The Old Rectory

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last inspection we rated this key question Requires Improvement. At this inspection the rating has changed to Good. This meant people were safe and protected from avoidable harm.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Incidents, accidents and near misses were recorded with clear details of what had happened, including what people were doing in the lead up to the incident. This helped staff identify situations which could escalate people’s anxieties. Staff took a pro-active approach to prevent situations escalating where possible and minimise distress for people. The registered manager reported they had identified a reduction in the number of incidents since the last inspection and the service no longer needed to use any physical interventions during incidents.

Incidents were reviewed by the registered manager and area director to ensure actions were taken to reduce the risk of a repeated incident. Staff told us learning from incidents was shared with them and gave them clear information on any changes to the way they needed to support people. Staff showed us examples of ‘safety huddle’ documents, which were used to communicate changes to all staff.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Relatives told us systems worked well when people started using the service, with good communication and close work with health services people were using. People’s health conditions were documented, and they were supported to access services from a range of professionals including the psychiatrist and learning disability nurses.

People had been supported to develop hospital passports, to ensure key information about their needs and how to meet them was shared with medical professionals if needed.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Relatives said they felt people were safe living at the service. Staff demonstrated a good understanding of their safeguarding responsibilities and said they completed regular safeguarding training. Staff were confident managers would take appropriate action if they reported safeguarding concerns. Staff were also aware how to raise these concerns outside of the organisation if they needed to.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found the provider had applied to the local authority for (DoLS) authorisations where appropriate. The registered manager had a record of all DoLS applications that had been made, including details of any conditions to the authorisations. Records demonstrated conditions on authorisations were being met.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People had been supported to develop clear positive behaviour support plans, setting out support they needed to managed periods of anxiety and minimise distress. The plans had been developed with relevant professionals and had been regularly reviewed and updated as people’s needs changed. Staff demonstrated a good understanding of the risks people faced and how to support them safely. Staff told us risk management plans were regularly reviewed and updated, as people’s needs changed. Staff had immediate access to updated plans through the electronic support planning system and were notified of any changes.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The provider completed various health and safety checks to make sure the premises, and any equipment was safe. Equipment was serviced regularly, and external contractors were used to check safety systems such as fire and water safety. Staff on site completed some checks such as fire alarms and means of escape routes in the event of a fire. Checks had identified work was required to the boiler flue and the provider reported they had applied for consent from the local authority for the work to be completed. Risk assessments and been completed and established the boiler was safe to use until the works had been completed.

Feedback from visiting professionals included, “The home environment is clean, well-kept, and includes a spacious, safe garden for independent use.”

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

At the last inspection we identified there were not always sufficient staff available to support people to take part in community activities. At this inspection we found staffing levels had improved.

During our inspection we observed there were enough staff to safely meet people’s needs. Staff were now available to support people out in the community and to be present at the service and encourage people to engage with indoor activity. Staff told us there were sufficient staff available to meet people’s needs. Records demonstrated staffing levels were now provided in line with people’s assessed support hours.

Staff had been recruited safely, with all pre-employment checks completed prior to staff starting work. Staff completed a thorough induction when they started and had regular training relevant to the needs of people living at the service. This included mandatory training in relation to supporting people with a learning disability and autistic people. The registered manager had a record of training staff had completed and when any refresher training was due.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. The service was clean, and most areas smelt fresh. One person’s bedroom contained a strong odour, which was being addressed by the provider. All areas of the service were frequently cleaned and well maintained. Staff had appropriate access to personal protective equipment and had received training on infection prevention and control good practice.

The provider did not always make sure that medicines and treatments were managed consistently. At our last inspection we found ‘as required’ medicines did not have effective protocols. This had now improved; however, further detail was required where people had been prescribed a variable dose of medicine. Some people had details recorded of how much medicine to administer and when, but this was not consistent for everyone. The registered manager took immediate action to address this shortfall.

Staff were not consistently following the provider’s ‘homely remedies’ policy. A ‘homely remedy’ is an over-the-counter medicine which can be bought from a pharmacy and does not need to be prescribed. We found 1 occasion when staff had administered a medicine before checking with the person’s GP if it was appropriate. Whilst the staff did seek authorisation from the GP for this medicine, they had administered it prior to this check. We raised this with the registered manager.

Medicines were now being stored safely, and everyone now had an up-to-date photograph on their medicines’ profiles. There were no gaps in medicines administration records (MAR) and there were minimal handwritten MARs in use. Staff had medicines training and regular checks for their competence in administering medicines safely.

The provider was signed up to STOMP (Stopping over medication of people with a learning disability and autistic people). This is a national initiative to stop over prescribing of psychotropic medicines. People had been supported to reduce doses of this type of medicine and ‘as required’ protocols clearly told staff to try other interventions first and use this type of medicine as a last resort.