The Old Rectory Care Home

The Old Rectory is a care home providing personal and nursing care to 26 older people at the time of inspection. The service can support up to 34 people.

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

A programme of improvement and development was being driven by the new management team, who had been in place since March 2022. We found significant improvements had already been made.

Care planning and risk assessment was clear, concise and provided enough information for staff to care for people. These documents had been updated when people’s needs had changed.

People’s medicines were managed, monitored and administered safely and there were enough staff to provide care to people at the time they required it.

The service was clean and there were appropriate procedures in place to minimise the risk of the transmission of infections including COVID-19.

The new management team had acted upon areas for improvement identified by Norfolk County Council in February 2022. This included improvements to care planning, management processes and the mealtime experience. Further improvements were still in progress.

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

Rating at last inspection (and update)

The last rating for this service was good (3 April 2019).

Why we inspected

This inspection was planned to assess progress with shortfalls identified by Norfolk County Council in February 2022.

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.

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.

People’s experience of using this service:

¿ Without exception people were positive about living in the home, and felt staff were caring and met their needs.

¿ People’s needs were met on an individual basis, and they received support according to their preferences.

¿ Staff treated people respectfully and ensured they had a right to privacy, and supported them to maintain independence where possible.

¿ People received a choice of meals and were positive about the quality of the food they received.

¿ There were activities to participate in and people could follow their interests with support from staff.

¿ People and relatives were positive about staff and the registered manager. Staff knew people and their needs very well, and built good relationships with them.

¿ The registered manager was visible and approachable, and people felt they could comfortably raise any concerns they may have.

¿ Quality assurance systems had improved since our last inspection and there was ongoing monitoring of the service.

Rating at last inspection: Requires Improvement (published 4 May 2018). This service has been rated Requires Improvement at the last two inspections. At the last inspection, there was a continued breach of one regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Why we inspected: Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe and well-led to at least good. They sent us an action plan with this information, and we met with the providers to discuss our concerns about the home and having the rating of requires improvement at the last two comprehensive inspections. This inspection was completed in line with the timescales required for services rated requires improvement.

Follow up: We will continue to monitor the service in line with our inspection schedule for services currently rated Good.

At our last inspection carried out on 12 December 2016, we found three breaches of Regulations in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of Health and Social Care Act 2008 (Registration) Regulations 2009. Although some improvements had been made within the areas of breaches, some further improvements were needed.

The Old Rectory is a ‘care home’ for up to 34 people. The home supports older people, many of whom are living with dementia, across two floors. When we inspected, there were 32 people living in the home. There was one room which was being shared by two people. The rooms had en-suite toilets and sinks, and there were other communal bathrooms with showers and baths on each floor.

People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There was a registered manager in post. The registered manager at the home had been registered with CQC since September 2017. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We last inspected this service on 12 December 2016, and we found three breaches of regulations. We completed this comprehensive inspection to see if the home had been improved in these areas. At the previous inspection in September 2015, we had also asked the provider to take action to make improvements in respect of the quality of care that was provided to people.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, caring, responsive and well-led to at least good. They had not managed to make all the improvements needed to increase the overall rating of the home. Therefore, we remain concerned that the provider has not implemented effective quality assurance systems in a timely manner to ensure full oversight of the areas previously identified as a concern.

There had been improvements in infection control and the home was clean, and the registered manager completed a further risk assessment needed. There were some improvements required to the oversight of infection control within the home to ensure actions were taken when needed.

We found that risks were not always fully mitigated as far as is practicable because not everyone was able to ask for support from staff. This was addressed shortly after the inspection. Risks to people were covered in their care plans and there was guidance for staff on how to mitigate risk.

The registered manager had overlooked safeguarding notifications which they sent us shortly after the inspection. They sent these immediately after the inspection. We found that improvements were needed in the systems to assess, monitor and improve the service, as some concerns had not been identified by the provider.

There were effective systems in place for the registered manager to observe whether staff had seen people, however these were not always used to full effect to check that people received care according to their care plans. However, there had been a decrease in falls and people were safer since the electronic care planning system allowed the registered manager to have a better oversight of people in the home.

Medicines were administered as prescribed, and the registered manager had taken action when errors were made. Improvements were needed to the care planning around ‘as required’ (PRN) medicines, and the registered manager completed these immediately. Improvements were required to ensure the safe storage of the sharps box.

Staff had received appropriate training and there were enough of them to meet people's care needs. However, some people reported waiting a longer time for them during certain parts of the day. The dependency tool did not cover all aspects of staffing required, and did not account for people’s behavioural needs and the layout of the building.

Care plans were detailed with people’s preferences and care needs, with guidance on how staff should support them. However, we found that people were not always supported as per their care plans with their continence needs.

People had access to a good choice of meals and staff supported them to have specialist diets where needed. There was always a drink available to people and we saw that staff recorded when people ate and drank so that the registered manager could maintain oversight of this.

People were supported to participate in a wide range of hobbies and activities within the home and staff were able to spend time with people who preferred to stay in their bedrooms. Staff were caring and kind, and knew people well.

Relatives and people were involved in the planning of care and the registered manager was visible and approachable. There was good leadership in the home and staff were well supported by the registered manager. They worked well together as a team.

The Old Rectory Care Home is a service that provides accommodation and personal care for up to 34 people. During the inspection visit, there were 32 people living within the home.

There was a registered manager employed at the home. 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 and associated Regulations about how the home is run.

At the last inspection on September 2015, we asked the provider to take action to make improvements in respect of the quality of care that was provided to people. At this inspection, we found that some improvements had been made but that further improvements are required. Some areas of the home and some equipment people used were unclean. Staff were not always responsive to people’s individual needs and the systems in place to assess, monitor and reduce the risk of people receiving poor care were not always effective. Some people’s care had not been fully planned for and some records in relation to their care contained inaccurate information. You can see what action we have told the provider to take at the back of our report.

Staff had received appropriate training and there were enough of them to meet people’s care needs. However, they were often very busy particularly in the morning and therefore did not always have time to spend with people interacting with them or providing them with stimulation to enhance their wellbeing.

The staff were kind and caring and they provided people with choice so they could make decisions about how they wanted to be cared for. However, people’s dignity and privacy was not always upheld.

Systems were in place to protect people from the risk of abuse. Staff sought advice from other healthcare professionals and acted in a timely manner when they identified any concerns about people’s health. People had access to a good choice of meals, snacks and drinks. The staff made sure people received enough food and drink to meet their individual needs.

The staff requested people’s consent before they provided them with care. Where people were not able to give consent, the staff made sure that they took any decisions they made on their behalf in the person’s best interests. People received their medicines when they needed them.

There was an open culture where people and staff could raise concerns if they wanted to. These were listened to and promptly dealt with. The people we spoke with were happy living in the home and the staff were happy working there. Staff were supported to progress in their roles if they wished to do so.

The registered manager had plans in place to improve the environment for people living with dementia with the ultimate aim to improve people’s quality of life and wellbeing.

Below is a summary of what we found. The summary describes the records we looked at to help us form our judgement. As part of this inspection we spoke with staff but we did not speak with people using the service on this occasion. If you would like to see the evidence that supports the summary, please read the full report.

Is the service safe?

We looked at the care records of four people with varying needs and dependency who were living at The Old Rectory on the day of our inspection. The records showed that care plans were in place, which provided guidance to staff about how each individual was to be supported. We saw that the daily care reports were up to date, although there were some gaps in the records that recorded the personal care provided each day.

Risk assessments were in place and these informed the risk reduction plans. They set out what action was required of staff to ensure that risks were managed and minimised. This meant that people received the care and support they needed to keep them safe.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to all care services. Proper policies and procedures were in place so that people who could not make decisions for themselves were protected. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

The care records showed that the service liaised with health and social care professionals appropriately. We noted that health professionals were contacted quickly when advice and guidance was required. GP, community nurse, dietician and consultants' visits were recorded clearly and there was evidence that changes were made to people's care plans to reflect any prescribed alterations in the care to be provided.

Is the service caring?

The care records demonstrated that the person's individual choices and preferences were considered when they were written and subsequently reviewed. Some of the care records contained the person's signature to show that they agreed and consented to the plan of care. Efforts had been made to ensure that the personal history of people was recorded where possible so that staff understood what was important to each person.

Is the service responsive?

The care plans were kept under review and alterations made to them to reflect any changes in the needs of the person. We saw that care plans were reviewed each month. We also noted that the care plans were audited periodically by the registered manager to ensure they were accurate and up to date.

This is a summary of what we found-

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were warm, friendly and respectful and that they offered choices and encouragement to people. One person told us, "I'm very happy here and can't fault the place." Another person said, "Staff speak to me nicely and they are caring. They help me to wash and dress in the morning." A relative told us, "We are very pleased with the care provided."

People told us they received the care and support they needed and had agreed to. People's interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes and preferences.

Is the service responsive?

People were able to access a variety of activities at the service. These included group and one-to-one activities and also outside entertainments.

People using the service and their relatives had completed an annual satisfaction survey. One person told us how their comments had resulted in a change to the way their care was given.

People told us they knew how to complain and believed they would be listened to and their concerns acted on. One person told us, "I speak to staff if I have any concerns." We looked at how complaints had been dealt with, and found that the responses had been open, thorough and timely. People could be assured that complaints were investigated and action was taken as necessary.

Is the service safe?

People told us they felt safe and that they were treated with respect by staff. The service was clean and hygienic although some areas had not been well maintained. Refurbishment plans needed to commence in order to keep people safe.

The registered manager set staff rotas that took people's care needs into account. This meant there were sufficient numbers of qualified, skilled and experienced staff on duty. This helped to ensure that people's needs were always met.

Is the service effective?

Some people had signed to show their agreement with the content of their care plans. None of the people we spoke with were aware of what was in their care plan. Some of the care plans and risk assessments had not been reviewed regularly and were therefore not able to support staff consistently to meet people's needs.

Visitors we spoke with confirmed that they were able to see people in private and that visiting times were flexible.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing people's needs and involving people in planning their care.

Is the service well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system and records seen by us showed that identified shortfalls were addressed. As a result the quality of the service was continually improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and this helped to ensure that people received a good quality service at all times.

We were told that people liked living at the home. One person said, "It's alright here, the staff are nice". Another person was able to make us understand that they were happy and enjoyed living at the home by smiling and nodding their head. A visitor told us they were able to visit whenever they wished and were always made to feel welcome.

Our observations showed us that people were encouraged to be as independent as possible, with staff providing support and encouragement when needed. The interactions between staff and people at the service was always warm and friendly. People joked and laughed with staff and many joined in with an activity during the afternoon.

We saw that visiting professionals were listened to by staff and advice and guidance recorded so that staff could follow treatment plans as described. Professionals told us that staff acted on their advice and referred appropriately so that interventions were timely.

Medication records were inaccurate and unreliable. There were gaps in the records and medicines not given when signed to say they were taken. Action is required.

People knew how to complain, although one person said they would prefer to talk with their relative first. We saw one person speaking with the manager about their concerns and they were listened to and action taken.

During this visit, we saw evidence that people's needs were being assessed and care plans written so that they received appropriate care and support. Care files contained all the information we would expect to find in order that people received individualised care and support when they needed it. The files contained guidance to staff about how care should be delivered and we saw risk assessments and risk reduction plans that helped to keep people safe.

We discussed with the line manager how the service was going to ensure it remained compliant with regulations and we were told that a review and reassessment programme had been developed. We saw this programme pinned to the wall so that staff were fully aware of when each care file needed to be reviewed.