This inspection took place on 21 and 25 April 2017 and was unannounced. The Vicarage is a care home which provides short term respite breaks for up to five adults with learning and/or a physical disability. There were three people staying at the home on the day of our inspection.

People and their relatives/carers needs were assessed by the local authority and allocated ‘an amount of respite days’ to be used within a year to have regular breaks from their role as a carer. The breaks were booked direct with the home.

At the last inspection in July 2014, the service was rated Good. At this inspection we found the service remained Good.

People received individualised care which reflected their personal preferences, wishes and routines. People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People’s care records were kept up to date with their changing needs. By closely working with health care professionals the risks to people’s health and well-being were reduced. People were supported to eat and drink which met their dietary requirements and preferences. They were encouraged to make choices about their care and support and to be as independent as possible.

People were treated with dignity, respect and kindness by suitable numbers of staff to meet their needs. We saw many warm and friendly interactions between people and staff. Relatives/carers complimented staff and the support they provided.

People were supported by staff who had access to training and support to acquire and maintain the skills and knowledge they needed to meet their needs. Staff felt supported by the managers and helped to develop in their roles through meetings and training.

People’s views were sought as part of the quality assurance process to drive through improvements to the service. A range of quality assurance systems monitored the standards of care provided. The registered manager valued the feedback from people, their relatives/carers and staff and acted on their suggestions.

Further information is in the detailed findings below.

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.

A registered manager was in place as required by their conditions of registration. 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 registered manager was present during our inspection.

The Vicarage is a care home which provides short term respite breaks for up to five adults with learning and/or a physical disability. People and their family’s needs were assessed by the local authority. Families were allocated ‘an amount of respite days’ to be used within a year to have regular breaks from their role as a carer. The respite breaks were booked direct with the home.

This was an unannounced inspection. This service was last inspected on 21st June 2013 when it met all the legal requirements and regulations associated with the Health and Social care Act 2008.

People told us their care and support needs were met during their time at the home but we found that people’s care records did not always reflect people’s levels of independence and skills.

During our inspection two people were in the middle of their stay at the home and two new people arrived to begin their break. Staff welcomed and greeted the people arriving warmly and in a friendly manner . It was clear that the staff knew the people well. People looked happy and pleased to be staying at The Vicarage; people told us it was like being on holiday.  All the relatives who we spoke with were overwhelmingly positive about The Vicarage. One relative said, “We have so much praise for this place”.

Staff and the registered manager understood their role and responsibilities to protect vulnerable people. People’s care needs and risks had been assessed. Staff were given guidance on how to best support people to when they were upset or at risk if harm.

The home was clean and safe. Plans were in place to improve the lay out of the building and access for people to an adapted bathroom on the ground floor.

New staff had received appropriate training before they supported people.  Staff were knowledgeable about the people who stayed at the home but we found that their skill levels were not being effectively monitored to ensure their knowledge was up to date with current care practices. Recruitment employment and criminal checks had been carried out to ensure that suitable staff were employed. Staffing levels were at a suitable level that supported the needs of the people who used the service. On occasions the staffing levels had been increased when the dependency levels of people were higher than usual.

The management of the home was good and there was a positive relationship between staff and the registered manager. We found that the registered manager understood their responsibility in meeting the requirements of the Deprivation of Liberty Safeguards and assessing people’s capacity under the Mental capacity Act 2005.

The purpose of this inspection was to follow up on a compliance action issued at the last inspection in relation to infection control. We also examined two other outcomes.

We were not able to speak with the three people in detail due to their complex needs, but we observed how care staff interacted with them. We found personalised care plans were in place for all assessed needs. Risks had been identified and plans were also in place for these. Care staff were very knowledgable about people's specific needs. Activities were also taking place.

Safety checks were required for the use of bedrails and the registered manager was going to address this.

A safe system was in place for the management of people's medication.

The provider had sent in an action detailing how they planned to address the compliance action. We found the service had met the compliance action.

This inspection was planned, but unannounced. On the day of the visit, only 4 people who use the service were staying at the Vicarage and 3 people had already left for their day activities or work.

We spoke to the remaining person prior to them leaving for their day centre, and they told us "the staff here are very nice and they look after me properly" they went onto tell us that "I would recommend it to other people because I do like it here".

Other feedback was seen in the way of thank you letters and e-mails from people who use the service and their relatives. This feedback told us "Thank you for all that you do", "thanks to all for the kindness and hospitality that is always shown to our son".

It was clear from the feedback seen that people looked forward to their stay at the Vicarage.

We used a number of different methods to help us understand the experiences of people using the service because people had complex needs which meant they were not able to tell us their experiences. We gathered evidence of people's experiences by looking at their care reviews, surveys and the compliments and complaints log. People's relatives had told the provider they were satisfied with the service provided, "appreciate good care my son receives" and "confident that she receives a high level of care and constant attention".

There were four people staying at the home for a period of respite between a few days and over a week. We looked at their care records which were person centred giving information about how they wished their care to be provided. Records were updated to reflect people's changing needs. We observed staff offering people choices about their day to day lives. Staff demonstrated a good understanding of people's needs.

We found that the laundry facilities were not satisfactory and could potentially put people at risk of infection. The laundry floor was not water proof and the handling of soiled linen was not satisfactory. This standard was not met.

The Vicarage provided accommodation of a high standard. Communal areas were pleasantly decorated and had good quality fixtures and fittings. People were provided with bedrooms which had specialist adaptations and equipment. The home and grounds were accessible to people with disabilities.