This inspection was completed on 30 April and 1 May 2108 and was unannounced.

The Old Vicarage Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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 accommodates up to 37 people in one adapted building. There were 33 people at The Old Vicarage at the time of the inspection.

The previous inspection was completed in July 2015 and the service was rated Good overall. We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service had not protected people against the risk of unsafe or inappropriate care arising from a lack of proper information about them. At this inspection we found improvements had been made and the provider met the requirement of this regulation. At this inspection the service remained Good.

Risk assessments were updated to ensure people were supported in a safe manner and risks were minimised. Where people had suffered an accident, action had been taken to ensure the on-going safety of the person.

Staff had received training appropriate to their role. Staff had received training around safeguarding and was confident to raise any concerns relating to potential abuse or neglect. The administration and management of medicines was safe. There were sufficient numbers of staff working at the Old Vicarage. There was a robust recruitment process to ensure suitable staff were recruited.

People were supported to access health professionals when required. They could choose what they liked to eat and drink and were supported on a regular basis to participate in meaningful activities. People were supported in an individualised way that encouraged them to be as independent as possible.

People and their relatives were positive about the care and support they received. They told us staff were caring and kind and they felt safe living in the home. We observed staff supporting people in a caring and patient way. Staff knew people they supported well and were able to describe what they like to do and how they liked to be supported.

The service was responsive to people’s needs. Care plans were person centred to guide staff to provide consistent, high quality care and support. Daily records were detailed and provided evidence of person centred care.

The service was well led. Quality assurance checks were in place and identified actions to improve the service. Staff and relatives spoke positively about the management team.

Further information is in the detailed findings below.

This inspection was conducted on the 8 July 2015 and was unannounced. The Old Vicarage Residential Home is a care home that does not provide nursing care. People’s nursing care needs were being met by the district nursing team through the GP practice. The home can accommodate up to 37 people. At the time of our inspection there were 31 people living in the home with six vacancies. The service supports older people who may live with a dementia.

The home has three double rooms and 31 single rooms, some have ensuites. The double rooms have screening available to give the occupants privacy.

People can move freely around the home and the secure garden to the rear of the property. There was level access to the property and lifts to the first and second floor. There was a key code fitted to the entrance to 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 and has the legal responsibility for meeting the requirements of the law; as does the provider.

The previous inspection was completed in July 2014 and there were no breaches in regulations. However, there were some areas where the service needed to improve. This included ensuring there was a registered manager, call bells to be accessible and improving the documentation where decisions were made in people’s best interest. We also asked the provider to ensure the signage in the home was appropriate for people who have a diagnosis of dementia, to assist them moving independently around their home. Improvements in these areas had been made.

People were receiving care that was effective and responsive to their changing needs. Care plans were in place that described how the person would like to be supported and these were kept under review. However, two people did not have a care plan in place to guide staff in all areas of their care. This was because they were relatively new to the home. This was rectified within 48 hours and copies of the care plans were forwarded to us electronically.

People’s medicines were managed safely. People were protected against abuse because staff had received training on safeguarding adults and they knew what to do if an allegation of abuse was raised. Newly appointed staff underwent a thorough recruitment process before commencing work with people.

People received a safe service because risks to their health and safety were being well managed. Staff were aware of the potential risks to people and the action they should take to minimise these.

People had access to healthcare professionals when they became unwell or required specialist help. They were encouraged to be independent and were encouraged to participate in activities both in the home and the local community.

People were treated in a dignified, caring manner which demonstrated that their rights were protected. People confirmed their involvement in decisions about their care. Where people lacked the capacity to make choices and decisions, staff ensured people’s rights were protected. This was done through involving relatives or other professionals in the decision making process.

Staff were knowledgeable about the people they were supporting and spoke about them in a caring way. Staff had received suitable training enabling them to deliver safe and effective care.

The service was well led. The team was supported by the registered manager and the provider. Staff confirmed they received support and guidance from the management of the service. Checks were being completed on the quality of the service, with action plans being implemented to aid improvement.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This was an unannounced inspection.

The Old Vicarage Residential Home is a care home that does not provide nursing care. People’s nursing care needs were being met by the district nursing team through the GP practice. The home can accommodate up to 37 people. At the time of our inspection there were 36 people living in the home with one vacancy. The service supports older people who may live with a dementia. The home has three double rooms and 31 single rooms, some have ensuites. The double rooms have screening available to give the occupants privacy.

The home does not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. However, a manager has been appointed in April 2014 and they have made an application to become registered with us.

There were no breaches in regulation but we have asked the provider to make some improvements to the service that people were receiving. This included how the staff record best interest meetings where a person lacks capacity whist these were happening the outcome could have been better documented. Some people did not have access to a call bell because of the position of their bed. This should be recorded in the person’s care plan to include what actions staff were taking to ensure care was responsive to people’s needs. We have also asked the provider to ensure the signage in the home was appropriate for people who have a diagnosis of dementia which may assist in them moving independently around their home. The provider told us that they were providing more training to staff on dementia and a plan to improve was in place.

People told us they were well cared for and staff treated them with kindness. However we saw during a keep fit session people were being instructed with “you must” and “you will” in a brusque tone. The provider addressed this immediately with the member of staff. Regular activities were taking place to keep people socially active and involved in the home. There were good links with the local community and there were no restrictions on visitors to the home. Relatives we spoke with were generally positive about the care and support. People looked well cared for.

People were supported by sufficient staff. Staff had received some training that was relevant to the care needs of the people they were supporting. This included some training on supporting people with dementia. However, training had been identified and was being planned for staff in dementia care and pressure area management.

We carried out this inspection because concerns had been raised with us that people did not have a choice about the time they got up in the morning. Information received said that staff started to get people up at 6.00am and everyone in the home was up and dressed by 08.30am.

We wrote to the provider to ask what arrangements were in place for getting people up each day. This included asking how they knew if people had a preferred time and how staff were allocated to people to ensure their wishes were met.

The provider responded to our request and gave us information about how they recorded people’s choices and how their wishes were met. We used this information and evidence from our visit to the home at 6.30am to check if people were able to get up at a time of their choosing.

We found that everyone in the home was still in bed on our arrival and staff did not start getting people up until 7.15am. Throughout the morning we observed the times that people got up and checked if times were in line with their wishes.

We were not able to ask people if they had agreed to the time they got up because they were unable to clearly communicate this to us. However, we spoke with staff and looked at the care records for seven people and saw that their preferred times for getting up were recorded. Staff we spoke with showed they had a good knowledge of people’s wishes for getting up. We found that the people we observed had all got up in accordance with their preferred times.

We were unable to ask most people about their views of living in the home because people had a diagnosis of dementia and as a result had some communication difficulties. However, we spent time observing people in communal areas and saw that staff interactions were kind and at the pace of the person they were communicating with. Staff understood the best way to communicate with people and were able to support people to make choices about their daily living.

We spoke with two relatives who were visiting on the day of our inspection. One relative told us, “I am extremely happy with the care provided, I am always made to feel welcome and the home keeps me informed”. We looked at the care plans for five people and saw that these detailed people’s daily routines and how they might communicate what they wanted. Care plans were person-centred, reflected people’s current needs and wishes and were regularly reviewed.

The home recognised when the behaviour of some people could put others and themselves at risk of harm and took appropriate measures to minimise the risk of harm to people. There were enough qualified, skilled and experienced staff to meet people’s needs. The provider sought the views of people who used the service and used these comments to improve and develop the service.

During our visit we spoke with seven people living in the home, three relatives and a visiting district nurse. We also spent time with people in the communal areas. People told us that staff were kind and they were happy with the care and support they received. During our visit we observed staff talking to people about how they wanted to spend their time and what they wanted to eat and drink. Care plans were personalised to each individual's needs and from the people we spoke with we were able to see that they accurately reflected their needs and wishes.

On the day of the visit we noticed that some rooms had an unpleasant odour. We saw the housekeeper using a carpet cleaning machine to clean some carpets and we noticed a slight improvement in the smell once the carpets had been cleaned. One relative told us “It’s homely here. If I could change anything, it would be the smell but I think the residents are well cared for and if I did have a concern I would know who to raise it with.”

Staff we spoke with and observed showed that they had good knowledge of the people they supported. We saw that all appropriate checks had been carried out when staff were recruited.

The home regularly asked people who used the service, their representatives and other professionals for their views about the care and support the home provided. When feedback was given by people the home acted on it and used these comments to improve the service.