This comprehensive inspection of the Old Vicarage took place on 23 and 26 October 2018. The inspection was unannounced. This meant that the provider and staff did not know we were coming. The second day of the inspection was announced.

The Old Vicarage is a care home providing personal care to a maximum of 26 older people. The home is a detached house located in the small village of Otterton situated in the coastal area of East Devon, mid-way between Sidmouth and Budleigh Salterton. On the first day of the inspection there were 22 people staying at the service. One person was staying at the service for a period of respite (planned or emergency temporary care provided to people who require short term support).

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. We regulate both the premises and the care provided, and both were looked at during this inspection.

At our last inspection we rated the service Good. At this inspection we found the service remained Good overall, with one key question now being rated as ‘Outstanding’. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. Some parts of this inspection report are written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated Good.

The service provided people with exceptional care and support from staff who valued them as individuals. Staff were highly motivated to ensure people received care which was compassionate, friendly and kind. They treated people with respect and dignity. There was a friendly atmosphere at the home and a strong ethos from all staff regarding it being a family and people’s home. The registered managers and staff daily went above and beyond what was required to support people. We were told numerous incidences where this had been the case. The registered managers and staff were committed to ensuring people experienced end of life care in an individualised and dignified way.

People remained safe at the service. People said they felt safe and cared for in the home. People were protected because staff knew how to recognise signs of potential abuse and how to report suspected abuse. People’s care needs were assessed before admission to the home and these were reviewed on a regular basis. Risk assessments were undertaken for all people to ensure their individual health needs were identified and met.

People were protected from unsafe and unsuitable premises. Risks for people were reduced by an effective system to assess and monitor the health and safety risks at the home. The home had a pleasant homely atmosphere with no unpleasant odours and was very clean throughout. The furnishings were of a good quality and in good condition.

The service has two registered managers. 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. Since our last inspection the provider had recruited a second registered manager to work alongside and support the registered manager who is one of the directors.

The service was well led by the registered managers. The culture was open and promoted person centred values. People, relatives and staff views were sought and taken into account in how the service was run. There were effective systems in place to monitor the quality of care provided. The registered managers made continuous changes and improvements in response to their findings.

There were sufficient and suitable staff to keep people safe and meet their needs. Thorough recruitment checks were carried out. New staff received an inducti

We carried out an unannounced comprehensive inspection on 8 and 14 March 2016. The Old Vicarage is a care home providing personal care to a maximum of 26 older people. The home is a detached house located in the small, picturesque village of Otterton situated in the coastal area of East Devon, mid-way between Sidmouth and Budleigh Salterton. On the first day of the inspection there were 23 people staying at the service. This was The Old Vicarages first inspection since they registered under their new company with the Care Quality Commission in October 2014.

There was a registered manager at the service. 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.

Everyone was positive about the registered manager and provider and felt they were approachable

and caring. The registered manager was very visible at the service. The provider and registered

manager demonstrated they had a clear vision and values for the service. This was captured in their description of the service, It stated, ‘The Old Vicarage, and its gardens, belong to the residents who have made it their home. We are here, as a team, to watch over the home, to make sure that we provide personalised care in a safe, friendly, family atmosphere. ’They were also caring and supportive to staff as they felt that this would reflect in the way staff cared for people at the service.

There were sufficient and suitable staff to keep people safe and meet their needs. The staff and registered manager undertook additional shifts when necessary and agency staff had been used to ensure adequate staffing levels were maintained.

The registered manager and staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. Where people lacked capacity, mental capacity assessments had been completed and best interest decisions made in line with the MCA.

People were supported by staff who had the required recruitment checks in place. Staff had received a full induction and were knowledgeable about the signs of abuse and how to report concerns. Staff had the skills and knowledge to meet people’s needs.

People were supported to eat and drink enough and maintain a balanced diet. People and visitors were very positive about the food at the service.

People said staff treated them with dignity and respect at all times in a caring and compassionate way. People received their prescribed medicines on time and in a safe way.

Staff supported people to follow their interests and take part in social activities. A designated enabling person was employed by the provider and supported people to visit the community.

Risk assessments were undertaken for people to ensure their health needs were identified. Care plans reflected people’s needs and gave staff clear guidance about how to support them safely. They were personalised and people had been involved in their development. People were involved in making decisions and planning their own care on a day to day basis. They were referred promptly to health care services when required and received on-going healthcare support.

The provider had a quality monitoring system at the service. The provider actively sought the views of people and staff. There was a complaints procedure in place and the registered manager had responded to a concern appropriately.

The premises and equipment were managed to keep people safe.