About the service:

The Old Vicarage is a residential care home which provides accommodation and personal care for up to 13 adults living with learning disabilities and autistic spectrum disorders. At the time of our inspection there were 11 people using the service.

People’s experience of using this service:

People remained safe and were relaxed and comfortable with the staff team. A consistent team of competent, knowledgeable and skilled staff was in place. Risks to people’s well-being were assessed and there was emphasis on positive risk taking. Medicines were handled safely by staff who had been assessed as competent to do so.

People received effective care that was in line with good practice. 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 remained treated with dignity and in a compassionate way. People's independence was encouraged as much as possible. People received person-centred care, which was tailored around their individual preferences, needs and wishes. People enjoyed positive and respectful relationships with the staff and management team. People's privacy and confidentiality was respected.

People’s needs were recorded in support plans and staff knew people’s needs well. People were supported to enjoy their hobbies and interests. The management saw complaints as a way to improve the service and people’s relatives told us concerns were being addressed promptly.

The service was well-run by the registered manager and a team of committed staff. People were involved and listened to. The team worked well with external professionals to ensure people’s needs were met.

Rating at last inspection:

Good (report published 3 August 2016).

Why we inspected:

This was our scheduled, planned inspection based on previous rating

Follow up:

We will monitor all intelligence received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.

More information is in Detailed Findings below.

This inspection took place on 28 and 29 June 2016. We gave the registered manager short notice of the inspection as we needed to be sure people would be there. This also enabled them to prepare people for our visit to avoid undue stress to those with needs on the autistic spectrum. The service was fully compliant at our last inspection in May 2014.

The Old Vicarage is a residential care home that offers a service for up to 12 people with learning and associated disabilities, some of whom may also have needs associated with autism. Some people may have behaviours that can cause distress or harm to themselves or others.

The service had a registered manager as required to manage its day to day operation. 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 service met the diverse needs of the people it supported effectively and in a person-centred way. The views of people and their representatives were sought and respected. People had individual care plans which incorporated their views and preferences and were supported by relevant risk assessments and specialist guidance.

Staffing levels were applied flexibly to ensure they met people’s needs and were adjusted as these changed or in response to particular planned activities.

The service had a robust recruitment system to help ensure staff were appropriate and had the necessary skills and approach to meet people’s needs. Staff were provided with a sound induction and training and expected and supported to attain a recognised care qualification. They received regular ongoing support through supervision meetings, appraisals and staff meetings.

The opinions of people, relatives and staff about the service were sought in various ways and any identified issues were addressed. People’s health and nutritional needs were met effectively and their rights and freedom were protected.

Staff respected people’s dignity and privacy and encouraged them to be as involved in day-to-day decision making and tasks as possible. People were provided with a wide range of opportunities to develop their skills, activities and access to the community so they could have a fulfilling lifestyle.

Appropriate health and safety servicing and monitoring took place to maximise the safety of the premises and specialist equipment was sought when needed to enhance people’s care.

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. We also spoke with three of the people living in the service and several staff.

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

This is a summary of what we found:

Is the service safe?

People received care and support in accordance with care plans and behaviour support plans in which they or their representatives had been involved. The care plans were regularly reviewed. Incidents were monitored and discussed to amend care where necessary.

Where people had healthcare needs, the home had sought the advice of external healthcare specialists appropriately to maintain their wellbeing and safety. Staff were aware of the health and support needs of the individuals they were supporting.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the home had liaised effectively with the local authority DoLS team and had made applications as appropriate. The manager was aware of a recent Supreme Court judgement relating to ‘deprivation of liberty’ and planned to contact the DoLS teams in relevant local authorities to agree the way forward.

The people we spoke with told us the service was caring and that they felt safe at The Old Vicarage. Where issues had been raised by people in the home about the behaviour of others, they had been advised how to better deal with any future concerns to keep them safe.

Is the service effective?

We saw that people’s needs were well met by a knowledgeable staff team. People’s care and health needs had been effectively met. Appropriate external advice had been sought where necessary to maximise wellbeing. We saw that the people supported, enjoyed positive relationships with the staff. They told us the home met their needs effectively and provided them with a fulfilling lifestyle. One person told us they went horse riding, attended college and church and was: “very happy now.” Another person told us: “the staff are very good”.

The home had been successful in managing and reducing the level and severity of incidents in situations where people had come from other placements with a history of challenging behaviour.

Is the service caring?

We saw staff working in a caring and respectful way while supporting people. They supported people to make decisions and choices and defused situations effectively and without drama. We saw that staff gave people time to make decisions and choices.

The people we spoke with thought the service was caring. One told us the staff were: “kind” and added: “they help me get up for work.” People told us the staff supported them to go to health appointments.

Is the service responsive?

We saw that people’s care plans and other documents recorded people’s needs and where these had changed. Care files showed that the home responded promptly to any changes and sought appropriate specialist advice where necessary.

Care was provided based on people’s known and indicated wishes and preferences and they had been asked their views. People had access to a good range of meaningful activities and to the community.

The people we spoke with all felt that they were involved and consulted and that the service responded to people’s needs. One said: “I am involved in my care plans and reviews.”

Is the service well-led?

We found that the home provided consistent care to people and was well-managed. There were clear lines of managerial responsibility. A range of systems were used to monitor the home’s operation and the provider visited the home regularly. Action had been taken to address issues where these were identified. The views of people, their relatives and staff were sought and acted upon.

We found that people were asked for their consent on a daily basis and staff understood people’s ability to consent. People told us, ''I can choose things for myself but staff help me a lot of the time''.

We saw that people were respected and were given care as described in their plan of care. People told us or indicated that they were happy living in the home, one person said, ''I love my home, I’m very happy here''.

People were provided with fresh, varied and nutritious food in ways that met their individual needs. They were involved in the planning of menus and preparation of food. People told us that they liked the food provided, one person said, ''the food is very yummy''.

We saw that the houses were homely, comfortable and well maintained. People were provided with accommodation and equipment which helped them to maintain an enjoyable lifestyle.

The home made sure, as far as possible, that staff were safe and suitable to work with the people who lived in the home.

We found that the home had ways of making sure that they listened to the views of those who lived there and other interested people. We saw that they took action to make it a nicer place to live.

We spoke with four people who used the service and observed the care of another. People told us that it was ‘’great ‘’ to live there. They told us that there was lots to do and that they went to their reviews so they could ‘’speak up for themselves’’. People told us or indicated by nodding their heads or smiling that staff treated them well. One person said ‘’ they help you whenever you need them, there’s always plenty of them around’’. We saw that staff delivered care in the way that was specifically described in people’s plans of care. We found that staff were well trained and knowledgeable about the needs of the individuals and their care.

People told us that it was a very good place to live. They told us that they were able to make their own choices. People told us that they felt safe in the home and with the staff. They said that the home was always clean and tidy and they helped to keep it that way. People told us that the manager was approachable and would take action to deal with anything they weren’t happy with.