Archived: The Old Rectory Care Home

About the service

The Old Rectory Nursing and Residential Home is a 'care home' registered to provide personal and nursing care to up to 34 older people. At the time of inspection, the home was supporting 22 people, including people with a learning disability and people with dementia.

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

Right Support

The provider had made improvements to the home following our previous inspection, to ensure it was safe for people. People had control of how their care and support was arranged. The registered manager had reviewed the governance and auditing system following the previous inspection. Audits were up to date and identified any lessons learnt following incidents and accidents so that they could take action to keep people safe. Risks to people's health were assessed so staff could support them safely. People's medicines were managed safely.

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 received care and support in an environment with specialist equipment to meet their physical needs. People and their relatives were able to personalise their bedroom. People were supported by appropriate numbers of staff who provided kind, caring, person-centred care and support. Staff communicated with people in ways that met their needs.

Right Care

Care plans and risk assessments were detailed, and person-centred ensuring people were supported to live full, active lives and encouraged to maintain their independence. One person told us, “Staff are always telling me to do my exercises. I’m very complex, they all try their best to keep me exercising and moving.”

Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to raise concerns.

Right Culture

People and those important to them, were involved in planning their care. People's needs were assessed before they moved into the home. The home worked together with healthcare professionals who provided specialist support to people to ensure people's needs could be met. One health and social care professional told us, “We get communication, they never ring after the person has arrived, they always let us know beforehand when a person will need a wellbeing plan so we can plan that support.”

Staff demonstrated good understanding around providing people with person centred care and spoke knowledgably about how people preferred their care and support to be given. Feedback was sought from people to help make continuous improvements to the home.

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

Rating at last inspection and update:

The last rating for this service was requires improvement (published 13 September 2021).

At our last inspection we made recommendations about risk, environmental safety checks, ongoing improvements to the home and the manager’s oversight of audits and systems in place to monitor the environment. At this inspection we found the provider had acted on the recommendations and had made improvements.

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to confirm they met legal requirements. This report only covers our findings in relation to the key questions Safe, Effective and Well-led which contain those requirements.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Old Rectory Nursing and Residential Home 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 Old Rectory Nursing and Residential Home is a ‘care home’ registered to provide personal and nursing care to up to 34 older people. At the time of inspection, the home was supporting 31 people, some of whom were living with dementia.

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

Some safety checks and monitoring within the home were not always carried out on time, governance systems were not always robust enough to identify when things needed doing. Audits and quality assurance systems were not set up to drive improvements and lessons learnt were not documented. The registered manager and provider accepted these shortfalls and were receptive in working to address issues during and after the inspection. We have made recommendations about environmental checks and the oversight of the home.

The décor and upkeep of the home needed some attention, and this was ongoing. However, it was not always clear what the priorities were. The provider took immediate action to identify what needed doing and supplied a plan for its completion.

People, their relatives and staff told us The Old Rectory was a nice, safe place to live. Staff knew how to recognise concerns and how to raise them. They felt confident action would be taken. Medicines were managed safely, and staff had enough protective equipment to keep them and people safe from the risk of infection. The registered manager told us that staff had worked extremely hard especially during the COVID-19 pandemic. They told us their staff team was, “brilliant”. Infection control procedures were in place at the home including regular testing for staff, people and visitors.

People had risk assessments in place for all their care and support. Records were in the process of being transferred to an electronic system which staff told us would improve the accuracy and enhance the responsiveness of care. People had enough to eat and drink and had choices. Access to healthcare was as required and records showed input from a variety of health professionals.

Staff were recruited safely and felt supported. They had access to a variety of training including specialist training for moving and handling. The moving and handling ‘champions’ told us they would support good practice within the home and advise staff in this area.

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.

Everyone we spoke with was positive about the management of the home. The registered manager was approachable and people, their relatives and staff had confidence in them. The home had made all necessary notifications and referrals as required. They worked well with external professionals.

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 9 August 2019).

Why we inspected

We received concerns in relation to infection prevention and control, medicines management and health and safety within the home. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has deteriorated to requires improvement. This is based on the findings at this 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.

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.

The home is registered to accommodate up to 34 people. At the time of our inspection there were 31 older people living there.

We found the following examples of good practice:

People were admitted into the home safely.

The home had a clear visiting protocol for people, staff and professionals. Information about this was prominently displayed at the entrance with reminders around the home. Relatives had received a letter informing them of the process.

Where people were anxious about PPE the home had talked them through the reasons why it was needed and provided reassurance. This was revisited with people if needed.

The home was visibly clean throughout and uncluttered. The cleaning schedule included general cleaning and advanced cleaning for high touch point areas such as light switches, handrails and door handles. Specialist cleaning products were used to minimise the risk of infection. Management spot checks were conducted to ensure infection prevention and control compliance.

Management had identified an area of the home that could be used to safely isolate people should they experience an outbreak. The home were regularly testing residents and staff in accordance with the government’s new testing programme. The home has been Covid-19 free so far.

People were actively encouraged to use the outdoor space and join in with activities. These were conducted in line with social distancing guidelines. The home understood the importance of helping people to maintain their mental and physical wellbeing.

Further information is in the detailed findings below.

The Old Rectory Nursing and Residential Home provides personal and nursing care for up to 34 people aged 65 and over, some of whom live with dementia. At the time of the inspection the service was supporting 34 people.

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

People told us they felt safe and happy living at The Old Rectory Nursing and Residential Home. Staff understood how to keep people safe and felt confident that they would be listened to, and action taken, if they had any concerns that people were at risk of harm or abuse.

People were supported by well trained staff who were competent in helping people achieve their desired outcomes and live their lives with as much independence as possible. Staff understood the importance of helping people to stay healthy by supporting them to access relevant healthcare services in a timely way. Risks people faced were minimised and regularly reviewed.

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 were supported by staff who were kind, caring and patient. Staff had got to know people well which enabled mutually beneficial and warm interactions. People told us they were listened to and were encouraged to make decisions about the care and support they received. Staff promoted meaningful choice and gained people’s consent before providing them with care.

People were encouraged to participate in a range of group and individual activities that reflected their interests and abilities. People could choose to spend their day how they wished. When people wanted to spend time alone or with visitors this was respected and supported. Relatives told us they felt welcomed and involved.

People, relatives and staff had the opportunity to feedback and influence what happened at the home via annual surveys. The management were well respected and promoted an open, friendly and supportive culture. Staff felt valued. Their professional development and continuous learning was encouraged.

Quality and safety checks helped ensure people were safe and protected from harm. Audits helped identify areas for improvement with this learning shared with staff. This also ensured that practice standards were maintained and improved.

The home had developed and maintained good working relationships with other agencies including a community mental health team, speech and language therapy and a local university to support student nurse placements.

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 21 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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 unannounced inspection took place on 13 December 2016.

The Old Rectory Nursing and Residential Home provides nursing or personal care for up to 34 people. There were 25 people living in the home at the time of our visit, some of whom were living with dementia.

The service had a registered manager. 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.

People, relatives and staff told us the home was well run and that the registered manager was visible and accessible. There were enough staff to meet people’s needs and staff were unhurried. Staff described the home as a happy place to work and told the registered manager was supportive.

Staff told us they received sufficient training to support them to carry out their job roles competently. New staff completed an induction to ensure they were orientated to the home, its policies and procedures and had knowledge about the care and support needs of people living there. Three new staff told us the induction was very good. Staff were supported through regular supervision and an annual appraisal.

People’s risks were assessed and plans developed to ensure care was provided in a safe way and that people’s risks were minimised. A variety of risks were assessed including risk of skin damage, falls and malnutrition. People’s risks were reviewed and if there were changes in the level of risk, plans were updated to reflect the change.

Staff were aware of what constitutes abuse and what actions they should take if they suspected someone was being abused. Relevant checks were undertaken before staff started work. For example checks with the Disclosure and Baring Service were undertaken to ensure staff were suitable to work with vulnerable people.

Medicines were managed safely. Medicine Administration Records (MAR) were signed to indicate that people’s prescribed medicine had been taken. Staff offered people a drink and remained with them when they administered their medicine. There were on-going checks throughout the day to ensure the amount of medicines were correct.

People were supported to eat and drink. They were offered a choice of where they would like to eat and what they would like. People told us the food was very good and feedback on the menus was obtained.

People were treated with dignity and respect and their privacy was maintained. They were supported to remain as independent as possible.

People and their relatives told us staff were kind and caring. There was a relaxed atmosphere in the home and there was appropriate use of humour. Staff told us it was a happy place to work and we saw there were positive interactions between staff and people and within the staff team.

People had the opportunity to be involved in a choice of activities, including one to one time, craft, and entertainers, pets as therapy or cake making. The activity coordinator was exploring resources to offer people more variety of activities as well as alternative activities aimed at people living with dementia.

There were quality monitoring systems in pace which meant areas for improvements could be identified and actions taken to ensure improvements were made. People’s views were obtained through surveys. We saw that responses to surveys was generally positive. Actions had been taken to address any comments made or when results indicated that improvements could be made. For example the activity coordinator had been appointed and was being supported to review activities and provide more variety of activities.

Concerns and complaints were managed appropriately. We saw that any complaints which had been received had been investigated and had a satisfactory outcome. Information on how to raise concerns or complaints was on display in the home and people told us they knew how they would complain if they needed to.