Archived: The Old Rectory

Updated 4 August 2015

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 inspection took place on 14 and 15 April 2015 and was unannounced. It was carried out by one adult social care inspector.

Before the inspection visit we looked at information we held about the home. This included information regarding significant events that the home had informed us about. At the last inspection we had identified some areas for improvement. We looked at these areas as part of this inspection.

During this inspection we spoke with ten people who lived at the home, two visitors, three relatives and a healthcare professional. We also spoke with six members of staff and the registered manager. Throughout the day we observed care practices in communal areas and saw lunch being served in the dining room.

We looked at a number of records relating to individual care and the running of the home. These included eight care plans, risk assessments for five people, quality assurance records and medicines records.

Updated 4 August 2015

This inspection took place on 14 and 15 April 2015 and was unannounced. At our last inspection in May 2014 we found areas for improvement in relation to risk assessments and safeguarding. We looked at these areas as part of this inspection.

The Old Rectory provides care and accommodation for up to 23 people. At the time of our inspection there were 18 people using the service.

There is a registered manager 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.

At our last inspection on 15 May 2014 we asked the provider to take action in completing comprehensive risk assessments. The provider sent us an action plan which said they would make these improvements by October 2014. We found on this inspection improvements had been made and detailed risk assessments were in place as part of people’s care planning arrangements.

The registered manager failed to demonstrate an understanding of where it was their responsibility to take action to protect people’s rights in relation to the Mental Capacity Act 2005 (MCA). We identified potentially three people where action was needed to protect their rights. We identified where staff had undertaken specific core skills training. However with regard to the MCA they failed to demonstrate knowledge and understanding of this act. We were told by staff and the registered manager this training had been completed by staff. The registered manager was unable to provide evidence of staff who had undertaken this training.

People told us they felt safe in the home. One person said this was because they felt “comfortable about the place and feel I can ask if I need something and staff will do something.” Staff demonstrated an understanding of the nature of abuse and their role in protecting people from possible abuse. They were aware of their rights to report concerns under the service’s whistleblowing policy.

The service had responded in a professional and thorough manner in investigating an allegation of abuse. The allegation had not been substantiated.

There were appropriate and safe arrangements for the management and administering of medicines. Staff had undertaken the necessary training to ensure the safety of people when dealing with medicines. However there had been an incident where medicines had been administered incorrectly. The registered manager had taken robust action in dealing with this failure and improved systems to alleviate the risk of further incidents and addressed the poor practice.

People had differing views about the availability of staff. This specifically related to the number of care staff on duty during the night. Additional staff had been placed on the morning shift as a result of increasing people living in the home. However there were no formal arrangements to help in making a judgement about the appropriate numbers of staff at night and during the day.

People had access to a range of healthcare services. One person told us they could see their doctor “at any time”. A relative had requested a GP visit and this had been arranged “and “the doctor called straight away”. Some people were receiving the support of community nursing to support them in their health condition.

People described staff as “caring and kind” and “can’t do enough for you they are so caring towards us.” Staff were observed supporting people in a sensitive and supportive manner and they respected people’s choices in how they lived their lives.

People were involved in reviewing their care arrangements. They were able to say how they felt about the care they received and whether it met their needs.

People’s care plans did not provide personal information related to people’s lives such as life history, important relationships, lifestyle and interests. There was no information about people’s preferences such as dietary and how they wished to spend their days in the home.

There was little opportunity for people to take part in activities and people felt there was not enough opportunity to be taken by staff out of the home. One person told us “There is very much a lack of activities.” Staff confirmed there were little activities in the home and they had little time to spend with people other than when providing care or support. From our observations and talking with people and staff the providing of activities or being able to spend time with people was not part of the culture of the home.

Care plans provided specific information and care task associated with people’s personal needs. For example where people had needs about maintaining their skin integrity or maintaining healthy weight this was identified.

Relatives spoke positively about how they were always made to feel welcomed when visiting the home. They told us how they were informed about their relatives where there were any concerns. One relative spoke of how they were really happy their relative was in the home.

People told us how accessible the registered manager was and how they were always asked about how they were and “if we were happy with everything”. The registered manager undertook regular care shifts so they were able to keep in touch with people and have a good understanding of people’s care needs. Other than people’s care reviews there were no other formal opportunities such as resident’s meetings for people to express their views about the service.

People were aware they could make a complaint if they wished however people told us they felt comfortable in talking with the registered manager or provider about any worries or concerns. They felt they would be listened to and action taken.

The registered manager told us of improvements they planned to make which included the greater involvement of people in the service and how it was provided. One of the improvements was to improve participation in the recruitment of staff and improve communication in the home. However whilst staff were positive about the approach of the registered manager and provider particularly their availability and accessibility they were not aware of these proposed changes.

Staff spoke of the registered manager listening and how they had acted on their view about the need for increased staffing. They said how they were approachable and in touch with the people’s care needs. There were inconsistencies about there being staff meetings in the service.

The registered manager did not have a robust system or processes in place to help in identifying and making improvements in the quality of the service.

We found 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 this report.