About the service: Old Vicarage Nursing Home is a nursing home that provides personal and/or nursing care for up to 50 people, some of whom are living with dementia. At the time of the inspection 38 people lived at the service. Most people lived there permanently, and some people spent short periods there to provide respite to their main carers.

People’s experience of using this service: Some parts of the building were in a poor state of repair and old and shabby. In one conservatory we saw that water was pouring through the ceiling into a bucket and the floor was rotting. There were also skirting boards falling off the walls and tape on the floor that was lifting up and a potential trip hazard. The décor was very old and paintwork was damaged and stained. We spoke with the acting manager who agreed that these areas needed to be actioned. Before the inspection had finished the acting manager was putting together a refurbishment plan for the home.

Feedback from people who lived in the home and their families was mixed. Some people raised concerns about staffing levels and having to wait for support. Some people made requests and were left waiting for what they had asked for. Other people reported to us that they were happy with the care that they received.

The acting manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions. We spoke with them about improving the audit trails in relation to decision making for people who needed support with this.

The food served at the home was of a very high standard. Everyone we spoke with told us that they enjoyed the food and we saw that it was plentiful and good quality.

Care plans were clearly recorded. They detailed how people wished and needed to be cared for. They were regularly reviewed and updated as required and nurses peer reviewed each other’s work. We saw that relatives were involved in supporting staff to understand how people wished to be cared for. There were activities provided at the home and people told us that they enjoyed them.

The acting manager had recently introduced a variety of methods to assess and monitor the quality of the service. These included regular audits of the service and staff meetings to seek the views of staff about the service. They also were trying to speak regularly with the people who lived in the home and their relatives so that people could get to know them.

More information is in the detailed findings below.

We identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around safe care and treatment and dignity and respect. Details of action we have asked the provider to take can be found at the end of this report.

Rating at last inspection: The service had been rated Good at the last inspection in April 2016.

Why we inspected: This was a scheduled inspection based on the previous rating of the service.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme.

This inspection took place on 22 April 2016 and was unannounced.

Old Vicarage Nursing Home is registered to accommodate up to 50 people who need nursing or personal care. On the day of our inspection there were 39 people living at the service.

There was 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.

At our last inspection on 15 July 2014 we found the provider was in breach of Regulation 13 of the Health and Social Care Act (Regulated Activities) Regulations 2010. This was because systems for managing medicines safely were not effective. At this inspection we found the provider had made significant improvements in how medicines were managed at the home. We saw that people were supported to take their medicine when they needed it.

People were kept safe because the registered manager and staff knew how to recognise abuse and understood their responsibilities to report potential harm and abusive practice. The registered manager regularly reviewed accidents and incidents to reduce the possibility of people being harmed. Risks to people's health and wellbeing were known by staff and well managed, including involving people in their own care planning. The registered manager and staff maintained close links with external health care professionals to promote people's heath.

People were supported by sufficient numbers of staff who knew them well and had a good relationship with them. The registered manager kept staffing levels under review alongside people's individual needs which ensured staff had time to care for people well. Staff knew what was expected of them in their role because the manager communicated well with them and led by example. Staff did not start work until checks had been made to make sure they were suitable to support people and keep them safe.

Staff treated people with kindness and respected people’s right to privacy and dignified care. They understood people's needs and abilities because they were able to access up to date information from care plans and good levels of communication between people, staff and management about changing needs. Staff were encouraged to reflect on their ways of working and learn from other staff. The registered manager supported their team to provide care when undertaking observed practice.

People were offered meals which were suitable for their individual nutritional needs and preferences. People told us, and we saw, that the meals were appetising and they were supported to eat and drink enough by staff who understood the importance of assisting people to maintain a balanced diet.

People knew how to raise any concerns and who they should report any concerns to. The registered manager responded to people's complaints and took action to improve the service as a result of complaints.

The registered manager was aware of their responsibilities and had developed systems to monitor the quality of the service people received. The registered manager was continually looking at how they could provide better care for people. In doing so, they valued people's views about the services provided and used these to further develop the services people received. The manager was well supported by the provider and both shared a clear vision for the continuous improvement of the service.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. We talked to four people who used the service and one visiting relative.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Risks to people had been identified, assessed and kept under review.

Incidents and accidents were recorded and analysed to identify any triggers. Systems were in place to ensure equipment was well maintained and safe for people to use.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no application had needed to be submitted at the time of our visit, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

Appropriate arrangements were not in place to safely manage medicines. The medication administration records were not always accurate and it was not always possible to determine if people had been given their medicines as prescribed. This meant that people were not protected against the risks associated with medication. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the management of medicines.

Is the service effective?

People's needs were assessed and care and treatment was planned and delivered in line with their individual needs. It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs.

People were protected from the risks of inadequate nutrition and dehydration. People were provided with a choice of suitable and nutritious food and drink, which was freshly prepared in the home. Special diets were catered for including diabetic, vegetarian and soft diets.

Is the service caring?

Each person commented positively on the service they or their relative received. One person told us, “Staff treat me well”. Another person told us, “Everyone is kind, helpful and considerate”. We observed positive and caring interactions between staff and people who used the service. Staff greeted people warmly and there was a very happy atmosphere in the home.

Is the service responsive?

People commented that they felt staff would listen to any concerns that they had. One person told us, “If I complain about anything, they sort it out”. Another person told us, “I have no complaints, but if I had any concerns I would speak to the manager.”

Is the service well-led?

The quality of service provided by the home was regularly assessed and monitored. Regular audits were undertaken which included audits for health and safety, medication, care planning and infection control. This meant that people’s needs were regularly reviewed and risks to their health and wellbeing were assessed and identified promptly.

In this report the name of a registered manager appears who was not in post at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

Everyone we spoke with who lived at the home was very positive about the service they received. One person told us, “I am fortunate to be here”. Another said, “It’s wonderful here”.

The staff we spoke with told us that there had been significant improvements in the management of the home since the beginning of the year. They told us that staffing levels had improved and that, “Things run much more smoothly now”.

The staff were in the process of creating new care plans for everyone living at the home. We saw good evidence that people were involved in the development of their own new care plans.

We found that the care plans were detailed and gave staff all the information they needed to provide god consistent support for people. People’s needs and preferences were clearly recorded.

People told us that they felt safe in the home. There was a clear policy to help keep people safe and the staff we spoke with understood it.

We found that the provider had a suitable system in place to monitor the quality of the service it was providing.

In this report the name of a registered manager appears who was not in post at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

People we spoke with were generally happy with the service they received. They told us that staff were, “Nice”, “OK”, “Very good” and, “Quite sociable”. One person described the care as, “Alright”. Other people told us that it was, “Very good” and they were, “Well looked after”.

Relatives we spoke with told us they were, “Happy with the care and communication” and that the staff, “Seem to know my relative well”.

Staff told us there had been lots of improvements in the home in recent months. They said they received very good support from the new manager and that training and supervision had improved.

We found many improvements in the home since our last inspection. People's care plans had been completely rewritten using a person centred approach. New nutrition plans had been produced for those people who needed them, but we found that records of people’s daily fluid intake were not always complete.

We found that staff had received updated training in safeguarding vulnerable adults and that a new internal safeguarding policy was readily available to them. Staffing levels had improved.

We found that record keeping had improved considerably and that a monthly internal quality audit had been implemented. However, records were not always kept securely.

We visited the home unannounced on the 3 and 4 July 2012. There were 39 people living in the home on both days of the inspection. We spoke with six members of staff, the registered manager, the operations manager of the organisation, two visitors and seven people who lived at the home.

People we spoke with told us that staff were very kind and looked after them well. People were satisfied with the food served to them. People told us that they frequently had to wait for staff attention, particularly to go to the toilet because staff were so busy. One person told us that staff were very kind but that “they don’t make a fuss of us as they don’t have time”.

All the people who lived at the home had a care plan detailing their needs and written information about any risks to their wellbeing. The records contained clear and detailed records of the nursing care given but were not all based on individuals personal life history and did not always reflect people’s choices and preferences. People who lived at the home were not being involved in deciding what should be in the written information about the care they needed.

The home was clean, tidy and free from unpleasant odours on both days we visited. Some areas of the home such as communal bathrooms did not reflect good practice in relation to reducing the risk of cross infection.

Staff were kind, professional and courteous towards people they cared for. Staff were very busy and apologised to people when they had to wait for staff assistance or attention. Our observations and discussions with people living at the home and with staff showed that there were not always enough staff on duty to meet people’s needs. The provider did not have a strategy for providing cover when staff did not arrive for work. This was particularly the case at weekends.

Following the inspection we asked the provider to send us an action plan showing how they would deal with staff shortages in the future. The action plan stated that they would initially contact other homes within the organisation to see if staff from there would be available. If this wasn’t possible the person in charge would use agency staff to make sure that there were enough staff on duty to meet people’s needs.

Staff were not offered regular formal supervision or appraisal to support them with professional development or to check their skills and competency. The staff training programme was limited and did not include some mandatory training topics such as fire safety and infection control. Although some people living at the home had dementia type illnesses staff were not trained in dementia care.

Records were stored securely but were not all written or stored in line with the Data Protection Act 1998 which protects people’s rights to privacy.

All of the people that we spoke to told us that they thought that the meals provided by the home were of good quality and served in good quantities. Some were able to say that they liked what they were eating but others could not although one gentleman gave a ‘thumbs up’ when he was asked what he thought. Comments about the food included such things as “Usually is very nice” and “I’ve never had anything on my plate that I don’t enjoy”.

All of the visitors that we spoke with said that they were made to feel welcome and one person told us that their spouse joined them for lunch each day.

People who live in this home told us that they felt able to raise any issues about which they had concerns with the manager or one of her staff.

They also told us that they felt safe and the relatives of some of those people that we talked to said that they felt that their family members were being well cared for and were safe.

Some of the people who live in this home could not talk to us as they had gone out for the day and others told us that they were looking forward to their turn to go on that particular outing later in the summer.

Those people also told us that they have had the opportunity to attend meetings with the home’s management where, as a group, they could make their views on their care known.