Background to this inspection
Updated
30 September 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place over two days, on 24 & 25 August 2016 and was unannounced. The inspection was conducted by one inspector.
Prior to the inspection we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We looked at the information provided in the PIR and used this to help inform our inspection. We reviewed the records we held about the service, including the previous inspection report and details of any safeguarding events and statutory notifications sent by the provider. Statutory notifications are reports of events that the provider is required by law to inform us about.
Many people we met were able to talk to us and tell us about their experience of living in the service, others were not and we observed them and their interactions with their environment, and staff over a lunch period and again briefly in a communal lounge, using an observation tool called the Short Observational Framework for inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
At inspection we spoke with 8 people and one relative. We observed staff interactions throughout the inspection days when they were supporting people with snacks and daily activities, or undertaking personal care. We visited with people’s permission a number of bedrooms to assess the quality of furnishing and cleanliness, and we viewed communal areas and bathing facilities. We spoke to the registered providers and registered manager, the deputy manager, three care staff and an agency worker, and the cook.
After the inspection we contacted a further six relatives to ask for their views. We also contacted seven health and social care professionals who have contact with the service.
We looked at four people’s care plans and risk assessments, medicine records, three staff recruitment training and supervision records, staff rotas, accident and incident reports, servicing and maintenance records and quality assurance surveys and audits.
Updated
30 September 2016
The inspection was carried out on 24 and 25 August 2016 and was unannounced. At the previous inspection in September 2015, we found that the provider was not meeting the regulations in respect of staff recruitment, the management of risks and medicines, and ensuring a complete and accurate record of peoples care was maintained. The provider sent us an action plan detailing the actions they were taking to ensure they met the standards and at this inspection we checked that they had implemented and sustained these improvements.
The Old Rectory is a large detached building that has been extended twice since becoming a care home. It is located in a residential area of the small village of Dymchurch, it is close to a public bus service and there is off street parking available for 16 cars, as well as limited street parking. The service provides accommodation and personal care for up to 35 older people and there were 26 people in residence at the time of the inspection. The accommodation is provided over three floors with 32 bedrooms, the majority of bedrooms were for single person use but three can accommodate two people each for couples or for people who wish to share. People have access to two communal lounges, a dining room, a small library cum quiet room and a well maintained accessible garden to the rear of the premises.
This is a family run home and the registered providers have day to day involvement in the running of the service. One of the Providers is also the registered manager and was present on the days of our 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.
People, relatives and social care and health professionals told us that they were satisfied with the quality and delivery of care provided in the service and no concerns were raised.
Our inspection found that the frequency of formal supervision sessions held by managers to discuss training and development opportunities with individual staff were not being held in accordance with the service’ own supervision policy. We have recommended that the provider liaise with the fire service in regard to the content of personal evacuation procedures to ensure these meet the requirements of fire legislation. Medicines were managed appropriately but we have made a recommendation to expand some current practice in regard to the dating of medicines on opening.
Staff knew how to protect people from harm and the action to take in an emergency. Staff had received training in safeguarding adults and knew what action to take if there was any suspicion of abuse. Business continuity plans were in place to respond to events that could stop the service. All servicing and tests of fire alarm and firefighting equipment were routinely conducted. The premises were kept clean and a maintenance plan was in place and a programme of upgrading ongoing. Risks that could impact on people’s safety had been assessed and strategies implemented for managing people’s behaviour that could challenge staff and others. Systems were in place for the assessment and monitoring of service quality and the analysis and review of accidents and incidents; these helped to make relevant improvements to the service and the safety of people.
People were provided with the equipment they needed to mobilise or bathe, and grab rails were visible in communal bathrooms and ensuites. All necessary equipment servicing, checks and tests were carried out. The registered manager also carried out regular environmental and health and safety checks to ensure that the environment was safe and that equipment was in good working order.
At the time of our inspection there were enough staff on duty during the day and night to meet people’s individual needs; this was kept under review in response to changing needs. The suitability of prospective staff was checked prior to employment and records showed all appropriate checks and documentation was in place.
People’s health needs were assessed and monitored. Health and social care professionals said that staff were proactive in seeking advice and guidance from them and putting this into practice. People were provided with a varied diet that reflected their personal likes and dislikes, and any specific dietary needs.
All new staff received an induction into their role but those without previous experience or vocational qualification in health and social care were expected to complete a nationally recognised qualification: the ‘Care Certificate’. All staff were trained in areas necessary to their roles and some additional training in specific areas was provided where necessary to make sure that they had the right knowledge and skills to meet people’s needs effectively.
CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Staff sought people’s consent on a daily basis. DoLS applications had been authorised for three people to ensure that they were not deprived of their liberty unnecessarily.
Staff spoke kindly to people and treated them with respect. People were able to make decisions and choices for themselves about what they did, and where they ate their meals and with whom, people were encouraged where possible to maintain their independence seeking support when needed.
People’s care, treatment and support needs were clearly identified in their plans of care and included people’s choices and preferences. Staff knew people well and understood their likes and dislikes.
People were offered an appropriate range of activities and were consulted about changes to this at residents meetings. Relatives and friends were made welcome and people were supported to keep in contact with people who were important to them. Relatives and other stakeholders were asked to complete feedback surveys on a regular basis and their responses were analysed, action taken where necessary and a summary of responses and actions taken published within the service.
We have made one recommendation:
We recommend that the provider seeks advice from a relevant person within the fire service to advise whether the current detail within personal evacuation plans is sufficient to meet the requirements of fire legislation.