At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Since our last inspection two managers’ had withdrawn their applications to register with the Care Quality Commission (CQC). The last registered manager in post voluntarily resigned their registration on 31 March 2017. It is a condition of registration that all providers must have a registered manager in position to comply with Section 33 of the Health and Social Care Act 2008. This was discussed during our inspection and the deputy manager told us the current acting manager was absent. Since our inspection the deputy manager has submitted an application to register as manager with the CQC. They had received a letter to attend a fit and proper person’s interview in April 2018. This interview forms part of the registration process for all new registered managers.

People were protected from avoidable harm and abuse. Systems were in place to record and analyse concerns and included actions the provider had taken to safeguard people. Staff were knowledgeable about potential types and signs of abuse and knew how to report internally and to external agencies.

Risks had been identified and assessments completed and regularly reviewed each month. These included guidance for staff on how to reduce risks to ensure people received safe care and treatment. The provider had processes in place to manage safe administration, disposal, ordering and storage of medicines.

The acting manager reviewed people’s dependency levels monthly to ensure appropriate staffing levels were in place. The provider had robust recruitment processes in place which included pre-employment checks to confirm new applicants were of suitable character prior to commencing their employment.

Staff were knowledgeable about people’s needs and specific health conditions. The provider ensured staff received training and regular supervisions to support them in delivering person centred care to people.

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.

Staff worked with people to understand their likes, dislikes and preferences so they could build person centred care plans. This ensured people’s well-being, privacy, dignity and independence were respected.

The provider had equality and diversity policies in place. Staff understood and valued people’s diverse needs and recognised the specific individual needs of each person.

Staff delivered person-centred care in line with the information held in people’s care plans. People felt supported to live as they had chosen and enjoyed a range of daily activities and events organised by the provider.

Staff, relatives and people living at the service told us they knew how to complain should they need to and felt confident that management would address their concerns.

The provider sought feedback from staff, relatives and people living at the service to continually improve practices and empower people to voice their views and opinions which were utilised to improve the running of the service.

Quality assurance systems highlighted any areas that required attention to ensure the service remained effective. Regular audits were completed by senior members of staff to ensure best practices were being followed and to highlight any areas that required development, such as additional staff training when minor concerns had been identified.

Further information is in the detailed findings below.

This inspection took place on 14 and 15 December 2015 and was unannounced. At our last inspection of the service on 25 February 2014 the registered provider was compliant with all the regulations in force at that time.

The Old Vicarage Residential Care Home is a home for older people in Skidby. The detached house accommodates 33 people in comfortably furnished and decorated shared and single bedrooms and has plenty of lounge and dining space. The registered provider has places for 33 people but prefers to operate at 29, thus using four shared bedrooms as singles, giving the effect that all rooms are single occupancy. Gardens are ornamental and well maintained. There is a passenger lift to upper floors and there are ramps into the home from the outside. There is a car park to the rear of the property for approximately ten cars.

At this inspection we found there were 19 people living in the service, plus three people who were in the ‘Time to Think’ beds. These were short stay beds utilised by the Hull Royal Infirmary to help get people out of hospital and back into their own homes. People using the Time to Think beds usually stayed for between seven and twenty-eight days in the service before moving back into their own homes. The age range of people using the service was between 79 and 102 years.

The registered provider is required to have a registered manager in post and there was a registered manager at this service. 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 who used the service and their relatives told us they had been consulted about care and support and we found that they received the care they required to meet their needs. We noted that the recording in two care files could be improved, but this had already been picked up in a recent care plan audit and was being addressed by the registered manager.

People told us that they felt safe living at the home. We found that staff had a good knowledge of how to keep people safe from harm and that there were enough staff to meet people’s needs. Staff had been employed following robust recruitment and selection processes. Medicines were administered safely by staff and the arrangements for ordering, storage and recording were robust.

People’s nutritional needs had been assessed and they told us they were satisfied with the meals provided by the home.

People spoken with said staff were caring and they were happy with the care they received. They had access to community facilities and most participated in the activities provided in the service.

Staff received a range of training opportunities and told us they were supported so they could deliver effective care; this included staff supervision, appraisals and staff meetings.

The registered manager monitored the quality of the service, supported the staff team and ensured that people who used the service were able to make suggestions and raise concerns. We saw from recent audits that the service was meeting their internal quality standards. The registered manager was described by people, relatives and staff as being ‘open and friendly’ and there was an ‘open door’ policy as far as they were concerned.

When we visited the service to assess progress with compliance against regulation 10, 'Assessing and monitoring the quality of the service', we found that a new manager had been appointed. Since they had been in post they had been working closely with the company area manager and together they had implemented changes in quality monitoring the service.

We found that the changes were sufficient to show that improvements had been made in auditing areas of the service and in seeking peoples' views of their care and support. This meant that the service was once again in a position to be able to monitor the quality of care and support it provided, the safety and suitability of the environment, the level of staffing skills and the effectiveness of care practices. Therefore people were more confident improvements would be made in meeting their needs.

We spoke with five people that used the service and with the staff and we looked at records and documentation to make a decision about compliance with regulations.

People told us they were satisfied with the care and support they received. One person said, “We are well looked after." We saw and heard staff asking people about the help they needed and staff provided it in an efficient manner, with regard to peoples' privacy, dignity and respect. Another person said, "The staff are nice. We get a choice of foods," while a third person said, "We can pretty much do as we like.”

We saw staff being helpful and caring and including people when giving them support. We saw that the environment in the main lounge was not as good as it could be with regards to lighting, temperature and space for manoeuvring and the provider was informed.

We saw that case files had care plans that had been reformatted since our last visit to The Old Vicarage. These had improved. We looked at the medication administration systems within the home and saw that they were satisfactory in the main, with some minor points made for consideration by the provider.

We also saw that staffing levels were appropriate once an initial identified staffing shortage had been rectified. We saw that there was a complaint procedure for handling complaints and people told us that they knew how to complain if need be. We saw that records had been accurately maintained and were held safely and appropriately.

We carried out this inspection to check that the provider was compliant with three standards for which improvement and compliance actions had been made at the last 'follow up' inspection in February 2012.

These related to ensuring there were enough staff on duty to meet peoples' needs, to keeping of accurate and thorough medication and risk assessment records, and to ensuring there was a registered manager managing the service.

We did not speak with any of the people that used the service about these standards.

We spoke with people about their experiences in the home. One person told us about their activities in the garden and told us that last summer they had been accompanied by another person living at The Old Vicarage. They told us they had 'kept an eye' on them because they often wondered about.

People told us they did not want to handle their medication as they did not want the responsibility. They told us they preferred the staff to look after and administer their medicines.

People asked us if we knew what had been happening in respect of the manager position. We advised people to talk to the provider or the acting manager for information.

Some of the people we spoke with remembered being involved in making decisions about their care. They told us they were satisfied with the care they received and they could ask staff for almost anything and it would be done.

They told us they liked the food very much and if they asked for different things they usually got them. They told us they were happy with the medication arrangements and the staff were very good, though sometimes short staffed.

We spoke with nine people that used the service, seven staff and the provider during our two day visit to the service. We looked around the premises and we viewed people's case files, staff files and documents relating to maintenance and service contracts.

We found that before people received any care they were asked for their consent and the provider acted in accordance with their wishes. People confirmed to us that this was the case and we saw evidence of consent being given to the implementation of care plans in the form of peoples' signatures.

We were told that peoples' needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We saw care plans to confirm this. People were satisfied with the service of care they received though some of them thought it could have been better. They said, "Some staff are very good, others are not”, “Oh I am quite satisfied here”, “Most of the girls are lovely” and “The food is good and the staff look after us well”. They said, “It’s not bad here, I could be a little more comfortable if it was a bit warmer".

We found that peoples' health, safety and welfare was protected when more than one provider was involved in their care or when they moved between different services. This was because the provider worked in cooperation with others.

When we looked round the premises we found that there were effective systems in place to reduce the risk and spread of infection and the service was clean and hygienic. People were protected from the risk of infection because appropriate guidance had been followed.

When we looked round the premises we also saw that the provider had taken steps to provide care in an environment that was suitably designed and adequately maintained. Peoples' bedrooms were safe and they had personalised them to their liking.

People were protected from unsafe or unsuitable equipment because the provider made sure equipment was suitable, safe and properly maintained.

When we looked at staff files we found that staff received appropriate professional development. Some of them had completed the mandatory training and others, new staff, were booked to do so. Staff received appropriate supervision.

When we looked at the quality assurance system we found people that used the service, their representatives and staff were not asked for their views about their care and treatment. We also found there were insufficient audits on the service to accurately determine its performance delivery.