About the service: The Old Vicarage in Ludham is a residential care home for up to 29 older people. It is one of three services owned by Hewitt-Hill Limited (Ashley Care Group).

People’s experience of using this service:

The service had made improvements since our last inspection and there were no breaches of regulations.

Risks to people’s health and safety had been identified and people felt safe and well looked after. Staff administered medicines as prescribed.

Staff were kind, respectful and caring. They supported people to be as independent as possible.

There were activities and trips outs available for people, and they received care as they preferred.

Staff asked for consent before delivering care. People had access to healthcare professionals when required, and staff followed recommendations when needed.

Staff knew how to care for people and received training in their roles, and support from the management team. Staff supported people to have a range of healthy balanced meals and enough to drink.

The registered manager had clear oversight of the service and supported an effective staff team, who communicated well. The registered manager was approachable and available to people and staff. We found the service had improved and met the characteristics of a “Good” rating in all areas.

More information is available in the full report.

Rating at last inspection: Requires improvement (published 22 May 2018). This service has been rated Requires Improvement at the last two inspections. At the last inspection, there were three breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Why we inspected: This was a planned inspection based on the period since the last report was published by CQC. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions to at least good. They sent us an action plan with this information.

Follow up: We will continue to monitor the service according to our schedule for returning to locations rated Good.

This unannounced comprehensive inspection took place on 5 April 2018. The Old Vicarage is a ‘care home’, where people receive accommodation and personal care as a single package. CQC regulates both the premises and the care provided, and these were looked at during this inspection.

The Old Vicarage accommodates people in individual rooms, each with an en-suite toilet and basin facility, and one had an en-suite shower room. Each floor has some communal bathrooms and further communal toilets. The Old Vicarage is a residential care home for up to 29 older people. It is one of three services owned by the provider Hewitt-Hill Limited, also known as the Ashley Care Group. At the time of our inspection, 26 people were living in the home, which was situated across two floors.

We last inspected this service in January 2017. At that inspection, the service was rated ‘Requires Improvement’ in two areas, which were safe and well-led. The service had not always managed risks associated with certain medicines, and the provider did not have fully effective quality assurance systems in place. The service was rated ‘Good’ in effective, caring and responsive. The overall rating for this service was ‘Requires Improvement’ and therefore we asked the provider to make some improvements to the service. At this inspection in April 2018, we found that the service had not made all of the improvements required and was rated ‘Requires Improvement’ in all areas. There were also three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There was a registered manager in post. A registered manager is a person who has registered with the 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 service was not consistently safe for people. This was because risks to people were not always thoroughly assessed and staff did not always have guidance on how to mitigate risks to people. Risk assessments and care plans were not always in place for the safe management of people’s conditions.

Topical medicines were not always administered and recorded consistently, and there was not sufficient guidance for staff on how to administer them. Oral medicines were stored securely and administered safely.

Although there were audits in place, the quality assurance systems did not always identify areas where improvements were needed. The systems in place were not fully effective in monitoring and improving the service.

People did not always receive person-centred care and support in a way that reflected their individual preferences and needs. Care plans did not always contain details of how people wanted to be cared for, and therefore there was not always enough guidance for staff.

People were not always involved and consulted about their care and how they wished to be supported. Staff did not always support people to engage in activities which reflected their interests.

The potential of the environment was not always used to enhance people’s wellbeing. There had been some trips out during the appropriate season, with further trips planned this year in summer.

Staff did not always interact with people appropriately and engage with them effective during their delivery of care. They did not always provide sufficient prompting to eat and drink when needed. There were not always full records of people’s care where they relied on staff for the majority of their daily living tasks such as eating or drinking. Therefore the registered manager did not always have full oversight of whether people were receiving a high standard of care.

Staff received training which supported their roles, however training was not followed up by competency checks. There were employment checks in place which contributed to people’s safety.

People had ac

The inspection took place on 24 and 25 January 2017 and was unannounced.

The Old Vicarage provides residential care for up to 29 older people. Accommodation is in a period property over two floors which are served by a lift. There are a number of communal areas, including a conservatory, and well maintained gardens. All bedrooms have en suite facilities compromising of a toilet and wash basin. One room has a walk in wet room. At the time of our inspection, 29 people were living at the home.

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 in October 2014, we identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach related to non-compliance with the Mental Capacity Act 2005 (MCA). At this inspection, carried out in January 2017, we found that although further improvements were required, the provider had made sufficient progress to no longer be in breach of the regulation.

We have made recommendations to the service about the management of medicines and adherence to the MCA.

There was no evidence that people had come to harm as a result of medicines administration, but due to the service not following current good practice guidance, the risk was present.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. Improvements had been made in relation to staff knowledge of the MCA and they had received training. However, the service was not fully adhering to the MCA although no overly restrictive practice was in place.

A newly registered manager was in post who had identified, and begun to rectify, some shortfalls within the service. During our inspection they were open to our feedback and took steps to action our reported concerns promptly.

A quality monitoring system was in place to drive improvement but this had not been wholly effective at identifying concerns in the service. Audits had been completed regularly, at home level, on different areas of the service but they were basic and lacked detail. The provider had not completed any audits since November 2015.

Processes were in place to help reduce the risk of employing unsuitable staff. These included the completion of a police check and obtaining identification. New employees received an induction and their competency to perform their role was assessed and recorded. Staff had received training that was relevant to their work and that would benefit those living at the service.

The service had an open, positive and supportive culture. Staff were happy in their roles and felt supported. They told us they enjoyed working at The Old Vicarage. They worked well as a team and communicated effectively amongst themselves and with others. The home ran smoothly and efficiently.

There were enough staff to meet people’s individual needs and staffing levels were consistent. People told us that they received care and support promptly and staff had time to spend with people.

Staff demonstrated warmth, respect and kindness when supporting people. Humour was used in interactions and laughter was evident during our inspection from staff, visitors and those that used the service. We saw that people’s dignity, privacy and confidentiality were maintained and that staff encouraged choice and independence. Staff gained consent before assisting people with their needs.

Staff had a good understanding of how to prevent, protect, identify and report potential abuse both inside and outside of their orga

This inspection was carried out on 23 October 2014 and was unannounced.

The last inspection was completed in April 2014 where breaches of regulations were found for Regulation 15 (safety and suitability of premises), Regulation 22 (staffing) and Regulation 10 (assessing and monitoring the quality of the service provision). During this inspection we found the breaches from the April inspection had been acted upon and the regulations were being met.

This is a residential care home for up to 29 older people. On the day of this inspection 25 people were living there. It does not provide nursing care.

This home did not have a registered manager. 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.

People felt safe and secure in the home. They told us they were relaxed and supported safely. Relatives told us they were reassured by the management and staff that their family members were safe and well looked after.

The staff were knowledgeable about safeguarding people. They knew what signs to look for regarding any poor treatment, who to report this to and how to protect people as much as possible.

People’s needs were met quickly and safely showing enough staff were available to meet the individual needs of people living in the home. The manager had acted fully on the safety concerns of the premises and all action had been completed by the time this inspection was undertaken.

Management of medicines was completed safely. However some areas could be improved upon.

Staff were supported with induction and training. However, updated training was not fully in place for all staff. The knowledge required by staff on the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) was not fully evident.

People who require special meals or supplemented diets were supported effectively by knowledgeable kitchen staff . Meals were offered with an alternative choice.

The people who required health care support were able to receive this from the local GP and district nurse. Their guidance and support, to promote good health, was followed by the staff team.

Staff were respectful, kind and caring. Relatives told us the staff were very caring and knew the individual people well.

Care plans were completed comprehensively and the care required was detailed. However, some information about the person’s past life were limited and little information was written to promote independence and how to retain skills or follow interests.

The home had a comprehensive and varied activities programme and people had the opportunity to be involved when they wanted. People who preferred their own company were supported with one to one time with reading or conversation.

The people living in the home and relatives assured us that any concerns or complaints would be acted upon quickly and efficiently. Regular meetings were held with people and their relatives to discuss ideas and make changes as and when required.

The manager had sent out a questionnaire to ask for people’s views on the quality of the service provided. Audits were in place to monitor most of the service provided. However, the manager still had some improvements to make to ensure all areas of the service had a thorough checking process.

There was one of breach of a regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

You can see what action we told the provider to take at the back of the full version of the report.

We considered our inspection findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who used the service, the staff supporting them and looking at records.

Is the service caring?

People were supported by kind and supportive staff. We observed that staff were patient and understanding when supporting people. We saw staff treating people with respect and with dignity. People told us that the staff were caring. One person said, “They (the staff) are always polite and kind.” Another person told us, “The staff are always very kind.”

Is the service responsive?

Staff answered people’s call bells quickly when they requested assistance. However, some people’s choices were not always responded to. We observed some people were still in bed at 10.30am in the morning. They told us that they had wanted to get up earlier. The staff told us that they did not always have enough staff to assist people to get up when they wanted to.

Although everyone received a main meal, we observed that some people did not receive this in a timely manner. Some people who needed assistance to eat had their meal times interrupted as staff had to assist other people at the same time. This was because there were not enough staff to provide them with the assistance they required over the lunchtime period.

People told us that they enjoyed the activities and entertainment that were offered to them.

Is the service safe?

People told us that they felt safe. Risks to people’s personal safety had been assessed and action had been taken to keep people safe where required.

Lifting equipment had been recently serviced to ensure that it was safe to use. The premises looked clean and hygienic and there were no offensive odours evident. However, we were advised that Environmental Health and a Fire Safety Officer had recently inspected the service and found that some areas of the service did not meet current legal requirements. We saw records to confirm this. This was putting people at risk of harm. The provider was aware of this and was taking steps to ensure that the premises were safe.

Is the service effective?

People told us that they were happy with their care and that their needs had been met. All of the people we spoke to said they would recommend the home to others. One person told us “I am very well looked after.” Another person said, “I am happy with everything and would recommend this place to anyone.”

We spoke with two visiting healthcare professionals. They told us that the service contacted them quickly when people were unwell or needed specialist attention and that they felt that the communication between them and the service was very good. The staff told us that they felt supported by the management team.

Is the service well led?

The service had a manager who told us that they had been in post since July 2013. We recently received an application from the manager to register with us. This is currently being processed.

Regular staff meetings were held that enabled staff to discuss topics relating to people’s care and welfare. People were asked for their feedback on the care they received.

However, we did not see evidence that an effective quality assurance process was in place to monitor the safety of the premises or to ensure that there were enough staff to meet people’s needs. The current system had failed to identify a number of shortfalls that had been identified during recent professional inspections.

People's needs were assessed and care and treatment was planned and delivered according to their individual needs. People who used the service told us they were happy with the care and support they received. People told us, "Staff look after me really well" and "Everyone is very helpful.”

We spoke with ten people, two visitors and several members of staff. Staff were clear about their responsibilities and showed a good knowledge and understanding of how to meet people's needs. People who used the service told us that staff were kind and always there if they needed help.

We saw that people were relaxed with staff, who listened to their views and concerns. People told us that they would speak with staff if they had a problem or were worried about anything. People told us, "I like it here. Staff are friendly and polite and I feel secure, they know me well.”

We saw people being assisted with their meals. However we observed that two people in their own rooms who had lunch in front of them did not get assistance from staff so their lunch had gone cold.

One visitor told us: “My relative’s every need is catered for and she is very happy", "good ambience, beautiful gardens and views, caring staff and good menu"... and ..."very good selection of entertainment and things to do, no reason for any complaints.”

We spoke with three people living in The Old Vicarage, two visitors and three members of staff during our visit on 22 August 2012. We observed how people were cared for, spoken to and how they were treated and looked at their records.

People were generally satisfied with the care and support they received from staff at The Old Vicarage.

One person said: "Some of the carers are very good, they're always smiling, its so nice to have cheerful people look after you." Another said: "The chap that does the meetings is really funny and I get asked if I want a pre-lunch drink, that's a nice thing, it wouldn't happen in other places."

People told us that they liked the meals and they got some 'good home-cooking'. They said that the care and support they received met their needs, they got their medicines on time and staff asked them regularly if they were comfortable.

None of the people we spoke with had any complaints, although there were two issues that arose, when speaking with people, which we passed onto the manager to deal with. One person had been waiting for some time for a new charger for their electric chair and another wanted to know what had happened to their razor. These were followed up immediately and the people concerned were satisfied with the results.

People with whom we spoke were generally satisfied with the way that staff supported them. One person was finding it difficult to get on with all staff and described some as, “not very understanding.” However, they did go on to say, “The carers are OK and some of them are very good.”

They spoke highly of the manager and were able to raise any issues or concerns with them if necessary.

People told us that they had choices of food at mealtimes, that the food was good and that food and drink were available to them when they needed it.

People said they have opportunities to ‘have their say’ about the home by attending regular meetings with the manager. Some said they chose not to go but they knew the meetings took place and they could read about them if they wanted to.