Archived: The Old Rectory

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.

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.

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.

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.