This inspection took place on 6 December 2016 and was unannounced. At our previous inspection we found the provider was in breach of three Regulations of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was not safe, effective or well led. At this inspection we found that improvements had been made and the provider was no longer in breach of any Regulations.

The Old Vicarage provides accommodation, personal and nursing care for up to 44 people. At the time of this inspection 31 people were using the service.

There was a manager in post who was in the process of registering with us (CQC). 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 were safeguarded from abuse as staff and the manager knew what to do if they suspected abuse and followed the correct safeguarding procedures to keep people safe.

Risks of harm to people were assessed and plans put into place to minimise the risks. Staff knew people’s risk assessments and followed them to reduce the risk and keep people safe.

People’s medicines were stored and administered safely by trained staff. There was sufficient suitably trained staff to keep people safe and meet their care needs in a timely manner.

The principles of The Mental Capacity Act (MCA) 2005 were being followed to ensure people were consenting to or being supported to consent to their care, treatment and support.

Staff received support, supervision and training to be able to be effective in their roles. Staff recognised and responded when people became unwell and sought medical advice from health care agencies. People were supported to maintain a healthy diet and if people lost weight they were referred to their GP for advice.

People were treated with dignity and respect and their right to privacy was upheld. People felt able to complain and confident that the manager would listen and respond.

People received care that reflected their individual assessed needs and reflected their preferences. There were opportunities to engage in hobbies and activities of people’s liking including external entertainment.

The manager had implemented systems to monitor and improve the service. Improvements had been made throughout the service. People and staff respected the manager.

We inspected to look for improvements following our previous inspection in March 2016 where we had found several breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to people not receiving care that was safe, effective, responsive or well led. The provider had been sending us weekly action plans informing us how they planned to improve and their progress towards these plans. We undertook this focused inspection on the 27 September 2016. This report only covers our findings in relation to the areas of concern. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Old Vicarage Nursing Home on our website at www.cqc.org.uk.

The Old Vicarage provided accommodation and nursing care to up to 45 people. At the time of this inspection 35 people were using the service.

The previous manager had left and a new manager was in post who was in the process of registering with us. 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 were not always safeguarded from potential abuse as the provider was not following the local authority safeguarding procedure by ensuring that all incidents of suspected abuse were reported and investigated.

The provider was still not consistently follow the principles of the MCA 2005 to ensure that people consented to or were supported to consent to their care, treatment and support.

The systems the provider had in place to monitor and improve the service were ineffective as not all the required improvements had been made since our previous inspection and as stated in the provider's action plan.

People were cared for by staff who were supported and trained to fulfil their roles. There were sufficient staff to meet people's needs safely.

People's nutritional needs were met and when their health care needs changed or they became unwell advice and support from other health care professionals was gained.

People's medicines were stored and administered safely. However records relating to reviews of people's medicines were not up to date.

People received care that was personalised and reflected their individual preferences. People were encouraged to be participate in hobbies and activities of their choice.

People and their relative's views were sought on the quality of service they received through regular reviews, meetings and surveys.

The provider had a complaints procedure and people and their relatives knew how to use it. Complaints were managed according to the procedure.

This inspection took place on 30 March 2016 and was unannounced. At our previous inspection in January 2016 we had serious concerns for people's welfare as the service was not safe, effective, responsive, caring or well led. We had judged the service as inadequate and placed it into special measures. At this inspection we found that some improvements had been made although further improvements were required. There were still five breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have taken the service out of special measures however we will be returning to check for further improvements in the near future.

The Old Vicarage provided accommodation and nursing care to up to 45 people. At the time of this inspection 38 people were using the service.

There was a new manager in post who was in the process of registering with us. 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.

Risks to people's safety were assessed, however staff did not always follow people's risk assessments to ensure they kept people safe.

The provider did not consistently follow the principles of the MCA 2005 to ensure that people consented to or were supported to consent to their care, treatment and support.

People's nutritional needs were not always met as weight loss was not noticed and acted upon.

People had access to some health care services, however some people would have benefited from referral to other health care agencies for advice and support.

People did not always receive care that met their assessed needs and reflected their preferences.

Systems were in place to monitor the quality of the service and some improvements had been made, however further improvements were required.

Medication was stored and administered safely.

People were treated with dignity and respect and their privacy was respected.

There were enough suitably skilled staff to keep people safe employed using safe recruitment procedures.

Staff felt supported and received supervision and training to support them to be effective in their roles.

Complaints were listened to and acted upon by the new manager. There was an open door policy and people felt they could approach the manager.

The new manager had made several improvements since being in post and acted quickly when issues of concern were identified with them.

This inspection took place on 12 and 13 January 2016 and was unannounced. At our previous inspection in January 2015 we had concerns that people were not receiving care that was safe and effective. We found two breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and asked the provider to improve. At this inspection we found that no improvements had been made and there were further breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The Old Vicarage Nursing Home provides accommodation and nursing care for up to 45 people. There were 43 people using the service at the time of this inspection.

There was no 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. We were supported throughout the inspection by the provider's nominated individual.

The provider was not working within the guidelines of the Mental Capacity Act 2005. The MCA and the DoLS set out the requirements that ensure where appropriate decisions are made in people's best interests where they are unable to do this for themselves. People were being unlawfully restricted of their liberty within the service and were not consenting to their care.

People were not protected from the risk of abuse. Incidents of suspected abuse were not reported or investigated.

People's medicines were not managed or administered safely.

People did not always receive the health care support they needed. Staff felt supported and trained however this did not always reflect in their care practices.

People did not receive care that was personalised and reflected their individual needs and preferences.

People were not always treated with dignity and their privacy was not always respected.

People knew how to complain but complaints were not always managed appropriately.

No improvements had been made since our previous inspection and the systems the provider had in place to monitor the quality of the service were ineffective.

The inspection took place on 22 January 2015 and was unannounced.

The Old Vicarage Nursing Home provides nursing and residential care to older people. The provider had a manager in post who had yet to register with us. 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 were protected from avoidable harm because safety risks were identified and managed and the staff understood how to keep people safe.

Medicines were not stored or managed safely.

There were sufficient numbers of staff to meet people’s needs. Staff received training that provided them with the knowledge and skills to meet people’s needs, but updates were needed to ensure current guidance was followed.

Infection control systems were not effective in ensuring the service was clean.

Staff sought people’s consent before they provided care and support. Some people who used the service were unable to make certain decisions about their care. In these circumstances the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were followed.

People had access to suitable amounts of food and drink, but their choices were limited because of a lack of information. Specialist diets were catered for.

People’s health and wellbeing needs were usually monitored and advice from health and social care professionals was sought when required. Problems with the delivery of care were highlighted.

Staff treated people with kindness and people’s dignity and privacy was promoted. People were encouraged to make choices about their care and the staff respected the choices people made.

People and their relatives were involved in the assessment and review of their needs and care was delivered in accordance with their stated preferences.

People’s feedback was sought and used to improve the care. People knew how to make a complaint but were not always confident their concerns had been listened to in the past. The provider monitored complaints to ensure they were responded to in accordance with their policy.

The manager and provider regularly assessed and monitored the quality of care to ensure standards were met and maintained. Some areas of concern had not been identified meaning improvements in the quality of the audits were needed.

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

People were able to choose how to spend their time and what activities to be involved with. People could choose to socialise with other people or spend time in their bedroom or smaller lounge areas.

Where people were not able to make decisions, capacity assessments were completed and information about why others had made decisions on their behalf had been recorded. This meant people could be confident decisions had been made in their best interest.

Systems were in place to protect people from the risk associated with the unsafe use and management of medicines.

The service had an effective recruitment policy which was followed by staff.

The provider had a number of systems in place to enable them to monitor and assess the quality and effectiveness of the service provided.

We spoke with a number of people during our inspection of The Old Vicarage nursing home; these included four people who used the service, two relatives of people who used the service; four members of staff and a member of the management team. The manager of the home was not present at the time but we did speak with her later. We wanted to know their views about how the service was delivered and the quality of service provided.

We observed that staff responded to people’s needs. We checked records which showed people had provided consent to their care and treatment. Where people did not have capacity to give informed consent, we saw how decisions had been made in their best interest.

People received care and support that met their individual needs. Care records were based on people’s individual needs. A person who used the service told us, “The staff are lovely; they can’t do enough for you”.

We saw that the home was kept clean. We spoke with staff, people who used the service and their relatives about the cleaning routines and infection control.

We saw from training records we checked and what staff told us that staff had appropriate qualifications and skills to provide care.

There was a complaints system for identifying and dealing appropriately with complaints and comments.

We carried out this inspection because we had not visited the service since 2010 and we did not have enough information about the service to assess compliance. We wanted to see what life was like for the people who lived in the home.

The Old Vicarage is a nursing home providing accommodation for up to 45 people who have general nursing needs and some who have dementia care needs. There were 43 people in residence when we visited. Our visit was unannounced, meaning people living there and the staff were not aware that we were coming.

We spoke with six people privately and a further eight people who were in the lounge areas.

All were positive about their experience at the home, comments included “I have been here for two years, I am cared for very well by staff that really can’t help us enough.” “I like this home, the food is good, I can do what I want to and the staff are so helpful and friendly.”

A visitor told us that their relative had been at the home for three years and due to a progressive illness had become totally dependent for all aspects of living. The visitor told us: “We visit each day at different times, the staff are brilliant, we just can’t fault them, they treat (name) as a human being. Although she cannot speak they take her to the lounge each day where she can be with other people. If something worries us, we tell them and they are straight on to it. It is an excellent home and I don’t have to worry about my (relative’s) care."

Before our visit we contacted other people who have an interest in the service, such as a local authority commissioning the service, environmental health and fire safety officers. No concerns were identified by any of these agencies.