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Archived: The Old Rectory Inadequate

The provider of this service changed - see old profile

Reports


Inspection carried out on 14 July 2016

During a routine inspection

The Old Rectory is a care home that provides accommodation and personal care for up to 60 older people including care and support for people living with a diagnosed dementia. There were 41 people in the service when we inspected on 14 and 18 July 2016. This was an unannounced inspection.

The registered manager was on leave at the time of inspection and an interim manager was 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.

There was not a culture in the service which promoted a holistic approach to people’s care to ensure all physical, mental and emotional needs were being met. Robust and sustainable audit and monitoring systems were not in place to ensure that the quality of care was consistently assessed, monitored and improved

Quality assurance systems had failed to identify the issues we identified during our inspection. The provider had failed to demonstrate that there were sufficient financial or practical resources to drive forward improvements and for these to be sustained.

There were not enough staff on duty to meet people’s care and support needs. People told us that they often had to wait for assistance when using their call bell. There were a high incidence of falls in the service and we were concerned that at times this was due to a lack of staff being available.

People were at risk due to poor monitoring of environmental factors and essential maintenance not taking place when needed. Risks to people injuring themselves or others were not always appropriately managed.

People’s medicines were not being managed effectively to protect them from the associated risks of not receiving prescribed medicines. Staff had not been proactive in seeking professional advice when there were concerns relating to peoples medicines.

The provider had not ensured the service was being run in a manner that promoted a caring and respectful culture. Although staff were attentive and caring in their interactions with people, they were not supporting people in a consistent and planned way.

Staff had not always taken appropriate action to protect people who had conditions which may put them at risk. They did not always respond appropriately and in a timely manner to all of people’s needs.

Care plans were lacking in information to assist staff in meeting the specific needs of people living with dementia. There was little detail to guide staff how to support people with the things that interest them, details of social activities they enjoyed or details of their life history and people of importance to them.

Staff were aware of their responsibilities with regard to safeguarding people from abuse and knew how to report concerns. However, they did not recognise or understand the wider aspects of safeguarding people from risk as identified in this report.

Training and development was not sufficient in some areas to show that people’s healthcare conditions were fully understood by staff. Records showed that where there had been cause for concern regarding the conduct of staff there had been little or no action taken.

Staff demonstrated a lack of knowledge regarding the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS.) However, staff understood the importance of gaining people’s consent and we observed that they asked people's permission before they provided any support or care.

Relatives had been updated regarding recent changes and asked for their opinion. However, there had not been the same opportunity for the people living at service.

During this inspection we identified a number of breaches of the Health and Social Care Act 2008

(Regulated Activities) Regulations 2014. You can see what action we told the prov

Inspection carried out on 16 June 2015

During an inspection to make sure that the improvements required had been made

This focused inspection took place on 16 June 2015. This focused inspection was carried out to check that the provider had made the improvements required following our comprehensive inspection 7 October 2014 and our unannounced focused inspection on the 6 January 2015.

Following our previous comprehensive inspection in October 2014 and our focused inspection in January 2015, we asked the provider to take action to make improvements as we found evidence of major concerns at both inspections in relation to the quality and safety monitoring of the service. We were concerned about the high turnover of staff and found shortfalls in the availability at all times of suitably qualified and competent staff with the range of skills required in order to meet the needs of people. The provider was not meeting the requirements of the law as the service was not well led and the management of the service did not protect people against the risk of receiving care or treatment that was inappropriate or unsafe.

The Old Rectory is a residential care home which provides accommodation and personal care support and is registered for up to 60 people. On the day of our inspection there were 38 people living at the service.

This report only covers our findings in relation to the previous breaches. You can read the reports from our comprehensive inspection carried out on 7 October 2014 and our last focused inspection 6 January 2015, by selecting the ‘all reports’ link for The Old Rectory’ on our website at www.cqc.org.uk

At this unannounced, focused inspection 16 June 2015 we found that significant improvements had been made.

Since our last inspection of this service in January 2015 the registered manager has resigned. There was a new manager in post who told us they had submitted their application to register with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

All of the staff and relatives we spoke with were positive about the management of the service and said that the service had become more stable and the morale of the staff had improved.

In the main there were enough staff to support people to have their needs met. However, there was a potential risk of people not having their needs met in a timely manner if senior staff were not available to support at meal times and if sufficient staff were not available to respond to unforeseen events. Staffing hours to support people with access to planned activities had been increased but we were unable to judge the impact of this as those staff were not available on the day of our inspection.

Staff had been supported with access to regular supervision and opportunities to discuss their training and development needs.

People had their nutritional needs met and, where required, specialist advice and support had been accessed.

Staff were kind and caring. They demonstrated the right approach to the care and support of people and were attentive to their needs. People had their privacy and dignity respected and were relaxed and comfortable with staff.

The provider had systems in place to regularly monitor the quality and safety of the service.

The service was not consistent in planning to prevent and mitigate risks to people. For example, those people at risk of falls. Specialist support had not always been sought to provide advice and guidance to the service to safeguard people from the risk of harm.

Care plans described well the daily routines of people, but were sometimes lacking in guidance for staff in how to support people with planned strategies to safely de-escalate incidents of distressed reactions. Staff designated to work on the dementia unit had not always been provided with the support and guidance they needed to monitor and support people safely and effectively.

It was not always evident that people had been involved in the planning and review of their care. Where this would be beneficial for people living with dementia, information with regards to people’s personal life histories was often left blank in their care plans.

Residents and relatives meetings had taken place which enabled and supported people to express their views about how the service was being run.

Inspection carried out on 6 Janaury 2015

During a routine inspection

This inspection took place on 6 January 2015 and was unannounced.

When we inspected this service in October 2014, we had major concerns regarding the lack of action taken by the provider when they had identified shortfalls in their audits monitoring the quality and safety of the service. We took action in response to our concerns and issued the provider with a warning notice. We carried out this inspection to check that the provider had taken action to improve the quality and safety of the service. We found that whilst some improvements had been made to the environment, we continued to be concerned about the leadership of the service, the high turnover of staff and the number of staff available to meet people’s needs, at all times.

The Old Rectory is a residential care home which provides accommodation and personal care. support and It is registered for up to 60 people. On the day of our inspection there were 46 people living at the service.

There was a registered manager in place. 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 service is run.

Although people told us that they felt safe this service was not providing consistently safe care. There was a high proportion of agency staff who did not have a knowledge of people’s needs. Account had not been taken of people’s needs when deciding on staffing levels which led to concerns about the ability of the service to ensure people’s safety at all times.

We found staff to be kind and caring, however we remained concerned that staff did not always respond to people's needs in a timely way. We found that staff were focussed on the completion of tasks, such as the provision of meals and personal care with minimal engagement with the people they were supporting.

The provider was meeting the requirements of the Mental Capacity Act (2005).People’s best interests had been assessed. Advice had been sought and best interests assessments requested from those qualified to do so where people’s freedom of movement was being restricted in line with the Deprivation of Liberty Safeguards (DoLS). This helped to ensure people’s rights were protected.

People’s expressed preferences were not taken into account when preparing menus. Nutritional needs had been assessed and specialist advice sought when required. However, people had varied experiences at mealtimes as support from staff was not always provided in a caring, dignified manner and did not promote their health and wellbeing.

People had mixed experiences of staff. Whilst some told us staff were kind and caring others found staff focussed on tasks rather than them as a person.

Prior to our inspection we received information of concern that people’s opportunities to enjoy social interaction with others whilst taking part in group activities had been reduced. They also told us that opportunities to pursue individualised leisure interests had been reduced as staff designated for this role had been assigned to work in the kitchen to cover for staff shortages.

Inspection carried out on 7 October 2014

During a routine inspection

This inspection took place on 7 October 2014 and was unannounced.

The Old Rectory is a residential care home which provides accommodation and personal care support and is registered for up to 60 people. On the day of our inspection there were 47 people living at the service.

There was a registered manager in place. 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 service is run.

At our previous in inspection June 2014 the provider was not meeting the requirements of the law in relation to cleanliness and infection control, insufficient staffing levels, the deployment of staff to provide opportunities for people with social and leisure activities and how the quality of the service was monitored. We asked the provider to take action to make improvements. During this inspection we looked to see if these improvements had been completed.

People who used the service and their relatives told us contradictory things about the quality of the service they received. While some people told us they felt safe, were treated with kindness and respect by the staff, others expressed concern about the lack of social interaction provided and insufficient staffing levels.

The provider did not have a robust system in place to assess staffing levels and make the necessary changes when people’s dependency needs increased. Everyone we spoke with raised concerns about the low number of staff available. This meant that the provider could not be sure that there were enough qualified staff to meet people’s needs.

Care provided was mainly centred on providing for people’s personal care needs. There were insufficient numbers of staff available to meet the social care needs of people living with dementia on Redwood unit.

Staff did not understand their roles and responsibilities with regards to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff were not always following the MCA 2005 for people who lacked capacity to make a decision. For example, the provider had not understood the need to make an application under the MCA 2005, Deprivation of Liberty Safeguards for two people, who we observed to have their freedom of movement restricted, which meant that there was a potential deprivation of their liberty.

The provider had a system in place to respond to concerns and complaints. All the people we spoke with did not know how to make a formal complaint but did however express their confidence in the manager to respond to any concerns they might have.

The provider had a range of checks in place that monitored the quality and safety of the service. The provider’s audits had identified the shortfalls and risks associated with a lack of adequate maintenance of the premises. However, the provider had failed to plan and take action to ensure adequate maintenance of the service. The process for monitoring the quality of the service was not robust and effective in picking up some of the concerns we found and so had not led to the necessary improvements.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we have told the provider to take at the back of the full version of this report.

Inspection carried out on 9 June 2014

During an inspection in response to concerns

We carried out our inspection in response to information of concern received from the local authority and others about the care and support provided to people who used the service. As part of this inspection we spoke with 12 people who used the service, four Relatives, seven staff and the registered manager. We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is the summary of what we found:

Is the service safe?

We did not find that all areas of the service were safe.

We saw that infection control checks were not robust and effective. We found areas of the service that were poorly maintained and unhygienic. A compliance action has been set in relation to this and the provider must tell us how they plan to improve. There was insufficient domestic staff available to keep the service clean and free from the risk of cross infection.

The registered manager had a good understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). There were no DoLS currently in place. Staff had been provided with the training they needed which would ensure that people were only deprived of their liberty when they needed to be so.

The staff team were skilled and experienced. However, we found concerns with regards to the staffing levels on Redwood unit which was designated to provide care and support for people living with an advanced dementia. Staffing levels were not consistently maintained and were at times insufficient to meet people’s needs. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

We found medicines were stored safely for the protection of people who used the service. We were assured that appropriate and effective monitoring arrangements were in place to identify and resolve medication errors promptly.

Is the service effective?

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

During our observations we saw that people on the Redwood unit were bored, and disengaged. We saw that there was little evidence that the service provided activities specifically designed to engage and stimulate people living with a dementia.

The provider had a quality assurance system in place and the records we examined showed that health and safety audits had been carried out. However, due to our concerns found during this inspection, it was not evident that these audits were effective in keeping people safe from the risk of infection and robust enough to ensure that their needs were met by enough qualified staff. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service caring?

Staff supported and interacted with people in a friendly and supportive manner. However, staff were seen to be rushed and stressed, which meant that we could not be assured that the people who used the service received appropriate care and support.

Is it responsive?

Where concerns about an individual's wellbeing had been identified, staff had taken appropriate action that ensured people were provided with the healthcare support they needed. This included seeking support and guidance from care professionals, including dieticians, doctors and community nurses.

We found that activities provided for people living with a dementia were limited and not always appropriate given some people’s complex needs as a result of their living with a dementia.

Is the service well led?

The manager held 'residents' meetings and a weekly surgery where people could speak with them to discuss any concerns they may have about how the service was managed.

We saw there were insufficient numbers of trained staff available on a daily basis to meet people’s needs. Action had been taken by the manager to recruit new staff. However, there was insufficient staff deployed to meet the needs of people living with a dementia on Redwood unit.

Quality audits were not always robust in identifying shortfalls, for example in monitoring the cleanliness of the service. There were insufficient systems in place to control the risk of cross infection.

Inspection carried out on 17 October 2013

During a routine inspection

People who lived at The Old Rectory Residential Care Home had a range of needs including those associated with dementia. Where people were unable to tell us directly about their experiences, we observed that they appeared calm and relaxed; they interacted positively with staff and actively sought staff out. We observed that staff were attentive to people`s needs and treated them with respect and dignity.

People who were able to speak with us were all positive about the care and support they received at The Old Rectory. One person told us: "I am very happy here and the staff are very kind.” Another person said: "Staff do a very good job, they look after me very well.” Another person said: “Everybody is very nice, can’t beat it really. I go about my day as I choose to; I make use of all the lounges, I get up when I choose and go to bed when I want to. The food on the whole is OK and we have a choice of meals.”

They told us that their wishes to be independent were respected and they were supported to make decisions about their care. People told us that they enjoyed the social activities that were arranged for them.

We spoke with visiting family members. They were all satisfied with the standard of care delivered to their relatives and they all found the staff to be approachable, helpful and informative.

People had detailed and personalised care plans in place that guided staff as to the care and support they needed. We found that the people living at the home were cared for by sufficient levels of staff who received a good level of training and support.

The provider had systems in place to monitor and to help ensure quality and safety at the home. However we found that there was a lack of hand rails in the corridors, bathrooms and shower room and some toilets were very low and did not have hand rails.

Inspection carried out on 4 January 2013

During a routine inspection

We spoke with five relatives and friends visiting people who used the service. They told us that they were happy with care provided at The Old Rectory. Comments included "The manager is approachable and efficient and the staff kind and cheerful" and “The ambience in the home has improved and things have settled down in the last few months".

People who live in the home and/or their families told us that they were consulted about how their care was delivered and that they had input into how the home was run. We looked at care plans and these showed that people, where they were able, made choices and consented to their care planning arrangements.

There were arrangements in place to ensure the safe management of medicines.

Overall we found that staff had been through a period of change and the new manager, with the support of the provider, was making positive improvements to the environment and quality of the service delivered. However we found that staffing levels were not sufficient to meet the individual needs of people using this service and this needs to be addressed.

Inspection carried out on 21 June 2012

During an inspection to make sure that the improvements required had been made

People who lived at The Old Rectory told us they were generally happy with the care they received. They had a choice about meals and menus and could stay and eat in their room if they wanted.

One person told us "They look after you really well, can’t fault them. I like reading and there is a library. There are record players and the food is alright." A relative who was visiting said "Everything is going well. They (staff) follow the care plan and do what they can."

A number of people were not able to tell us directly about their experiences. However, we observed how they interacted with staff and how they were assisted. We saw that staff understood people's needs and were respectful when assisting and supporting them. The staff took their time, were patient and treated people with dignity.

Inspection carried out on 9 March 2012

During an inspection in response to concerns

People told us that they liked living at The Old Rectory and the staff were kind and caring. People said they didn't have any complaints as the staff did their best. People could decide when they got up and went to bed but sometimes they had to wait for help. Relatives told us that there had been a lot of staff changes lately and sometimes they didn't see many staff around which concerned them.

Inspection carried out on 6 January 2012

During an inspection to make sure that the improvements required had been made

People with whom we spoke to on our visit on 06 January 2012 told us they were happy with the way that the home managed their medicines on their behalf and that the staff were 'very good' but that they were 'always busy'.