Archived: The Old Rectory Nunney Limited

The Old Rectory provides care and accommodation for up to 24 people in one adapted building. At the time of our inspection there were 12 people living in the home.

The Old Rectory is a “care home”. People living in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Currently there is no registered manager for the service this is a legal requirement. However, a manager has recently been appointed and is planning to make an application to be the registered manager of this service. 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 last inspection a breach of Regulation15 was found in relation to the environment of the home. At this inspection improvements had been made in the environment which had been appreciated by people living in the home, particularly making outside space more accessible and pleasant to use. One person said, "The garden is lovely now they have done it and we used it a lot in the summer it is much better now we can get out."

At the last inspection we had found concerns about recruitment practices of the service. On this inspection we looked at recruitment records and were satisfied the correct procedures had been followed.

There was a failure to ensure all staff had completed necessary training in order for them to demonstrate their knowledge and help in meeting people's care needs in a safe and effective manner.

There was a lack of governance of the service around the provider having oversight of the quality of care being provided specifically having robust and effective audits of the care arrangements so they could identify and drive improvements.

Staff had a good knowledge of people as individuals but this was not always reflected in care plans to ensure care was consistently being provided in a person centred way.

Medicines were administered at the time required and we found no concerns around storage and administration, other than where given covertly. We have made a recommendation in relation to some aspects of the current medicines management.

The service had been subject to an inspection by the fire service. They had found that the service was not fully complying with fire safety legislation and had made some conditions. We asked the provider to provide us with full information as to how they had and were planning to meet the conditions. They had failed to provide us with this information. We have contacted the fire service to advise them of this failure.

People described the service as caring and a number of people spoke positively about the relationships they had with staff and how they were treated with respect. One person said, "I’m happy and get on well with all the staff, they’re very kind, it’s such a nice atmosphere and you can ask them anything." Another said, "I get treated how I like to be treated with respect."

People told us they felt safe and staff recognised and were confident about reporting any concerns about the safety and welfare of people.

The service was responsive to people's changing care needs and had good arrangements for getting support from outside professionals such as community nurses. People received good support from health professionals.

Activities provided by the service were varied and people said how they enjoyed the, "Opportunity to do something." The home had made real efforts to improve the opportunity for people to use the village facilities and be part of the local community.

People enjoyed a varied and nutritious menu and said how much they enjoyed the food. One person said, "The food is lovely and I always get a choice."

People and staff spoke of an open and approachable management and provider.

We have identified two breaches of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

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.