• Care Home
  • Care home

Archived: The Old Rectory

Overall: Requires improvement read more about inspection ratings

High Street, Nunney, Frome, Somerset, BA11 4LZ (01373) 836747

Provided and run by:
Mr & Mrs R Hill

Important: The provider of this service changed. See new profile

All Inspections

14 and 15 April

During a routine inspection

This inspection took place on 14 and 15 April 2015 and was unannounced. At our last inspection in May 2014 we found areas for improvement in relation to risk assessments and safeguarding. We looked at these areas as part of this inspection.

The Old Rectory provides care and accommodation for up to 23 people. At the time of our inspection there were 18 people using the service.

There is 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 last inspection on 15 May 2014 we asked the provider to take action in completing comprehensive risk assessments. The provider sent us an action plan which said they would make these improvements by October 2014. We found on this inspection improvements had been made and detailed risk assessments were in place as part of people’s care planning arrangements.

The registered manager failed to demonstrate an understanding of where it was their responsibility to take action to protect people’s rights in relation to the Mental Capacity Act 2005 (MCA). We identified potentially three people where action was needed to protect their rights. We identified where staff had undertaken specific core skills training. However with regard to the MCA they failed to demonstrate knowledge and understanding of this act. We were told by staff and the registered manager this training had been completed by staff. The registered manager was unable to provide evidence of staff who had undertaken this training.

People told us they felt safe in the home. One person said this was because they felt “comfortable about the place and feel I can ask if I need something and staff will do something.” Staff demonstrated an understanding of the nature of abuse and their role in protecting people from possible abuse. They were aware of their rights to report concerns under the service’s whistleblowing policy.

The service had responded in a professional and thorough manner in investigating an allegation of abuse. The allegation had not been substantiated.

There were appropriate and safe arrangements for the management and administering of medicines. Staff had undertaken the necessary training to ensure the safety of people when dealing with medicines. However there had been an incident where medicines had been administered incorrectly. The registered manager had taken robust action in dealing with this failure and improved systems to alleviate the risk of further incidents and addressed the poor practice.

People had differing views about the availability of staff. This specifically related to the number of care staff on duty during the night. Additional staff had been placed on the morning shift as a result of increasing people living in the home. However there were no formal arrangements to help in making a judgement about the appropriate numbers of staff at night and during the day.

People had access to a range of healthcare services. One person told us they could see their doctor “at any time”. A relative had requested a GP visit and this had been arranged “and “the doctor called straight away”. Some people were receiving the support of community nursing to support them in their health condition.

People described staff as “caring and kind” and “can’t do enough for you they are so caring towards us.” Staff were observed supporting people in a sensitive and supportive manner and they respected people’s choices in how they lived their lives.

People were involved in reviewing their care arrangements. They were able to say how they felt about the care they received and whether it met their needs.

People’s care plans did not provide personal information related to people’s lives such as life history, important relationships, lifestyle and interests. There was no information about people’s preferences such as dietary and how they wished to spend their days in the home.

There was little opportunity for people to take part in activities and people felt there was not enough opportunity to be taken by staff out of the home. One person told us “There is very much a lack of activities.” Staff confirmed there were little activities in the home and they had little time to spend with people other than when providing care or support. From our observations and talking with people and staff the providing of activities or being able to spend time with people was not part of the culture of the home.

Care plans provided specific information and care task associated with people’s personal needs. For example where people had needs about maintaining their skin integrity or maintaining healthy weight this was identified.

Relatives spoke positively about how they were always made to feel welcomed when visiting the home. They told us how they were informed about their relatives where there were any concerns. One relative spoke of how they were really happy their relative was in the home.

People told us how accessible the registered manager was and how they were always asked about how they were and “if we were happy with everything”. The registered manager undertook regular care shifts so they were able to keep in touch with people and have a good understanding of people’s care needs. Other than people’s care reviews there were no other formal opportunities such as resident’s meetings for people to express their views about the service.

People were aware they could make a complaint if they wished however people told us they felt comfortable in talking with the registered manager or provider about any worries or concerns. They felt they would be listened to and action taken.

The registered manager told us of improvements they planned to make which included the greater involvement of people in the service and how it was provided. One of the improvements was to improve participation in the recruitment of staff and improve communication in the home. However whilst staff were positive about the approach of the registered manager and provider particularly their availability and accessibility they were not aware of these proposed changes.

Staff spoke of the registered manager listening and how they had acted on their view about the need for increased staffing. They said how they were approachable and in touch with the people’s care needs. There were inconsistencies about there being staff meetings in the service.

The registered manager did not have a robust system or processes in place to help in identifying and making improvements in the quality of the service.

We found breaches 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.

15 May 2014

During a routine inspection

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

is the service well led?

This is a summary of what we found:

Is the service caring?

We found from our observation and talking with people the service was caring. We observed staff interacted with people in a sensitive and caring manner. We saw when people needed assistance such as in moving around the home this was provided in a supportive manner. People told us they felt staff treated them with respect and their privacy was protected. One person told us how staff always knocked on their room door before entering and we heard staff asking for permission to enter the room. On one occasion we observed a staff member supporting an individual to use the toilet. They did so in a quiet and unassuming manner protecting the person's dignity.

People we spoke with commented positively on their relationship with staff. One person told us "I can always talk with staff about how I am and they don't ever make a fuss about anything I want or need". Another person said "staff are always polite and friendly I can speak to them about anything". A third person told us "if I have a problem I always go to the manager she is very good and listens to me".

Is the service responsive?

We found the service was responsive to people's wishes and needs. One person we spoke with told us how they preferred to spend most of their time in their room. They told us "this is not a problem staff know it is my choice and what I prefer". Another person told us how they were able to choose when they got up and went to bed. They said "it is up to me staff always ask what I want". A third person told us how the staff always responded quickly to their request to see a doctor "they immediately arrange for me to see my doctor". This was also confirmed by an individual who told us "we have access to a doctor whenever we want".

We saw how the service had responded to people's changing needs. In one instance following a change in a person's health a referral was made to the individual's GP so they could be seen by a specialist. We saw how one individual had been referred to a physiotherapist for treatment. In another instance the home had requested specialist mental health support to advise them about caring for an individual whose mental health had declined. This resulted in a review and change in medication and the individual's health had improved.

Is the service safe?

We found the service to be safe however there were some improvements needed to ensure staff acted in a safe, appropriate and professional manner when providing care. There was a lack of comprehensive guidance and risk assessments about specific care needs. There were areas of care planning such as nutrition, skin integrity and moving and handling where there was a failure to provide appropriate care plans and risk assessments.

People told us they felt safe in the home. They told us "I can always talk to staff about any worries or concerns" and "staff have always treated me in a way I wanted to be treated". A relative told us how they were confident their relatives were being well looked after and "when I leave here I don't worry about them I know they are safe".

Staff demonstrated an understanding of their role and responsibilities in relation to any possible abuse. They were clear about reporting any concerns. The provider had a safeguarding policy in place however this needed reviewing to reflect accurately their responsibility and role in responding to any allegation of abuse.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. The manager told us there were no individuals who were subject to a Deprivation of Liberty Safeguard. They told us they were due to undertake training in this area of their role. We noted there were no assessments of people's capacity to consent to care and treatment or related to daily living tasks and other decisions. Assessments are needed in order to safeguard people's best interests and to evidence how people are involved in making decisions and where people lacked capacity. This is an area for improvement.

Is the service effective?

We found the service to be effective because the care people received achieved improvement and good outcomes. However there were risks to the effectiveness of the service through lack of guidance and risk assessments. We saw evidence where people's health had improved through the actions of the provider and staff in responding to changing needs or deteriorating health. We have noted examples of this improvement in relation to skin care, reviewing and management of people's medicines and supporting an individual whose mental health had declined.

We saw how people were encouraged and enabled to lead as independent lives as possible and the service supported people in maximising their independence. It was evident from conversations with staff how they had a good understanding of the personal circumstances of individuals. One person said to us "they know us so well they know what help we need and when we struggle". This demonstrated how the service was effective in supporting people to achieve a quality of life which reflected their needs and abilities.

Is the service well led?

We saw how people and staff had positive and open relationships with the manager. They found them approachable and in touch with the needs of people in the home. Staff told us they received good support and there was good communication in the home. We noted how the majority of staff had worked in the home for a number of years in one instance for 27 years. This meant there was a continuity of staff being employed in the home which reflected in part the approach and support of the manager and owner of the home. This demonstrated how the service, with respect to these areas, was found to be well led.

However we found shortfalls in areas where the manager had failed to ensure there were the appropriate systems, policies and records in place to ensure the effectiveness and quality of the service. These shortfalls potentially placed the welfare and safety of individuals at risk and therefore did not reflect a well led service.

24 October 2013

During an inspection looking at part of the service

We carried out a follow-up inspection to check the provider had achieved compliance with the management of medicine. At the previous inspection we set compliance actions because the provider was not fully meeting essential standards of quality and safety.

We spoke with three people about the management of their medicines. People told us the staff administered their medicines. One person we asked told us 'I am happy with the staff giving me my medicines.'

People told us the staff administered pain relief medicines when they needed them. One person said 'Its written in my notes they (staff) ask if you need paracetamol.'

People told us they were able to recognise their medicines but were not able to recall the purpose of each prescribed medicine. One person said 'I used to be able to name my medicines but I can't now. I know how many I have and the colour.' Another person told us I know when I have my medicines, they are all before meals.'

A new medicine system was recently introduced to improve the administration of medicine. One person told us 'I chose to stay with my suppliers. I've had them for 30 years.'

Appropriate arrangements for the management of medicines were not in place.

14 May 2013

During an inspection looking at part of the service

We asked five people to tell us how they experienced care from the staff. The people we asked told us the staff were good and they knew how to care for them. Two people told us 'nothing is too much trouble, the staff are friendly and we have a good rapport.'

People told us how they kept themselves occupied during the day. One person said: 'The day goes so fast here. I watch the television; I do word searches and talk to other people.' Another person said: 'I listen to talking books in my room and on Tuesday's I join group activities.' A third person told us they walked to the shops without staff support.

The people we asked said there was no need to complain. Two people told us the manager spoke to them and sought their views about the care they received and about the running of the home.

We spoke with a CQC regional pharmacist inspector. We asked their advice about the administration of controlled medicines, the storage of medicines and their disposal. We found improvements were needed for the safe management of medicines.

12, 20 December 2012

During a routine inspection

The five people we spoke with gave us positive feedback about the care staff provided. One person told us: 'we have wonderful care and we are well looked after.' The people we asked said their privacy and dignity was respected. They said they were able to make decisions and choices about their day to day living at the home.

People told us staff always asked how they wanted their care to be provided and explained the tasks they were about to undertake. However, people's needs were not always assessed and where needs were identified a care plan for meeting these needs was not always devised. People living at the home at the time of our visit were independent and were mostly able to make sure staff attended to their needs. But the system of care planning in the home meant people who became less able to communicate, or had increased dependency may be at risk. People said they felt safe at the home and if they were unhappy about their care or the staff they would approach the manager.

We were told by the people we asked and the staff that although activities were arranged by the manager, these group activities were not well supported. They told us how they spent their days and it was their choice to stay in their room and not participate in group activities. The manager had not reviewed whether activities were organised around what people wanted to do.

26 August 2011

During a routine inspection

During our visit we spoke to nine of the 14 people living at The Old Rectory. We also observed the way staff and residents interacted and the way care needs were met.

All the people we spoke with said they were happy living at The Old Rectory. Everybody knew all the staff by their first names and praised the care they received. One person said, 'The staff are wonderful, nothing is too much for them,' another person said, 'The girls are a pleasure to have caring for me, cheerful and helpful.'

We asked people about how they were involved in planning their care, we were told that they felt their opinions were respected and taken into account. One person said, 'The cook comes to my room every morning and we can choose what we want for lunch. If there is nothing I like she is happy to make something else.' Another person said they had regular activities in the home, 'some people go and some don't we can chose whether to join in, it is so relaxed here.' People said they were happy with the way their care was provided and we observed staff acting in a professional but friendly manner towards people living in the home.

Both people living and working in the home said there was an open and shared culture. Staff and resident meetings showed that opinions were sought and acted upon. One person said they had mentioned the need for relaxing music at lunchtime. We observed that quiet classical music was playing, which everyone said they liked.