The Vicarage

About the service

The Vicarage is a residential care home providing accommodation and personal care to up to 6 adults with learning disabilities. At the time of our inspection there were 6 people using the service.

People’s experience of using this service and what we found

Right support: Model of care and setting maximises people’s choice, control and Independence;

People were kept safe from avoidable harm because staff knew them well and understood how to protect them from abuse. The service worked well with other agencies to do so. People were not able to comment on their safety. However, their body language while interacting with staff was relaxed and positive, which indicated they felt safe.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People lived safely and free from unwarranted restrictions because the service assessed, monitored and managed safety well. There were comprehensive risk assessments in place covering all aspects of the service and support provided.

Medicines were managed safely. Infection control measures were in place. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

There were effective staff recruitment and selection processes in place.

Right care: Care is person-centred and promotes people’s dignity, privacy and human rights;

Staff relationships with people were caring and supportive. Staff provided care that was kind and compassionate. A person commented, “I like living here, I am happy.”

Right culture: Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive, and empowered lives;

People’s equality, diversity and human rights were respected. The service’s vision and values centred around the people they supported. The organisation’s statement of purpose documented a philosophy of maximising people’s life choices, encouraging independence and people having a sense of worth and value. Our inspection found that the organisation’s philosophy was embedded in The Vicarage. For example, people were constantly encouraged to lead rich and meaningful lives.

The service worked hard to instil a culture of care in which staff truly valued and promoted people’s individuality, protected their rights and enabled them to develop and flourish.

Staff felt respected, supported, and valued by the registered manager which supported a positive and improvement-driven culture.

A number of methods were used to assess the quality and safety of the service people received. The service made continuous improvements in response to their findings.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 12 April 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service and length of time since the last inspection. We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Vicarage on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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 below

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 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.'