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Archived: The Old Rectory Inadequate

Inspection Summary


Overall summary & rating

Inadequate

Updated 26 October 2018

The inspection was carried out on the 31 July 2018, 01 and 08 August 2018. The inspection was unannounced on 31 July and 08 August 2018 and announced on 01 August 2018.

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 provides care and support for up to 40 people who have physical disabilities, learning disabilities and autism. People's needs varied and some people needed lots of support with communication and their healthcare needs. Some people were living with autism and some people needed support with behaviours that challenged. On the day of our inspection there were 31 people living at the service.

The registered provider was in charge of the day to day running of the care home. A registered provider is a '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.

We carried out our last comprehensive inspection of this service on 31 January and 1 February 2018 and we gave the service an overall rating of ‘Requires Improvement.’ At that inspection we found six breaches of the legal requirements of the Health and Social Care Act Regulated Activities Regulations 2014. The breaches related to Regulation 9- person centred care, the registered provider had failed to ensure that people received person centred care. Regulation 12- safe care and treatment, the registered provider had failed to ensure that care was provided in a safe way to people. Regulation 13-safegaurding people from abuse and improper treatment, the registered provider had failed to ensure that restrictions on people’s liberty was appropriately authorised. Regulation 17- good governance, the registered provider had failed to maintain accurate and complete records. Also, the registered provider had failed to establish and operate systems to assess, monitor and improve the quality of the services provided and reduce risks to people. Regulation 18- staffing, the registered provider had failed to ensure that staff were fully trained to be able to complete their roles effectively. Regulation 19- fit and proper persons employed, the registered provider had failed to ensure that staff were recruited safely. We also found a breach of the Care Quality Commission (Registration) Regulations 2009, Regulation 18- notifications of other incidents. The registered provider had failed to notify CQC of notifiable events in a timely manner.

We also made three recommendations. The recommendations related to the management of cleanliness and infection control, the management of complaints, the management of end of life care planning.

After our last inspection the registered provider sent us an improvement action plan telling us how they intended to meet the legal requirements of the Health and Social Care Act Regulated Activities Regulations 2014 and the Health and Social Care Act Registration Regulations 2009. They told us they would meet the regulations by 01 May 2018. At this inspection we found there had been an improvement to Regulation 19- fit and proper persons employed, but we found continuing breaches of Regulation 9- person centred care, Regulation 12- safe care and treatment, Regulation 13-safegaurding people from abuse and improper treatment, Regulation 17- good governance and Regulation 18- staffing. We also found breaches in Regulation 10-dignity and respect, Regulation 14-meeting nutritional needs and Regulation 15-premises and equipment.

We found one of the recommendations had been acted on, which was the management of end of life care planning. The management of complaints had been partially met. However, we found the other recommendation had not been implemented, which was the management of cleanline

Inspection areas

Safe

Inadequate

Updated 26 October 2018

The service was not safe.

People in the service had not been protected from physical and emotional harm. Risks were not properly assessed and managed to keep people safe. People were not protected by a culture of learning from incidents.

The registered provider had not reported alleged abuse. Staff told us they knew how to recognise abuse, however we found a culture where staff may not recognised abuse when it happened.

The registered provider did not have adequate systems to assess the staffing levels required to meet people’s needs safely. There were not enough staff available to meet people’s assessed needs and manage the risks to people to protect them from harm.

Staff had not had appropriate training to manage challenging behaviours.

The premises were not maintained to protect people from potential harm.

Medicines were administered safely.

Effective

Inadequate

Updated 26 October 2018

The service was not effective.

People’s needs were not fully assessed so that they received care based on their needs and choices.

The training did not fully equip staff with the skills they needed to provide safe person-centred care for people. Staff did not have sufficient knowledge to deliver care to people with learning disabilities.

People’s capacity to make their own decisions had not been properly assessed. People were subject to restrictions and decisions had been made without staff implementing the best interest decision process.

People’s health and wellbeing was not protected through the proper management of their nutritional and hydration needs. Staff did not always refer people to their GP or respond appropriately to recommendations made by external health care professionals.

Caring

Inadequate

Updated 26 October 2018

The service was not caring.

Staff in the service did not fully understand how to care for people living with a learning disability or autism. People were not always involved in decisions about their care and treatment.

The registered provider had allowed an institutional culture to develop in the service so that the care was service led rather than person centred.

Privacy and dignity was not upheld by the provider as people in the service could not stop others from entering their bedrooms.

People’s personal belongings were often taken by other people as they could not keep them secure.

Staff were friendly towards people but did not have time to interact or respond to people.

Responsive

Inadequate

Updated 26 October 2018

The service was not responsive.

Care plan records were not fully updated following changes in people's needs or after an incident.

When people needed support from other professionals such as GP’s, staff did not respond with any urgency so people’s health needs were not met.

Complaints were recorded and had been responded to in writing. However, there was lack of information or assistance that made the complaints system accessible to everyone.

The opportunities for people to develop their goals, life skills and community participation, or take part in meaningful activities or occupation were limited.

Well-led

Inadequate

Updated 26 October 2018

The service was not well led.

The registered provider did not have systems in place to fully monitor and respond to risks.

The service did not reflect modern care for people with a learning disability.

The registered provider had not monitored the quality of care people received.

The registered provider did not encourage an open culture where incidents or issues of poor practise could be investigated and responded to.

People and their visitors were asked for their views about their experiences of the service.