Our unannounced inspection took place on 4 June 2018. At our last inspection we identified one breach of regulation relating to safe care and treatment. We found people were not always being supported to transfer in the safest possible way by staff who were competent. At this inspection we observed good practice in this area, and found staff training was up to date.

Vicarage Court 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.

Vicarage Court can accommodate up to 80 people, in a single, adapted building which contains units for residential and nursing service users, younger people with disabilities and people living with dementia. At the time of our inspection there were 61 people using the service.

There was a registered manager in post when we inspected 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.

People told us they felt safe living at Vicarage Court Care Home, which was clean and well-maintained. We saw staff were recruited safely and deployed in sufficient numbers to meet people’s needs, although some staff said they would like to have more on each shift to increase the amount of time they had to socialise with people. Medicines were managed safely, and staff and the registered manager had a good understanding of how to report accidents and incidents including concerns about potential abuse. Risks associated with care and support were well managed, although we have made a recommendation about the quality of records on the electronic system.

Staff had the training and support they needed to be effective in their roles, including a formal induction for newly recruited staff. 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. We found staff were knowledgeable about people’s needs and preferences.

Nutrition and hydration were well managed, and we observed a pleasant mealtime experience on the day of our inspection. Although we received some mixed feedback about meals, we saw the registered manager consulted people on what they wished to see on the menus, and observed people could ask for alternative meals if they wished.

People received support to access health and social care professionals when needed, and there were systems in place to ensure people were supported if they needed to be admitted to hospital. The environment in the Forget-Me-Not dementia support unit required some adaptation in order to improve its suitability for people living with dementia, however the registered manager and provider had already recognised this and were preparing to act.

We observed people and staff had good relationships, and there was good, caring practice in the home, including ensuring people’s rights, privacy and dignity were respected.

There were systems in place to ensure staff had access to information about people’s up to date needs and preferences, and the provider was working to involve people more in the processes of reviewing care. Staff were confident in their ability to provide end of life care when needed, however some electronic care plans lacked detail about people’s wishes in this area.

There was a varied programme of activities available in the home led by knowledgeable and enthusiastic staff, however people gave very mixed feedback about this and we did not see a high level of activity on the day of our inspection. People told us they would feel confident in raising conce

The inspection of Vicarage Court Care Home took place on 23 and 25 January 2017 and was unannounced on both days. The home had previously been inspected in June 2015 and found to be requiring improvement in all areas. There were breaches of the Health and Social Care Act 2008 regulations in relation to person-centred care, dignity and respect, good governance and notifications. During this inspection we looked to see if improvements had been made.

Vicarage Court provides nursing and personal care for up to 70 people with a specialist facility for people with dementia. On the days we inspected there were 54 people living in the home with 22 of whom were people living in the facility for people with dementia, and a further 14 received nursing care.

The registered manager had retired a week before the inspection A new manager had been appointed and was in process of registering with the CQC, and there had been a transition period between the registered manager retiring to ensure an effective handover with the new home manager. They were in the process of registering and were available on both days of the inspection. 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 and relatives all told us they felt safe. Staff demonstrated what signs of abuse to look for and how to respond if any such concerns were noted.

Staffing levels were reflective of people’s needs which meant people were responded to quickly. We observed high levels of communication between staff when they were responding to call bells which helped efficiency of support further. All necessary checks had been carried out prior to employment of new staff. Although there were some issues with the recording, we found medication was administered, stored and recorded correctly.

We had concerns around moving and handling practice and documentation as not all staff appeared confident with assisting people to move and there was a lack of clarity as to how some people were to be supported if they had variable mobility. We spoke with the manager and registered provider about this who agreed to action immediately. We confirmed improvements were actioned with further training being provided and amended documentation implemented.

Staff had access to regular supervision and training. They were encouraged to develop in their roles and the home promoted learning. This was evidenced through individual and group supervisions alongside regular staff meetings for all staff.

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.

Most support with nutrition and hydration was improved form the previous inspection as people had choices of drinks and meals, and any preferences were known and met. However, the deployment of staff occasionally meant a lack of supervision for people needing this at mealtimes and some care records did not indicate the required food consistency for people even though kitchen staff did provide this correctly.

Positional changes were offered to most people on a regular basis and were recorded accurately.

Care staff demonstrated a high level of commitment to supporting people, being responsive to their needs and emotions and acknowledging distress with kindness and patience. People were involved in reviews of their care wherever possible and their wishes regarding end of life care had been noted where discussed.

There was a range of activities throughout each day, both for groups and individuals and the home had plenty of resources to engage people. We saw much higher levels of interaction than previously and this added to the

At the time of our inspection visit to Vicarage Court Care Home there were a number of circumstances that meant this was not a typical day for the people who lived in the home, or for the staff. The home had recently been extended and its CQC registration changed to increase the number of beds and to include nursing care. A new manager had started in post two months prior to our inspection and the home was in the process of recruiting nurses to their workforce. On the day of our inspection the new dementia unit was being opened and some people were being transferred into their new rooms. During our inspection, two members of staff were called away to attend to urgent personal emergencies at home. This meant the home was short staffed for some time until replacement staff arrived. This may have impacted on the provision of care on the day.

There were 48 people living in the home on the day of our inspection, of which seven people were in the process of being transferred onto the new dementia unit. During our visit we spoke with three people who lived in the home and four visiting relatives. We spoke with the two owners, the registered manager and a sample of care staff. We reviewed four people’s care records and spoke with two visiting health care professionals. We left comment cards following our visit to gain feedback on the service and received 7 responses which were all complimentary.

One relative said, “Staff handle residents with great patience. I like the friendly atmosphere and I think there is a caring attitude here. I have seen staff paying good attention to residents even when they didn’t know I was listening.”

We reviewed four people’s care records and found detailed care plans had been developed from information gathered at assessment. However, we found instances where changes had taken place during the month, but the care plan had not been amended to reflect the change. We spoke about this with the manager who told us she had carried out a care plan audit since she started in post. The analysis of the findings indicated there were gaps in documentation. She provided us with an action plan of how this was to be addressed to ensure care records were maintained to a high standard.

The staff worked well with other agencies and were proactive in ensuring that people with dementia received all the care and support they required from the appropriate agency. A health professional confirmed the home utilised other professionals and external agencies appropriately to ensure people’s needs were met.

Appropriate measures were in place to ensure the quality and safety of the service. However, the provider may find it useful to note that the environment of the home required further development and consideration of best practice guidance for people with dementia.

We used a number of different methods to help us understand the experiences of people using the service including talking to people and observing the care provided. We spent time with people and we observed staff being friendly and warm towards people. We observed that staff and service users had positive relationships and we saw some light hearted banter. People appeared relaxed and comfortable with their surroundings; with staff and the activities they were engaged in. We saw that staff supported people to make choices about their daily living.

We spoke to people who use the service and they told us that they had been included in decisions about what care and support they received and when this would be available.

One person said “the staff are wonderful here, we are treated really well, nothing is too much trouble”. A person’s relative said “when I leave here I know my relative is well cared for and I can trust the staff to look after them properly”.

We spoke with two members of staff who were able to demonstrate a good understanding of the needs of the people who lived at Vicarage Court. They told us that they were well supported by managers of the home and there were good opportunities for training.

The people we spoke to were positive about the care that they received. They stated that the liked the food, that the home was clean and that they felt staff were kind and caring.

We spoke with seven people about their care. All said they were happy with the care and support they received in the home. Everyone praised the staff and said they were very well looked after. Comments included;

“They are very good here.”

“The staff are very caring and polite.”

“It’s always clean and nice.”

All the people we spoke with said they were had no complaints about the food, it was all fresh and home made and they could always have more if they chose. They said they were always given a choice. People told us that they felt safe in the home and happyto talk to staff if they were worried about anything. We spoke with two people's visitors, who were sitting with their relatives at tea time and they were full of praise for the home, the food, the care provided and for the attentiveness of staff. One told us that they were kept very well informed about their relative's welfare.

The inspection of Vicarage Court Care Home took place on 15 and 18 June 2015 and was unannounced. The previous inspection had taken place in September 2014 and found the service was not meeting specific regulations. We issued warning notices for the registered provider to take immediate action in regards to the care and welfare of people, and assessing and monitoring the quality of service provision. We requested action plans for the other areas of non-compliance. This inspection was to follow up on areas of progress following this previous inspection.

Vicarage Court provides care and accommodation in three separate units, for people who require nursing care, people living with dementia and people who require personal care. On the day of our inspection there were 57 people living at Vicarage Court, 21 were receiving nursing care, 19 were living in the unit supporting people with dementia and 17 were receiving support for personal care.

People and relatives told us they felt safe. We found staff had a good understanding of the principles of protecting people from abuse and were aware of the importance of recording. We saw that accidents and incidents were dealt with appropriately and records were kept. We saw detailed risk assessments and resulting action plans ensuring that people were supported in the most appropriate manner. However, we found that the registered manager was not notifying us of such situations as required under law. We referred the registered manager to our guidelines and they agreed to remedy this with immediate effect.

We found the service to be suitably staffed on both days of our inspection and that medicines were handled safely and in accordance with NICE guidelines.

Staff had received an induction, supervision and training and feedback from other professionals was positive. We found that people were offered nutritious meals but there was poor practice in regards to how mealtimes were facilitated. People were not enabled to make choices such as which drink or meal to have. There was also a lack of best interest decision making for people in the service who were deemed to lack capacity.

Some staff were caring but we found others were not aware of how to support someone with dementia effectively. This was observed during activity times and mealtimes. We observed some activities were carried out in a way which did not always respect the needs of the individual, particularly those living with dementia and staff sometimes appeared disinterested.

There were improvements in the care records since our last inspection which aimed to be person-centred. Since the last inspection there had been an increase and focus on the activity programme. However, we witnessed that individual engagement was sometimes poor between staff and a person unless it related to a specific care task.

There was a registered manager in post on the day of our inspection. 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 found that the use of audits for care records and medicines were detailed as were the checks on the premises, health and safety and infection control. The service also had in place a variety of mechanisms in securing feedback about its quality of care and this had been recognised in specific awards. However, we found that as people were not being supported to make choices there was a lack of understanding by the service as to how best care for people who were living with dementia.

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