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 assessment we rated this key question Good. At this assessment the rating has remained Good. This meant people were safe and protected from avoidable harm.

This service scored 75 (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 improve, identify and embed good practice. Staff knew the procedures to follow and the importance of making people safe. Processes were in place to manage and record accidents and incidents. The peripatetic manager kept an overview of accidents and incidents and undertook root cause analysis when required. Any issues were discussed at staff safety huddle meetings, team meetings and at supervisions. If patterns or trends were identified, they were discussed as a team as a learning exercise, to learn, to minimise risk and to prevent a recurrence. The peripatetic manager said, “Incident and accident reports are all reviewed by management team and signed off. We look at what needs addressing, what needs reporting to the local authority and CQC, and keep families informed.”

One relative told us that they were kept informed when things went wrong and how the service learned from incidents. The relative said, “Totally honest and transparent, if anything happens, they inform us immediately.”

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.

People’s move into the service was planned, slow and focussed on what best suited the person themselves and their families. The transition was as long as needed to ensure that they liked the home, the people who lived there and staff who worked there. We spoke with some people who had lived in the home for many years moving from a previous home that had closed. They said they had been made welcome and that having people they knew and staff move with them had ensured a smooth transition and they were very happy.

When people moved or were admitted to hospital, staff worked with other managers and professionals to ensure smooth transitions and that all necessary paperwork was up to date. A condensed care plan which contained key information about people was used when a person had to go to hospital. These were regularly reviewed and updated. During hospital visits and overnight stays, staff from the service would accompany people and remain with them throughout their visit, including overnight. A senior staff member told us, “If someone needs to go to hospital, we send one of their key workers with them to reduce anxiety and help settle them.”

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.

Staff we spoke to were confident and knowledgeable about safeguarding. They knew how to recognise signs that abuse may be occurring and how to raise alerts and report concerns, by whistleblowing if necessary. Staff knew people well and could describe their difficulties and how to support them individually. One staff member told us, “We have really lovely residents, all different and each day can bring different challenges.”

People were supported with kindness and respect by staff who knew them well. We saw staff respond to an escalating situation with calmness and fairness which calmed the situation down.

There was a safeguarding and whistleblowing policy in place, and staff confirmed they had read the policies as part of their induction and training. We saw that procedures had been correctly followed, and the provider had made referrals as required to the local authority and notified CQC appropriately.

The management team explained that people’s capacity was assessed in accordance with the Mental Capacity Act (MCA) and assessments were stored within people’s records.

The service worked within the principles of the Mental Capacity Act (MCA) and if needed, appropriate legal authorisations were in place to deprive a person of their liberty (DoLS). Records reflected MCA assessments had been undertaken to consider people’s capacity to make decisions about their care.

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.

Each person had up to date individual care plan and risk assessments. The care plans and risk assessments were now all computerised and contained information about care and support needs, and associated risks and staff entered daily notes on hand-held devices. These provided information about people’s risks and mitigation strategies for staff to provide safe and effective care.

Risk assessments supported staff to manage identified risks whilst ensuring people's rights and independence were promoted and respected. Positive risk taking was supported and encouraged in line with the principles of Right support, Right care, Right culture to support people safely whilst promoting independence and encouraging them to live life to the full. For example, people were encouraged and supported to go out in the community, go shopping, go on holiday and to visit clubs for events such as bingo.

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 was fully aware of all potential risks in the care environment and controlled them well. They made sure equipment, facilities and technology supported the delivery of safe care. The premises were old and before admission consideration was given to people’s mobility and mobility aids to ensure people’s safety. People had access to both internal and external spaces which were safe and promoted independence.

The environment was safe for the people who lived there. There was no clutter, and the home and gardens were accessible for people with mobility needs.

Processes ensured the environment was safe and well kept. Health and safety checks had been undertaken to ensure safe management of utilities, food hygiene, hazardous substances, moving and handling equipment, staff safety and welfare. There was a business continuity plan which instructed staff on what to do in the event of the service not being able to function normally, such as a loss of power or evacuation of the property. There were detailed fire risk assessments, which covered all areas in the home. Premises risk assessments and health and safety assessments were reviewed on an annual basis, which included gas, electrical safety, legionella and fire equipment. There was a rolling plan of redecoration and maintenance in place which the management team monitored continuously.

People had a personal emergency evacuation plan (PEEP) in place. This is guidance for staff on what to do in the event of an emergency, and how to safely evacuate people.

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.

The staffing levels were based on people’s needs and regularly reviewed. We looked at 3 months of rotas, and the staffing levels were consistent and supported by relief staff to cover vacant positions, sickness and holidays. Staff numbers and the deployment of staff had ensured people’s needs were met in a way that met their preferences. Care delivery was supported by records that evidenced that people’s care and social needs were being met.

Our observations showed us that staff were visible and available to support people’s requests for support and company and take the time to engage with people. We saw some lovely interactions where staff were singing along to the radio with people, whilst making drinks.

People received timely care, people we spoke with did not have any concerns regarding staff numbers. People told us, “I go out and staff come with me, never a problem,” and “lots of staff around.”
Staff were recruited safely. The provider undertook checks on new staff before they started work. This included checking their identity, their eligibility to work in the UK, obtaining at least two references from previous employers and Disclosure and Barring Service (DBS) checks. The DBS helps employers make safer recruitment decisions and prevent unsuitable people from working with vulnerable people.

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 premises provided people with a clean, and well-maintained environment. People’s rooms were cleaned regularly by people and their key worker. Some areas were hard to clean due to it being an old building, but there was on-going redecoration planned to assist with this. The bathrooms had recently been upgraded.

People told us, “Always clean, because I do clean my own room.” Visitors told us the home was clean and well maintained. A visitor said, "Well-kept, comfortable and welcoming."

Staff told us they are well resourced for cleaning and infection control. One said, “We have enough gloves and aprons and also cleaning products and equipment.”
Laundry was managed well, and the laundry room was clean and well organised, people were well dressed.
All staff understood their responsibility to reduce the risk of infection and followed infection control guidance. There were posters and training to assist staff in keeping up to date with any changes to infection control measures. Audits were completed to ensure compliance with the procedures and policies of the home. Staff were trained in the use of personal protective equipment (PPE) and of the importance of good hygiene practice. The peripatetic manager told us they ensured staff continued to follow Public Health England guidance to reduce risk of infections.

Overall, the provider made sure that medicines and treatments were safe and met people's needs, capacities and preferences. We found some minor shortfalls which were immediately addressed.

Staff involved people and families in planning, including when changes happened. Staff supported people to have their prescribed medicines and followed best practice for administering medicines. Not all people could not share their views regarding medicines, but one person told us, “I get my medicine from staff, they arrange it all.”

The staff worked closely with the GP and the Medicines Optimisation in Care Homes team, which is a program by NHS England, which focuses on improving medication management for people, to ensure medicines were reviewed regularly. Staff spoken with were aware of the protocols about Stopping Over Medication of People with a learning disability, autism or both (STOMP).

There was no dedicated clinical room and people’s medicines were either stored in an appropriate lockable cupboard in their bedrooms with their individual medicine administration record (MAR) or in the medicine cupboard in the main house. Both bedroom and medicine cupboard temperatures were checked and recorded daily to ensure medicines were stored at the correct temperature. Staff who gave medicines had the relevant knowledge, training and competency that ensured medicines were handled and stored safely. We observed staff giving medicines safely and that they were recorded accurately on the medicine administration record (MAR.) Risk assessments were in place for certain medicines. All discrepancies and medicine errors were recorded and investigated and action taken as required.

Daily checks and monthly audits were carried out, and any shortfalls were addressed. Protocols for 'as required' (PRN) medicines such as pain relief, and anti-anxiety medicines were in place. Staff were able to discuss how people showed they were in pain or discomfort, but this was not easily found within people’s documentation. The medicine administration chart did not include recording when people were on social leave, to explain the gaps. These issues were fully acknowledged by the management team and was being addressed.