicarage. People and relatives spoke positively about the staff team, felt listened to and gave examples of what had been achieved with their support. One person told us, “They do a good job”. A relative said, “It is nice to be able to say [my relative] is in a ‘safe haven’.”

Staff felt that despite some staffing difficulties, the team worked well together. Staff described a family-like atmosphere, gave examples of how well people and staff knew each other and how staff ensured people were always put first. We heard examples of how the service applied the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People, relatives and staff were involved in the development of the service through regular meetings and reviews.

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 sy

Inspection carried out on 2 March 2017

During a routine inspection

This inspection took place on 02 and 03 March 2017 and was announced.

The Old Vicarage provides accommodation and personal care for up to 10 people with learning disabilities. At this inspection they were providing care and support for nine people.

A registered manager was in post and was present throughout this 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.

People were safe as staff had been trained and understood how to support people in a way that protected them from danger, harm and abuse. People had individual assessments of risk associated with their care. Staff knew what to do in order to minimise the potential for harm. People and staff knew what to do in an emergency in order to keep themselves safe.

People were supported by enough staff to safely meet their needs. People received help with their medicines from staff who were trained and assessed as competent to support them safely. The provider followed safe recruitment practices and completed checks on staff before they were allowed to start work.

Staff members had received training appropriate to those they supported and had the skills and knowledge to meet people’s individual needs. Additional training and support was provided when necessary to meet people’s changing needs.

Staff members were aware of current guidance and legislation that governed their practice. People were supported in a way that maintained their individual rights. People were involved in decisions about their care and were given information they needed in a way they understood. When people were not able to make decisions themselves staff members knew what to do to ensure any decisions made were in their best interests.

People had positive and caring relationships with the staff members who supported them. People’s personal histories, likes and dislikes were known by staff who assisted them in a way which was personal to them. People had their privacy and dignity respected by staff members.

People were supported to eat and drink sufficient amounts to maintain good health. People had access to healthcare when needed and staff responded to any changes in needs promptly and consistently.

Staff were supported by a management team who they found approachable and supportive. The provider undertook regular quality checks in order to drive improvements. People were involved in their home and felt their opinions mattered to the provider. Any suggestions people made were valued. The provider had systems in place to respond to the suggestions of others.