The inspection took place on 12 November 2018 and was unannounced. The Old Vicarage is a care home that provides accommodation with personal care and is registered to accommodate ten people. It provides a service to younger adults with a learning disability and complex needs.

The accommodation was within a large old house. There was a communal dining area and two lounges. Each person had their own room and there were two communal bathrooms. There was an accessible, but secure garden on site. At the time of our inspection ten people were using the service.

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. The care service was registered before we introduced Registering the Right Support, this is a set of guidance which has been developed and designed in line with the values that underpin best practice. The provider reflected these values to 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.

At our last inspection in June 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.

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. However, we have made a recommendation in relation to the provider looking at best practice in this area.

People were safe and staff knew how to protect them from the risk of harm. Risk assessments had been completed and guidance provided to reduce the risk. Medicines was managed safely. Lessons were learnt from events and incidents.

There were sufficient staff to support the people’s needs and the staffing levels were flexible to accommodate appointments or events. When staff were recruited the appropriate steps had been taken to ensure they were safe to work with people. Staff received training for their role and ongoing support from the registered manager.

Health care was managed for people to ensure good health and wellbeing. People enjoyed the meals and were able to participate in deciding the choices they received. Care plans were detailed and include all aspects of people’s choices and preferences.

People enjoyed the atmosphere of the home. They could personalise their own spaces. Staff had established relationship with people and provided care which was kind and compassionate. People’s privacy was respected and individual dignity observed.

Complaints had been addressed and the information on this subject and others was available in easy read formats to assist people to receive information in a way they could understand. People’s views had been considered and their choices used to shape the care being delivered.

Audits had been completed to reflect aspects of the home and where improvements were needed to be made. The provider had sent us notifications and they had displayed their rating at the home and on the website.

Further information is in the detailed findings below

This inspection took place on 17 June 2016 and was unannounced.

The service is registered to provide residential care for up to 10 people who have a learning disability or who are on the autistic spectrum. At the time of our inspection 10 people were using the service.

There is a requirement for The Old Vicarage to have a registered manager and a registered manager was in place. 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.

Risks to people’s health were identified and well managed, however hospital passports were not always in place for those people who needed them. Records had not always been made for when medicines, such as creams prescribed for use, ‘as and when required’ had been administered. In addition, guidelines as to when these creams were needed and the best methods of administration were not in place. Other medicines were seen to be managed and administered safely.

Staff recruitment practices were followed to ensure people were safe to work at the service, however not all staff had been asked about their health prior to starting their employment. Checking people’s health in relation to the role they are to be employed in is a recruitment requirement.

People knew how to keep safe and to tell staff and their families if they were worried or upset. This showed the provider had taken steps to reduce the risks of abuse to people. In addition, staff had training on how to safeguard people and care plans and risk assessments considered what actions were required to keep people safe.

The registered manager understood the principles of the Mental Capacity Act (MCA) 2005 and care plans supported how to support people’s decision making. Policies were in place to follow if a person lacked the capacity to make a specific decision, however a system to record capacity assessments should they be needed was not established. The registered manager confirmed shortly after our inspection they had put in place a system to record any capacity assessments in relation to decision making should this be required in the future. People’s consent was obtained prior to staff providing any care and support.

People had healthy, nutritious food and drink and received effective care for any health conditions. They had access to a range of specialist health professionals as and when required.

Staff cared for people with kindness and supported their dignity and independence. People’s views were sought and respected and people were involved in planning their own care.

People received personalised and responsive care as staff understood their needs and preferences. People contributed to their care planning and were asked for any complaints or feedback at regular meetings.

The registered manager was clear on their role and responsibilities and was supported by an established and supportive staff team. Staff were motivated and understood their roles and responsibilities. Systems were in place to check on the quality and safety of services provided.

At the time of our visit there were nine people receiving care at The Old Vicarage, including one person who was receiving treatment in hospital. During our inspection we were able to speak with one person about their experiences at The Old Vicarage. They told us, “I’m happy here”, “They (the staff) look after me and the food is lovely” and, “We went to Spain on holiday and went in the pool.” We also spoke with the relative of one other person. They were happy with the care being provided. Their comments included: “(my relative) loves it there, they’re very happy” and, “In 11 or 12 years (my relative) has always been happy spending Christmas there and I think that says a lot to how happy they are.”

We found that people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan

The home was clean and tidy. There were systems in place to reduce the risk and spread of infection.

Appropriate arrangements were in place to ensure that people received their medicines. Medicines records were in place and had been completed accurately. People’s medicines were kept securely.

Staff members received appropriate support. We noted that some training was out of date but the registered manager was in process of arranging further training updates for staff.

No complaints had been received by the provider in the twelve months prior to our visit. There was a complaints system in place and details of this were displayed in the home.

We spoke with the relatives of three people who live at The Old Vicarage. They told us “they are fully occupied; they (the staff) know what they want”. Another person said “They do what they can, to their own abilities”

We were told “you always get a warm welcome; it’s a lovely contented place”. Another person said “there’s a lovely atmosphere when you go in, it’s a beautiful home, and everywhere is very clean”

Everyone with spoke with felt that their relatives were safe in the home and were well looked after. People also told us that they had never had any complaints with the service provided. We were told “I wouldn’t mind living there myself” and “its like being in your own home”.

We also spoke briefly with three people living at the home, they told us about recent holidays they had taken with staff. One person told us they had recently been to Skegness and had visited the beach and the market. Another told us they had been to Majorca and had been in the sea and played bingo