We inspected the Old Vicarage on 14 August 2017. This was an unannounced inspection. The service is registered to provide accommodation and care for up to 44 older people, with a range of medical and age related conditions, including arthritis, frailty, mobility issues, diabetes and dementia. On the day of our inspection there were 42 people living at the service, including one person who was in hospital.

At our last inspection on 8 and 9 June 2015 the service was found to require improvement relating to the management and recording of certain medicines. .At this inspection we found the necessary improvements had been made.

A registered manager was in post and present on the day 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 2008 and associated Regulations about how the service is run.

There were policies and procedures in place to assist staff on how keep people safe. There were sufficient staff on duty to meet people’s needs; Staff told us they had completed training in safe working practices. We saw people were supported with patience, consideration and kindness and their privacy and dignity was respected.

People received care and support from staff who were appropriately trained and confident to meet their individual needs and they were able to access health, social and medical care, as required. There were opportunities for additional training specific to the needs of the service, such as diabetes management and the care of people with dementia. Staff received one-to-one supervision meetings with their line manager. Formal personal development plans, such as annual appraisals, were in place.

People’s needs were assessed and their care plans provided staff with clear guidance about how they wanted their individual needs met. Care plans were person centred and contained appropriate risk assessments. They were regularly reviewed and amended as necessary to ensure they reflected people’s changing support needs.

Thorough recruitment procedures were followed and appropriate pre-employment checks had been made including evidence of identity and satisfactory written references. Appropriate checks were also undertaken to ensure new staff were safe to work within the care sector.

Medicines were managed safely in accordance with current regulations and guidance by staff who had received appropriate training to help ensure safe practice. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals, where necessary.

The service was clean, well maintained and readily accessible throughout. There were quality assurance audits and a formal complaints process in place. People were encouraged and supported to express their views about their care and staff were responsive to their comments. Satisfaction questionnaires were used to obtain the views of people who lived in the home, their relatives and other stakeholders.

We spoke with five people using the service, three relatives, three staff, the management team and five external health and social care professionals. We observed the care and support provided to people who were less able to communicate verbally with us.

We received information between April and July 2014 about a number of incidents that had been, or were still being, investigated by the Local Authority under safeguarding procedures.

This is a summary of what we found.

Is the service safe?

We found people were not having their capacity to make decisions assessed consistently and their consent to care and treatment was not being obtained consistently. We also found people subject to a Deprivation of Liberty Safeguards were not being properly supervised.

We found that the service had had a high number of incidents referred for investigation under Derbyshire County Council safeguarding procedures. This meant people’s safety was not always being maintained.

Medicines were prescribed and given to people appropriately but were not always kept safely.

Is the service effective?

External health care professionals we spoke with were complimentary about the care provided by the service; one told us “It’s a really nice home. There are no problems with carrying out instructions” and another said “The senior carers seem to be ‘on the ball’”.

We found care records were incomplete, reviews were not up to date and some issues had not been followed up. This meant the records maintained by the service were not always adequate and there was the potential for people to receive inappropriate care.

Is the service caring?

Some people we spoke with were complimentary about the care; one person said “It’s a beautiful home”, another said “I like it here” and a relative told us “The staff are very friendly and helpful”. However, another person using the service told us “I am not happy about the way I am looked after. No one takes the time to understand what I am saying”.

Our observation of people’s care found that most staff were caring and helpful but we saw that where people had cognitive impairments, those who were less able to communicate received less attention.

Is the service responsive?

People we spoke with told us that they liked the staff and told us they received the right support. One person said “They’re really careful making sure I don’t slip in the shower”.

We received mixed feedback about the availability of staff. One person told us they did not have to wait long for assistance. However, a relative told us “Staff are run off their feet. Buzzers are taking ten minutes plus to be answered”. Our observation during this inspection visit also showed us that there were periods in the communal lounges when no staff were around and we found one person who was at risk of falls walking around unsupervised upstairs asking for assistance. This indicated there were insufficient staff on duty and requests for assistance were not always responded to in a timely manner.

People we spoke with told us they would go to the manager if they had any concerns about the service although some people said they had not received a copy of the formal complaints procedure. We found complaints received a written response and people could be sure their concerns were properly addressed.

We found staff received health and safety training and training related to care. This meant they received appropriate training to work safely.

Is the service well led?

We found there were issues relating to record keeping and responding to care and welfare issues that indicated the provider was not aware of potential problems affecting people’s health, welfare and safety.

On the day of our site visit to the Old Vicarage there were eighteen people living at the home.

We spoke with three people who live at the care home. They told us that: “I am quite happy, thank you. I’ve got everything I need, and the staff are very friendly.” Another person said: “They are making it better, have you seen the workmen? I do like to see what’s going on, and it’s all very busy. I think it should be very nice when it’s finished.” A third person said: “I’ve got a very nice bedroom, I like to go outside to see the birds, they have had little ones recently, and we went out to see them.”

We carried out a Short Observational Framework for Inspection (a SOFI) during this inspection visit. This involved us sitting in the dining room and observing for an hour over the lunch period. This enabled us to see how the staff spoke with people who live at the home, and how they offered help and support. This observational technique is also very useful for identifying issues relating to privacy, dignity and respect. Our observations showed that people were treated with respect, and that staff had good relationships with the people who live at the care home. We saw staff offering support and encouragement in a pleasant, friendly and helpful manner.

At the time of our visit there were 37 people receiving care at The Old Vicarage Nursing Home. As a number of the people living at The Old Vicarage Nursing Home have dementia, we were unable to hold meaningful discussions with people to consistently seek their views and experiences. We were, however, able to speak with the relatives of three people receiving care in the home.

We saw that where possible, people had been involved in the assessment of their needs and the writing of their care plans. We spoke with the relatives of three people and one relative we spoke with told us how they are regularly involved in reviewing their relatives care. People’s care plans had been regularly reviewed with changes being made where necessary.

Not all of the staff in the home had received training in safeguarding or the deprivation of liberty safeguards (DOLS). Two of the staff we spoke with had limited understanding of safeguarding and how they would report any concerns.

Staff members were being supported in their roles and were having regular supervision sessions with the home manager or their line manager. One of the relatives we spoke with told us, “the staff are welcoming and friendly, they seem happy and they stay which is good, I have seen a few new faces but not many.”

The provider was regularly seeking the views of people living in the home, relatives and staff members. Most recently a survey had been completed on activities available within the home.

The Old Vicarage Care Home provides accommodation for people who require personal care. It provides accommodation for up to 44 older people, some of whom are living with dementia. There were 38 people using the service at the time of our inspection.

Our last inspection of 24 July 2014 found the provider was not meeting three regulations. These were in relation to consent to care and treatment, care and welfare of people who use services and safeguarding people from abuse. At this inspection we found that all of the actions we required had been met.

This inspection took place on 8 and 9 June 2015. The first day was unannounced.

There was a registered manager at the service 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.

We received information in June 2015 suggesting controlled drugs were not well managed. We found records relating to controlled drugs were not adequately maintained. Stock checks were not always accurate and the amount of medicine given was not recorded consistently. We have made a recommendation about the management of controlled drugs.

People using the service were protected from the risk of abuse because the provider had provided guidance to staff to help minimise any risk of abuse. Decisions related to peoples care were taken in consultation with them, their representative and other healthcare professionals, which ensured their rights were protected.

Staff followed guidance in people’s risk assessments to ensure people were cared for safely.

The provider’s recruitment procedures were comprehensive and ensured staff employed were suitable to work with people at the service. There were enough appropriately trained staff available at the service to meet individual needs.

People told us they enjoyed their food and we saw they were assisted to eat in a sensitive manner. People were able to take part in hobbies and interests of their choice.

Consent to care and support had been sought and staff acted in accordance with people’s wishes. The principles of the Mental Capacity Act 2005 were known and understood.

People were cared for by staff with the skills and knowledge to meet their needs, including how to support people with their health needs.

People told us the care staff were caring and kind and that their privacy and dignity was maintained at all times. People were involved in the planning of their care and support.

Complaints were well managed and the provider had effective systems in place to monitor the quality of the service.

There were systems in place to enable people to give feedback on the service. People were listened to and the service had received positive feedback on the improvements it had made during the last twelve months.