The inspection took place on 29 August 2017 and was unannounced.

The Old Vicarage is a privately owned care home offering residential care and support for up to 37 people. One of the owners is responsible for the day to day management of the home. It is situated about two miles from the centre of Bolton, and is close to bus routes, shops, pubs and other amenities.

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 we spoke with told us they felt safe at the home. There were sufficient, suitably trained staff and the recruitment process was robust. Good staffing levels and low staff turnover helped to ensure staff had good knowledge of people who used the service and could deliver person-centred care. Medication systems were safe and staff were trained in medicines administration.

The safeguarding policy and procedures were appropriate and up to date. Staff had undertaken safeguarding training and demonstrated a good knowledge of safeguarding issues. Staff we spoke with were aware of whistle blowing and assured us they would report any poor practice they may witness. The registered manager was committed to raising the profile of safeguarding within the home and on a wider level.

General and individual risk assessments were in place. Accidents and incidents were recorded appropriately. Health and safety measures were in place and equipment was maintained and serviced as required.

The induction programme was thorough. Training was on-going and refresher courses were undertaken as required. We saw records of regular staff supervisions and annual appraisals.

There were no malodours and the environment was homely, clean and uncluttered. The home had recently had an extension to the premises built and this had been done to a very high standard. There was a good choice of food for all meals and special diets were catered for.

Care plans included relevant health information. Communication between health professionals and the service were documented. The service was working within the legal requirements of the Mental Health Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS).

We observed interactions between staff and people who used the service throughout the day and found them to be kind, courteous and friendly. People’s dignity and privacy was maintained at all times.

A service user guide was in place as well as a statement of purpose. Residents meetings were held regularly.

Care plans included advanced care planning if people had expressed their wishes for the end of their lives. The service endeavoured to respect these wishes and support people to remain at the home if they wished to do so, when nearing the end of their lives.

Care plans were person-centred and included information about people’s preferences, likes and dislikes. Staff communicated well with people who had difficulty with verbal communication and responded quickly to individuals who were unwell.

There were lots of activities and outings arranged by the service. People’s diversity was respected and there were visits to the home from leaders of various faiths.

There was an appropriate, up to date complaints procedure, which was outlined within the statement of purpose. There was a complaints book, but no complaints had been received.

All the people we spoke with felt the service was well run and the management were approachable. Staff observations took place to help ensure their competence remained at the correct level.

Audits were undertaken for issues such as falls, accidents and incidents, medicines, health and safety and feedback from people who used the service and staff. Care files were regularly audi

The Old Vicarage is a large detached house that is situated in a residential area of Bolton. The home is close to local amenities and public transport is easily accessible. The home is set in extensive mature gardens where four small bungalows are available for private lease for older people. There is car parking available within the grounds and on the main access road.

This was an unannounced inspection that took place on 27 March 2015. There were 20 people living at the home on the day of our inspection. We last inspected the home on 09 October 2013. At that inspection we found the service was meeting all the regulations we reviewed.

The provider of the service was also the registered manager. The registered manager was present at the time of the 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 and associated Regulations about how the service is run.

The service had suitable arrangements in place to help safeguard people from abuse. Staff spoken with knew what to do if an allegation of abuse was made to them or if they suspected that abuse had occurred. Staff were able to demonstrate their understanding of the whistle blowing procedures. Staff also had an understanding of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions.

On the day of our visit we found that people were being cared for by sufficient numbers of suitably skilled and experienced staff who were safely recruited. We saw that staff had received training and support that was relevant to their roles to enable them to do their job effectively and care for people safely.

From observations we saw that people were well cared for and there was equipment to ensure people’s safety and comfort. We saw people’s care records contained detailed information to guide staff on how people wished to be care for and supported. Several visitors were spoken with throughout the day and they all had positive comments about the care, commitment and compassion that their relatives received from the registered manager and staff.

We saw that the home offered a wide range of activities, including trips out and holidays.

We spoke with the chef who had a good understanding of people’s likes and dislikes and dietary needs. We spent time in the dining room and saw that the food provided look appetising, was nicely presented and portions were of a good size.

All areas of the home were clean and well maintained and accessible for people with limited mobility; making it a safe environment.

We found the medication system was safe and we saw that staff worked with other healthcare professionals to ensure people received appropriate care and treatment.

There were a number of processes in place to monitor the quality of the service provided to help ensure people received safe and effective care. Regular checks were undertaken in all aspects of the running of the service and there were opportunities for people to make comment of the quality of the care provided. Regular staff, residents and relatives’ meetings took place that enabled people to discuss the service. The complaints procedure was clearly displayed and people spoken with told us they would have no problem raising any issues of concern if they needed to.

We visited The Old Vicarage on 9 October 2013 and it was clean, warm and welcoming. Staff treated people with respect and carried out care interventions competently. Privacy and dignity was respected at all times.

We looked at a sample of care plans which contained relevant health and personal information. Care plans were reviewed on a monthly basis with changes noted, and we saw evidence of good partnership working.

We spoke with one person who used the service. They said, “I would recommend this home to anyone”. We spoke with three visitors and one told us, “Communication is good, if anything changes they let us know”. Another said, “It has changed my opinion about care homes, I have no concerns”.

We spoke with a number of professional visitors, such as GPs and district nurses, who were all very positive about the home. They told us the home made appropriate referrals, followed instructions well and communicated well with them.

People’s nutritional needs were recorded and dietary needs adhered to. Monitoring charts, such as weights were completed and appropriate referrals made to other services.

Staff were recruited appropriately and were qualified for their roles.

There was a complaints procedure complaints were followed up appropriately. Regular audits were carried out to ensure consistency in the quality of service delivery. People who used the service were consulted and their views and wishes taken on board with regard to service delivery.

We visited The Old Vicarage on 18 December 2012 and found that the premises were clean, tidy and warm. The people who used the service were well presented and we saw that staff were interacting with them politely and with respect. We saw that care was delivered in a timely and efficient way.

We spoke with three people who used the service and they all expressed satisfaction with the care they had received. One person said “All the staff are polite and caring. They look after us very well, they help me with everything.” A visitor at the home told us “visitors are always made welcome and offered food and drinks."

We looked at a sample of five care plans and found them to contain up to date and relevant medical and health information as well as records of care needs. We saw evidence of good partnership working and saw that the records were person centred and individualised to incorporate people’s choices and preferences.

We saw that efficient cleaning regimes were in place and that efforts were made to minimise the risk of infection occurring.

We found that relevant policies and procedures were in place within the home and that staff were aware of them. We saw evidence of a good induction and comprehensive training programme for staff members and encouragement of staff members to continually develop their knowledge and skills.

We saw that there was a complaints procedure in place and noted that complaints were taken seriously and followed up appropriately.

People said that they were able to go out when they preferred and we heard “Staff let you do what you want” and “Staff always ask what I want”. People were complimentary about the food, and a few people mentioned that their favourite meal was ‘Chippy Friday’ every Friday lunchtime.