Rectory House

Rectory House is a residential care home providing personal and nursing care to up to 10 people who lived with physical and learning disabilities. At the time of the inspection the service was supporting eight people.

People’s experience of using this service and what we found

People were safe and protected from harm. The managers at the service had invested time in ensuring that safeguarding policies were in place that they were followed by staff and that all incidents were investigated and reported. People were not able to tell us they felt safe but we observed people and their interactions with staff and saw they were looked after well. Staff understood risk and care plans had risk assessments specific to each person. Staff were recruited safely and were deployed in sufficient numbers to ensure people were supported. Medicines were provided safely and infection prevention and control measures were in place with government guidelines being followed. Accidents and incidents were recorded with any trends being identified and learning shard with all staff.

The provider had made progress with its auditing processes and the way accidents, incidents and safeguarding concerns were recorded and then analysed. Staff were confident to report issues and systems were now in place to ensure nothing was missed. The registered manager had only recently been appointed but demonstrated knowledge about people and their staff. Similarly, progress had been made with improving communication with relatives and loved ones through the introduction of a ‘family survey’, regular opportunities for relatives and people to speak directly with the registered manager and the sending of newsletters. A key worker system of care operated which provided staff with clear roles and enabled positive relationships with people. The service worked well with statutory partners. A professional told us, “The registered manager is well engaged and is always happy to share reports and relevant information.”

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of safe and well-led key questions the service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support

¿ Model of care and setting maximises people’s choice, control and independence. People were encouraged and supported to engage in activities they enjoyed. Staff promoted independence and supported people in these activities.

Right Care

¿ Care is person-centred and promotes people’s dignity, privacy and human rights. Through the key worker process staff had got to know people well and were able to support people with making choices whilst respecting and protecting their dignity.

Right culture

¿ Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives. The registered manager told us that their focus was to enhance life experiences and for people to achieve their goals. People were involved in their care planning and were supported to engage in activities and setting of goals and targets.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 26 July 2018). On 21 January 2021 we carried out a targeted inspection. We looked at our safe domain which was inspected but not rated and our well-led domain which was rated requires improvement.

Why we inspected

We received concerns in relation to the reporting of safeguarding incidents, auditing processes relating to accidents and incidents and quality monitoring processes. For example, there were no processes for relatives to provide feedback about the service and poor communication between the service and relatives and loved ones. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has not changed following this inspection and remains good. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well-led sections of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rectory House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Rectory House is a residential care home providing personal care to up to 10 people with physical and learning disabilities in one adapted building. At the time of the inspection the service was supporting eight people.

People’s experience of using this service and what we found

Relatives told us they felt their loved ones were safe and “Staff look after people well.”

The provider introduced a new management structure within the service to provide oversight and support to staff while the registered manager was away from the business. We found the new management team had made improvements and were reporting relevant concerns to the local authority. However, people’s relatives and staff told us they were not always aware of the outcomes when things had gone wrong.

The area manager told us they were awaiting training in the provider's auditing system and they had not completed any recent audits to review. After the inspection, the provider told us they had undertaken audits however we did not receive copies of these. Some records were out of date and it was unclear whether there had been reviews to some documentation. The management team had a plan in place to bring record keeping up to date. We have made a recommendation about the oversight of the service in the Well-Led section of this report.

Risks around people’s needs were assessed and mitigated by staff providing person-centred care. Staff were aware of their responsibilities to report concerns and where to report them to keep people safe. Staff had received infection control training and used personal protective equipment (PPE) in line with guidance.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting maximises people’s choice, control and independence. People were supported to do activities they enjoyed and to develop their skills to promote their independence.

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights. Staff knew people well and adapted their engagement to suit each individual. People’s preferences were respected, and their dignity maintained.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives. The new management team and staff were looking for ways to provide people with as much support and engagement as they wanted. Adaptation to people’s daily lives had been made to ensure that they were still empowered and engaged during the pandemic. People were involved in producing their support plans.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 26 July 2018).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about a lack of staffing, as well as concerns about safeguarding, and incidents not being reported. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with the oversight and leadership of the service, so we widened the scope of the inspection to become a focused inspection which included the key question of Well-led.

The overall rating for the service has not changed following this inspection and remains Good.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Rectory House is a ‘care home’ for up to 15 people with a learning disability. People in care homes receive accommodation and 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. There were 14 people living at the service at the time of our inspection.

At the last inspection, on 9 June 2017, the service had an overall rating of ‘Good’. This inspection report is written in a shorter format because our overall rating of the service has not changed.

At this inspection we found the service remained ‘Good’.

A registered manager continued to be employed at the service. 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.

The service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities using the service can live as ordinary a life as any citizen.

There continued to be sufficient numbers of staff to meet people’s needs. Staff continued to be appropriately supervised and had the skills and knowledge they needed to support people with learning disabilities. New staff had been recruited safely and pre-employment checks had been carried out.

People continued to be protected from abuse. Staff had undertaken training in safeguarding and understood how to identify and report concerns. Medicines were managed safely and people received their medicines when they needed them. Risks were assessed and there were mitigations in place to minimise risk and keep people safe.

Peoples’ support met their needs. Support plans continued to accurately reflect people’s needs. People were supported to have choice and control of their lives and staff support them in the least restrictive way possible. Staff were aware of people’s decisions and respected their choices.

The service continued to support people to maintain their health and wellbeing. People had access to healthcare services when they needed it and were supported with nutrition and hydration. When people accessed other services such as going in to hospital they were supported by the service and there was continuity of care.

People were treated with respect, kindness and compassion. People were provided with emotional support and reassurance when they needed this. People were supported to maintain relationships with those who were important to them. People’s privacy was respected and they were supported to lead dignified lives.

People were supported to increase their independence and undertake activities of daily living. Where people had identified that they wanted to move to a more independent setting they were being supported to do so.

People were encouraged to express their views and were listened to. There were systems in place to seek feedback from people and their relatives to improve the service. Relatives told us that they were informed about the services’ plans and that communication was proactive.

The service was clean. The environment had been adapted to meet people’s individual needs. Staff were aware of infection control and the appropriate actions had been taken to protect people.

Staff, relatives and community health and social care professionals told us the service was well-led. The registered manager had a clear vision and values for the service which staff understood and acted in accordance with. The service was regularly audited to identify where improvements were needed and actions were taken.

Staff understood their responsibilities to raise concerns and incidents were recorded, investigated and acted upon. Lessons learnt were shared and trends were analysed. The service worked in partnership with other agencies to develop and share best practice.

Further information is in the detailed findings below.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Rectory House on our website at www.cqc.org.uk”

Rectory House is a home that provides personal care and accommodation for up to 15 people with learning and physical disabilities. The home is currently used by male service users only.

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 previous inspection on 26 and 27 April 2016, the provider was in breach of Regulation 17 of the Health and Social Care Act 2008 (regulated activities) Regulations 2014. We found that records were not complete, accurate or contemporaneous. At this inspection improvements had been made and the provider was no longer in breach of this regulation.

There were effective auditing systems in place to ensure that people’s records were kept up to date by staff. Audits were carried out in all aspects of the service to identify how the service could improve and action was taken as a result.

The registered manager was approachable and took an active role in the day to day running of the service. Staff were able to discuss concerns with the registered manager at any time and felt they would be addressed appropriately.

The registered manager had a good understanding of their responsibilities and was notifying the Care Quality Commission of any notifiable event.

People and staff were enabled to express their views on the running of the service. This included regular meetings, surveys and being involved with the interview process of new staff.

Rectory House provides personal care and accommodation for up to 14 people who have physical disabilities and learning disabilities. All of the people living in the home were male. People had sensory impairments, epilepsy, limited mobility and difficulties communicating. Some people were on the autistic spectrum. One person was living with dementia. On the day of our inspection there were 14 people living at the home.

The home had a registered manager. 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.

We received positive feedback from people, relatives and staff about all aspects of the service.

Records were not always complete, accurate or stored securely. People’s information was not always treated confidentially because personal records had not been stored securely.

Staff knew and understood how to safeguard people from abuse, they had attended training, and there were effective procedures in place to keep people safe from abuse and mistreatment.

Risks to people had been identified. Systems had been put in place to enable people to carry out activities safely with support.

The premises and gardens were well maintained and suitable for people’s needs. The home was clean, tidy and free from offensive odours. The home was not suitably decorated to meet everyone’s needs, we made a recommendation about this.

Medicines were appropriately managed to ensure that people received their medicines as prescribed. Records were clear and the administration and management of medicines was properly documented.

Staff and people received additional support and guidance from the behaviour support manager when there had been incidents of heightened anxiety. Staff received regular support and supervision from the management team.

There were suitable numbers of staff on shift to meet people’s needs. The provider followed safe recruitment procedures to ensure that staff working with people were suitable for their roles. Robust recruitment procedures were followed to make sure that only suitable staff were employed.

Procedures and guidance in relation to the Mental Capacity Act 2005 (MCA) was in place which included steps that staff should take to comply with legal requirements. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Where people were subject to a DoLS, the registered manager had made appropriate applications.

People had access to drinks and nutritious food that met their needs and they were given choice.

People received medical assistance from healthcare professionals when they needed it. Staff knew people well and recognised when people were not acting in their usual manner and took appropriate action.

Relatives told us that staff were kind, caring and communicated well with them. Interactions between people and staff were positive and caring. People responded well to staff and engaged with them in activities.

People and their relatives had been involved with planning their own care. Staff treated people with dignity and respect.

Relatives told us that they were able to visit their family members at any reasonable time, they were always made to feel welcome and there was always a nice atmosphere within the home.

People’s view and experiences were sought during meetings. Relatives were also encouraged to feedback by completing questionnaires.

People were encouraged to take part in activities that they enjoyed, this included activities in the home and in the local community. People were supported to be as independent as possible.

The complaints procedure was on display within the foyer of the home and this was also available in an easy read format to support people’s communication needs.

Relatives and staff told us that the home was well run. Staff were positive about the support they received from the senior managers within the organisation. They felt they could raise concerns and they would be listened to.

Communication between staff within the home was good. They were made aware of significant events and any changes in people’s behaviour. Handovers between staff going off shift and those coming on shift were documented, they were detailed and thorough.

The provider and registered manager had notified CQC about important events such as serious injuries, deaths and Deprivation of Liberty Safeguards (DoLS) these had been submitted to CQC in a timely manner.

Audit systems were in place to ensure that care and support met people’s needs and that the home was suitable for people. Actions arising from audits had been dealt with quickly.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, the staff supporting them and looking at records.

Is the service safe?

The service was safe because staff understood their roles and responsibilities in relation to infection control and hygiene.

People were protected from acquired infections because the home was kept clean and hygienic.

People and their belongings were safe because the service assessed and managed the risks associated with the environment.

Is the service effective?

The service was effective because people were involved in decisions about the environment they lived in.

People had access to appropriate space: to see and look after their visitors, participate in activities and to spend time alone if they wanted to.

There were quality assurance systems in place.

Is the service caring?

The service was caring because there were policies and procedures in place to ensure staff understood how to respect people's privacy, dignity and human rights .

Is the service responsive?

The service was responsive because people who used the service knew how to share their experiences and felt comfortable doing so.

People, their relatives and friends were encouraged to provide feedback about the service.

Is the service well led?

The service was well led. Resources and support were available to the manager and the staff team to develop and improve the service.

The manager of the service been in post since the beginning of September 2014. They had been managing another home on the same site.

We spoke with two people who lived in the home, one relative and three staff during our inspection. People told us "I do like living here, all the people are nice here"; "Some of my friends are here" and "It's alright".

The relative told us that "Staff are really good here, they are helpful and my brother is happy here".

Staff said that they had confidence in their manager and told us "It is quite a good place to work".

We toured the premises and saw that the dining room had been decorated and the spare bedroom and small hallway on the top floor were in the process of being decorated.

We found that the home had a schedule of cleaning, but we found that some areas had not been cleaned to an appropriate standard, which could place people at risk of infection.

We found that the premises were in a poor state of repair, even though we had highlighted issues surrounding the premises in several of our last inspection reports. The provider had reassessed priorities of work that had been on their action plan, which meant that some areas of work had not been completed. We had concerns about the health and safety of people, staff and visitors to the home.

Although regular audits had been carried out in the home, we found that actions had not been followed up to resolve the areas of concern.

We found that a detailed programme of maintenance and repairs had been implemented since our previous visit.

Most of the people using the service had been taken on holiday while the works were carried out. We spoke with three people during our inspection. One person met us excitedly and said: 'Come and see our lovely new house'.

We toured the premises and recorded that carpets had been renewed, the kitchen re-fitted and a range of remedial repairs and refurbishment had been completed.

Staff told us that the service had a 'new feel' following the changes, and was a much nicer working environment.

People told us that they could speak to staff with any worries and staff had received training in protecting vulnerable adults.Staff were able to demonstrate to us a good understanding of how to recognise abuse. We checked recruitment records and saw evidence that staff had undergone all the necessary checks before being employed.

Peoples medicines had been stored, administered and recorded correctly by the home.

We found that the home had not been cleaned to an appropriate standard; which could place people at risk of infection.We recorded that the premises was still in a poor state of repair even though our last inspection report had highlighted this to the provider. An action plan to address the problems had not been completed and we had concerns about the health and safety of people, staff and visitors to the home.

Although regular audits had been carried out, the service had not always used the findings of these to improve the service.