The Old Vicarage

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Staff worked effectively to monitor and improve outcomes for people at the service. They ensure people's right to choice and control over their everyday life were supported.

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

People’s relatives were positive about how people were monitored and felt they were involved in the process. One relative said, “We know all upcoming appointments. We’re emailed or phoned, and at the same time we can broach any queries or questions we may have.”

Staff and managers we spoke with were clear about how they monitored and worked to improve outcomes for people. Both the registered manager and the positive support team manager were able to discuss how the monitoring processes in place supported good outcomes for people. They showed us a graph of one person’s level of incidents over the number of years they had lived at the service. It showed how their incidents of anxiety had significantly decreased as a result of staff working together to provide consistent support for the person.

There were excellent processes in place to support positive outcomes for people in their everyday care. The information in their care plans on how they liked to receive care was detailed and the service used a range of sources to gather the information. This included feedback from relatives, observations of people’s behaviours to identify triggers that might lead to displays of anxieties and guidance and support from external health professionals. People had identified goals to enhance their independence and wellbeing. For example, a person had a goal of going to stay at their family home overnight. Staff had begun to prepare the person for this. The provider had an overnight facility which allowed staff to support people to stay overnight away from the service and had used this to prepare the person, getting them used to being away from their own environment for short periods of time. The staff had also undertaken day trips to the person’s family home incorporating the journey with a meal on the way back to the service. A further person who had recently moved to the service enjoyed swimming but the period of time directly before and after going into the pool caused anxiety. Staff had worked with the person’s relatives and had clear processes in place that had started to have a positive impact on the activity and the person’s wellbeing. Through consistent monitoring of the effects of small changes to people’s routine their goals were being achieved.

Relatives told us staff worked in ways to ensure their family member’s wishes around daily decisions were well managed. One relative said, “They have a very clear way of helping [Name] make a decision. They hold their hands up and say, ‘do you want this?’ or ‘do you want that?” Another relative said, “We’re having a best interest meeting to sort [Name’s] teeth out, they’ll need an anaesthetic, they (staff) sort all that out.”

Staff and managers showed good knowledge of the Mental Capacity Act (2005). They were able to discuss the different ways they worked with people to ensure where possible they gained their consent to provide care and treatment. One member of staff said, “(There is) lots of training on MCA - it is important to have people's capacity assessed, you can't just assume people haven't got capacity because they make different choices, or they have learning difficulties. We use all sorts of things to make sure people who are able to make choices have the tools to do so.” The registered manager told us staff at the service worked hard to make sure people’s choices about their care were heard. They said, “Each individual has something called 'my say meetings' once a month. For example [Name] has been stating they want to see the Emmerdale set. But for some people it might not be a big activity. Also people who have verbal communication needs, staff will pick up on different things that excite or please them, and add this information to the meetings.”

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguarding (DoLS) The provider was working in line with the Mental Capacity Act. There were clear processes in place to show the staff at the service used the principles of the Mental Capacity Act (MCA) 2005 to support people with decision-making. There was evidence of best interests meetings for individual decisions for people. These involved the person (where possible) and their relatives, staff and appropriate health professionals.