The inspection took place on 11 July 2018 and was unannounced. The last comprehensive inspection of this service took place on 4 July 2017 when we identified two breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to safe care and treatment and good governance. On 4 October 2017, we carried out a focused inspection to check if the provider had made the necessary improvements and found that they had met the requirements.

Options the Old Vicarage 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.

Options the Old Vicarage provides accommodation and personal care for up to eight people who have a range of needs including autism, mental health needs and/or learning disabilities. There were seven people using the service at the time of this inspection. The provider had a range of registered care services including several adult social care services across the country.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Staff were passionate about supporting people to achieve their full potential. They invested time to developing ways to work with individuals to help them improve their quality of life. Their dedication resulted in people making improvements including some leaving the service to become independent.

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 to ensure this remained safe.

The premises were clean and the provider had effective systems to protect people by the prevention and control of infection.

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 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.

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 who used the service were young and although their own end of life wishes were not discussed, staff supported them to understand and deal with bereavement.

People living at the service and their relatives 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

This inspection took place on 4 October 2017 and was announced. We gave the registered manager one day's notice as the service was small and we wanted to be sure someone would be available to assist with the inspection.

Options The Old Vicarage provides support and accommodation for up to eight people who have a range of needs including, autism, mental health needs and/or learning disabilities. There were seven people using the service at the time of this inspection.

The last inspection of this service took place on 4 July 2017 when we identified two breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The issues were relating to safe care and treatment (Regulation 12) and the good governance of the service (Regulation 17). At the previous inspection we found that there was missing risk assessments on one person's care file and inaccurate information in another person's care records. Also the quality assurance systems had not included audits on people's care and daily records to ensure they were available, up to date and written in a person centred way.

Following the inspection in July 2017 the provider sent us an action plan in which they told us that improvements would be made by 24 September 2017. At this inspection we reviewed the actions identified in the action plan and we found improvements had been made.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 'Options The Old Vicarage' on our website at www.cqc.org.uk.

Since the last inspection information about people's needs and the risks to themselves and/or others was available to view. The information we saw was up to date and informative. Documents had been dated and signed so it was clear when they had been written or reviewed.

Improvements had also been made to the temperature of the room where medicines were stored. We saw it was cooler and the temperatures taken were within an appropriate range, as previously the room had been warm. Staff had also been assessed to administer medicines safely.

During the inspection the registered manager informed us that the kitchen fire door was not in good working order. The registered manager sought to resolve this and two days after the inspection we saw evidence that the door had been fixed and afforded the necessary protection as a fire door.

The registered manager had implemented an audit of people's care records since the last inspection. This check had been carried out monthly and included viewing daily records to ensure they were appropriate and person centred. The audit enabled the registered manager to follow up on any issues and be confident that staff had the information they needed to safely support people.

Following the inspection in July 2017 the service was rated Requires Improvement overall with the key questions, ‘Is the service safe?’ and ‘Is the service well–led?’ rated as Requires Improvement. Following the inspection in October 2017 the ratings for the Safe and Well-led key questions have been changed to Good with the service now given an overall rating of Good.

The inspection took place on 4 July 2017. We announced the inspection the day before as this was a small service with people living with a range of needs and we wanted to be sure someone would be available.

The last inspection took place 27 and 28 April 2015 when we rated the five key questions we asked of services and the service was rated ‘Good’.

Options The Old Vicarage provides support and accommodation for up to eight people who have a range of needs including, autism, mental health needs and/or learning disabilities. There was one vacancy and therefore there were seven people using the service at the time of this inspection. One person was on social leave.

The provider had a range of registered care services including several adult social care services across the country.

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.

Although on one person’s care file there were risk assessments in place, on another person’s file there were none to inform and guide staff about the potential risks faced by the person using the service and/others.

There were quality checks in place. However, these were not that effective because they had not identified the issues we found during the inspection. In addition the provider did not ensure appropriate and complete records were maintained about the care people received and about the management of the service.

We found two breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which related to safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of the report.

People received the medicines they needed safely. Staff received medicines training but were not formally assessed, in between the training, to ensure they continued to be competent to carry out this task. We were informed that a competency assessment would be introduced to ensure staff continued to understand their role in administering medicines to people using the service.

Although people’s care records included people's needs and preferences and were individualised, some of the language used in the daily records was not appropriate or informative and did not reflect people in a dignified manner.

Feedback from people using the service, a relative and staff we spoke with was positive about the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the systems in the service supported this practice.

There were checks and systems in place to check the fire procedures and ensure that equipment protected people in the event of a fire.

Staff knew how to report any safeguarding concerns. There were safeguarding policies and procedures in place to inform and guide staff what to do if they had a concern that a person using the service was at risk of abuse.

Staff continued to receive support through one to one and group meetings. They also received an annual appraisal of their work. Training on various topics and refresher training had been arranged that were relevant to staff member's roles and responsibilities.

There were sufficient numbers of staff working to meet people’s needs. The registered manager had been in post for several years and regularly worked alongside staff on shift so that they could see how the service met people's needs.

Recruitment checks were carried out to make sure staff were suitable to work with people using the service.

People had access to the health care services they needed and their nutritional needs were being met.

There was a complaints procedure, which was also avail

We spoke with four people who use the service, four members of staff and the manager.

Staff had an awareness of what to do if people needed to be assessed using the Deprivation of Liberty Safeguards assessments. The staff team supported people to make choices, whilst balancing the presenting risks to the person and/or others.

People who use the service were assessed prior to their admission into the home. This was to ensure their needs could be met. People were supported to gain independent daily living skills, such as preparing meals or communicating their needs more effectively. Staff followed people’s individual care plans and risk assessments which recorded people’s particular needs and any potential risks. Where possible, people were involved in the development of their care plan and their views were taken into account.

The staff team supported people with a wide range of needs, for example some people understood commands and activities if they were presented using pictures and/or photographs, whilst other people needed minimal support and guidance.

Medicine systems were in place to ensure people received their prescribed medicines. People, where able, were also supported to self administer their medicines. One person told us “I know what medicines I take and the reason why I take them”. Another person said “I know the medicines keep me well”.

There were sufficient numbers of staff working in the home to support people effectively and safely. One person commented “I know I can always find a member of staff if I want to talk to them”.

Staff received on-going support, supervision and training to carry out their roles.

There were systems and audits in place to check and review the quality of the care being provided in the home.

We met with one person who lived in the home, the manager and two members of staff. We also carried out telephone interviews with three people who use the service, two relatives and had received feedback from three social care professionals.

People were supported in promoting their independence and community involvement. People attended a local college that provided them with the opportunity to develop and learn skills that promoted their independence. In addition the two staff we spoke with confirmed various activities were on offer in the evenings and week-ends, such as going to the cinema and the pub. People told us that if they could go out without staff support, then this was encouraged to help them gain confidence and social skills with other people.

One professional told us the staff were “motivated, professional and knowledgeable”. Another professional said the staff team “empowered” the people living in the home and could work with the different challenges that might present them when supporting people with complex needs.

One professional told us that, “the team actively listen and talk with the person”. In addition, the two staff we spoke with and the two relatives confirmed that the people living in the home were capable and willing to voice their concerns or raise a complaint if they needed to. The three people we asked also said they felt comfortable talking with staff if they had a concern or complaint.

People told us that they are happy in the service. They find the staff kind and helpful and willing to listen and help if they have comments or complaints to make about the service. They told us that they are involved in compiling and updating their care plan and that they are consulted about proposed changes to the service. They said that they attend regular meetings with staff and other people who use the service as well as meeting with their key workers.

This inspection took place on 27 and 28 April 2015 and was unannounced. There were five people living in the service and one person in hospital at the time of the inspection. At the last inspection in September 2013 we found the service was meeting the regulations that we assessed.

The Old Vicarage provides accommodation and support to people living with Autism and Aspergers.

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.

People told us that they felt safe and staff treated them with dignity and respect. People said they liked living in the service. Comments from people included, “it is very nice here”, “I have learnt how to be independent” and “I have choices.”

We found the service to be meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them. Where necessary, people’s capacity to make decisions about their lives was assessed and those people involved in the person’s life had their views considered.

There were procedures in place to recognise and respond to abuse and staff had been trained in how to follow these. Staffing numbers on each shift were sufficient to help make sure people were kept safe.

People’s care was personalised and reflected their choices and individual needs. These had been assessed and people had been involved with planning their own care. They took part in a range of activities and were supported to be independent where they wished. People were able to make complaints and felt listened to and valued.

The staff received support through supervision and appraisals to enable them to carry out the duties they performed. The provider used safe systems of recruiting new staff. They had an induction programme in place that included training staff to ensure they were competent in the role they were doing at the service.

We found that medicines were managed safely and records confirmed that people received their prescribed medicines.

People had the support they needed to meet their health and nutritional needs.

There were systems in place to monitor the quality of the service and identify where improvements needed to be made.