Archived: 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.

At our last inspection on 18 August 2015 we asked the provider to make improvements to ensure people who used the service were protected from avoidable harm or risk of harm. This was specifically in relation to the environment. At this inspection, we found that the provider had made, and was in the process of making improvements to the home. By doing this, the risks identified previously were minimised.

We had also asked the provider to make improvements in how individuals care needs were planned and assessed. At this inspection we saw that some improvements had been made however we saw information was missing that would have assisted staff to understand and respond to people’s care needs better.

The provider had not been effective in the use of the audits to identify improvements that were needed. We asked them to make improvements so they had an effective and consistent way of analysing incidents and accidents to identify emerging trends. At this inspection we saw that some improvements had been made. However we did not see that an overall analysis of trends took place which would have brought each piece of individual information together.

People were not always supported to make choices. When they were unable to make decisions, it was not clear how the provider had acted in their best interests. The home environment lacked signage to enable people to find their way around the home. People enjoyed the food and were supported with their nutritional needs, but the meal time experience was not a positive one for everyone.

People’s interests and hobbies were not always considered and there was little stimulation for people. Not everyone was aware how they could raise concerns and the way of doing this was not accessible to all the people who lived there.

We found that people were protected from harm and staff were aware of the different types of abuse that could happen and were confident in how to raise any concerns. Risks were managed and there were enough staff to keep people safe. Medicines were managed safely. Staff had the knowledge they needed to support people and people were supported to maintain their health.

People were treated with kindness and their dignity and privacy were promoted and respected. People were encouraged to be independent and when possible were enabled to make choices and have some involvement with the planning of their care. Visitors were made to feel welcome.

There was a visible management presence and people spoke positively about the overall culture of the home.

You can see what action we told the provider to take at the back of the full version of the report.

During our inspection we wanted to understand people's experience of the service they were using. We did this by spending time sitting and talking with people. We used a Short Observational Framework Inspection (SOFI) to observe care. SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We read care records and spoke with staff about people's needs.

In September 2013 we made compliance actions in the following areas: Assessing and monitoring the quality of service provision, Consent to care and treatment, Meeting nutritional needs, Safety, availability and suitability of equipment, and Staffing. At this inspection we followed these up and found they were still not fully met.

In August and September 2014 concerns were raised about practices at the home. This included moving and handling methods, and untidy and unsafe premises.

Below is a summary of what we found.

Is the service safe?

There were areas of potential risks to people who used services. This was because not all pipes were guarded in an area where people could be at risk from burns because of this.

Communal areas were sometimes cluttered. The registered person had not taken sufficient steps to promote people's safety following accidents in the home.

Systems were in place to ensure staff were recruited so that they were safe to work with people who used the service. When staff shortages were identified the provider would find cover whenever possible.

The was an odour in some areas of the service and staff did not always remember to wash their hands in between giving eye medicines. This showed that staff did not always follow the provider's infection control measures.

Is the service effective?

Staff were trained to enable them to carry out their roles. However, when they communicated with people this was not always evident. There were times when staff did not listen to people's wishes therefore they were not respecting their dignity.

Staff did not demonstrate an understanding of the relevant requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards. This is a law that protects people's right to consent to care and treatment and to their freedom.

People were not always involved in decisions about what they ate and drank. This was because the mealtime experience did not always support their needs.

Is the service caring?

We observed a meal left outside a bedroom. The staff member did not return to check if the person had collected it. We found that staff did not always give consideration to people's dignity and well- being.

Is the service responsive?

We observed people to take part in the activities provided by a staff member who motivated them and engaged with people throughout the day. People told us they were encouraged to take part in activities that they preferred and found interesting.

Concerns and complaints procedures were provided for people and their family representatives to use. The provider was able to use their comments, compliments and concerns to improve the service. For example, people wanted to participate in activities during the day and these were now provided as group and individual activities.

Is the service well led?

At our last inspections in July 2013 and September 2013 there was no registered manager for the service. The provider was aware that the service required a manager to be registered with us. At the time of this inspection, a registered manager was still not in post although the provider told us they had started the process of a registered manager for the service. Staff told us that the management team provided them with support.

There were systems in place to check the quality and safety of the service but these were not always effective. Not all shortfalls identified during our inspection had been identified by the provider and some issues had not been acted on.

We found that there was no registered manager in place at the home. The provider told us that he was in the process of recruiting a new manager to work at the home.

We found that the provider had put systems in place to ensure that people who used the service were protected against the risks associated with the unsafe management of medicines.

We found that the provider had introduced a quality monitoring system to identify discrepancies and gaps in people's care records. However, we found that the system was not effective in addressing and managing the risks to people's health and welfare. Care plans did not always reflect people's current treatment needs.

We found that the provider had commenced a programme of monthly quality monitoring audits. However we found that risks identified in these audits were not always addressed.

We found that there was a continued lack of provider oversight to ensure the effective operation of systems designed to ensure that service users benefitted from safe, quality, care, treatment and support. People were at risk of receiving unsafe treatment and support due to the lack of effective management of the risks to their health, welfare and safety.

We found that people were not protected from the risk associated with the unsafe management of medicines.

People and relatives we spoke with told us that food at the home was provided in sufficient quantities but the quality had recently declined. One person told us 'It's below par now'. We found that the provider was failing to protect people from the risks associated with poor nutrition.

We found that there were not always enough suitably qualified and skilled staff to meet people's needs. Relatives we spoke with told us 'staff never have enough time, because there aren't enough of them' another relative told us some staff are willing to do anything, but some of them don't have the right knowledge and skills to do the job properly'.

People could not be assured that decisions were made in their best interests because staff lacked sufficient knowledge of the Mental Capacity Act and the Deprivation of Liberty Safeguards which meant that people could not be assured that decisions were made in their best interests. We also found that staff did not always ensure people's choices were respected.