This was an unannounced inspection which we carried out on 21 March 2018. We inspected the service to follow up on the breaches and to carry out a comprehensive inspection.

The Old Vicarage is a ‘care home’. People in care homes receive accommodation and personal care as a 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 is registered to provide accommodation and personal care to a maximum of 36 older people, including people who live with dementia.

We last inspected The Old Vicarage in December 2016. At that inspection we found the service was in breach of its legal requirements with regard to Regulation 11 and Regulation 17 of the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve to at least good in the areas identified. These included with regard to where people lacked capacity to consent the provider had not always acted in accordance with the Mental Capacity Act 20015. Robust quality assurance systems were not in place and records did not provide an accurate account of the care people received.

At this inspection we found improvements had been made so the service was no longer in breach of its legal requirements. Staff had an understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves. Records were in place that reflected people's care and support requirements and they were regularly reviewed to ensure they remained accurate. The home had a more effective quality assurance programme to check the quality of care provided.

A registered manager was 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.

Due to their health conditions and complex needs not all people were able to share their views about the service they received.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, the policies and systems in the service supported this practice.

People and staff told us they felt safe and there were enough staff on duty to provide safe and individual care to people. People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

Risk assessments were in place and they identified current risks to the person. Staff knew the people they were supporting well.

People said staff were kind and caring. Limited activities and entertainment were available to keep people engaged and stimulated. We saw staff did not always interact and talk with people. We have made a recommendation about training about person-centred care.

Appropriate training was provided and staff were supervised and supported.

People received a varied and balanced diet to meet their nutritional needs. People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. Systems were in place for people to receive their medicines in a safe way.

A complaints procedure was available. Staff and relatives said the management team were approachable. People had the opportunity to give their views about the service. There was consultation with people and family members and their views were used to improve the

This inspection took place on 1 and 5 December 2016. The visit on the 1 December was unannounced. This meant that the provider and staff did not know we would be visiting. The Old Vicarage provides accommodation, care and support for up to 36 people. There were 31 people living at the home at the time of the inspection.

At our last comprehensive inspection of the service, in March 2015, we found the service was in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, namely Good Governance. We returned to the service in September 2015 and found the provider had made improvements to meet legal requirements.

A registered manager was 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.

People and their relatives told us they felt safe living at the home. Staff had undertaken training in how to respond to safeguarding issues and concerns and were able to describe to us the correct processes to follow. We saw where concerns had been raised these had been shared promptly with the local authority safeguarding team.

Accidents and incidents had been monitored and analysed. Risks had been assessed and where possible action had been taken to reduce the likelihood of the risks occurring again.

People, their relatives and staff told us there were enough staff to meet people’s needs. We saw staff were able to respond to people’s requests quickly. Robust recruitment procedures had been followed.

Medicines were managed appropriately.

Staff training was up to date. The manager monitored essential training to ensure any refresher courses were booked before training expired.

The principles of Mental Capacity Act 2005 (MCA) were not always followed. Some people had capacity assessments completed which were not decision specific. Where decisions had been made on people’s behalf, documentation had not been completed to evidence that their capacity had been assessed or that the decision was in the person's best interests.

Where restrictions on people’s liberty were in place to keep them safe, applications had been made to the local authority to grant Deprivation of Liberty Safeguards.

People told us the food on offer was plentiful. A choice of food was available at every meal and food was on offer throughout the day. However, we found records relating to people's nutritional needs and food and fluid intake had not always been completed.

People spoke highly of the staff team. Through our observations we saw staff were friendly and treated people with respect.

Care records were personalised and contained specific information so staff could provide people with consistent care.

People's needs and their plans of care were regularly assessed, however, we noted on some occasions advice from healthcare professionals had not been incorporated into care plans.

People provided us with mixed feedback about the activities on offer. We observed people enjoying a reminiscence session, but one person told us they would like to go on more trips out of the home. The registered manager told us she was trialling different staff shifts so staff had more time to focus on activities.

People and staff were positive about the leadership in the home. Staff described the improvements they had seen in the home. Staff told us they were proud to work at The Old Vicarage.

The provider did not have a robust system in place to monitor the quality of the service provided. Whilst a schedule of audits was carried out regularly, they had not identified or addressed the shortfalls which our inspection highlighted.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These relate

We carried out an unannounced comprehensive inspection of this service on 17 and 30 March 2015. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2010 – good governance.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Old Vicarage Care Home on our website at www.cqc.org.uk.

The Old Vicarage provides accommodation and personal care for up to 36 older people, some of whom are living with dementia. There were 24 people accommodated at the home and receiving care at the time of our inspection.

We checked governance arrangements and found improvements had been made. A quality assurance system had been implemented which consisted of a range of audits to monitor the quality of the service provided.

However, a registered manager was not in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. The current manager of the service told us they had started the application process to become registered manager, but had not completed it as yet. We asked the provider for written confirmation of the steps they were taking to ensure they met the condition of their registration, to have a registered manager in place.

We found people’s privacy, dignity and independence were respected. Relatives told us they were able to express their views and were involved in making decisions about care and treatment. One person said, "I am fully involved, kept informed and have a good rapport with the staff and the owner." We saw people were supported to maintain their independence and their privacy was respected when meeting with family members.

We found care was planned and delivered in a way that was intended to ensure people's safety and welfare, though review of their care could be improved. Each person's needs, including risks, had been assessed and care plans were in place. Care plans were not being routinely reviewed but were reviewed when people's care changed or their needs altered.

We found people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We saw there were effective recruitment and selection processes in place because appropriate checks were undertaken before staff began work. Staff had been recruited who had suitable qualifications and experience to provide care to people.

We found people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard with some further planned opportunities for staff development still to be put in place.

We carried out an unannounced visit on 17 March 2015 and a further announced visit was made on 30 March 2015. The previous inspection was carried out on 24 January 2014 and was found to be meeting the standards of the five outcomes that were inspected.

The Old Vicarage provides accommodation and personal care for up to 36 older people, some of whom are living with dementia. The home is situated in the centre of North Shields, Tyne and Wear. There were 16 people living at the home at the time of our inspection.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

The registered provider had policies and procedures in place to help ensure people were protected from harm. The staff on duty confirmed they had received training related to these. There was a system to ensure medicines were stored and administered safely.

People and their relatives told us there were sufficient staff on duty to respond to people’s needs and staff said they always had sufficient time to complete their daily duties.

Accidents and incidents were recorded and risk assessments were in place if any concerns were apparent. Health and safety checks were carried out on the equipment within the home and the premises were well maintained.

Appropriate checks were carried out prior to staff being employed in the home to help ensure they were suitable to work with vulnerable people.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure that people are looked after in a way that does not inappropriately restrict their freedom. The registered manager had authorisations in place where it was necessary to restrict people’s liberty in their best interests and to safeguard them from harm.

People said they enjoyed the food served to them and there was plenty to eat. Staff supported people who required help to eat and drink. This included prompts and encouragement.

The records showed and staff told us they had undergone appropriate training to meet people’s needs. Some staff had not had an up to date formal supervision session or appraisal with their manager. However, they felt well supported and could approach the manager at any time.

People told us their privacy and dignity was respected and staff were able to give examples about how they did so.

The records showed the staff made prompt referrals to health care professionals if required. Two health care professionals told us the registered manager was proactive and requested their input and advice when appropriate. New activities had recently been introduced to the home and the staff confirmed they were able to spend time with people on an individual basis.

People and their relatives said they knew how to make a complaint and felt their complaint would be taken seriously by the registered manager.

We looked at six care records and some sections were incomplete and had not been updated. This meant that staff were not provided with up to date information regarding people’s care. However, the staff were very aware of people’s individual needs and their preferences, likes and dislikes.

Annual surveys were sent to people and their relatives to seek their opinion of the service and meetings were held to discuss day to day issues in the home and to ask people if they had any suggestions to improve the service provided.

The registered manager had carried out audits and checks to help ensure standards were met and maintained. However, these were out of date which meant standards may not always be maintained. The registered manager was aware of this and had plans in place to address this. The registered provider visited the home regularly but did not provide a written report on his findings.

We found that there was a breach of regulation 10 (1)(a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This corresponds to regulation 17 (2)(a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and have told the provider to take action to remedy this. You can see what action we told the provider to take at the back of the full version of the report.