The Old Vicarage is a residential care home, providing accommodation and personal care for up to 21 people. At the time of our inspection, there were 21 people living at the service. The people’s rooms are situated across two floors. There is a large lounge area, with an adjacent quiet lounge-conservatory. Both rooms overlook the garden and people enjoyed watching the ducks that people and the staff have helped to hand rear. The dining room is opposite the lounge and the management offices are situated along the main corridor.

The inspection took place 26 and 29 January 2018 and was unannounced. At our previous inspection in December 2015 the service was rated as Good in all areas. At this inspection we found that standards had been maintained and that efforts were being made in working towards achieving Outstanding.

People and their relatives spoke highly of the staff and management team. One relative said, “They treat everyone as they would their own, it is like one big family here.” This was echoed by the staff and registered manager, who also described the ethos of the service as being “family orientated”.

Relatives and health and social care professionals praised the staff team for their knowledge and skills, as well as how the team “go above and beyond” to support people. One relative said, “it gives a real peace of mind knowing mum is safe, happy and looked after here.”

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Where people had their liberty restricted, the service had completed the related assessments and decisions had been properly taken. Staff had been trained and understood the general requirements of the Mental Capacity Act (2005).

The service sought to offer holistic alternatives to medicines where possible. For example, exploring alternative methods to mild pain relief. There were also regular medicine reviews to prevent people from being over medicated. Medicines continued to be stored, administered and recorded safely. The service had built a good working relationship with the local health centre, as well as with visiting health professionals.

There were safe recruitment processes in place. Staff had the skills and knowledge to support people. Staff received up to date training and could request additional training where required, and every staff member had completed, or was in the process of completing dementia awareness training.

The activities programme was tailored to suit individual and group interests. We found that staff understood people’s interests and hobbies. Staff incorporated people’s interests into the social programme and supported people to maintain routines. For example, some people had enjoyed reading specific newspapers and magazines, and these were brought into the home; and one person was supported to the local shop to purchase their lottery tickets.

The activities coordinator understood and utilised the interests of individuals and groups of people to build community links and offer activities in and out of the service. Staff used a positive risk taking approach to support people to access their local community.

Care plans were very person centred and evidenced an understanding of what was important to the individual. These included information around the day to day decisions, such as how a person liked their hot drinks, but also the more complex decisions, such as information around their preferred end of life treatment and support. There was a person-centred culture within the service, with staff valuing each person as an individual.

Staff undertook training in end of life care and relatives spoke highly of the service their loved ones had received while living at the service. Staff understood the importance of dignity and empathy while providing end of life care.

Creative support methods were used to enable people

The Old Vicarage is a residential care home providing personal care for up to 21 people. The inspection took place on 14 December 2015 and was unannounced. The service had a registered manager who was responsible for the day to day operation of the home. 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.

During a previous inspection carried out on 25 July 2014, we asked the provider to take action regarding the safety, availability and suitability of equipment and some areas of record keeping. This related to the call bell system not working as it should, insufficient space in a top floor bathroom and care records not being updated when care was given. We followed up these concerns and found the provider had made the necessary improvements. There was a new call bell system in place and this was monitored weekly and response times audited. A development plan is in place for the refurbishment of the top floor bathroom and was not accessible for people to use until after the renovations. Staff were documenting the daily care people received as given on the person's care plan.

At the time of our inspection on 14 December 2015, there were 18 people living at the Old Vicarage. The home had a warm and homely atmosphere and relatives and people told us this was one of the reasons they had chosen the home. People liked the staff who supported them and positive relationships had formed.

Throughout the day we observed staff treated people with respect and afforded people their privacy when carrying out personal care. Staff were knowledgeable about people's background, cultural and faith beliefs. Staff were able to tell us about people's preferences on how they wished their care to be delivered, along with people's likes and dislikes.

Staff were knowledgeable about the rights of people to make their own choices, this was evident in our observation of the interactions between staff and people and reflected in the way the care plans were written. A range of activities was available which people could take part in if they wished. People told us they made their own decisions about how they spent their day and what activities they wanted to take part in.

One person told us "I always get my meals on time, and the food here is good, they are always feeding us". Other people commented that the food was good and they had enough to eat. The chef catered for different types of diets such as vegetarian and fortified diets. Medicines were managed safely and people received their medicines on time.

People told us they felt safe living in the home and with the staff who supported them. Staff had received training in how to recognise and report abuse. There was an open and transparent culture in the home and all staff were clear about how to report any concerns they had. Staff were confident that the registered manager would respond appropriately. People we spoke with knew how to make a complaint if they were not satisfied with the service they received.

Staff received training which was specific to their role and told us they felt supported and valued by the management team.

The registered manager carried out audits on the safety and quality of the service provided. People told us they were asked for their views on how the service was run.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report. This is a summary of what we found:

Is the service safe?

We saw that there were procedures in place in the event of a fire and emergency hospitalisation.

We saw that there was equipment available at the home to meet some of people’s needs. However, some equipment was inadequately maintained and not fit for purpose. This meant that people were not protected from risks associated with faulty equipment.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. People were not detained under Deprivation of Liberty Safeguards. One person living at the home said, “My daughter visits and takes me out.” Relevant staff were involved with conducting mental capacity assessments where appropriate.

Is the service effective?

We saw that people living at the home had care assessments and plans to identify their needs. Staff said that records gave them enough information about how to support people. One person living at the home said, “I haven’t been able to fault anything.” One relative said, “People are well turned out. There is enough food and drink.”

Appointments with external professionals were arranged when needed and advice was followed by staff at the home. One relative said of staff at the home, “The doctor and nurse they are quick to arrange.”

Is the service caring?

We observed that interactions between staff and people living at the home were supportive and caring. We saw staff talking with people living at the home about a range of topics. One relative said, “Staff are pleasant.” One person living at the home said of the home, “It’s very nice, good staff.”

Is the service responsive ?

Systems were in place to make sure that managers and staff learnt from complaints, concerns, accidents, incidents, and audits. We saw that action plans had been put in place where needed and the manager told us that these had been carried out.

Staff told us that where recommendations were made by external professionals about care then these were followed. One external health professional said, “Advice is taken on board.”

Is the service well led?

We saw that the provider had sought the views of people living at the home and had implemented changes following this.

The provider did not have an effective system in place to identify, assess and manage risks to the safety and welfare of people who use the service and others.

People told us they were satisfied with the care they received. One person told us "the care is very good. I'm always nice and fresh and clean." A relative said they thought staff had looked after their family member "very well". Staff were caring, friendly and professional.

We observed people were involved in care decisions and their consent was sought before care was provided. We saw staff were patient and caring and allowed time for people to make their choices. Staff we spoke with knew about working in people’s best interests if it had been established a person did not have the mental capacity to make decisions for themselves. This could involve speaking with people’s representatives for example, family members, their GP or practice nurse, in line with guidance from the Mental Capacity Act 2005.

We observed the home was clean. Staff were knowledgeable about their roles and responsibilities in the prevention and control of infection.

Staff told us they were well supported. We saw there was a comprehensive training programme including dementia, the Mental Capacity Act and specialist areas, for example, diabetes and tissue viability.

Overall people's care records reflected their needs. People's monitoring charts for example, food and fluid charts were completed daily.

People told us that the care was very good. A family member said that they could not fault the care and one person said “nothing is too much trouble”

People told us they were treated with dignity and respect. We saw that people were encouraged to become involved in a variety of activities. People were asked for their views and we saw that they were listened to and acted upon.

People told us the food was very good. They were offered a choice of what to eat and drink. People's nutrition and hydration was being assessed and appropriate support was given to maintain weight.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

The building and grounds were suitable for the people who lived there. We were told that there were plans for some improvements to be made to the decoration.

People told us that staff answered the call bells in a timely fashion. We saw that there were sufficient staff numbers to meet people's needs.

There were appropriate systems in place to monitor quality and manage risk.

We found there were some risks to people because not all records were completed

accurately. This may mean that people may not always get the care they need.