The inspection took place on 12 September 2017. The Old Vicarage is a care home supporting up to 59 people with personal and nursing care. This includes support for people living with dementia. On the day of our inspection there were 44 people using the service.

People benefitted from support provided by staff who were extremely kind and compassionate. Staff were caring in their approach to people and throughout the inspection we saw people being treated with dignity and respect. Staff took time with people, reassuring and calming them when they became anxious.

There was a caring culture throughout the service that ensured people were at the centre of the service. This culture was promoted throughout the staff team.

The service provided excellent end of life care. People were treated with dignity and respect, ensuring they remained pain free and comfortable at the end of their life. Relatives were supported throughout and the service had a chapel which provided a seamless path for relatives dealing with a person's death. The service was accredited to the Gold Standards Framework and had attained a platinum rating recognising their outstanding support for end of life care.

People were supported by a service that had systems in place to keep them safe. Medicines were managed safely to ensure people received their medicines as prescribed. There were effective recruitment procedures in place to ensure staff were fit to work with vulnerable people.

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 were complimentary about the food and the provider ensured people had food and drink to meet their dietary needs.

Staff were supported through regular supervision. Staff had access to development opportunities and felt valued for the support they provided.

There was a wide range of activities available and people were encouraged to be involved in developing an activity programme that interested them.

The registered manager promoted a culture that valued everyone involved in the service as individuals. There were effective systems in place to monitor and improve the service which included seeking feedback from people which was used to drive improvement.

We inspected The Old Vicarage Residential - Nursing and Dementia Care Home on 23 June 2015. The home provides residential and nursing care for people with a range of conditions, including people living with dementia. The service provides accommodation for up to 52 people. At the time of our visit there were 46 people living in the home.

At our last inspection on 9 July 2013 we found the provider was meeting all the standards inspected at that time.

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 2008and associated Regulations about how the service is run.

People enjoyed living in the home and were complimentary about the registered manager and staff team. Staff were kind and caring and took time to get to know people. There was a cheerful atmosphere and we saw people laughing and enjoying interactions with staff.

Relatives and visitors spoke highly of the end of life care provided in the home and the effort all staff made to ensure the person, their relatives and representatives were supported and cared for. The home was accredited to the Gold Standards Framework.

Staff were well supported and were positive about the management team. There was an inclusive culture in the home where people, their relatives and staff worked in partnership to provide good care.

The registered manager involved outside agencies to help improve the care of people living with dementia. Relatives and staff were positive about improvements in care provided as a result.  

People's needs were assessed and where there were risks these were assessed and managed. Some people's care plans did not always contain clear information in relation to how risks would be managed. Systems in place to monitor medicines were not always effective.

The registered manager had introduced effective ways to improve communication in the home and had systems in place to monitor and improve the quality of the service.

We spoke with six people about how they were involved in their care. One person summed up their feelings and told us, “I have an electric chair. I can go outside. I’ve been to the mobile library today. What I do is my choice, they encourage me. The carers bend over backwards to let me choose what I want”.

We conducted a Short Observational Framework for Inspection (SOFI) exercise in the homes dementia unit. We noted a number of positive interactions and that all staff on the dementia unit assisted with meals to ensure that people had a pleasant mealtime.

We found people were safe. Care workers were aware of the different forms of abuse and knew who to report to if they felt people were being abused. Care workers also confirmed that they would feel comfortable raising any concerns.

Care workers, nurses and domestic workers received appropriate professional development. Care workers we spoke with felt that they were supported by the provider and had access to mandatory training, specific training and a structured supervision and appraisal programme.

The provider conducted a detailed quality audit, which covered medication, quality of service, infection control. We saw that actions had been implemented by the provider.

People were supported to have enough to eat and drink. We saw a care worker give a person with dementia choice regarding their meal. The care worker did this to ensure the person had meaningful choices, offered in a way that suited the person.

During our inspection, we spoke with six people using the service and eight members of staff. One person said that the service was “really lovely” and that staff were helpful. Another person said The Old Vicarage “was a home from home”.

Staff we spoke with were able to discuss people’s needs, and the care they provided. Staff felt that they benefitted from a good level of communication between themselves and management.

The building appeared clean and bright with the majority of areas in good decorative order. There was effective maintenance arrangements and plans in place to deal with concerns that had been raised by the homes management.

People spoken with felt that staff were easy to get hold of and were polite and engaging, one person said "staff always have five minutes to chatter", while another stated "staff are always cheerful" and "staff really listen".

The provider took account of complaints and comments to improve the service. People we spoke with felt confident in raising their concerns to a member of staff, or the management. A relative of a person using the service felt that if there was any issue or concern they would speak to the management and had done so in the past.

The care assessments we saw were reviewed and the changing needs of people were documented. This did not always affect relevant care or risk assessments or provide affective care assessments for staff to follow.

We were told that staff listened to people and acted upon what their wishes. Staff supported them to remain as independent as possible.

People told us that they received the support and the medical help that they needed. They told us that they were ‘glad’ they had chosen to live in the home.

One relative said that they had observed that the health of the person they visited had ‘very much improved’ since they had come to live in the home.

People said they joined in with the activities provided in the home if they wished to. One person told us they enjoyed the activities and the activities lady was good and encouraged them to take part.

People said the staff were good and there were enough staff available, although they did not see the manager much. They said they thought that staff were selected carefully to ensure that they were right for the home.

Some of the people living in the home who required very little help from staff said irrespective of this the staff always asked if they wanted assistance and were willing to help if they could.

The people we spoke with expressed confidence in speaking to staff about how the home was run.