The inspection took place on 2 May 2018 and was unannounced. At our last inspection on 3 May 2016 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 ongoing 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.

Vicarage Farm nursing 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.

Vicarage Farm Nursing Home provides accommodation and nursing for up to 59 people in one adapted building split over two floors, each of which have separate adapted facilities. There is a seven bedded high dependency unit on the ground floor which specialises in providing care to people living with advanced dementia.

At the time of our inspection there were 59 people living at the home. The home is managed and run by Astoria Healthcare Limited, a private organisation. The organisation does not have any other services.

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. 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.

There were systems and processes in place to protect people from the risk of harm. There were enough staff on duty to meet people’s needs.

Checks were carried out during the recruitment process to ensure only suitable staff were employed.

There were arrangements in place for the safe management of people’s medicines and regular checks were undertaken.

The service was clean and had effective systems to protect people by the prevention and control of infection.

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.

The provider was aware of their responsibilities and had acted in accordance with the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People’s nutritional and healthcare needs had been assessed and were met.

People were supported by staff who were suitably trained, supervised and appraised.

Staff were caring and treated people with dignity and respect. Care plans addressed each person’s individual needs, including what was important to them, and how they wanted to be supported.

People were involved in undertaking activities of their choice. People were cared for in a way that took account of their diversity, values and human rights.

People’s end of life wishes were discussed and recorded.

People living at the home, their relatives and stakeholders told us that the management team was approachable and supportive. People and their relatives were supported to raise concerns and make suggestions about where improvements could be made.

The provider had effective systems in place to monitor the quality of the service and ensure that areas for improvement were identified and addressed.

The registered manager kept themselves informed of developments within the social care sector and cascaded important information to the rest of the staff team.

The inspection took place on 29 April 2016 and 3 May 2016 and was unannounced. The service was last inspected on 27 and 28 July 2015 when we found five breaches of the Health and Social Care Act 2008 and associated regulations. At this comprehensive inspection we found the provider had taken action to address the breaches we had identified.

Vicarage Farm Nursing Home is a residential and nursing home registered for up to 59 older people. Some of the people are living with the experience of dementia and some people have health needs which require nursing care. At the time of our inspection there were 57 people living at the home. The home is managed and run by Astoria Healthcare Limited, a private organisation. The organisation does not have any other services.

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. 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.

The provider had taken action to meet the concerns identified at the inspection of 27 and 28 July 2015 and had put in place measures to keep the environment clean and prevent the spread of infections.

Improvements had been made to the training of staff, and we saw that staff were appropriately trained, supervised and appraised to carry out their roles and responsibilities.

Improvements had been made with regards to the way staff treated people who used the service. We saw that staff treated people with kindness and dignity and took into account their human rights and diverse needs.

The provider had taken steps to improve the delivery of activities for people and provided activities which reflected people’s individual needs and preferences.

There were appropriate procedures in place for the safeguarding of vulnerable people and these were being followed.

The provider had processes in place for the recording and investigation of incidents and accidents. The risks to people’s safety were identified and managed appropriately.

There were enough staff to keep people safe and meet their needs.

The environment had been modified to support orientation and help positive stimulation for people living with dementia.

The provider was aware of their responsibilities and had acted in accordance with the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People’s nutritional and healthcare needs had been assessed and were met.

Assessments were carried out before support began to ensure the service could provide appropriate care. Care plans were developed from the assessments and reviewed regularly.

There was a complaints procedure in place and people and their relatives knew how to make a complaint. They felt confident that their concerns would be addressed. Relatives were sent questionnaires to gain their feedback on the quality of the care provided.

The provider had a number of systems in place to monitor the quality of the service and put action plans in place where concerns were identified.

People, relatives and professionals we spoke with thought the home was well-led and the staff and management team were approachable and worked well as a team. The staff told us they felt supported by the registered manager and there was a culture of openness and transparency within the service.

As part of this inspection we looked around the building and we looked at records relating to the environment and quality monitoring. We also spoke with the registered manager and some of the other staff. We did not speak with people who live at the home on this occasion because we were following up actions we had made regarding the environment and quality monitoring.

At the previous inspection on 8 July 2014 we found that not all areas of the home had been thoroughly cleaned. In particular we found the provider had not taken steps to ensure bathrooms and toilets were deep cleaned. We also found areas of the building had not been appropriately maintained. Some of these presented a risk to people's safety and wellbeing. Although the provider had undertaken some audits of the service, they did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others. We told the provider they needed to make improvement in these areas. The provider told us they would make the necessary improvements by 28 August 2014.

During this inspection we found that improvements had been made. The provider had put in place systems to maintain safety and cleanliness and to regularly audit these.

We spoke with people who lived at the home, although many people were unable to tell us about their experiences because of their communication needs; so we observed how they were being cared for. We met with one relative and one visiting professional. We spoke with ten members of staff including the manager.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found-

Is the service safe?

The service was not always safe because people were at risk from environmental hazards. These included exposed hot water pipes, areas of the building that had not been thoroughly cleaned and safety equipment which had not been suitably checked.

People’s care needs had been assessed and there were sufficient staff employed to meet these needs. The staff were appropriately trained and supported.

Is the service effective?

The service was effective. People’s care was planned according to their individual needs. The staff demonstrated a good understanding of these needs and the support they required. The staff were provided with training and support so they could care for people appropriately.

Is the service caring?

The service was caring. The staff were kind and considerate of people’s choices, preferences and individual needs. With the exception of a small number of incidents, the staff treated people with respect.

Is the service responsive?

The service was not always responsive. Where problems had been identified there were plans to address these but not always in a timely manner. For example, the provider had identified environmental hazards and had started to refurbish the building, but some of the significant hazards to people’s wellbeing had not been addressed and people were at risk. However, there was evidence that the service had responded to individual changes in people’s needs and had taken appropriate action to meet these.

Is the service well-led?

The service was well led. There was a registered manager and a team of senior staff. The staff knew their roles and responsibilities and felt well trained. The provider had consulted with people living at the home, relatives and other professionals to assess the quality of the service. There was evidence they had responded to input and suggestions from other stakeholders. There were plans to improve the running of the service.

When we inspected the service on 21st December 2013 we had concerns about whether people’s privacy and dignity were respected by staff, the use of tables to restrain people when staff were not present to support them, the completion of Do Not Attempt Resuscitation (DNAR) forms and the skill mix of staff working with people using the service.

The provider sent us an action plan on 9th January 2014 and told us all of our concerns had been addressed. We carried out this inspection to make sure the provider had made the changes necessary to achieve compliance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We spoke with four people using the service, nursing and care staff and the home’s manager. Most people told us they were happy with the care and support they received. One person said “everything is good, I’m ok today.” Another person said “it’s a good day today.” However, one person did say “I can do a lot for myself. Sometimes the staff don’t understand and treat me like a baby.”

We saw people’s care plans included information about privacy and dignity and evidence these issues had been discussed with the person concerned or their representative.

There were enough staff to meet people’s needs and people were not left unsupported during our inspection.

Staff had worked with the home’s GP’s to make sure do not attempt resuscitation forms were completed correctly.

Arrangements had been made to ensure sufficient numbers of qualified and experienced staff were available to support people using the service.

We carried out this inspection after we received anonymous concerns about staffing levels in the home. We arrived at the home at 8:00 am on a Saturday morning and stayed until 11.30 am. We spoke with 10 people using the service, one visitor and nurses and care staff working in the home. The home’s deputy manager came into the home for a short time and we discussed and clarified some of our findings with her. We also looked at the care plans for ten people living in the home and the staff rota for each unit.

Most people told us they were happy in the home. One person said “I’m fine, no complaints.” Another person said “the staff know what help I need and I don’t usually have to wait too long.” However, other people told us “the staff are always very busy, they could do with a few more” and “sometimes the staff are busy with paper work and they don’t have time for the residents.”

We saw that staff did not always respect people’s privacy and dignity. Bedroom doors were routinely left open while people were sleeping in bed. Tables were used as a form of restraint to prevent people from getting out of their chairs.

People’s medicines were managed safely.

The staff rotas we saw accurately recorded the number of staff on duty but the skill mix of staff that were on duty was not always as planned for the home. This meant people were not protected against the risks of poor care because the number of nurses on duty was less than planned.

During the inspection we talked with four people who used the service, four relatives and six members of staff to get their views about the service that is provided in the home.

People appeared well cared for during the inspection. They said they received the care and treatment they needed. Relatives confirmed this. One of them said “I do not have any worry about the care of [my family member] and if I have, I know what to do about it”. The care records showed that people were appropriately supported with their healthcare needs and were referred to healthcare professionals according to their needs.

People were supported to make choices in their daily life according to their individual abilities. They said staff explained their care and treatment so they understood this. Relatives confirmed that they were involved and could give their views about their family members' care. One relative said in relation to the care records of their family member, “I can see the care records at any time I want to and staff always keep me informed of changes”.

The provider had arrangements to ensure medicines were appropriately managed but these were not always effective in ensuring people received their medicines as prescribed.

The provider had systems to assess and to monitor the quality of the service. These worked well in some cases, but in a few instances these were not as effective as they could have been in effecting change and in ensuring improvement of the service.

The inspection took place on 27 and 28 July 2015 and was unannounced. The last inspection of the service was on 23 September 2014 where no breaches of Regulation were identified.

Vicarage Farm Nursing Home is a residential and nursing home registered for up to 59 older people. Some of the people are living with the experience of dementia and some people have health needs which require nursing care. At the time of our inspection 58 people were living at the home. The home is managed and run by Astoria Healthcare Limited, a private organisation. The organisation does not have any other services.

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. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

There was a malodour throughout the environment and cleaning had not eliminated this or the risks of spread of infections

The staff had not received training in some areas and some staff did not understand the training they had undertaken.

Some staff did not treat people with dignity and respect. However, other staff did treat people in a positive way.

Although there were some organised activities, people living at the home were not engaged in stimulating activities which reflected their individual needs and preferences.

There were appropriate procedures for safeguarding vulnerable people.

The risks to people had been assessed.

There were enough staff to keep people safe and meet their needs.

People living at the home and their relatives had positive relationships with staff and thought they were kind and caring. Their privacy was respected

People’s needs were assessed and care had been planned to meet these needs.

There was a complaints procedure and people knew how to make a complaint. They felt confident these would be acted upon.

The provider had systems for monitoring the quality of the service and these were detailed and responsive. However, we identified areas for improvement which the provider’s systems had not identified or acted upon.

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