We carried out a review of the data available to us about The Old Rectory 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, you can give feedback on this service.
We found the following examples of good practice
The home was clean and well maintained. There was regular cleaning throughout the day, and this included high-touch areas. The care staff were also responsible for both the cleaning and laundry and were knowledgeable regarding current COVID-19 cleaning guidelines. Robust cleaning schedules were in place. The registered manager was the infection lead for the home and undertook spot checks on staff practice. The registered manager also did daily walk rounds to observe practice and support staff and people.
Following an outbreak of COVID-19, the home was currently following government guidance and was closed to visitors apart from those whose visits were essential to the health and well-being of a specific person. At present there was one person who had a dedicated visitor who had had a thorough risk assessment undertaken and followed the visiting procedure on every visit. Visitors at this time were asked to wear personal protective equipment (PPE), have a lateral flow test on arrival and have their temperature taken. This included health professionals.
Staff supported people to remain in contact with their families by phone calls and video calls during the pandemic. There was a visiting policy to support visitors once the home re-opens to visitors. There was a separate activity building away from the main house which could be used for visitors as this enables social distancing. Staff said that people had been accepting of the lockdown and use of PPE, and staff had kept people motivated with in-house activities and been involved with redecorating the premises.
The home has just re-opened for admissions. All new arrivals to the home will only be accepted with a negative polymerase chain reaction (PCR) test and will isolate for 14 days.
There were systems in place that ensured that people who had tested positive for COVID-19 and self-isolating were cared for in their bedrooms to minimise the risk of spreading the virus. Staff were provided with adequate supplies of PPE and staff were seen to be wearing this appropriately. Staff had received specific COVID-19 training from the provider, and this included guidance for staff about how to put on and take off PPE safely. Updates and refresher training took place to ensure all staff followed the latest good practice guidance. They were seen to be following correct infection prevention and control practices (IPC). Hand sanitiser was readily available throughout the home.
Regular testing for people and staff was taking place. There had been changes to testing following their outbreak of COVID-19 as people and staff who tested positive were not tested for 90 days as per government guidance. Routinely all staff have a weekly PCR and twice weekly lateral flow test (LFT). In addition, they have their temperatures taken daily. People have a monthly PCR test with daily temperatures and oxygen level checks.
The premises has large communal rooms and people who chose to visit the dining areas or communal areas were supported by staff to maintain social distancing. For example, chairs and tables had been re-arranged to allow more space between people.
The service was registered before Registering the Right Support policy was introduced. The service has been further developed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
People’s experience of using this service and what we found
The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
People received safe care and support by staff who had been appropriately recruited, trained to recognise signs of abuse or risk and understood what to do to safely support people. One person said, “It’s my home and I feel safe.” People were supported to take positive risks, to ensure they had as much choice and control of their lives as possible. We saw that people were supported to be as independent as possible with the use of walking aids and access to mobility cars to go out when they wished to. Medicines were given safely to people by trained and knowledgeable staff, who had been assessed as competent. There were enough staff to meet people's needs. The provider used a dependency tool to determine staffing levels. Staffing levels were regularly reviewed to meet peoples’ individual needs and to ensure they can access the community and hospital appointments. Safe recruitment practices had been followed before staff started working at the service.
Staff had all received training to meet people’s specific needs. During induction, they got to know people and their needs well. One staff member said, “It’s really lovely here, everyone works as a team to make sure we support people in the safest and best way. We got lots of training to do this.” People’s nutritional and health needs were consistently met with involvement from a variety of health and social care professionals.
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 relaxed, comfortable and happy in the company of staff. People’s independence was considered important by all staff and their privacy and dignity was promoted.
Staff were committed to delivering care in a person-centred way based on people's preferences and wishes.
There was a stable staff team who were knowledgeable about the people they supported and had built
trusting and meaningful relationships with them. Activities were tailor-made to people’s preferences and interests. People were encouraged to go out and form relationships with family and members of the community. Staff knew people’s communication needs well and we observed them using a variety of tools, such as sign language, pictures and objects of reference, to gain their views.
People were involved in their care planning. End of life care planning and documentation guided staff in providing care at this important stage of people’s lives.
People, their relatives and health care professionals had the opportunity to share their views about the service. Complaints made by people or their relatives were taken seriously and thoroughly investigated. The provider and registered manager were committed to continuously improve, and had developed structures and plans to develop and consistently drive improvement within the service and maintain their care delivery to a good standard.
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 Requires Improvement (published 22 January 2019).
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 Old Rectory provides care for up to 16 people with learning disabilities, who may also live with an attached diagnosis such as autism, diabetes, Down's Syndrome or epilepsy. There are two properties set within large grounds, one accommodating up to 13 people and the other up to three people. The ages of people who lived in the Old Rectory currently, ranged from 30 years up to 75 years old.
Rating at last inspection:
The rating of this service at our last inspection was "Requires Improvement.” (Report published 28 December 2017)
At our last inspection, there were four breaches of the regulations.
Why we inspected:
This was a planned inspection based on the rating at the last inspection and aimed to follow up on concerns we found in August 2017. In addition, we had received some information of concern received anonymously prior to the inspection. We explored the areas of concern as part of our inspection.
People’s experience of using this service:
Whilst the provider had progressed quality assurance systems to review the support and care provided, there was a need to further embed and develop some areas of practice that the existing quality assurance systems had missed. This included updating care plans when an identified need or directive of care changed. For example, management of diabetes. We also found the cleaning audits had not identified shortfalls in the cleanliness of the premises.
There was still a need to improve the provision of meaningful activities for people to prevent isolation and boredom. Plans were in place but there had been delays in implementing the changes due to staffing changes.
People spoke positively of the home and commented they felt safe. Our own observations and the records we looked at reflected the positive comments people made. Most care plans reflected people’s assessed level of care needs and care delivery was person specific, holistic and based on people's preferences. Risk assessments included falls, skin damage, behaviours that challenge or cause distress, swallowing problems and risk of choking, and mobility. The care plans also highlighted health risks such as diabetes and leg ulcers. People said they felt comfortable and at ease with staff and relatives felt people were safe. Staff and relatives felt there were enough staff working in the home and relatives said staff were available to support people when they needed assistance. Pre-employment checks for staff were completed, which meant only suitable staff were working in the home. All staff had attended safeguarding training. They demonstrated a clear understanding of abuse; they said they would talk to the management or external bodies immediately if they had any concerns.
The manager and staff had completed training on the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. They had assessed some restrictions were required to keep people safe for example, some doors were locked. Where this was the case referrals had been made to the local authority for authorisations. People had access to healthcare professionals when they needed it. This included GPs, dentists, community nurses, and opticians. Staff received regular support from management which made them feel supported and valued. They were encouraged to develop their skills and take on additional responsibilities. Staff spoke positively about the changes made to the running of the home and the way the home was managed.
Staff were kind and caring, they had developed good relationships with people. They treated them with kindness, compassion and understanding. Staff supported people to enable them to remain as independent as possible. They communicated clearly with people in a caring and supportive manner. We received positive feedback from relatives and visiting professionals about the care provided. The service worked well with allied health professionals. A number of audits had been developed, including those for accidents and incidents, care plans, medicines and health and safety. Maintenance records for equipment and the environment were up to date, such as fire safety equipment and hoists. Staff said they were encouraged to suggest improvements to the service.
Follow up:
The service remains Requires Improvement. The service had met the breaches of regulation, however further time was needed to ensure the improvements were continued and sustained.
As the service remains rated as requires improvement, we will request an action plan from the registered provider about how they plan to improve the rating to good. In addition, we will monitor all information received about the service to understand any risks that may arise and to ensure the next planned inspection is scheduled accordingly.
We previously inspected this service in July 2014 when the provider was found to be meeting all the required standards.
This was an unannounced inspection. The newly appointed manager who has been registered with the Care Quality Commission (CQC) was present during the inspection. 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.
Systems were in place for the safe management of medicines but these were not always followed; there was a risk people might not receive their medicines appropriately. Staff understood their responsibilities to report and respond to accidents but there was an under reporting of incidents and this could place people at risk of continued incidents. A risk assessment process was in place but this was not always effectively monitored to ensure risk management strategies were working. The provider was not ensuring that the information gathered about prospective staff was to the required standard to inform recruitment decisions.
Fire prevention arrangements were in place but Not all staff had received training in this area. There was a comprehensive training programme in place to provide staff with basic core skills and specialist training, however the turnover in staff meant that nearly 50% of staff were still to complete infection control, moving and handling and first aid training with a third of staff still to complete safeguarding and mental capacity training.
The quality assurance processes did not provide the provider with regular oversight of the service. Internal checks within the service to monitor care plan content and risk management and medicines were not being completed robustly to be effective. Staff felt supported but their involvement in staff meetings was limited. People and relatives feedback was not specifically used to influence the service development.
There were enough staff to meet people’s care needs but their availability to spend time with people was limited and staffing levels and deployment were an area for improvement. People had activity planners to reflect their individual interests, hobbies and preferences but some people went out more than others and those who stayed in the house lacked stimulation. A pre-admission process was in place to assess the needs of new people and ensure their needs could be met, but records of the assessment and transition arrangements for a newer person could not be found.
People’s health was monitored by staff that supported them to access routine and specialist health care appointments. People were given choices about what they ate and special dietary needs were supported. Staff sought peoples consent for everyday care and support tasks; staff understood and were working to the principles of the mental Capacity Act 2005 and DoLS to ensure the least restrictive measures were in place.
People liked the staff that supported them, they showed they were comfortable and relaxed around staff and enjoyed a laugh and a joke with them, staff appeared to be kind and respectful towards people.
There had been investment in the premises to make this a more comfortable place to live; this was on going and there were further improvements that the registered manager had identified and had received permission to progress. People who needed special equipment for their everyday needs had been provided with this and this was maintained and serviced. Where possible people’s changing mobility and care needs had been accommodated and adaptations made. Other equipment, such as fire prevention equipment, electrical installation and boiler and heating system were regularly serviced. Staff also undertook visual checks and tests weekly and monthly to ensure some equipment remained in working order. Although not all staff had yet received safeguarding training, staff showed they understood their responsibilities to safeguard people from harm and all forms of abuse, they knew to report any suspicions they might have through whistleblowing or safeguarding processes.
People’s care plans were comprehensive and provided a person centred view of people’s needs and how they preferred support to be delivered including how staff should communicate with them. These were regularly evaluated and updated by staff, these guided staff in their day to day support of people to ensure this was in accordance with their preferences.
Some people were able to tell us who they would go to if they were unhappy about something and were confident of doing so, relatives equally felt able to raise concerns if necessary. An easy read version of the complaints procedure was in place to inform people about making a complaint. Staff understood how those people who could not use the procedure showed their emotions when angry, sad or upset and staff would seek to find the causes for this and try to resolve any concerns.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of this report.
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.
This was an unannounced inspection. The Old Rectory provides care for up to 16 people with learning disabilities. There are two properties set within large grounds, one accommodating up to 13 people and the other up to three people. The smaller property reflected the needs of a quieter group and the larger property was more lively and spacious.
People’s needs were varied, some people had communication difficulties, a number displayed behaviours that challenged and a number were on the autism spectrum. The rear garden was secure which meant that people could use this area safely. Specialist equipment was available for those who required this and the property had been adapted in areas to accommodate people’s individual needs. To the rear of the property there was day centre and some people chose to spend time there each day.
The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. The manager provided good leadership and support to the staff. In addition to speaking with the manager we spoke with six people who use services, a senior care worker and two care workers. Throughout our inspection, staff were positive about the home, they said there was good teamwork and they felt supported. A staff member said that the manager, “Listens and values our opinions.”
Staff treated people with respect and dignity. They had a clear understanding of people’s individual needs and aspirations and could tell us how each individual liked to be supported. Each person had a keyworker who they spent time with. A keyworker is a named staff member who has specific responsibilities to assist the person in meeting their individual needs and wishes. People told us that if they had any concerns or worries they could speak with their keyworker or the manager of the home.
One person raised a number of concerns/worries with us during the inspection. By the end of the inspection the home had taken action to address the concerns and the person told us that they were happy with the actions taken and the outcome.
At one to one meetings with their keyworkers and at the monthly residents ‘your voice’ meetings people were supported to choose what activities they wanted to do the following month. Activities were flexible and people could change their mind if they wanted to opt out of an activity. Monthly meetings were also used to keep people informed about a range of matters for example, staff changes or upcoming maintenance of the home. In addition, they were opportunities for people to have a say in the running of their home.
Staff attended regular supervision meetings and received an annual appraisal of performance. Staff meetings were used to ensure that staff were kept up to date on the running of the home and to hear their views on day to day issues. Staff were also able to feedback their views through annual questionnaires. All staff received training to fulfil the duties of their role and more specialist training was also offered to ensure that staff met the needs of people.
Staff received training on the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and they had a good understanding of the legal requirements of the Act. They were aware of restrictions posed on some people in the home and why they were in place.
Care plans were comprehensive and were written in a way that meant that any new carer would have been able to read the care plan and know how to support the person including specific information about their personal preferences. They had been reviewed regularly and people confirmed that staff had read the care plans to them and made sure they understood the contents.
Within each person’s care plan there was detailed information about how best to communicate with the person. Staff were knowledgeable about people’s needs and were clearly able to explain how they made sure they understood the choices made by people with limited verbal communication skills.
We found that care plans clearly documented the needs of people and how they should be met. Staff ensured that consent was obtained prior to providing care and support. Where appropriate, specialist advice and support was obtained to meet people's individual needs.
We looked at measures in place to ensure the risk of infection was minimised and found that procedures were clear, the home was clean and it was free from odours. Staff received regular training to meet the needs of people. Systems in place ensured that all staff attended regular supervision and appraisal meetings. There were detailed systems to ensure that the quality of care provided was monitored and reviewed on a regular basis.
We observed staff interacting positively with people. Care plans were reviewed regularly but they were not sufficiently detailed and fully reflect people's needs. Where appropriate, specialist advice and support was obtained and included in care plans.
The environment both internally and externally was in need of redecoration and plans were in place to commence refurbishment in June 2013.
There were sufficient numbers of staff on duty and staff felt well supported. Staff were clear about what they should do if they suspected abuse.
There were systems in place to monitor the quality of the care provided. These identified that improvement was needed in many areas. Close monitoring was in place but the new systems and procedures were not fully embedded into everyday practice.