The Old Rectory

About the service

The Old Rectory accommodates 10 people who have a learning disability and/or autistic people. The service is located in a large house in the rural village of Chewton Mendip. Despite being a large service, it was operated in line with some of the values that underpin the Right support, right care, right culture guidance and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autistic people using the service can live as ordinary a life as any citizen.

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

Based on our review of the key questions safe and well-led, the service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right Support

The home was reliant on agency staff that did not always know people well or were confident to support people when out of the home. This meant at times the service could not fully meet the underpinning principles of Right support, right care, right culture and we could not be assured that people who used the service were able to live as full a life as possible and achieve the best outcomes.

People were supported to have some choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice.

Staff did everything they could to avoid restraining people. The service recorded when staff restrained people, and staff learned from those incidents and how they might be avoided or reduced. The provider’s behaviour specialist was supporting the staff to ensure appropriate support was being delivered.

People were supported by a key worker who met with them to seek their views about how they wanted to be supported. People relied on staff to enable them to go out in the community to ensure their safety and that of others.

Right Care

People’s medicines were mostly managed safely. Other health and social care professionals were involved in the care and support of the people living in the home. Referrals had been made to the local community learning disability team.

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

People received care from staff that had been through a thorough recruitment process. Staff were caring in their approach towards people.

Right culture

Not everyone was happy with the care and support and the relationships within the home. Two people said they did not like all the staff or the people living in The Old Rectory. They said they had raised this with the manager and were being supported to find alternative accommodation. The person said some of the staff had left. Relatives were mostly positive and said since the new manager had been in post, they had seen improvements in communication.

There had been a lack of leadership in the home. There had been no registered manager at the service since January 2021. The new manager started working in the home in October 2021. They had an improvement plan they were working towards. However, due to workforce pressures they had not managed to address many of the areas for improvement due to supporting people themselves because of the lack of permanent staff and high agency usage.

Staffing was not always planned in respect of people’s individual needs which meant they were not always receiving their one to one support.

The provider and the manager had failed to implement a robust system to monitor the quality of the service. Improvement in areas of risk management had not been fully implemented in respect of the property, fire and cleanliness.

The home was in a rural area, however, there was good public transport links to Bristol, Bath, Wells and other neighbouring towns. There was a shop, a café and public house in the village.

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 (published 12 December 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service. The inspection was prompted in part due to concerns received about an increase in incidents within the home, staffing and governance arrangements. A decision was made for us to inspect and examine those risks.

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.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this report. You can see what action we have asked the provider to take at the end of this full report. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to systems to monitor risks in relation to fire and infection control, staffing and the governance arrangements.

We recommend the provider consider current guidance on supporting people with a learning disability and autistic people to improve people’s experience.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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 Safe, Effective and Well Led to at least good. We found the provider had made the required improvements and the service is now rated as Good.

The Old Rectory is a ‘care home’. People in care homes receive accommodation and nursing or 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.

The Old Rectory accommodates 10 people who have a learning disability and/or autism. The service is located in a large house in the rural village of Chewton Mendip.

Despite being a large service, it was operated 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 and autism using the service can live as ordinary a life as any citizen.

The service did not have 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. The previous registered manager had left the service in September 2018. The provider had placed an interim manager at the service whilst a new manager was recruited. The interim manager informed us the new manager was due to start work at the service the day after our inspection. They would then start the application process to become the registered manager.

Staff had been trained to administer medicines safely. The previous registered manager, interim manager and staff had worked with health professionals to review people’s medicines and ensure they were not being over-medicated. They had done this by working with the professionals to find alternative strategies to support people when they displayed behaviours that could challenge others.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the providers policies and systems supported this practice. The interim manager and staff understood and followed the requirements of the Mental Capacity Act 2005. They were committed to supporting people to achieve as much independence as possible, whilst ensuring each person was safe.

We found there were adequate numbers of staff working at The Old Rectory to support people effectively. The staff were well trained and supported well by the interim manager and provider.

The atmosphere of The Old Rectory had a friendly, calm atmosphere and people living in the home told us they got on well with both staff and other people at the home. People accessed the community regularly and were supported to plan their days and activities.

Risks to people were assessed and measures taken to keep people safe, without impacting on their rights to make choices and take some risks.

The home was clean and tidy and effective infection control procedures were in place to keep people safe. We did note that the decoration of some parts of the home was not very homely and had an institutional feel. However, this had been identified by the provider and plans were in place to change this.

We found the home was well managed and effective systems were in place to monitor and improve the quality of the care and support provided to people on an ongoing basis.

The Old Rectory provides accommodation and personal care for up to 10 adults who have a ¿learning disability. The service is located in a large house in the rural village of Chewton Mendip.¿

A registered manager was responsible for the service. This 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.¿

People were protected from abuse and avoidable harm; risks to people were not always fully ¿assessed or planned for. People received effective support to help them manage their ¿behaviour. Staff recruitment and people’s medicines were managed safely. ¿

Staff were well supported and well trained. Staff knew people and understood their care and ¿support needs. One staff member said, “I know people well, it takes time building their trust.” ¿People made choices about their own lives, although their legal rights in relation to decision ¿making and restrictions were not always upheld.

People’s diverse needs were well supported; they chose a range of activities and trips out.

People were part of their community and were encouraged to be as independent as they could ¿be. People interacted well with staff. Staff had built trusting relationships with people over time. ¿One person said, “The staff are very nice people. They’re here to look after us.”

¿

People had benefitted from reductions in the medicines they took. People, and those close to ¿them, were involved in planning and reviewing their care and support. Some care planning ¿needed to be reviewed and improved.

¿

There was a management structure in the home, which provided clear lines of responsibility and ¿accountability. All staff worked hard to provide the best level of care possible to people. The aims ¿of the service were well defined and adopted by the staff team.

¿

The quality assurance systems in place were not fully effective. There were systems in place to ¿share information and seek people's views about their care and the running of the home. People ¿knew how to complain if they were unhappy.

¿

We found three 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 the report.¿