Archived: The Old Rectory Singleton

We found the following examples of good practice.

There was clear communication with visitors, arrangements for visiting were by appointment only, and allowed for social distancing whist meeting individual's needs. A garden room was set aside for visits, which meant visitors did not need to enter the home. Visitors took a lateral flow test and had a temperature check before the visit to test for Covid-19. Personal protective equipment was used by visitors.

People told us they were well supported during the recent outbreak of Covid-19. People who live at the Old Rectory had a good understanding of the precautions needed to prevent the spread of infection and wore face masks when in the communal areas of their home.

Staff spent time with people in meaningful activities. This included creating a coffee shop in the grounds and providing a range of activities. People were supported to remain in contact with relatives during the pandemic.

The service was clean with personal protective equipment available on each floor.

Staff were knowledgeable about their responsibilities for infection prevention and control and told us they were trained and supported in their role.

The Old Rectory provides care and accommodation for up to 19 people with learning disabilities. On the days of our inspection there were 17 people living at the care home.

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 the last inspection on the 28 July 2015, the service was rated Good overall. However it was Requires Improvement in Well-Led. At this inspection we found the service Good overall.

Why the service is rated good:

We met and spoke to all 17 people during our visit and observed the interaction between them and the staff supporting them. However, some people were not able to fully verbalise their views, so staff used other methods of communication, for example by providing visual prompts. Others were able to tell us able the care and support they received.

The service was now well-led. At our inspection in July 2015 it recorded that improvements had been completed from our inspection of July 2014 however the registered manager had only been registered with us since April 2015. Therefore our previous inspection report stated; “We found, however, that follow up action was not yet fully embedded in practice and further improvements were needed.” At this inspection we found those improvements had been embedded into the service.

People lived in a service where the registered manager and provider’s values and vision were embedded into the service, staff and culture. Staff told us the registered manager and provider were very approachable and made themselves available. The provider’s governance framework, helped monitor the management and leadership of the service, as well as the ongoing quality and safety of the care people were receiving.

People lived in a service which had been designed and adapted to meet their needs. The service was monitored by the registered manager and provider to help ensure its ongoing quality and safety.

People remained safe at the service. One person said; “Yes I’m safe here, because all my friends are here.” People were protected as the company had safe recruitment procedures in place to help ensure staff were suitable to work with vulnerable people. Staff agreed there was sufficient numbers of staff on duty to support people and meet their needs. Comments from staff on why people were safe included; “People are safe because we are all well trained and have a good staff team” and another said; “We know where people are and what they are doing at all times.”

People’s risks were assessed, monitored and managed by staff to help ensure they remained safe. Risk assessments were completed to enable people to retain as much independence as possible. People received their medicines safely by suitably trained staff.

People continued to receive care from staff who had the knowledge and skills required to effectively support them. Staff had all completed safeguarding training and new staff had completed the Care Certificate (a nationally recognised training course for staff new to care). Staff confirmed the Care Certificate training looked at and discussed the Equality and Diversity needs of people.

People were supported to have maximum choice and control of their lives as much as they were able to. Staff supported people in the least restrictive way possible; the policies and systems in the service supported this practice. Some people had their end of life wishes documented. People's healthcare needs were met and their health was monitored by the staff team. People had access to a variety of healthcare professionals.

People’s care and support was based on legislation and best practice guidelines, helping to ensure the best outcomes for people. People’s legal rights were up held and consent to care was sought. Care records were person centred and held comprehensive details on how people liked their needs to be met, taking into account people’s preferences and wishes. Information recorded included people’s previous medical and social history and people’s cultural, religious and spiritual needs.

People were observed to be treated with kindness and compassion by staff who valued them. The staff, many had all worked at the service for some time, had built strong relationships with people. Staff respected people’s privacy. People or their representatives, were involved in decisions about the care and support people received.

The service remained responsive to people's individual needs and provided personalised care and support. Some people had complex communication needs and these were individually assessed and met. People were able to make choices about their day to day lives. The provider had a complaints policy in place and the registered manager confirmed any complaints received would be fully investigated and responded to.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with four people who lived at the service, five members of staff, the manager and the nominated individual. We also looked at a selection of records. These included people’s assessments and care plans, staff rotas, menus, maintenance records and quality monitoring records that related to the management of the service.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. On the day of our inspection we were informed that no one who lived at the service was subject to a DoLS authorisation. However, relevant staff had been trained to understand when an application should be made to deprive someone of their liberty and how to submit one.

There were systems in place to make sure that the manager and staff learned from events such as accidents and incidents. This helped reduce the risk of harm to people and reduced such incidents reoccurring in the future.

The laundry room was in a very bad state of repair and did not promote good infection control for people who lived at the service and staff. We have set a compliance action in relation to this and the provider must tell us what they are going to do to address this.

People said that they were happy with the environment in which they lived. People particularly liked their bedrooms and the large, well maintained gardens that surrounded the service. As one person told us, “My room has a big bed, painted walls. I have a TV in my room. I have my own shower”. Another said, “I like my room. I’ve got pictures of me with my friend. My bed is nice and comfortable”.

Is the service effective?

People told us that they were happy with the support they received and their needs had been met. One person told us, “The staff would support me to contact the doctor. They would make sure I’m okay. They would check me and then phone the doctor or the nurse. It’s a very good thing”. Another person said, “Yes I have a care plan. It involves going on holidays, support workers, diet. My key worker wrote it but spoke to me about it. It is reviewed quite regularly. I’ve got a communication passport in my room. It’s good for helping new staff to get to know me”.

It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew them well.

We found that care plans provided up-to-date information about people's care needs and preferences. This meant that people were sure that their individual care needs and wishes were known and planned for. We found that people’s needs were assessed and monitored effectively.

People were supported to be able to eat and drink sufficient amounts to meet their needs. When we spoke to people about their views on the meals provided they expressed satisfaction. For example, one person told us, “We’ve got a lot of food choices. I help ‘X’ (chef) in the kitchen on Thursday”.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. People that we spoke with expressed satisfaction with the staff that supported them. One person told us, “I’ve lived here two and a half years now. I like it here. I get on well with the staff and the other residents”. Another said, “I know all the staff and their names and what they do. Staff support me. I feel safe, very safe here”.

Staff told us that they had time to deliver good care to people and that they were able to spend time with them. This was because there were enough staff on duty to provide individualised care to people. We observed that staff were quick to respond to people’s needs and clearly knew them well.

Is the service responsive?

Where staff identified a concern about people's diet referrals were made to the appropriate agency and support was given. This meant that people were supported to maintain and manage changes in their health.

People were offered choices with regard to activities they could participate in and supported to maintain their independence and to access the local community. Everyone that we spoke with said that they enjoyed the activities the participated in. One person told us, “I recently joined the gym at a local hotel. Staff go with me. I go there two times a week. We do budgeting and shopping on Saturday mornings”. Another said, “Staff explain what I’m able to afford with my money and if an activity is appropriate or not. I’ve been going horse-riding for a year. Before that I went to watch to see what it was like whilst waiting for a place. Horse-riding is comforting. I usually come back from it in a good mood”.

Is the service well-led?

We saw there were systems for monitoring the quality of services provided. These included seeking and acting on the views of people who lived at the service. As one person told us, “We have a resident’s meeting once every month”. A member of staff also informed us, “They also have a grumble book. Residents can write down complaints and these are then given to the manager”. Since our last inspection a new manager has been recruited and is in the process of applying to be registered with us.

We gathered evidence of people's experiences of the service by observing how people were cared for, looking at records and talking with three members of staff. We also spoke with the manager and the nominated individual. We found that people's care needs were being managed safely by the service and that staff had a good understanding of their roles and responsibilities in this area.

People's rights with regard to consent were being promoted by the service and staff understood how people's capacity should be considered. One member of staff explained, "For all support we ask if it is what they want. Some people will show agreement in non verbal ways such as holding your hand. If they don't agree we offer other choices. It's important to respect people and to help by giving information to make decisions".

Systems were in place that supported people to raise concerns. People told us that they would talk to staff if they were unhappy.

People who lived in the care home told us that they were happy with the support they received with their medicines. Our evidence confirmed that people who lived in the care home received their medicines when they needed it.

People who received a service from the domiciliary care agency also told us they were happy with the support they received with their medicines. However, our evidence demonstrated a lack of safe care planning that resulted in the potential that people would receive inconsistent support. This was compounded by a lack of robust policies and procedures for staff to follow.

People told us that they were happy with the staff that supported them. One person told us, "They are nice". Another said, "I like X (naming a member of staff), they help me".

We also spent time indirectly observing care practices and interactions between people at the service. We observed staff interacting with people in a positive and supportive way. We saw people being supported to prepare to go out on activities and doing in house activities such as colouring and art work.

Staff told us that improvements had taken place with the support they received from management to undertake their roles and responsibilities. They said that training was now being provided. Some comments were made that gaps in training remained. Our evidence supported their comments, however where gaps remained the provider had plans in place to address these in the near future. The nominated individual informed us that training had been prioritised based on risks to people and was being rolled out accordingly.