The Old Rectory

We found the following examples of good practice.

People received visits from their loved ones in line with government guidance. People also had access to telephone and video calling. People were encouraged to maintain social distancing; furniture had been moved to support this. The home had good ventilation in place. Staff were encouraged to support each other with reminders about safe use of personal protective equipment and were observed wearing this in line with guidance. Risk assessments had been updated to consider any additional risks from Covid-19 for example where people were isolating falls risks were considered. Cleaning products had been updated to be in line with government guidance and cleaning regimes were updated to reduce the risk of infection. People, relatives and staff were kept up to date with changes to the government guidance.

The Old Rectory is a residential care home that was providing personal care to 27 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

Audits were in place that checked the quality of the service but it was not always clear what audits were looking at and what actions required follow up. People and staff told us they found the management team approachable. The management team continually sought ways to improve the quality of the service.

Systems were in place to protect people from abuse and staff understood them. Risk was managed and reviewed to ensure people were kept safe. Medication was stored and administered safely. People were supported by a sufficient number of safely recruited staff who knew how to keep people safe.

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 kind and caring staff. People and their relatives were encouraged to be involved in making decisions about their care. People were supported by staff who respected their privacy and dignity and promoted their independence.

Staff understood people’s preferences and individual communication needs. People’s end of life wishes were considered when needed.

Rating at last inspection: The service was rated as Requires Improvement at the last inspection (report published 23 June 2018).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected: This was a planned inspection based on the rating at the last comprehensive inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

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

The Old Rectory accommodates 27 people in one adapted building. People who use the service may have a physical disability and/or a mental health condition such as; dementia. At the time of the inspection there were 23 people using the service.

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.

At this inspection we identified 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.

We found that some medicines were not always managed in a consistent and safe manner.

People were not protected from the risks of abuse because staff had not always recognised and reported possible signs of abuse, which meant investigations had not been carried out as required.

There was a lack of effective systems in place to assess, monitor and improve the quality of care. This meant that areas of concern had not always been identified and rectified.

Records were not always an accurate reflection of people’s needs.

Risks to people’s health and wellbeing were not always managed and people were at risk of inconsistent care.

Improvements were needed to ensure that people received the least restrictive care and treatment to keep them safe and staff understood and followed the Mental Capacity Act 2005.

Improvements were needed to ensure staff were adequately trained to carry out their role and there was system in place to check their competency.

Improvements were needed to ensure that people’s past lives, cultural and diverse needs were assessed and considered to enable individualised care that met all aspects of people’s needs.

Improvements were needed to ensure people’s end of life wishes were taken into account.

There were sufficient suitability recruited staff to provide support to people. People were protected from the risk of infection because the provider had policies and systems in place to control infection risks at the service.

The provider had a plan in place to ensure the environment was of a good standard and met people’s needs.

People were supported with their nutritional needs and action was taken to ensure people at high risk of malnutrition were supported effectively.

Advice was sought from health and social care professionals when people were unwell, which was followed by staff.

People had the opportunity to be involved in interests and hobbies and their social needs were met.

People received support from staff that were kind and compassionate. People’s dignity was respected and their right to privacy upheld. People were supported top make choices in line with their individual communication needs.

People and their relatives knew how to complain. Complaints received had been investigated and responded to in line with the provider’s policy.

The provider had recognised some areas of improvement within the service and had implemented an action plan to improve.

People, relatives and staff felt able to approach the registered manager and the manage4ment team. Feedback had been gained from people to inform service delivery.

The registered manager understood their responsibilities of their registration and worked in partnership with other agencies.

This inspection visit took place on 19 August 2016 and was unannounced. At our last inspection on 18 March 2014 the provider was meeting all of the legal requirements.

The Old Rectory is a care home registered to provide accommodation and personal care for up to 27 people including those living with dementia. There was 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.

Some people did not receive the level of support they needed with their decision making as relatives had been asked to make choices on their behalf.

There were arrangements in place to keep people safe from harm. Staff understood how to recognise potential abuse and the actions they should take in response to their concerns. People’s individual risks associated with their care were identified, assessed and managed to reduce the risk. Staff received training and support to gain the skills and knowledge to provide care for people and completed pre-employment checks to ensure they were suitable to work in a caring environment. People received their prescribed medicines correctly and there were arrangements in place to ensure all medicines were stored and recorded correctly.

People were provided with food and drinks in the most appropriate way to meet their needs. People’s health and wellbeing was monitored and the support of healthcare professionals was sought whenever specialist advice was required. Staff spoke to people politely and provided kind and compassionate care. People’s privacy and dignity was maintained. Relatives and visitors were welcomed by staff and could visit whenever they wished.

People were asked about their likes and dislikes to ensure the care they received met their preferences. People enjoyed a varied programme of entertainment and support with their hobbies to prevent them from becoming socially isolated.

There was a complaints procedure in place and people and their relatives felt that any concerns they raised would be treated appropriately. People, relatives and staff were happy with the management arrangements in the home and felt the managers and the provider were approachable. The quality of the service was monitored to ensure any required improvements were addressed.

In September 2013 we reviewed the administration of medicine in the home, including the documentation, storage and guidance. We found that some medication was stored incorrectly; the medication room was in need of redecoration and some guidance was out dated.

At this inspection we met and spoke with the registered care manager and the deputy care manager. We found that all the issues had been addressed and the home was now compliant.

During the inspection we spoke with the provider, deputy manager, two carers, five people that use the service and three relatives.

We looked at the care records of three people and reviewed their care plans and risk assessments. We saw that people's care and support needs were well documented and up to date. We reviewed the administration of medicine in the home, including the documentation, storage and guidance. We found that some medication was stored incorrectly, the medication room was in need of redecoration and a general tidy was required. Some documentation issues were also identified.

We looked at the recruitment of staff and the safety checks that the provider completed to ensure suitable staff were employed. Three staff files were found to be in order.

We looked at the complaints procedure and spoke with people that used the service about making a complaint. People and relatives we spoke with told us they had not had cause to formally complain. One person told us: 'The staff are very friendly and approachable and they do change things if issues arise. The communication is good, which probably avoids a complaint occurring'.

Some of the people that lived in the home had dementia and therefore not everyone was able to tell us about their experiences. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences. Some people using the service were able to tell us about their experiences and we also spoke with other health professionals.

People told us they were very happy with the care and attention they received. One person told us, 'I have settled in well and I enjoy the meals and all the company'.

We saw care staff interacting with people and their relatives.

We found the home to be warm and inviting. The building was well maintained and homely. People told us they felt safe in the home and well respected by the staff. The provider told us that staffing levels were high to ensure that's people's needs were met. We looked at the staff training matrix and saw that staff had completed the mandatory training.

The provider asked the people who used the service and their relatives to complete an annual questionnaire and give feedback about their experience.