This unannounced inspection took place on 15 October 2018. 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 up to 24 people in one building. At this inspection 22 people were using the service.

The accommodation consisted of a lounge, dining room and a conservatory and private en-suite bedrooms. There was a large garden at the rear of the property and a gated courtyard for people to sit. The home was on the outskirts of the village of Bakewell but within a short walking distance of local amenities.

The service had a registered manager in place 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.

At our last inspection in March 2016 we rated the service, Good. At this inspection we found improvements were now needed and the service is rated as Requires Improvement.

Medicine management systems were not always safe as medicines were not recorded and audited effectively to ensure people had received their medicines as prescribed. Where people needed help to make some important decisions about their care, it was not always clear how each decision was reached and assessments about people’s capacity had not been completed. This meant people were not always supported to have maximum choice and control of their lives. People’s care plans needed to be reviewed to ensure risk were assessed and recorded and reflected how people needed to be supported. Improvements were needed with how the provider responded to concerns and how people received information in an accessible format. Quality assurance systems were in place, however these were not always effective as they had not identified these concerns.

People felt there was sufficient staff in the home to provide care and support when this was needed. The staffing levels had been reviewed to meet people’s support care needs in the evening to ensure people’s safety.

Staff understood their role in protecting people from the risk harm or abuse and the actions they needed to take if they had concerns. People were confident that the staff supported them well and had received training to develop the skills they needed to provide their care. Recruitment checks were made before staff employment to confirm they were of good character and suitable to work in a care environment.

People were happy with the quality of the food and could have food and drinks that they enjoyed throughout the day. People received support from health care professionals to help ensure their well-being was maintained. Health concerns were monitored to ensure people received specialist health care intervention when this was needed.

Staff were kind and caring when supporting people and knew their likes and dislikes. People’s privacy was respected and the staff made visitors feel welcome and were approachable.

We found one 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 the report.

This inspection took place 8 March 2016 and was unannounced.

The service is registered to provide accommodation with personal care for up to 24 older people. There were 22 people living in the service on the day of our inspection. The service provides care and support for older people, with a range of medical and age related conditions, including mobility issues and dementia.

At the time of our 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.

People were included in decision making about their care and support. For people who lacked capacity to consent to their care and support the provider had followed the principles of the Mental Capacity Act (MCA) 2005. The registered manager had applied for approval of any restrictions on a person’s freedom in line with the Deprivation of Liberty Safeguards (DoLS). Staff training in areas relevant to people’s care needs was up to date.

Staff received supervision and support from the registered manager. Staff demonstrated a knowledge of people’s needs. When required, people were supported to have access to health professionals. People were provided with sufficient food and drink that met their nutritional needs.

People received responsive and personalised care. People, and where appropriate their relatives, were involved in planning people’s care and support. People were able and encouraged to maintain relationships with those who were important to them. People were supported to engage in interests and activities.

Staff understood people’s individual needs and encouraged and supported people to remain as independent as possible. People were supported by staff who were compassionate and caring. Staff were mindful of respecting people’s dignity and supporting their privacy.

The registered and staff understood their responsibilities in relation to safeguarding people. The provider’s arrangements helped to ensure staff were safely recruited and fit to provide people’s care at the service. Staffing levels met people’s support needs and requirements.

Risks to people’s health were identified and care plans were in place to ensure any risks were reduced. Any accidents and incidents were recorded and actions taken by the registered manager to reduce risks to people. Records and audits were available to check and monitor the quality and safety of services provided to people.

Systems were in place to ensure medicines were stored, administered and disposed of in a safe way. Senior staff administered medicines and training was provided to ensure their practice was safe. Medicines were managed in line with current legislation and guidance.

The registered manager was regarded as being approachable and supportive. We saw information was available advising of how to make a complaint, raise any concerns or provide suggestions or feedback.