All inspections: The Old Rectory Residential Home

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.

The inspection took place on 4 and 5 August 2015, and was an unannounced inspection. The previous inspection on 28 August 2013 found no breaches in the legal requirements.

The service is registered to provide accommodation and personal care to 35 older people a few who may be living with dementia. The premises were previously a rectory and have been extended twice, most recently in December 2014, increasing its numbers from 26 to 35. At the time of the inspection the service also offered short-stay care and accommodation dependant on vacancies. It has 31 bedrooms, four of which can be used for double occupancy. Most bedrooms are suitable for people for those with physical mobility problems. People had access to assisted bathrooms, dining room/coffee area, hairdressing salon, library and lounge/conservatory. There is a secure and well maintained accessible garden with level paving and seating areas.

The service has an established registered manager, who is one of the providers. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 told us they received their medicines safely and when they should. However we found shortfalls in areas of the management of medicines, including records and guidance and administration.

Most risks associated with people’s care and support were assessed, but the level of detail recorded in the risk assessments was not sufficient to ensure people always remained safe. There was a shortfall in the recruitment records held on staff files relating to one type of record.

People were involved in the initial assessment of their care and support needs. However there was no evidence that people were involved in reviewing these needs. Care plans lacked detail about how people wished and preferred their care and support to be delivered or what independence skills they had in order for these to be encouraged and maintained.

People told us their consent was gained through discussions with staff. People were supported to make their own decisions and choices and these were respected by staff. Staff had received training in the Mental Capacity Act (MC) 2005. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant. We found in one instance a capacity assessment had not been recorded and where people had given written consent this had not been reviewed when their capacity had changed.

People benefited from living in an environment and using equipment that was well maintained. There were records to show that equipment and the premises received regular checks and servicing. Over the last year the premises had benefited from second large extension. A development plan was in place to address areas that were tired and work was due to start in August 2015. People freely accessed the service and spent time where they chose.

New staff underwent an induction programme and shadowed experienced staff, until staff were competent to work on their own. Staff training included courses relevant to the needs of people supported by the service. Staff had opportunities for one to one meetings, staff meetings and appraisals, to enable them to carry out their duties effectively.

People felt safe in the service. The service had safeguarding procedures in place and staff had received training in these. Staff demonstrated an understanding of what constituted abuse and how to report any concerns in order to keep people safe.

People were happy with the service they received. They felt staff had the right skills and experience to meet their needs. People felt staff were kind. People had their needs met by sufficient numbers of staff.

People were supported to maintain good health and attend appointments or were visited by healthcare professionals. Appropriate referrals were made when required and recently assessments had been undertaken by a physiotherapist.

People had access to adequate food and drink. They told us they liked the food and enjoyed their meals. People were involved in the planning the menus. Staff understood people’s dietary needs and special diets were well catered for.

People felt staff were caring. People were relaxed in staff’s company and staff listened and acted on what they said. People said they were treated with dignity and respect and their privacy was respected. Staff were kind in their approach and knew people and their support needs well.

People had a varied programme of suitable leisure activities in place, which they had help choose to help ensure they were not socially isolated. People enjoyed activities and outside entertainers who visited, such as singers and playing musical instruments, darts, board games, reminiscence, reading and audio books, walks in the garden, exercises, and bingo and movie nights. Family and friends visited and were made welcome at the service.

People told us they received person centred care that was individual to them. They felt staff understood their specific needs. Staff had built up relationships with people and were familiar with their life stories and preferences. People’s individual religious needs were met.

People felt comfortable in complaining, but did not have any concerns. People had opportunities to provide feedback about the service provided both informally and formally. Any negative feedback received had been addressed or a plan was in place to take action. People and visitors could also complete feedback about the care and support provided to an independently organised national survey. The responses had scored 9.8 out of ten.

People felt the service was well-led. The registered manager adopted an open door policy and senior staff sometimes worked alongside staff. They took action to address any concerns or issues straightaway to help ensure the service ran smoothly. Staff felt the registered manager motivated them and the staff team.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.

At the time of our inspection twenty three people were living at the service. We spoke with two people who used the service, three relatives and three staff and the manager of the service.

People and their relatives told us that they were treated with respect by the staff. A person told us that staff were "Always polite and courteous...no complaints".

People and relatives we spoke with talked positively about the care and support they received. One relative told us that the service was "A homely home" and another relative said the "Care and treatment is very thorough".

People told us that the staff spoke to people about their menu choices to ensure people had the food they liked.

People told us that staff have the necessary skills and capabilities to support people safely and to meet their needs. One person told us that "For myself, there are enough staff...very busy though...I am confident the staff are skilled in providing my care".

The service had processes and procedures in place to regularly check on the quality of the service people received and to keep them safe.

We spoke with people in a group in one of the shared areas and five people who used the service or their relatives. People told us they were treated with respect by staff. We saw that people had personalised their rooms with their own belongings. People said they were involved in their care and told us about their own choices and that "You couldn't get as much in your own home...it is very good". People who used the service, their relatives and the staff were asked for their views about the service and actions had been taken by the provider. One person said they were "Able to express their opinion freely".

People and their relatives were very happy about the care they received and people said they felt safe in the service. They told us they talked to the manager or staff about any problems they had. One person told us they "Couldn't want more"... The staff are so kind".

The service was clean, tidy and well maintained throughout. There was a pleasant garden and patio with a conservatory attached to one side of the property. People told us they enjoyed the outside space in the better weather.

People told us that the home promoted their independence and they were given choices about their daily routines. They said that staff were kind, caring and friendly and met their needs well.

People said they felt safe at the home and that it was always kept clean. They liked the meals provided and told us there was plenty of choice. People liked the activities provided and said they could choose what to do and that home was a happy one with cheerful staff.

The people we spoke with were very satisfied with the standard of the service and the care they received, their comments included,

'You can do what you like. If you want to go out anywhere you just have to let them know'

'You couldn't do better than here, they are absolutely marvellous'

'The girls are marvellous'

'You hear them laughing when they come on duty at 8 A.M, it is good they are cheerful at work'

'The staff are beautiful here, especially with people who need more help'

These older reports are from our old approaches to inspection, including those from before CQC was created.

Archived: The Old Rectory Residential Home

All Inspections

24 August 2016

During a routine inspection

4 and 5 August 2015

During a routine inspection

27 August 2013

During a routine inspection

10 January 2013

During a routine inspection

1 November 2011

During a routine inspection

Reports under our old system of regulation