We carried out a review of the data available to us about The Old Rectory Nursing Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The Old Rectory Nursing Home, you can give feedback on this service.
The Old Rectory is a nursing home in one adapted building providing personal and nursing care to 42 people aged 65 and over at the time of the inspection. The service can support up to 47 people.
People’s experience of using this service and what we found
People and relatives gave consistently positive feedback about the care provided at The Old Rectory. Comments included: “I can't give this home enough praise. You literally have got everything here. They (staff) are worth their weight in gold, outstanding. Warm, friendly welcome, beautiful atmosphere. I would recommend this home to anybody. If I needed looking after properly, I want to go to the Old Rectory. I would recommend it to the queen. For everybody here they give you support in their own unique ways”; “Friendly staff. Kind, caring and compassionate”; “I am blown away. The level of compassion and care”; “Wonderful, wonderful nurses, they give me courage to get on, don’t know what we'd do without them.”
There was a strong, visible person-centred culture. This was evident from all staff within all roles. From care staff, domestic staff and management. The person-centred culture was embedded at all levels. The service ensured staff focussed on building and maintaining open and honest relationships with people and their families, friends and other carers. This really helped to promote and ensure the service was person-centred. A staff member commented: “It's about enriching people's lives. It’s amazing here. We are like a family here. Everyone wants to make the residents happy, if they aren't happy, we aren't. Lifelong friends with staff and relatives. I love making the residents smile.”
People were respected and valued as individuals, with staff thinking ‘outside of the box.’ For example, the staff were pro-active in ensuring care was based on people's preferences and interests, getting to know people as individuals, seeking out activities and opportunities in the wider community and helping people to live fulfilled lives, individually and in groups.
Staff were good at anticipating people’s needs. We observed this throughout the inspection. Sensory stimulation is a very important part of the care provided to people living at The Old Rectory to aid their well-being. The service had created a haven of relaxation and therapeutic opportunities, including sight, sound and smell. People were enabled to relax in a lavender garden populated by bees and butterflies in the summer, watch the ducks and listen to running water from the duck pond. This gave people a sense of enjoyment and engagement. A relative commented: “(Relative) had a lovely summer here last year. She loves the garden. Her health improved last summer.”
Staff were motivated to ensure people received care which was compassionate and kind. The atmosphere in the home was warm and friendly. We saw people had developed strong relationships with staff, and it was evident that this was an important ethos of the service. Staff told us they spent quality time chatting and building interpersonal relationships with people and saw this as a vital part of their role. They recognised how this gave people a sense of overall well-being and ensured the family feel of the home. This was evident throughout our inspection with the general conversations and banter which were observed.
Staff had an excellent understanding of people's individual needs which protected their values and beliefs in a way the person wanted to receive care and support. The approach to care and support meant there was a multi-professional process which aimed at maintaining continuity, independence and autonomy for the person.
The service supported people to learn new skills and maintain their independence. For example, one person had learnt to paint, something they thought they would never be able to do. Their relative commented: “My aunt has become a talented painter! In the past she always said she couldn't draw or paint, but a few months ago she painted a large Van Gogh Sunflowers picture, which the home framed and now hangs in her room. It’s amazing! Thank you to The Old Rectory for encouraging this latest talent.”
A number of methods were used to assess the quality and safety of the service people received and continuous improvements were made in response to the findings.
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.
The service provided safe care to people. One person commented “The staff are brilliant. I feel safe here and well cared for." A relative commented: “My (Mum) is very safe here. I feel reassured.”
We did find certain issues with regards to medicines management, repositioning times and recruitment. However, these had been promptly addressed by the registered manager and provider following our inspection.
Staff ensured infection control procedures were in place. Personal protective equipment was readily available to staff when assisting people with personal care. For example, gloves and aprons. Staff had also completed infection control training.
Care files were personalised to reflect people’s personal preferences. People were supported to maintain a balanced diet. 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.
People received effective care and support from staff who were well trained and competent.
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 Outstanding (published 4 August 2017).
Why we inspected
This was a planned inspection based on the previous rating.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Old Rectory Nursing Home on our website at www.cqc.org.uk
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
This inspection took place on 22 and 23 May 2017. At the time we visited, 39 people lived at the home. We found The Old Rectory to be providing an excellent service. The provider and manager were clearly passionate about providing a high quality, individualised service and regularly promoted and shared this with people, relatives and the staff team. Their ethos was to create a family orientated feel and to ensure when people moved into a care home setting they, “didn’t have to leave their life at the door”. The manager said, “We are all about the lived experience. We support staff to think about the care they are giving. It’s about engaging with people. I don’t sit in the office. I’m out there, I like to be visible. We all live and work together.” They felt well supported by the provider who, “ultimately wants the right outcome for people.”
People had access to and were involved in developing personalised activities that complemented their individual hobbies and interests. Links with the local community had been established and people were supported to participate in community events and other events that were important and meaningful to them. This provided people with a sense of purpose and wellbeing. This was enhanced by social communal areas such as a country style pub and beer garden, lifestyle kitchen and café offering specialist coffee and snacks. Areas were available for family parties, private space, fine dining and a cinema club.
People were supported by very kind, caring and compassionate staff who often went the extra mile to provide people with good, high quality care. This high standard of care enhanced people's quality of life and wellbeing. The staff as a team were extremely passionate about providing people with support that was based on their individual needs, goals and aspirations and often visited the home outside of working hours to attend events and visit people. One staff member lived locally and visited people every night to say goodnight. They were pro-active in ensuring care was based on people's preferences and interests, getting to know people as individuals, seeking out activities and opportunities in the wider community and helping people live a fulfilled life, individually and in groups.
The staff were happy working in the home and felt very supported in their role. They were clear about their individual roles and responsibilities and felt valued by the management team. Good leadership was demonstrated at all levels with a pro-active effort to encourage ideas from staff to further benefit the people in their care and maintain a strong, stable staff team with a shared goal. This was underpinned by use of positive language and communication and heavy investment in quality training promoting the ethos based on nationally recognised Butterfly and Eden philosophies. Each individual staff member was engaged in sourcing new opportunities for people and putting ideas into practice using their particular skills, whether related to their role or not.
People were safe living at The Old Rectory. There were enough staff to meet people's care needs safely and also to provide individualised support in and out of the service. There was a strong culture within the home of treating people with respect. The staff and managers were always visible and listened to people and their relatives/friends, offered them choice and made them feel that they mattered.
People and the staff knew each other well and these relationships were valued. Staff saw the service as a nice place to be and often popped in when not on duty to say hello to people or attend particular events. Relatives were pro-actively encouraged to maintain a relationship with the home when their loved one had died and the service’s café was used as a meeting place.
Staff had received appropriate training in line with nationally recognised qualifications and regular supervision to provide them with the necessary skills and knowledge to provide people with effective care. There was a strong emphasis on resourcing training that was meaningful in relation to dementia care, for all staff who put their learning into practice.
People received their medicines when they needed them. People received a nutritious, varied and interesting diet and enough to eat and drink to meet their individual needs and timely action was taken by the staff when they were concerned about people's health.
There were very effective systems in place to monitor the quality and safety of the care provided. People felt able to raise any concerns and be confident they would be addressed. Where concerns were raised by people, relatives or through regular auditing we saw the home took them seriously and took appropriate actions to focus on learning and improvement for the benefit of the people using the service.
The Old Rectory Nursing Home is a care home with nursing for people with a physical disability and people with dementia. It is registered for a maximum of 47 people. There is a registered manager who is responsible for 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 and associated Regulations about how the service is run.
At the last inspection carried out in July 2014 we had identified some concerns with the care provided to people who lived at the home. These were in relation to proper steps not being taken to ensure people were protected against the risks of inappropriate care and treatment, insufficient numbers of staff, deployed in an effective way to meet peoples’ needs, quality assurance failings and accurate records not being maintained. We found that since that inspection the service had worked very hard to rectify all of these areas to ensure that people were receiving a service which was safe, effective, caring, responsive and well led. We did not find any concerns during this inspection .
On the day of this inspection there was a calm and relaxed atmosphere in the home and staff interacted with people in a friendly and respectful way. People were encouraged and supported to maintain their independence. A high proportion of people living at the home were unable to mobilise unassisted, were cared for in their beds or were living with dementia. Where possible, people were able to make choices about their day to day lives which were respected by staff.
People said the home was a safe place for them to live. One person said they felt “completely safe” at the home, and that staff did their work in a safe way at all times. There were enough staff to meet people’s needs in a timely way. Staff said the way staff were allocated to different areas in the home and new timings for shifts had enabled staff to work more effectively. For example, one person living with dementia relaxing on their own in one lounge who was unable to use a call bell effectively, was checked at least every fifteen minutes and offered drinks whenever awake by staff. Another person who chose to spend their time in their room said staff discreetly checked that he was alright throughout the day, in a way he found reassuring. One person added that staff were very careful and thorough when undertaking personal care tasks, for example when helping them to move from bed to wheelchair. Equipment was well maintained and checked regularly.
Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns. Staff spoken with were confident any allegations made would be fully investigated to ensure people were protected. We had received notifications about any safeguarding issues and the home had been open and transparent in ensuring these issues were dealt with effectively to keep people safe. For example, following one safeguarding issue improvements had been shared with the staff team and food and fluid monitoring forms had been improved to ensure details of optimum inputs and outputs and weights were included.
People said they would not hesitate in speaking with staff if they had any concerns. People knew how to make a formal complaint if they needed to but felt that issues would usually be resolved informally. Records of complaints were detailed and included detailed responses and actions taken.
People were well cared for and were involved in planning and reviewing their care where able. Relatives and advocates were also included as necessary where people lacked mental capacity and if people wished them to be included. There were regular reviews of people’s health and staff responded promptly to changes in need. People were assisted to attend appointments with appropriate health and social care professionals to ensure they received treatment and support for their specific needs in a timely way. For example, staff were able to show us records of their actions when someone fell, which resulted in a timely visit by a GP because of a concern identified through staff monitoring the person. The person had also been referred to the local falls team for further advice to minimise risks of falling again after staff analysed the person’s history of falling.
Staff had good knowledge of people including their needs and preferences. Staff were well trained and there were good opportunities for on-going training and for obtaining additional qualifications. Some staff members had lead roles as Link Nurse Champions in a range of topics such as end of life care, infection control and health and safety so they were able to guide staff practice in these areas. Comments about staff included “ One senior carer is quite exceptional”, “The two apprentices are excellent”, “The carers are wonderful they will do anything”, “Her key worker is very much on the ball” and “Staff are lovely and always very approachable. They know how to care for me. If you ask them to do anything for you they will do it”.
People’s privacy was respected. Staff ensured people kept in touch with family and friends. Each visitor we spoke with told us they were always made welcome and were able to visit at any time. People were able to see their visitors in communal areas or in private. One visitor said “We felt it was homely here, we could see Mum here so we all agreed. The room’s nice and it overlooks the garden, there’s flowers outside. She stays in her room but there’s always people coming up and down the corridor and the staff look in and speak to her”.
People were provided with a variety of activities and supported by an activities co-ordinator who was knowledgeable about people’s needs and preferences. People could choose to take part if they wished. Two people said they knew what was going on from the newsletter and they enjoyed some things but staff didn’t push them to do anything. A trip to the beach was being planned for the warmer weather and there was a wide range of events including one to one chats with people to ensure that people were not isolated.
There was a management structure in the home which provided clear lines of responsibility and accountability. The registered manager and provider were very keen to provide the best level of care possible and had clearly made substantial improvements in how the service was run. Since the last inspection in July 2015 where some concerns were identified staff had clearly adopted the same ethos and enthusiasm and this showed in the way they cared for people. Staff said the home was much improved with more teamwork and understanding of their roles. One staff member said “It is so much more relaxed and organised here, a new way of working. We are listened to and the manager and owner take action”. A non-care worker said they had really enjoyed being included in attending dementia care training with the nurses and care workers and had learnt a lot as a valued team member. Communication was good with regular meetings, detailed handover records and staff felt listened to.
There were effective quality assurance processes in place to monitor care and plan on-going improvements. There were systems in place to share information and seek people’s views about the running of the home. For example, there was a comprehensive action plan showing how the service was monitoring and responding to any issues with areas identified, actions, reviews and learning . The service gained feedback from regular “themed surveys” with people and their relatives, stakeholder surveys, complaints and compliments to continually develop the service. These outcomes were shared with everyone in the home on the notice board so people could see results.
Is the service safe?, effective?, caring? responsive? well led?
This is a summary of what we found.
Our inspection was over two days, one visit at a week end and one a week day. One inspector visited on the Sunday and two inspectors visited on the Thursday.
The summary is based on our observations during the inspection. We looked closely at the care of five people, including three with complex needs, spoke with many other people, some family members, nursing, care, domestic and catering staff, the registered manager, director of nursing and the provider. We also received information from health and social care professionals who had reviewed people's care at the home.
If you want to see the evidence supporting our summary please read the full report.
Is the service safe?
The service was not safe. Staffing levels were insufficient to ensure people's needs were met in a timely manner. This had the potential to increase risk as care workers were unable to monitor people according to the assessed level within their care plan to ensure their dignity was maintained and emotional needs met.
The service was not safe because of the standard of record keeping. There were gaps in some records which could affect the care or treatment people required. Gaps in recording had been picked up in the homes audit and were being addressed with individual staff through training and supervision. Some information was not transferred between documents, which could lead to mistakes. Some records were disorganised.
The service was not safe because the home's quality monitoring did not always identify areas of risk. These included broken window restrictors and unclean equipment.
Is the service effective?
With regard to people's health care needs the service was effective. Generally health and care assessment and planning was detailed and informative with risk monitoring regularly reviewed. Some monitoring was of a high standard, such as diabetic monitoring.
The service was less effective with regard to meeting people's personal and emotional care needs. Some people received very little stimulation or emotional support. One person received personal interaction with staff only eight times in a three month period other than for personal care. One staff told us 'Some days it seems nigh on impossible to do what we have to do'.
Activities were effective for people well enough and wanting to engage in them.
Is the service caring?
Care and nursing staff were felt to be very caring with comments including, 'Carers are brilliant', 'They are all very friendly", "Generally speaking staff are pretty good", "Lovely staff'They are kind" and "Care assistants are gentle and safe when helping her." The registered manager was also considered to be very caring.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Applications have needed to be submitted and authorisation had been agreed so that one person's liberty was restricted in their best interest and with regard to their rights.
The service was not caring when people had to wait to get up, wait for assistance with the toilet or were lonely and seeking attention.
Is the service responsive?
The service was responsive, both to concerns identified about the service and people's views about the service. For example, notifying the CQC of events, making safe a window with a broken restrictor and garden steps where there had been a fall.
The service was responsive to people's health care needs. Where advice was needed from external health care professionals this was sought in a timely manner.
Is the service well-led?
Staff felt the home was well led. One told us, '(The registered manager) is always willing to listen, always helpful and always trying new things. She is very fair'. Another said '(the registered manager) is brilliant'. People using the service and their families also spoke highly of the registered manager. However, audits and quality monitoring, had not always identified and taken action where improvement were needed.
People told us they liked living at the home and felt well cared for. One person said, 'Staff are very nice', another person said, 'The staff are very good here'. A third person said, 'I've settled in well here, they make everybody welcome'. Most people said they enjoyed the food at the home and said their individual tastes and preferences were catered for. Health professionals told us staff worked well with them and contacted them appropriately about people's health care needs. A GP who regularly visited the home said, 'The manager is very experienced and skilled and wants to keep on improving the quality of care provided'.
We found people's care needs and risks were assessed and care plans were developed to meet individual needs. People told us and care plans we looked at showed people were well supported with their care and treatment. We observed staff interacted well with people, and were caring and compassionate. Staff we spoke with knew about people's needs and how to meet them, which was in accordance with their care plans. People told us staff responded to their needs in a timely way most of the time. We observed staff were available in all areas of the home and worked with individuals at a pace that suited each person.
Staffing levels had been assessed according to people's needs and rotas showed the correct numbers of staff needed were made available on each shift. We saw that the environment was well maintained, we saw some improvements had been made and others were planned. We found all areas of the home had enough equipment to promote the independence and comfort of people who use the service, and that all equipment was regularly serviced and maintained.
We spoke with 14 people and three relatives, and observed people's care in communal areas of the home. We looked at care records for three people who lived at the home. We spoke with the registered manager and eleven staff as well as a visiting health professional and asked them about how people's care needs were met.
We found that people were offered choices about their care and treatment and were involved in decision making. The home made detailed assessments of people's needs and preferences. People's care and treatment was provide by staff who were trained to deliver effective care.
The home was clean and hygienic with systems in place to prevent the spread of infection. The home had a range of ways in place to seek feedback from people and took action in response. We saw that complaints were taken seriously, fully investigated and lessons were learned. These included improvements in food, laundry services and in the care provided.
The home was compliant with the five outcomes we inspected.
Outcome 2: Consent to care and treatment
Outcome 4: Care and welfare of people who use services
Outcome 12: Requirements relating to workers
Outcome 21: Records
At this visit we met with four people who lived at the home, spoke to two relatives, a friend and ten care workers. We also spoke to two health professionals who visited the home. Some people we met were not able to express their view about their experiences of care but we observed staff interactions with them, looked at care records and asked care workers how they met those people's individual needs.
We checked records about advanced decisions in relation to resuscitation in the event of unexpected collapse for three people. Two people did not have capacity to make those decisions for themselves. For those people, we found that relatives, people with power of attorney and the person's GP had been appropriately consulted and the best interest decisions were clearly recorded and communicated to care workers.
Five people we spoke with told us they were happy with the care provided. Two people said the home was meeting their needs and that staff were kind and caring. One relative said ' I'd give them 100% for their care'. We found that any concerns or issues raised about care were investigated and appropriate improvement actions taken. For example, in relation to cleanliness and repairs of equipment.
We looked at three sets of care records and found that the quality of record keeping had significantly improved since our last visit. The care plans seen were expressed in a simple and straightforward way that enabled care workers to understand the person's care needs and how to meet them. All food and fluid charts were completed and up to date. We found the care plans and risks assessments seen were regularly reviewed and updated. One area of record keeping identified for further improvement was accuracy of record keeping on creams used on people's skin.
At this visit, we checked that the provider was monitoring the quality of care at the home to ensure that previous improvements made were being maintained. We saw a range of measures in place through which the home monitor the quality of service provided. We saw and examples of improvements that had been made as a result of audits and incidents, as well as following feedback from people and staff.
We made an unannounced visit to the home on 16 August to check that suitable action had been taken to address the areas of medicines handling highlighted in the warning notice. We found that its systems for the management of medicines now complied with the essential standard of quality and safety.
People are very complimentary about staff and the efforts they make to meet their needs. People say that staff are very busy yet ensure their needs are met.
There was evidence that people who cannot ask for help receive the care and attention they need. These people have their personal hygiene needs attended to frequently.
No one living here has developed a pressure sore at the home. Two people have been admitted with pressure sores and the way that these have been managed for one person is not sufficient to address the risk as the plan of care does not address all the areas of skin damage this person has. In addition, a number of people have skin damage which not all staff are sufficiently aware of, and robust plans to manage this risk for individuals are not always in place.
The care plans we looked at are not written in a way that sufficiently helps people to provide care in a consistent way. Some are confusing, contradictory and/or incomplete. There is a lack of individual accountability for the plans of care as some are not signed by the person who wrote them.
Since the last review the management team have undertaken updated training from the local team in safeguarding vulnerable people. They are now more aware of the local procedures to be followed if an allegation of abuse is made.
The system for managing medicines is not robust enough and people are at risk because of this. Audits of medicines have not taken place since our last inspection in January. Records of medicines in stock could not be reconciled with the actual stock.
Records show that the fridge used for storing some medicines has been running at a temperature above the recommended temperature, and no action has been taken to address this. Some records are confusing in relation to the route of administration. Prescribed creams are being used beyond their 'use by' date and records relating to the use of prescribed creams were not always signed, meaning that it is unclear if these creams are being used as prescribed. Prior to our visit the community pharmacist has been contacted for advice relating to medicines management.
When using agency staff the home should receive a statement from the agency to say that agency staff checks, including police and nurse registration checks, and details of training, have been carried out. These statements were not in place for all agency staff who had worked in the home.
We did not speak with people about their records. However, we found the quality of record keeping to be below a standard that would support and promote effective care delivery, and below the standards set by the nursing and midwifery council (NMC). Some records were not signed or dated or did not have the name of the person the record related to recorded. Staff were sure that some records we requested existed, but could not find them. Some records were in danger of being lost because the file holes had ripped. Some records contained contradictory information.
People told us the food is 'lovely', 'excellent' and 'the best'. One person said 'you'll never be hungry living here'. We also saw this service has carried out a great deal of work to ensure that everyone living here is well nourished, including those who are most at risk and frail. Frequent nutritional assessments are carried out and people living here are supported to gain or maintain their weight. The record used to show how much each person drinks in a day is easy to understand and helps staff to ensure that each person has had enough to drink. One relative told us how easy it is for them to complete and to see that their relative has had enough to drink.
We found that not all records are always up to date and can contain conflicting information about people's needs and the actions needed to address these needs. For example it is recorded in the same chart that one person has both a normal diet and a soft diet. We found that this person is given meat and sandwiches to eat, although they are at risk of choking because of swallowing problems. This shows that some people at risk of not receiving safe care. Medicine records were not completely up to date and medicines requiring refrigeration were not stored safely.
People told us the home is always clean and well cared for and we found that overall good hygiene and infection control procedures are in place.
People told us that the activities and day to day life at this home has really improved. They told us about the visiting owls, about quizzes, bingo, the aroma therapist. They also told us about the dog that visits and that there are always treats available so that they can feed and pet him. There is also a large supply of bird feed and nuts and the gardens attract many birds and squirrels which residents tell us they enjoy. Staff told us that there is a film club about to start and we saw another large screen TV being fitted to accommodate this. We were also told that reminiscence sessions are held and that opportunities are taken to celebrate national and local events.
Some people told us that there had been a lot of changes at the home over a long period of time. There have been a number of changes to the management of the home. Some people are happy with the current arrangements and others are not. Many people, including staff, told us they wanted a period of stability.