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The Old Rectory Nunney Limited Requires improvement

The provider of this service changed - see old profile

We are carrying out checks at The Old Rectory Nunney Limited using our new way of inspecting services. We will publish a report when our check is complete.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 14 October 2016

This inspection took place on 18 and 19 August 2016 and was unannounced. At our last inspection we found areas for improvement in relation to the Mental Capacity Act 2005, providing of activities and quality assurance arrangements. We looked at these areas as part of this inspection.

The Old Rectory provides care and accommodation for up to 23 people. At the time of our inspection there were 10 people using the service.

There is 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.

Recruitment arrangements failed to ensure perspective employees were fit and proper persons to be employed. There was a risk to people's health and welfare through not undertaking the required checks before employment of staff. People told us they felt safe living in the home. One person told us "I always feel safe here I know staff are there to look after me". A relative told us they did not worry about their relative and said "I know they are happy and safe here." Staff understood their responsibilities about reporting any concerns about possible abuse.

The registered manager failed to act swiftly and effectively in responding to risk of abuse to people living in the home.

Improvement were needed to ensure consistency when administering and managing "as required medicines". There was however satisfactory arrangements for the storage, administration and management of all other prescribed medicines. People received their medicines at the time they were required.

Improvements had been made in ensuring people were protected and their rights upheld when restricting people's liberty and right to freely leave the home without restriction. The registered manager had, as required, made applications under the Mental Capacity Act 2005 and obtained an authorisation under Deprivation of Liberty Safeguards (DoLS) arrangements. However there needed to be improvements in the process and recording when making best interests decisions.

There were consistent numbers of staff on duty. People told us care staff responded promptly to requests for assistance. The service protected people's rights by seeking consent for care and use of certain equipment.

People told us they felt confident about staff having the necessary skills and training.

People had access to community health services and their GPs when this was requested. Healthcare professionals we spoke with were positive about the care provided by the service.

People spoke positively about the quality of meals provided by the service. Improvements had been made after discussion of menus and meals with people in their regular meeting with the registered manager.

People spoke warmly of staff and described them as caring and kind. One person said, “I am always treated in a caring and respectful way.”

Staff had an understanding of people as individuals, their preferences, likes and dislikes. Care staff supported people in a professional, calming and sensitive manner.

People were involved in their care arrangements and had yearly reviews so care plans accurately reflected their care needs.

There were areas of the home which were in a poor decorative state and required redecoration and refurbishment and to reflect a less instuitional appearance. There was a lack of attractive and accessible outdoor space.

There was a welcoming environment where people were able to maintain their relationships with family and friends. One relative commented, “It is like home and we are always made to feel welcome staff are always friendly.”

People told us they found care staff caring and friendly. One person said "I have been very pleased with the care shown and staff are very kind”. Staff supported people in a way which upheld their dignity, privacy and with respect.

There had been some improvement in activities and people being part of the local community. However this remained an area for improvement with action needed on suggestions made by people about the activities they would like to have. There were plans to undertake a questionnaire specifically asking people about their views in relation to activities.

The service had introduced regular meetings with people so they could discuss and make suggestions about the care they received. Some actions had been taken in response particularly about the meals and menu however there remained suggestions which needed to be acted upon.

The registered manager promoted an environment where people and staff were able to express their views which had resulted in some improvements in areas of care provided by the service.

There had been some improvements in the undertaking of quality assurance audits and action taken as a result.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the recruitment arrangements did not ensure perspective employee were fit and proper persons and areas of the home had not been maintained to provide an environment which was homely and suitable.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We have made two recommendations one about the arrangements for undertaking best interests decision's and the other to seek advice and guidance about the administration of "as required" medicines.

Inspection report


Inspection areas

Safe

Requires improvement

Updated 14 October 2016

The service was not always safe.

People did not benefit from safe recruitment and selection arrangements.

People could be confident there were safe arrangements for the administration and management of medicines.

People were protected from the risk of abuse through care staff having an awareness and understanding of how to protect vulnerable people.

People received support and assistance at the time it was needed

Inspection report


Effective

Requires improvement

Updated 14 October 2016

The service was not consistently effective.

Arrangements for undertaking best interest's decisions did not evidence or demonstrate the registered manager had taken the necessary steps to ensure they had acted lawfully in protecting people's health and welfare.

People did not always benefit from a warm and inviting environment because some areas of the home required refurbishment, decoration and updating.

People's rights had been protected in the use of DoLS.

People’s consent to care was sought and people were able to make choices about their daily lives.

People, where able, were not encouraged to be independent when having their meals.

Inspection report


Caring

Good

Updated 14 October 2016

The service was caring.

People were supported by caring and professional staff.

People were supported by staff who were patient and had respect for people’s dignity and privacy.

Inspection report


Responsive

Good

Updated 14 October 2016

The service was effective.

People had benefited from improved activities though further opportunities for people's interests and activity choices to take place were needed.

People had a number of opportunities to say what they felt and make suggestions in how the home provided care and the personal care they received.

People were able to maintain valued and important relationships and friendships.

The provider ensured people's individual and particular health needs were met so people benefited from having their health and welfare protected by responsive care.

Inspection report


Well-led

Requires improvement

Updated 14 October 2016

The service was not consistently well led.

The registered manager had failed to act swiftly and decisively in responded to risk of abuse from an employee.

Quality assurance audits were not consistent and thorough in identifying areas for improvement.

People and staff benefited from an environment which was open and promoted a culture where people and staff could express their views.

Inspection report