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Inspection Summary


Overall summary & rating

Good

Updated 26 November 2015

We carried out this unannounced comprehensive inspection on 12 October 2015. This inspection was undertaken to ensure improvements had been implemented by the service following our last inspection on 08 January 2015.

At the previous inspection on 08 January 2015 the home was found to have five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to: the provision of sufficient staffing numbers; the provision of appropriate food in relation to people’s requests; the management of medicines; the provision of appropriate training, personal development; supervision and appraisals for staff; seeking the views of people who used the service and people acting on their behalf. At the comprehensive inspection on 12 October 2015 we found that improvements had been made to meet the relevant requirements previously identified at the inspection on 08 January 2015.

The Old Rectory provides personal care and accommodation for up to ten people. At the time of our inspection there were nine people using the service. The home has eight single rooms on the first floor, of which four have en-suite facilities and one shared room on the ground floor. The first floor is accessible by a passenger lift. There is a garden area to the rear of the home and a small car park within the grounds.

There was a registered manager at the home. 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. At the time of the inspection there was also an acting manager who had been in post since July 2015, who was gaining experience.

The provider told us that it was their intention for this manager to become the registered manager for the service and an application to become the registered manager would be submitted to CQC in due course. The home was also supported by an area manager who worked a few hours each week to provide support within the home.

People who used the service and their relatives told us they felt the service was safe. There were appropriate risk assessments in place with guidance on how to minimise the risks. We observed good interactions between staff and people who used the service during the day. People felt staff were kind and considerate.

Safeguarding policies were in place and staff had an understanding of how to report concerns.. Recruitment of staff was robust and there were sufficient staff to attend to people’s needs. Rotas were flexible and could be adjusted according to changing needs.

Medication policies were appropriate and comprehensive and medicines were administered, stored, ordered and disposed of safely. We saw that people’s nutrition and hydration needs were met appropriately and they were given choices with regard to food and drinks.

Care plans included appropriate personal and health information and were up to date. We saw evidence within the records of appropriate assessments and risk assessments being undertaken, which were reviewed regularly.

The environment was not consistently effective for people living with dementia and provided little stimulation. There was insufficient signage to aid people’s orientation and help them to be as independent as possible. The environment was also in need of some refurbishment.

Staff responded and supported people with dementia care needs appropriately. People’s health needs were responded to promptly and professionals contacted appropriately. Records included information about people’s likes and dislikes and we observed that people had choices, for example, about when to get up and when and where to eat. There was an appropriate complaints procedure and complaints were followed up appropriately.

There was a staff training matrix in place, but there were some gaps in staff training records.

There was a staff supervision cycle in place in addition to an annual appraisal. This meant that the home was now meeting the schedule identified in their supervision policy.

There was a four week menu cycle in use with at least two daily choices and two vegetable choices. Fresh fruit was also available and drinks and biscuits/cakes were served in between meals People could choose the time of their breakfast and could have a drink or snack whenever they wished.

There were appropriate records relating to the people who were currently subject to the Deprivation of Liberty Safeguards (DoLS.) There was documentation of techniques used to ensure any restrictions placed on people were as minimal as possible. There were appropriate Mental Capacity Act (MCA) assessments in place, which were linked to screening tools and restrictive practice tools which outlined the issues and concerns.

Staff sought verbal consent from people prior to providing support to them. This ensured that people gave their consent to the care being offered before it was provided. People’s health needs were recorded in their files and this included evidence of professional involvement. Relatives we spoke with told us they were kept informed of all events and incidents and that other professionals were called upon when required.

People’s bedrooms were personalised with individual items such as family photographs and personal objects. The home had a Service User Guide and Statement of Purpose which was given to each person who used the service. There was a monthly schedule of activities on display which included a wide range of activities

People using the service were treated with kindness and respect. Care staff spoke with people in a respectful manner, knocking on people’s bedrooms doors and waiting for a response before entering. There was a ‘privacy and dignity’ policy, which was up to date and recently reviewed in March 2015.

There was also an up to date ‘human rights’ policy, a residents ‘charter of rights’ and a policy on autonomy and choice, which helped staff to understand how to respond to people’s different needs. Staff were aware of these policies and how to follow them.

Care plans were easy to understand, person-centred in their format and contained a personal profile which identified personal relationships and family history.

Meetings with people who used the service were taking place regularly and information was shared with those people unable to attend and their families.

The home had procedures in place to receive and respond to complaints. There was a complaints policy and procedure in use and this was up to date reviewed in March 2015. Details of how to make a complaint were available and on view in the home on a notice board.

The service undertook a range of audits which were competed each month. There was also a business continuity plan in place.

Records of staff competency assessments via observations were carried out and these included individual feedback to staff on their performance.

Accident and incident forms were completed correctly and records included the action taken to resolve the issue and the corresponding statutory notification form required to be sent to the Care Quality Commission. The service had notified the CQC of all significant events which had occurred in line with their legal responsibilities. Policies and procedures were all up to date, having been reviewed in March 2015.

The service worked in partnership with a variety of other organisations in order to facilitate access to the local community.

The home undertook a range of audits and information from these was shared at staff meetings.

There was a staff meeting and staff supervision schedule in place.

Inspection areas

Safe

Good

Updated 26 November 2015

The service was safe.

People who used the service and their relatives told us they felt safe.

Staffing levels were sufficient on the day of the inspection to meet the needs of the people who used the service.

Staff recruitment was robust.

There were a range of policies and procedures that were up to date.

Effective

Requires improvement

Updated 26 November 2015

The service was not consistently effective.

The service worked within the legal requirements of the MCA and DoLS and there was direction on how to assist someone in the decision making process.

The design of the environment was not always effective for people living with dementia, in aiding their orientation and helping them to be as independent as possible.

There was a staff training matrix in place but there were some gaps in training records.

Caring

Good

Updated 26 November 2015

The service was caring.

People who used the service and their relatives told us they felt the service was caring.

Care staff spoke with people in a respectful manner.

There was a monthly schedule of activities on display which included a wide range of activities.

There was a ‘privacy and dignity’ policy, which was up to date and recently reviewed.

Responsive

Good

Updated 26 November 2015

The service was responsive.

People who used the service had a care plan that was personal to them.

All care plans were easily understandable and person-centred in their format.

There was a complaints policy and procedure in use and this was up to date reviewed in March 2015. Details of how to make a complaint were available and on view in the home on a notice board.

Residents meetings were held on a regular basis and information was fed-back to people who could not attend and their families.

Well-led

Good

Updated 26 November 2015

The service was well-led.

There was a registered manager in post.

People spoke favourably about how the service was managed.

Staff meetings were held regularly.

The service undertook a range of audits which were competed each month.

The service worked alongside other professionals and agencies in order to meet people’s care requirements where required. The service also worked in partnership with a variety of other local groups in order to facilitate access to the local community.