Archived: The Old Rectory Nursing & Residential Home

Is the service safe?

Some people were at risk of injury from poor moving and handling techniques. For example, the provider's own investigations had found that two people had sustained minor injuries including a skin tear and bruising as a result of 'rough handling' by staff. There was a generic response of 'staff to be more gentle' but these events were not individually investigated or addressed. A compliance action has been set for this and the provider must tell us how they plan to improve.

People who use the service were not always protected from the risk of abuse. The provider had not responded to an allegation of abuse and had failed to report the allegation to the appropriate authorities. Some people were not fully protected against the risk of unlawful restraint because the provider had not assessed all aspects of care that involved restricting people's movements or the Deprivation of Liberty Safeguards under The Mental Capacity Act 2005. A compliance action has been set for this and the provider must tell us how they plan to improve.

Some people's care records and daily care charts were inaccurate or incomplete. For example, for one person, we saw a re-positioning chart but on one side of the chart there was no date recorded and several food and fluid charts had inconsistent information, with gaps in daily and weekly logs. Records were not always kept securely. We found two people's daily records lying on the top of a cabinet at the end of the downstairs corridor. This meant that these records could have been seen by other people and visitors to the home. A compliance action has been set for this and the provider must tell us how they plan to improve.

Is the service effective?

Staff were provided with opportunities to learn and develop their knowledge and skills through the provision of training across a range of care topics. We saw training certificates from records we viewed and asked staff questions about what they had learnt. One staff member told us "We get a lot of support and work as a team. I received an induction and was offered communication training and fire awareness training when I first started."

People's needs were assessed and they had comprehensive care plans but not everyone's care was delivered in a way that met their individual needs and these people's outcomes were not as effective as they could have been. For example, some people did not always receive the individual help and support they needed with their food and drinks. We saw that one person had a drink of tea that was cold, and was not within their reach. This meant that people were at a risk of dehydration. A compliance action has been set for this and the provider must tell us how they plan to improve.

Is the service caring?

We saw that people were treated in a dignified manner and staff showed consideration and respect when involving people in their personal care. Staff were sensitive to people's wishes and preferences. One person said "I'm happier here than in my last home; I get to choose what I want to wear," and another person said "I'm treated very well here, staff are polite and respectful."

Is the service responsive?

While some complaints had been addressed and responded to, one serious complaint raised about the care and treatment of people at the home had not been acted upon or investigated. A compliance action has been set for this and the provider must tell us how they plan to improve.

One person said "I've got pain, I keep telling them." but when we checked with staff, they were not aware of this. This meant that for some people their concerns were not effectively or fully responded to.

Is the service well led?

There were systems in place to check the quality of the service. The views of people and their representatives were sought and relatives told us that if they had any concerns, they could approach the registered manager. However, there were not satisfactory processes in place to identify, monitor, assess and manage risks to the health, safety and welfare of people who use the service and others. Some audits did not identify risks to people and one complaint was not investigated in a timely manner. A compliance action has been set for this and the provider must tell us how they plan to improve.

The Care Quality Commission (CQC) request information about specific incidents occurring within services regulated by the Health and Social Care Act 2008. These are known as Notifications. During the inspection we learned there had been a medical emergency, resulting in an unexpected death. We checked our records and found that this and another notifiable incident had not been reported to the CQC, in line with the appropriate procedures. This meant that the Commission would not have been able to review or collect the data in connection with the incidents. A compliance action has been set for this and the provider must tell us how they plan to improve.

People told us that they felt safe and not restricted. One person told us, 'I do not feel in anyway restricted.' However, the provider had not made the necessary improvements to their policy in respect of the Deprivation of Liberty Safeguards and staff did not have sufficient knowledge.

Appropriate checks were carried out before staff were employed. Staff received appropriate training and support to do their jobs, which included induction training. One person's relative said, 'The staff have a good attitude and appear to know what they are doing.'

The provider had introduced an effective quality assurance process. One person's relative said, 'I feel able to make comments and suggestions, but have never done so. We have been encouraged to go to them with any concerns.' A new system of care documentation had also been introduced which ensured people's care records contained sufficient and accurate information.

People's care needs were assessed and plan's developed to meet these needs. Staff were knowledgeable about people's needs and we saw care was delivered to meet people's needs. However, accurate records were not always maintained in relation to people's care.

People were not protected from the risks of unlawful or excessive restraint as staff were unaware of the Deprivation of Liberty Safeguards. Staff were aware of the actions they need to take if they suspected someone was being abused.

People were not cared for by properly trained or supported staff. The provider undertook quality assurance audits but these were not effective. For example, the audit of training had not identified that staff had not received mandatory fire training.

The provider's recruitment processes were not effective. A number of relevant checks had been undertaken prior to staff being employed. However, we saw that full staff histories were not available for a number of the staff records we reviewed.