Archived: The Old Rectory

Updated 21 September 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This unannounced inspection took place on 14 and 18 July 2016 and was carried out by one inspector, an expert by experience and a specialist advisor. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The specialist advisor had knowledge and experience in dementia care.

Before the inspection the provider completed a Provider Information Return [PIR]. This is a form which asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

We reviewed information we had received about the service such as notifications. This is information about important events which the provider is required to send us by law. We also looked at information sent to us from other stakeholders, for example the local authority and members of the public.

We spoke with the interim manager, deputy manager and regional manager for the service. We also spoke with eight other members of staff, including care and catering staff.

We spoke with 10 people who used the service, six relatives and three health care professionals. We also observed the care and support provided to people and the interaction between staff and people throughout our inspection.

To help us assess how people’s care needs were being met we reviewed six people’s care records and other information, for example their risk assessments and medicines records.

We looked at three staff personnel files and records relating to the management of the service. This included recruitment, training, and systems for assessing and monitoring the quality of the service.

Updated 21 September 2016

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 provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special Measures’.

The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key

question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.