Archived: The Old Rectory

The Old Rectory is a residential care home providing personal care to up to 28 people in one adapted building across three floors. The service provides support to older people who may have a physical disability and/or live with dementia. At the time of our inspection there were 17 people using the service.

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

Potential risks to people's health and wellbeing had been identified and were managed safely, however records of when mitigation was put in place after an incident required further improvement. There were sufficient numbers of staff on duty to keep people safe and meet their needs, however more staff with medicines training were required. People's medicines were managed and stored in a safe way; improvements were required in the administration checks of controlled drugs. Safe practice was carried out to reduce the risk of infection.

Staff had the training and support to be able to keep people safe in line with best practice, however staff felt there were other aspects of training which would be beneficial to help support people with their dementia care needs.

People and relatives told us the service had improved since our last inspection. Staff told us there had been improvements which were working better, however staff felt that more engagement and opportunities to empower them with the knowledge and skills to care for people was needed.

The audits and checks required broadening to ensure the service was constantly striving to drive improvement.

People told us they felt safe and were supported by staff. Relatives felt their family member was safe and cared for in the right way. Staff recognised different types of abuse and how to report it. The registered manager understood their safeguarding responsibilities and how to protect people from abuse. People, and where appropriate, their relatives, had been involved with decisions in how to reduce risk associated with people’s care.

People's care needs had been assessed and reviews took place with the person and, where appropriate, their relative. People were supported to have a healthy balanced diet and were given food they enjoyed. Staff worked with external healthcare professionals and followed their guidance and advice about how to support people following best practice. People were supported to have maximum 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 did support this practice.

People told us staff were kind and treated them well. Relatives felt the staff cared for their family member in a caring and supportive way. Staff treated people as individuals and respected the choices they made. Staff treated people with care and respect and maintained their dignity.

People's care was delivered in a timely way, with any changes in care being communicated clearly to the staff team. People were supported to maintain contact with people who were important to them. People engaged in activities that were individualised to them. People had access to information about how to raise a complaint. People's end of life care needs was met in line with their preferences in a respectful and dignified way.

People, relatives and staff felt the registered manager was visible within the home and listened to people's and staff's views about the way the service was run. The nominated individual (NI) visited the home and carried out checks on the service provision.

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 inadequate (published 29 September 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

This service has been in Special Measures since 23 August 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Old Rectory on our website at www.cqc.org.uk.

Enforcement

We have identified a breach in relation to Regulation 17 good governance at this inspection. 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.

The Old Rectory is a residential care home providing personal care to up to 28 people in one adapted building across three floors. The service provides support to older people who may have a physical disability and/or live with dementia. At the time of our inspection there were 17 people using the service.

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

Staff were not competent in how to prepare food for people who required a textured modified diet and people who required this were given food which was unsuitable for them, which posed a risk of potential harm. Staff were not fully competent of what procedures they would follow in the event of a fire and how to safely evacuate people. The provider put immediate steps in place to ensure staff’s knowledge in this area improved.

Aspects of the home’s environment posed a potential risk of harm to people. The call bell system had not been working for one month. The process that was in place to ensure people were safe while the call bell system was not working was not effective. Environmental shortfalls had not been identified by the provider in order to mitigate potential risk of harm. The provider put steps in place to address these areas promptly. There were areas of the home which would be difficult to keep clean.

People's medicines were mostly managed in a safe way; however, improvements were needed to ensure staff waited with the person to ensure they had taken their medicines safely. Improvements were also required for better monitoring for people who required medicine through a patch, to ensure this remained in place. Medicines was stored and disposed of in a safe way.

The provider did not have effective systems in place to identify shortfalls in a timely way. We found areas that required improvement such as staff training and record keeping that the provider was not aware of. Record keeping was not always, accurate, contemporaneous, complete or dated.

People told us they felt safe and supported by the staff who worked in the home. Staff recognised different types of abuse and how to report it. The registered manager understood their safeguarding responsibilities and how to protect people from abuse; however; improvements were needed in processing unexplained bruises, to ensure these were reviewed and responded to. We received mixed views from people and staff about sufficient numbers of staff on duty to keep them safe. Rotas did not always reflect there was sufficient staff on duty particularly during the weekends.

People's care needs had not always been assessed and some reviews of people’s care had not consistently taken place. People were supported to have a healthy balanced diet and were given food they enjoyed. However, people who required a textured modified diet, were not supported by staff who knew how to prepare and provide this. Staff worked with external healthcare professionals however, some care records were not clear, so the provider could not be assured staff were following their guidance and advice about how to support people following best practice. People were supported to have maximum 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 did support this practice.

Some improvements were needed to truly reflect people’s individual choices. People told us staff were kind and treated them well. Staff treated people with care and respect.

People's care was delivered in a timely way, however changes in care were not always communicated and written clearly to the staff team. People were not always supported to maintain their hobbies and interests. People had access to information about how to raise a complaint. People's end of life care needs were met in line with their preferences in a respectful and dignified way.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 31 October 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Old Rectory on our website at www.cqc.org.uk.

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 safe care and treatment, recruitment and the governance of the service provision.

Full information about CQC’s regulatory response to the more serious concerns can be found 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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 28 people in one adapted building which is set over three floors. There were 18 people living at the home at the time of our inspection.

People’s experience of using this service

People were supported to have maximum 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 did not support this practice.

People continued to tell us they felt safe and well supported. Staff had a good understanding in how they protected people from harm and recognised different types of abuse and how to report it. Potential risks to people’s health and wellbeing had been identified and people had been involved with decisions in how to reduce the risk of harm. There were enough staff on duty to keep people safe and meet their needs. People’s medicines were managed and stored in a safe way. Safe practice was carried out to reduce the risk of infection.

People’s care continued to be assessed and reviewed with the person involved throughout. People were supported to have a healthy balanced diet and were given food they enjoyed. Staff worked with external healthcare professionals and followed their guidance and advice about how to support people following best practice.

Staff treated people as individuals and respected the choices they made. Staff treated people with respect and maintained their dignity.

People’s care was delivered in a timely way, with any changes in care being communicated clearly to the staff team. People were supported and encouraged to maintain their hobbies and interests. People had access to information about how to raise a complaint.

The registered manager was visible in the home, listened and responded to those who lived in the home and the staff who worked there. The checks the registered manager made to ensure the service was meeting people’s needs focused upon people’s views and experiences. The providers checks were basic, and they discussed plans with us to put more robust checks in place and develop clear action plans with the registered manager so that improvements could be clearly reviewed.

Rating at last inspection

The last rating for this service was Good. The last report was published 21 March 2017.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This inspection took place on 30 January 2017 and was unannounced.

A registered manager was in post at the time of our inspection, who had recently been appointed. 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 15 October 2014 we asked the provider to take action to make improvements to the way people’s medicines were managed. At this inspection, we found the improvements required had been made to the way people’s medicines were managed.

People told staff helped them to feel safe. Staff knew what action to take to protect people from the risk of potential abuse. Staff understood the risks to individual people’s safety and communicated information with other staff so people’s safety needs would be met. There were enough staff employed to care for people and people told us staff knew their care and safety needs well.

Staff had opportunities to develop the knowledge and skills they needed to care for people. Further training for staff was being planned, so to people’s needs would continue to be met. People’s right to make their own decisions was respected by staff. People enjoyed their mealtime experiences, and had enough to eat and drink to remain well. Staff took action to support people if they required medical assistance, and advice provided by health professionals was implemented. As a result, people were supported to maintain their health.

Caring relationships had been built between people and their relatives and the staff who supported them. Staff took action to show people they were valued and knew about their histories and preferences. Staff offered people reassurance in the ways they preferred when they were anxious. People’s right to privacy was taken into account in the way staff cared for them and people were encouraged to make their own day to day decisions about their care.

People were involved in deciding how their care should be planned and risks to their well-being responded to. Where people were not able to make all of their own decisions their representatives and relatives were consulted. Relatives told us their suggestions for developing their family member’s care further were listened to. People’s care plans and risk assessments were updated as their needs changed. People and their relatives understood how to raise any concerns or complaints about the service. Systems for managing complaints were in place, so any lessons would be learnt.

People and their families told us the registered manager and senior staff were approachable and were positive about the way the home was run. The registered manager had introduced changes to benefit people living at the home. The registered manager was in the process of developing plans to refurbish areas of the home, with the involvement of people living at The Old Rectory. The provider will need to facilitate resources for this to be achieved.

The registered manager checked the quality of the care provided and people and their relatives were encouraged to give feedback on the care provided.

During our inspection we spent time at the home watching to see how staff supported people, and talking with people about life at the home. We spoke with four people living at the home. We also looked at records, spoke with four staff and the manager.

People were very positive about the home. One person said "You'd have difficulty finding anywhere better" and another told us "I like my room, the meals are good and I can go for a walk in the garden as I choose".

We saw that staff were kind and caring when they provided support for people. Staff were respectful in the way they spoke with people. Staff had a good knowledge of the people they were caring for. They also showed empathy and were sensitive in the way they talked about people.

People said that they felt safe at the home. The manager was able to demonstrate that systems for monitoring the quality of the care and treatment were effective.