The inspection took place on 14 May 2018 and was unannounced. At the last inspection in November 2015, the service was rated Good. At this inspection we found the service remained good. 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.

The Old Vicarage is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The Old Vicarage accommodates up to 30 older people. The home is in a quiet residential area in the village of Ireleth and is within walking distance of local shops, the train station and the bus stop. The home is on two floors and there is a stair lift to provide access to the first floor. There is a secure garden area with seating for the people living there. At the time of the inspection there were 25 people living there.

There was a registered manager at 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 were satisfied with the way the home was run and the care they received. We were told by one person who lived there, “Any requests I have made, the staff have tried to fulfil.” We observed that staff were kind and considerate and that people who lived in the home were at ease with care staff. Relatives were welcomed in the home and raised no concerns about care with us.

We found staff had been recruited safely and were being trained and supported to carry out their roles. Staff spoken with and records seen confirmed training had been provided to enable them to support people who lived in the home. Systems were in place to give staff the opportunity to discuss their work. Staffing levels were seen to be sufficient to meet the needs of people who lived at the home.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These and individual care plans had been kept under review and updated when necessary to reflect people's changing needs. We found people had access to healthcare professionals and their healthcare needs were met.

Health and safety records were in place and regular checks and servicing had been undertaken. Arrangements were in place for contingency planning for foreseeable emergencies and for moving people in the event of fire. Accidents and incidents were recorded.

People who lived in the home told us they were happy with the variety and choice of meals being provided and that there was always a choice.

People had their medicines managed safely, and received their medicines in a way they chose and preferred. Staff who administered medicines had been trained and assessed as competent to do so.

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.

Systems were in place to deal appropriately with any complaints or concerns raised about the service. The registered provider had put systems in place to monitor the quality of the service and to develop services and make on-going improvements.

Further information is in the detailed findings below.

This unannounced inspection took place on 12th January 2015. We last inspected The Old Vicarage on 3rd January 2014. At that inspection we found the service was meeting all the regulations that we assessed.

The Old Vicarage is a residential care home providing personal care and accommodation for up to 30 people with a range of care and support needs. The home is in a residential area in the village of Ireleth, within walking distance of local shops, the railway station and the bus stop. There is some car parking available to visitors. The home is on two floors with a single storey extension and a stair lift to provide access to the first floor. There is a secure garden area to the side with seating for the people living there. On the day we visited there were 27 people living in the home.

The service had a registered manager in post. 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 and associated Regulations about how the service is run.

We spoke with people in their own rooms and those who were sitting in the communal areas. They told us that they felt “safe” and “well looked after”. We saw that people were treated with kindness and respect by the care staff. People we spoke with told us, “I am happy living here” and “They (staff) look after us very well”.

Staff we observed going about their work were patient and polite when supporting people who used the service. We observed staff supporting people to eat their meals at a pace dictated by the person eating. Staff supported people to maintain their dignity and were respectful of their privacy and respected their choices. Activities were on offer at the service and people told us how they were able to go out and access activities in the local community.

People’s personal and social needs were assessed and care plans were developed to identify what care and support people required. Staff worked with other healthcare professionals to help make sure specialist advice and support was accessed to help ensure people received the care and treatment they needed.

Medicines were handled safely and people received their medicines as their doctor had prescribed. Medicines were stored safely and records were kept of medicines received and disposed of so all could be accounted for.

The home had moving and handling equipment and mobility aids to meet people’s different needs and to help promote their independence. The home was being maintained and we found that all areas were clean and free from lingering unpleasant odours.

The registered provider had safe systems when new staff were recruited and all staff had appropriate security checks before starting work. The staff employed were aware of their responsibilities to protect people from harm or abuse.

The service followed the requirements of the Mental Capacity Act 2005 Code of practice and Deprivation of Liberty Safeguards. This helped to protect the rights of people who were not able to make important decisions themselves.

There were processes to monitor the quality of the service and we saw from recent audits that the service monitored areas of practice and made improvements where identified. We found that the manager knew what training staff needed and this was arranged for them but the monitoring systems used were not easily verifiable for overall monitoring purposes.

This was a follow up visit to our inspection of 29 October 2013 when we found that one of the ‘Essential Standards of Quality and Safety’ had not been fully met. Improvements had been made from our previous visit on 12 June 2013 in relation to the arrangements for gaining people's consent about their care and welfare. However in October we judged that the standard had still not been fully met and was having a minor impact on people who used the service.

The records we needed to check did not necessarily relate to people's views. Therefore at this visit we did not ask people to specifically comment upon the outcome we looked at.

During this visit we found that the provider had made the further improvements, that they told us they would, to the home's processes for gaining and recording consent. We found that the records on people's choices about daily matters, long term care preferences and ability to make decisions were being assessed, reviewed and updated. This meant that the information about how people needed or wanted to be supported with making choices, what their individual decisions were and who had legal authority to act for them were made clear.

We could see that information had been gathered about people's preferences at the end of life or if their physical condition changed. We saw where people did not want to discuss this aspect of care that had been respected.

This was a follow up visit to our inspection of 12 June 2013 when we found that two of the Essential Standards of Quality and Safety ('the standards) were not being met.

The first of these related to the provider's systems to identify the possibility of people being placed at risk of abuse and to prevent this occurring. During this visit we found that the provider had put systems in place and was now complying with the standard.

The second standard that had not been met related to the arrangements for gaining people's consent about their care and welfare. During this visit we found that the provider had made some improvements to the home's processes for gaining consent and how this was recorded. However there were inconsistencies in the application of the home's processes. In two instances there was a lack of information about the way that people's choices had been discussed and consent obtained.

People told us they were satisfied with the care they received. We found that staff knew the people who lived there well and were familiar with their conditions and needs. People living there appeared confident and comfortable with the staff helping them.

We were told "Care is not bad at all, good." We did not receive any negative comments about the standard of personal care received, the food served, the cleanliness of the home or the staff approaches and support. People told us the food was "good" and told us that they were always given a choice and asked what they liked and wanted. We saw the food choices on the menu board along with the days planned activities.

People we talked with confirmed that they got up and also went to bed when they wanted and had their meals when and where it suited them. On our walk around the building we saw that the home was clean and tidy and that people had been able to personalise their rooms with their own pictures and personal items.

During our visit we found that people had not always been well supported to be involved with decisions about their care and welfare and that poor internal communication had delayed processes intended to promote people's best interests.

People told us they felt safe living at the Old Vicarage and said they liked the staff who worked there. We spent a lot of time talking to people living there and observing daily life in the home. We did not receive any negative comments about the attention people received from staff, the food on offer to them or the cleanliness of the home. or the staff approaches and support. People we spoke with told us that they had not felt the need to complain.

People we spoke with said they took part in activities inside and outside the home which they chose and which they enjoyed.

People who lived in the home told us,

“I don't think I do too badly here".

“The staff are nice”,

“The meals are nice”.

" The food is pretty good, I can have what I want for breakfast".

Some people who lived in the home could not easily express their views about their care or the services provided. We observed people in communal areas of the home and at lunch time and saw people were treated in a manner which respected their dignity, independence and rights. We saw that people were comfortable and confident with the staff on duty and appeared well cared for.

We carried out this review of medication handling and records following information of

concern that we had received. We focused our attention upon medicine management,

medicines recording and the managemen of complex medication and health needs to see

if people living there were getting their medicines at the times they needed them and in a

safe way.

During the pharmacy inspection the people living there that we spoke did not raise any

specific concerns about how their medicines were handled or administered to them. Those

we talked with were happy with the support they received with their medication.

One person told us that they were "pleased" they were to be able to take charge of their

own medication or 'self medicate' as this enabled them to take their medication when they needed it and without delay.