The 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 Vicarage provides accommodation with personal care for up to six people over the age of 18 who have a diagnosis of a learning disability. People are accommodated in one house with bedrooms on the ground and first floor.

At our last inspection we rated the service good. However, at that inspection, we rated the service as requiring improvement in the Safe domain as medicine administration needed to be improved to make it safer.

At this inspection we found evidence that improvements had been made to the policies and procedures as well as the practice of medicines administration. We found the service was now good in all the domains and overall was rated as good. This inspection report is 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 care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values 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.

People said they liked living at the Vicarage; throughout the inspection, we observed people being treated with kindness and respect by staff who clearly knew them very well. Staff respected people’s right to privacy.

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 2008 and associated Regulations about how the service is run. The registered manager was supported by the provider who visited the home regularly. There were systems in place to monitor the quality and safety of the service. This included getting feedback from people, their relatives and staff about the home and the care provided. The service made continuous improvements in response to findings.

Staff had been recruited safely and were trained to meet people’s needs. Staff were able to get support and guidance from the registered manager when they needed it.

People were supported to have maximum choice and control of their lives in the least restrictive way possible; the policies and systems in the service support this practice. The service ensured people led meaningful and fulfilled lives. This included supporting people to do activities they enjoyed as well as to undertake activities to support daily living such as cooking and cleaning. People were also supported to be independent. Some people had been assessed as able to go out on their own. Staff had assessed the risks and had clear guidelines which they followed to keep people safe.

Care files were personalised to reflect people’s personal risks, needs and preferences. People were involved in developing their care plans. People’s views and suggestions were taken into account to improve the service. People were involved in decisions about what they had to eat and drink and were supported to maintain a balanced diet. Health and social care professionals were consulted about people’s care to ensure they received care and treatment which was right for them. People were supported with dignity and kindness at the end of their life.

People’s rights were protected because the service followed the Mental Capacity Act 2005. Medicines were safely managed on people’s behalf.

We have made a recommendation about the home’s infection control policy and procedures.

Further information is in the detailed findings belo

The inspection took place on 4 November 2015 and was unannounced. The service was last inspected in May 2014, using the new inspection methodology and had been found compliant in all five domains of safe, effective, caring, responsive and well-led. At the time of this previous inspection, ratings for each domain and for the service overall were not given.

The Vicarage provides accommodation with personal care for up to six people over the age of 18 who have a diagnosis of a learning disability. The home is a three storey house located on the edge of Bradworthy, a village near Holsworthy in Devon. It is within walking distance of the village. There are bedrooms on the ground and first floors and all bedrooms are for single occupancy. The home is staffed 24 hours a day.

At the time of the inspection, six people had lived at The Vicarage for a number of years. Some people had complex needs and communication difficulties associated with their learning disability. Because of this, we were only able to have limited conversations with some people about their experiences. We therefore used our observations of care and our discussions with staff to help inform our judgements.

The home had a manager who had been registered in the role with the Care Quality Commission since 2008. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers and nominated individuals, 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.

There was a clear vision of the purpose of the home which was described as “about giving people the opportunity to live the lives anyone else lives; but with a bit of support.” A health professional said the home was “extremely well led”. Staff commented that the registered manager was very supportive and approachable.

People living at the Vicarage said they liked living there and thought the registered manager and staff were kind and caring. Throughout the inspection we observed people being treated with respect, supported to make decisions about what they wanted to do and appearing happy and relaxed. People were supported to undertake activities either independently or with staff. Activities were planned each week at a home meeting and were based upon people’s expressed preferences. People were able to change their mind about what they wanted to do and staff were happy to help them rearrange their plans. People were also able to choose what they ate and get involved in menu planning for the home each week.

Care records were well written and described the risks, needs and aspirations of people living in the home. Risk assessments and care plans were updated regularly and also reviewed when a person’s needs changed.

Although medicines were administered and recorded safely, there had not been checks made on creams and emollients to ensure they were all within date. Medicine administration records were all stored in a single file without any separators between people’s records, which increased the risk of errors in medicine administration occurring.

We recommended that the provider should consider reviewing their medicines policy and procedures to ensure they are in line with national guidelines.

There were sufficient staff to support people’s needs throughout the week. However, staff were not always recruited safely as checks on previous employment had not always been carried out. Other checks, such as the Disclosure and Barring Service checks were in place prior to staff starting work at the home. Staff were supported to undertake an induction when they first joined the home. Staff also refreshed some training courses, such as safeguarding vulnerable adults, on an annual basis and were supported to undertake a nationally recognised qualification and other training, for example constipation, from time to time.

The home was maintained and looked after and there were audits undertaken regularly to ensure it met health and safety standards. However some areas of the home felt rather impersonal and cold. However staff said that people were checked to see if they were warm enough and there were no restrictions on the heating being put on.  

The Vicarage is a care home registered to provide accommodation with personal care for up to six people with learning disabilities.

The home has a manager registered with the Care Quality Commission.

People we spoke with confirmed that they felt safe and supported by staff at The Vicarage and had no concerns about the ability of staff to respond to safeguarding concerns. Comments included: “I like living here” and “The staff are nice.” We observed staff responding appropriately to people’s needs and interacting respectfully to ensure their human rights were upheld and respected.

Staff demonstrated a comprehensive understanding of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) and how they applied to their practice. We found the location to be meeting the requirements of the Mental Capacity Act (2005). People’s human rights were therefore properly recognised, respected and promoted.

Staffing was maintained at safe levels. Staff confirmed that people’s needs were met in a timely manner and felt there were sufficient staff on each shift.

Care plans reflected people’s health and social care needs and demonstrated that other health and social care professionals were involved.

Risk management considered the whole person and showed that measures to manage risk were as least restrictive as possible, such as the use of distraction techniques when a person was becoming distressed.

Staff had the skills and support to meet people’s needs. Staff informed us that they received a range of training, which enabled them to feel confident in meeting people’s needs and recognising changes in people’s health.

Staff adopted a strong and visible personalised approach in how they worked with people. There was evidence of commitment to working in partnership with people in imaginative ways, which meant that people felt consulted, empowered, listened to and valued.

The registered manager believed in the importance of creating an open environment to enable the quality and safe delivery of care and support.

On the day of our visit we were told that there were six people living at The Vicarage. We spoke to five people living at the home, spent time observing the care people were receiving, spoke to five members of staff, which included the registered manager and looked at two people’s care files in detail.

Before people received any care or treatment they were asked for their consent and staff acted in accordance with their wishes. Throughout our visit we saw staff involving people in their care and allowing them time to consent to care through the use of individual cues, such as looking for a person’s facial expressions, body language and spoken word.

We spent time talking to people who lived at The Vicarage and observing the interactions between them and staff. Comments included: “I like living here. The staff are nice”; “I went on holiday to Newquay. I went to the zoo, on the train and out for pub meals” and “The staff look after me.”

Medicines were kept safely. We saw that there was a locked medicine cupboard within the staff office. The cupboard was securely attached to the wall to ensure the security of the medication.

There were effective recruitment and selection processes in place.

People did not express any concerns about the home’s ability to maintain accurate personal records or whether they were stored safely and confidentially.

We spoke with the five men living at the home when we visited, and observed support that they received. We read care records kept for three of them and records relating to management of the service. We spoke with staff and the registered manager.

We found that people’s views and experiences were taken into account in the way they were supported. For example, staff asked people where or when they would like to go, if people asked about going out. People's privacy, dignity and independence were respected. One person told us that staff respected their privacy when they were showering. Another person explained they could lock their bedroom door if they wanted.

People experienced care that met their needs and protected their rights, with staff supported to deliver care safely and to an appropriate standard. People told us that they felt safe with staff, with one person saying they were ‘kind’ and ‘good’. People were protected from abuse because the provider had taken steps to prevent it from happening.

Pre-employment checks were undertaken for new staff but these did not include health checks. Thus the provider could not fully assess an individual's fitness for the job.

The provider had systems to assess the service's quality and manage risks to people using the service and others. Comments made in the home’s last survey included “There’s not much more you could do” and “In my opinion he receives excellent care…I would say he’s happier than he has been for years.”

We carried out a review with an inspection to the Vicarage on 23rd February 2012. We looked at essential standards covering respect and involvement, care and welfare, safeguarding people from abuse, supporting staff and assessing and monitoring the quality of the service.

We looked at the records of two people in detail; and where possible we spoke to the individual and or their carer. We observed other people being attended to whilst we were visiting. We also spoke to three professionals about people’s experiences of care and support at The Vicarage.

People we spoke to said that they “really like it here, it’s the best place”. We saw that people were treated as individuals in a respectful way and made comments like “they treat you really well”. They are supported to be actively involved in the community where they live and lead busy lives.

Professionals said that The Vicarage was a well run home, where people have a very good quality of life and their health had improved. For example, one professional told us “the staff are kind and considerate and empowering people who live there”.