The inspection took place on the 28 and 29 September 2016 and was unannounced.

The Old Vicarage provides care and support for up to 17 people. The Old Vicarage is a home which supports people who have mental health needs. The home comprised of two buildings, a period property offering accommodation over two floors and a purpose built block called St Mary’s comprising of self-contained flats.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. During this report the registered manager will be referred to as the manager.

Some important safety checks relating to water temperatures and some equipment used in the building had not been carried out for some time.

There were some systems in place to monitor the quality of the service. However, not all of these were robust. In some areas the manager and the provider did not have an oversight on elements of the service provided.

People benefited from being supported by staff who were safely recruited and well trained. Staff felt supported in their work by the manager. There was consistently enough staff to safely meet people’s individual needs. Staff understood how to protect people from the risk of abuse and knew the procedure for reporting any concerns.

Staff knew and understood the needs of people living at the Old Vicarage. People received care which was person centred, the manager and staff knew the people they supported.

Staff received yearly appraisals. Staff also had regular supervisions. The manager observed practice and was involved in the daily running of the service.

Staff told us they were happy working at the Old Vicarage. Staff were committed and dedicated to the service. They assisted people with kindness. People’s dignity and privacy was maintained and respected. People were treated as individuals. People’s wishes and what was important to them was promoted by staff and the manager.

The Care Quality Commission (CQC) is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The service was depriving some people of their liberty in order to provide necessary care and to keep them safe. The service had made applications for authorisation to the local authority DoLS team. The service was working within the principles of the MCA. The manager and the staff had a good knowledge of the MCA and DoLS.

People’s care plans contained important, relevant and detailed information to assist staff in meeting people’s individual needs. People’s needs were regularly reviewed and monitored.

People were supported to maintain good health and wellbeing. The service responded proactively to changes in people’s health and their wellbeing.

The service encouraged people to maintain relationships with people who were important to them. People benefited from being supported to do what they wanted to do. People experienced a variety of individual and group events. People were supported and given opportunities to explore their interests. The service encouraged people to be independent and to fulfil their goals.

There was a positive and open culture at the Old Vicarage. The service was welcoming and friendly.

On the day of our inspection 16 people were living in Hollybrook House. We spoke with the deputy manager and four members of staff. We looked at the care records of four people and spoke with two people in private.

Care records included individualised risk assessments and care plans. One person said that Hollybrook House was “A very good, safe, place. Service is excellent.” A staff member emphasised that care plans were written and care delivered “…with people’s own choices in mind.”

Each care record contained a ‘healthcare professional record’ where the person’s contact with health professionals was recorded. A ‘healthcare passport’ had also been prepared for each person, to be sent with them if they needed an urgent admission to hospital.

The provider had constructed a new laundry room for people living in Hollybrook House. A new carpet had been fitted on the stairs and landing of the main house and bathrooms and communal areas had been repainted. Three en-suite rooms were being developed in the house by combining existing smaller rooms.

One person told us that staff were “…first class…” . Staff members told us that they received feedback and support, although there was no appraisal timetable in place. The provider monitored the quality of care and took steps to deal with any issues that were identified. We noted that a system of audits was used to assist in quality monitoring.

One person we spoke with told us that the staff were all very good and that they were always treated with dignity and respect. This person also said: "My key-worker is "Really fantastic - and I don't use that word lightly!"

When they had been asked where they would like to go for their annual holiday, one person said that they had been amazed when they were told that it was their choice and that they could go wherever they wanted.

We were told by one person that their key-worker helped them get things sorted very quickly. For example, when their medication needed reviewing or if they had any issues with their health or care.

One person said: "The only thing I have to complain about here is where we do our laundry. First of all we get our washing ready, then we have to find a member of staff to go across with us but then you never know whether there are any empty machines. If they're all being used, it means that you have to take your washing back and then do the whole process over again later. It sometimes takes a long time and it does get really frustrating."

We observed the atmosphere in Hollybrook House to be calm, relaxed and comfortable and noted staff chatting and interacting with people in a pleasant and cheerful manner.

One person we spoke with said they knew how to make a complaint or raise any concerns. They also told us that they felt they were listened to and that any concerns were taken seriously by staff.

During our visit to Hollybrook House we spoke with five people who use the service.

They told us that the service was "well run" and "well organised".

People told us they felt safe living at the home, with most people praising the support they receive from the staff. One person told us, "I feel very safe here, if I didn't I would move.”

We were also told, , "I talk with the staff all the time, they're very friendly, I don't really need very much help, but the staff check that I'm alright, I'm sure they know what they're doing.”

Another person said, "The staff are always around if there is a problem, they're very good you know.”