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Inspection carried out on 7 January 2020

During a routine inspection

About the service: The Old Rectory is a 15 bedded care home for people with learning disabilities in Musbury, near Axminster. It specialises in caring for people with autism spectrum disorder and health, emotional and behavioural needs. The provider is Oakprice Care Limited, a family run business. People who live there range from young adults to older people. At the time of our inspection there were 15 people living there.

People's experience of using this service:

The Old Rectory provided people with a homely, happy and friendly environment. People were supported by staff that were caring and compassionate. People were treated with dignity and respect and in a way that was free from discrimination. People were encouraged to make their own decisions and staff understood how people communicated their choices.

People received a personalised service from friendly, supportive staff. People liked the staff and enjoyed being with them. Staff knew people's needs and preferences well. Relatives spoke highly of the staff team and the registered manager and said they made sure people had enjoyable experiences and a happy and varied social life.

People were relaxed around staff and relatives said the service was safe. Staff demonstrated an awareness of each person's safety and how to minimise risks for them. People's concerns were listened and responded to. Accidents and incidents were used as opportunities to learn and improve the service.

People were supported by staff with the skills and knowledge to meet their needs. Staff had regular training and felt confident in their role. They worked in partnership with local health and social care professionals to keep people healthy.

The service was well led. People, relatives and professionals said the registered manager and business manager were approachable, organised, and acted on feedback. Quality monitoring systems included audits, observation of staff practice and regular checks of the environment with continuous improvements in response to findings.

The service has been developed and designed 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.

The service was a large domestic style property. It is registered for up to 15 people. Although this is larger than current best practice guidance for learning disability services, any potential negative impact on people was mitigated because people lived in smaller groups together, within four separate units. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. Ongoing efforts were being made to find new opportunities for several younger people to undertake stretching and interesting work, towards gaining new skills and increased confidence.

People were supported to have maximum choice and control of their lives and staff assisted them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection: Good. (report published June 2017).

Why we inspected: This was a planned inspection based on the rating at the last comprehensive inspection. At this inspection, the service remained Good.

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

Inspection carried out on 23 May 2017

During a routine inspection

The Old Rectory is a 15 bedded care home for people with learning disabilities. It specialises in caring for people with autism spectrum disorder and health, emotional and behavioural needs. The provider is Oakprice Care Limited, a family run business. People who live there range from young adults to older people, and live within four separate units. At the time of our inspection there were 15 people living at The Old Rectory.

At the last inspection on 8 December 2015, the service was rated Good overall. However, we rated the ‘effective’ domain as requires improvement because there were two breaches of regulations found at that inspection. This was because consent arrangements for people who lacked capacity were not fully in accordance with the Mental Capacity Act 2005, as best interest decisions made were not always recorded. Also, because new staff did not receive a comprehensive induction when they started working for the service to enable them to carry out their duties. This inspection found improvements had been made in both those areas and the service was now meeting all the requirements of the regulations.

At this inspection we found the service remained Good.

Why the service is rated good:

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People’s rights were protected because improvements had been made in the policies and recording systems the service used for people who lacked capacity. They had improved their documentation to demonstrate involvement of professionals and relatives in best interest decision making.

Improvements had been made in induction arrangements for new staff. They received a more comprehensive induction, and worked alongside more experienced staff. This meant they got to know people well and how to meet their needs before working with them unsupervised. Staff received regular training and supervision which enabled them to feel confident in meeting people’s needs and recognising changes in their health.

The service continued to provide safe care to people. People were supported to have maximum choice and control of their lives. Measures to manage risk were as least restrictive as possible to protect people’s freedom. There were enough staff to meet people's needs and support them with activities and trips out. Medicines were safely managed on people’s behalf. There were effective staff recruitment and selection processes in place.

People received effective care and support from staff who received regular training and updating.

Health and social care professionals were involved in people’s care to ensure they received the care and treatment which was right for them. People were supported to maintain a balanced diet, and to keep active.

People had built strong relationships with each other and with staff who were caring and compassionate. There was a happy atmosphere in the home and people told us they liked staff who were always kind. People's privacy and dignity was respected. A visiting professional said, “I love going to The Old Rectory, it’s got a nice homely feel, and there is a good mix of older and younger people.”

People enjoyed a wide variety of hobbies and interests and were part of their local community. They received personalised care and support that met their individual needs. Care plans were personalised to reflect people’s preferences and provided detailed information about the support they needed.

The service was well led by a registered manager who was open and approachable. People had lots of opportunities to have their say and their views and suggestions were taken into account to improve the service. Staff spoke positively about good communication and teamwork and had opportunities for professional development. A number of methods were used to assess the quality and safety of the service and staff made continuous improvements in response to their findings.

Inspection carried out on 8, 11 and 15 December 2015

During a routine inspection

This unannounced inspection took place on 8 December 2015. We returned on 11 and 15 December 2015 as arranged with the management team. This inspection was brought forward in response to receiving information of concern about how people were spoken to by staff, a lack of incident reporting to the local authority safeguarding team, staff having limited access to care files and new staff receiving a poor induction when starting work at The Old Rectory. We were unable to substantiate these concerns during our inspection, apart from staff receiving a limited induction when starting work at the home and a lack of incident reporting. Our last inspection in December 2013 found the service to be meeting all of the Health and Social Care Act 2008 regulations inspected.

The Old Rectory is a 15 bedded care home for people with learning disabilities which is spread over four units. It specialises in caring for people with autism spectrum disorder and health, emotional and behavioural needs. At the time of our inspection there were 13 people living at The Old Rectory.

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.

On one occasion consent for care and treatment was not given in accordance with the Mental Capacity Act 2005.

Staff did not receive a comprehensive induction when they started working for the service to enable them to carry out their duties they were employed to perform.

There were effective staff recruitment and selection processes in place. Staffing arrangements were flexible in order to meet people’s individual needs. Existing staff received a range of training and regular support to keep their skills up to date in order to support people appropriately. Staff spoke positively about communication and how the registered manager worked well with them, encouraged team working and an open culture.

People felt safe and staff demonstrated a good understanding of what constituted abuse and how to report if concerns were raised. Measures to manage risk were as least restrictive as possible to protect people’s freedom. Medicines were safely managed on people’s behalf.

Care files were personalised to reflect people’s personal preferences. Their views and suggestions were taken into account to improve the service. They were supported to maintain a balanced diet, which they enjoyed. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

Staff relationships with people were strong, caring and supportive. Staff were motivated and inspired to offer care that was kind and compassionate.

A number of effective methods were used to assess the quality and safety of the service people received.

Inspection carried out on 13 December 2013

During a routine inspection

There were 11 people living at the home when we visited. We spoke with eight people and asked them about their experiences of living at the home and we spoke with five relatives who regularly visited the home. We spoke with seven staff which included the provider, a member of management team and five care staff and asked them about people's needs. We observed people�s care in communal areas of the home and looked in detail at four people's care records. We also spoke with two health professionals who regularly work with the home to ask them about their experiences.

Once person said, �Staff are quite nice�, another person said, �I�m really happy here�. We saw another person use sign language to indicate to staff that they were feeling happy. Relatives we spoke with told us they were very happy with the care provided at the home. They said they were included involved and included in the person�s life and in decision making about their care and felt welcome to visit the home anytime. One relative said, �The home is marvellous, we couldn�t survive without them. The change in him is amazing, he was quite aggressive at home. Now he is so relaxed and happy�. Another relative said, �They have been brilliant, staff are so supportive. X looks happy, relaxed and chatty�. Health professionals told us staff worked well with the family and contacted them appropriately about people�s health care needs. A GP we spoke said, �I have no concerns at all about the home, it is very well run�.

We found people's care needs and risks were assessed and care plans were developed to meet individual needs. Staff we spoke with knew about people's needs and how to meet them, which was in accordance with their care plans. People were protected from abuse because staff were trained to recognise signs of abuse and report any concerns. We found the provider had taken steps to provide care in an environment that was suitably designed and adequately maintained.

Inspection carried out on 3 January 2013

During a routine inspection

We met all of the people who lived at the home and looked in detail at the care given to three people. Some people we met were unable to communicate with us and we observed their care to help to understand their experience of living in the home. We spoke with six staff about how they were supported to meet people's needs.

People told us they were happy at The Old Rectory and that they have the opportunity to go out and do different things. They told us that staff listened to what they wanted and helped people to do things they found difficult. People told us that they felt safe, were well looked after and are involved in making decisions about their life.

We observed staff sensitively and positively responding to the needs of people that had no verbal communication. We also observed staff listening and responding to what people said to them.

Staff told us that they have opportunity to undertake training (in addition to mandatory training) and had regular supervision and appraisals. They felt well supported.

Staff at The Old Rectory work closely with other service providers to ensure good quality care was maintained.