Archived: The Old Rectory

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 provides care and support for up to 40 people who have physical disabilities, learning disabilities and autism. People's needs varied and some people needed lots of support with communication and their healthcare needs. Some people were living with autism and some people needed support with behaviours that challenged. On the day of our inspection there were 31 people living at the service.

The registered provider was in charge of the day to day running of the care home. A registered provider is a '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.

We carried out our last comprehensive inspection of this service on 31 January and 1 February 2018 and we gave the service an overall rating of ‘Requires Improvement.’ At that inspection we found six breaches of the legal requirements of the Health and Social Care Act Regulated Activities Regulations 2014. The breaches related to Regulation 9- person centred care, the registered provider had failed to ensure that people received person centred care. Regulation 12- safe care and treatment, the registered provider had failed to ensure that care was provided in a safe way to people. Regulation 13-safegaurding people from abuse and improper treatment, the registered provider had failed to ensure that restrictions on people’s liberty was appropriately authorised. Regulation 17- good governance, the registered provider had failed to maintain accurate and complete records. Also, the registered provider had failed to establish and operate systems to assess, monitor and improve the quality of the services provided and reduce risks to people. Regulation 18- staffing, the registered provider had failed to ensure that staff were fully trained to be able to complete their roles effectively. Regulation 19- fit and proper persons employed, the registered provider had failed to ensure that staff were recruited safely. We also found a breach of the Care Quality Commission (Registration) Regulations 2009, Regulation 18- notifications of other incidents. The registered provider had failed to notify CQC of notifiable events in a timely manner.

We also made three recommendations. The recommendations related to the management of cleanliness and infection control, the management of complaints, the management of end of life care planning.

After our last inspection the registered provider sent us an improvement action plan telling us how they intended to meet the legal requirements of the Health and Social Care Act Regulated Activities Regulations 2014 and the Health and Social Care Act Registration Regulations 2009. They told us they would meet the regulations by 01 May 2018. At this inspection we found there had been an improvement to Regulation 19- fit and proper persons employed, but we found continuing breaches of Regulation 9- person centred care, Regulation 12- safe care and treatment, Regulation 13-safegaurding people from abuse and improper treatment, Regulation 17- good governance and Regulation 18- staffing. We also found breaches in Regulation 10-dignity and respect, Regulation 14-meeting nutritional needs and Regulation 15-premises and equipment.

We found one of the recommendations had been acted on, which was the management of end of life care planning. The management of complaints had been partially met. However, we found the other recommendation had not been implemented, which was the management of cleanliness and infection control.

At our last inspection we found that the care service had not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. This best practice guidance is there to promote modern, inclusive, empowering care and support in services that include accommodation for people with learning disabilities and autism. At this inspection the service people continued to receive care which was not based on current best practice including Registering the Right Support.

We observed unsafe care. Staff had received training about protecting people from abuse. However, the registered provider, the deputy manager and the staff lacked a clear understanding of their responsibilities in preventing abuse. There had been an allegation that people had been exposed to inappropriate physical behaviour within the service and there were records of people’s belongings being taken by others. The registered provider and staff were dismissive towards the allegations and failed to take proper steps to protect people whilst the allegations were investigated. The arrangements that were in place to safeguard people from the risk of abuse were not adequate as incidents had not been reported to the local authority and CQC.

People’s safety was being compromised in a number of areas. The management of risks relating to people’s health, safety and well-being were inadequate. This put people at risk of serious harm.

The provider did not have a system to assess the number of staff needed to meet people’s safety and basic care needs at all times This led to people being at serious risk of neglect.

The registered provider was not deploying enough staff to meet peoples funded and assessed needs. This created an institutional environment in the service. People were left for long periods without staff care, people were unoccupied and observed people moving around the service without interaction with other people or staff. There was a lack of opportunity for people who needed staff to support them to participate in their local community, with some people not leaving the service for days or weeks.

People who displayed behaviours which were challenging and a risk to others had not been properly assessed and there was no plan to mitigate risks. People did not have proper risk assessments or care plans in place to ensure they were adequately supported. This put them, and other people in the service at risk of harm. The registered provider had not taken any action to ensure people were cared for and supported properly and to ensure people were not harmed. The registered provider had not promoted a learning culture when managing and responding incidents or accidents.

Care plans lacked information about people’s health and care needs. They were not sufficient to enable staff to plan people’s care, manage risk and respond to people’s needs. When people’s needs changed, for example if their behaviours became progressively worse, their care was not properly reviewed. Referrals were made to outside community services, like the community nursing teams, but they were not followed up with any urgency.

The registered provider had not met their action plan to provide training for staff. They had not included the actions they intended to take in response to all of the breaches and recommendations we made at our last inspection on their action plan. Training about ‘person centred care’ and the management of challenging behaviours had not been received by the staff responsible for the delivery of care. People’s needs had not been assessed in line with best practice when supporting people with learning disabilities. Staff had not received accredited training in positive behaviour support or de-escalation techniques, even though some people displayed behaviour that could be challenging. Other training specific to people’s needs, such as autism had also not been provided.

We continued to find that there was a lack of accessible communication and tools in place to assist people with more profound needs to make their needs known. Adjustments had not been made for people with hearing or visual impairment so that they were involved. There was no systematic plan in place to increase people’s independence, involvement in the service or to enable people to test, develop, and learn new skills. People were not enabled to gain new skills nor increase their independence.

Staff we observed during the inspection had a caring approach, but they lacked the skills and knowledge to recognise the culture in the service was institutional and uncaring. There were people in the service who had become isolated in their bedrooms or by the lack of person centred care, but staff failed to recognise this. There were not enough activities to keep people occupied in a meaningful way. People were not always involved in the planning and review of their care and care plans were not written in an accessible format to enable people to do so.

Although people had access to specialist nursing support from the learning disability community teams, the staff managing the service did not have the skills, qualifications or expertise to meet people’s needs.

People’s health and wellbeing were not protected by the proper assessment and management of their nutritional and hydration needs. Not all people were provided with appropriate opportunities to have food, snacks and drinks.

People had access to GPs but their health and wellbeing was not supported by prompt referrals and access to medical care if they became unwell. Good quality records were not kept to provide information to health care professionals and guidance was not provided to assist staff to monitor and maintain people’s health.

Staff had received training about the Mental Capacity Act 2005 (MCA). However, the implementation of the MCA was not consistent. Restrictions imposed on people did not consider their ability to m

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 provides care and support for up to 40 people who have physical disabilities and learning disabilities. People's needs varied and some people needed support with communication and their healthcare needs. Some people were living with autism and some people needed support with behaviours that challenged. On the day of our inspection there were 33 people living at the service.

The provider was in charge of the day to day running of the care home. A registered provider is a '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 in January 2017, the service was rated 'Requires Improvement'. We asked the provider to take action and they sent us an action plan. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches we found. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. Some improvements had been made, however we found some continued and some new breaches of the regulations. This is therefore the second consecutive time the service has been rated Requires Improvement.

At our last inspection we found that the care service had not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service should live as ordinary a life as any citizen. Although the numbers of people had reduced since our last inspection, the service continued to be outdated and not based on current best practice including Registering the Right Support. The provider was in the process of converting the service into smaller, self-contained units that they were planning to use for supported living. This continued from the last inspection and no one had yet moved into the smaller units/flats yet. .

At our last inspection we found that staff were attentive to people, but due to the large number of people present and their varying needs they did not always receive person centred care. At this inspection, we found that this was still the case. There were enough staff to keep people safe but people living at the service had a wide range of needs. Some people were able to talk and make their needs known. However, there was a lack of accessible communication and tools in place to assist people with more profound needs to make their needs known. Similarly, people who were physically able were involved in the running of the service and completed household tasks. But, there was no systematic plan in place to increase people’s independence, so opportunities for those with more profound needs were limited.

Staff had spoken with people about their ‘hopes and wishes’ for the future. However, when people had complex needs staff had recorded they ‘did not understand’ as opposed to seeking advice and guidance from those that were important to them. As such goals for people to work towards had not been formally identified

The provider and deputy manager told us they had learnt about ‘person centred care’ when researching supported living. However, they had not formally cascaded this information to their staff team. As such, people’s needs had not always been assessed in line with best practice when supporting people with learning disabilities. Staff had not received accredited training in positive behaviour support or de-escalation techniques, even though some people displayed behaviour that could be challenging. Other training, in topics specific to people’s needs, such as autism had also not been provided.

Risks relating to people’s care and support had not always been assessed and mitigated. The provider had invited a visitor to stay at the service, but had not done any assessment regarding the risks this may pose to people. People had not been asked if they wanted this person to stay. Visitors to the service bought food that one person was unable to eat, and had not been informed their eating and drinking guidelines had been changed by a health professional. We found the person eating food unsupervised that could have caused them to choke, and which was not in line with their updated guidance.

Some people at the service were assessed as requiring continual supervision. The provider had not completed formal capacity assessments on anyone living at the service. However, they told us that these people would be unable to consent to requiring this supervision. They had not applied for Deprivation of Liberty Safeguards, to ensure this restriction was appropriately authorised and lawful. As such, people were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in the service did not always support this practice.

The provider and deputy manager completed a range of checks and audits on the service, but had not identified the issues we highlighted at this inspection. Although accidents and incidents were recorded they were not collated and analysed, and as such the provider was unable to identify if there were any patterns or trends which could be acted on to reduce the chances of incidents happening again. Similarly, complaints were documented and responded to, but there was no central log held to review any themes or trends. The provider had not completed right to work checks on staff that begun working at the service. The provider had failed to inform us of important events that had happened in the service.

Some areas of the service smelt of urine, and there was no soap available in the kitchen for staff and people to wash their hands. We discussed this with the provider and they arranged for this to be rectified during the inspection. We made a recommendation regarding ensuring the service was clean and the risk of infection minimised. There was a plan in place to completely renovate the service in a phased way,

People received support to manage their health care needs, and saw a doctor when they became unwell. Medicines were managed safely. The service was not currently supporting anyone at the end of their life. Staff had discussed with some people what they wanted to happen at the end of their lives, but this had not been formally recorded for everyone living at the service. The provider agreed this was an area for improvement.

People and their relatives told us the provider was a visible presence within the service, and they would go to them if they had any concerns. The rating from our previous inspection was displayed clearly and legibly in a frame, as you entered the service.

The Old Rectory provides accommodation and personal care for up to 40 people who have physical disabilities and learning disabilities. People's needs varied and some people needed support with communication and their healthcare needs. Some people were living with autism and some people needed support with behaviours that challenged. On the day of our inspection there were 36 people living at the service.

We last inspected this service in June 2016. We found significant shortfalls and the service was rated inadequate and placed into special measures. The provider had not ensured that care and treatment was being provided in a safe way. Staff had not ensured the proper and safe management of medicines. People did not receive the support they needed to eat and drink safely. Staff had not received appropriate support and training to enable them to carry out their duties. The provider had not ensured that the systems and processes that were in operation to assess, monitor and improve the quality and safety of the service. The provider had failed to maintain accurate and complete records in respect of each person. The provider had failed to meet the conditions on their registration and had failed to display their rating.

We took enforcement action and required the provider to make improvements. This service was placed in special measures. Services that are in special measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. The provider sent us regular information and records about actions taken to make improvements following our inspection. At this inspection we found that improvements had been made in many areas. There were still areas where improvements were required.

The provider told us they were in day to day charge of running of the service. The provider is a registered person. 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.

Staff were attentive to people, but due to the large number of people present and their varying range of needs they did not always receive person-centred care. Staff had not identified goals for people to work towards and some people required more support to be as independent as possible. There were enough staff to meet people’s needs, however, they were not always deployed effectively. People sometimes had to wait to receive the care they needed and on two occasions, we had to alert staff that people needed support.

Records were not always clear and up to date and information relevant to people’s care and support was not always shared amongst the staff team. One person had lost weight and staff had not recorded the conversation with the person’s doctor. The person had continued to lose weight and no consideration had been given to ways of reducing this risk. Incident forms were not always completed when incidents occurred. When accidents and incidents did occur they were not collated and analysed to look for any themes or patterns that may reduce the likelihood of them happening again.

Risks relating to people’s care and support had been assessed but guidance was not always available for staff on how to manage these risks. Some people had a catheter in place to assist them passing urine. Their care plan stated they were at risk of ‘urine infections’ and directed staff to liaise with health care professionals with regards to ‘any abnormalities such as blockage, no output etc.’ There was no guidance in place for staff about how the person may present if they were unwell, or what other ‘abnormalities’ may occur.

A new system of auditing was being introduced by the provider and they felt this would help rectify some of the issues identified at this inspection.

People were relaxed in the company of staff and everyone told us that staff were kind and caring. Staff knew people well and had built up strong relationships with them. People were treated with dignity and respect. People took part in a range of activities, both inside and outside of the service. On the morning of the inspection, some people took part in an arts and crafts activity.

People’s medicines were managed safely. There were appropriate arrangements in place for obtaining, recording, administering and disposing of prescribed medicines. Staff had sought advice and guidance from a variety of healthcare professionals to ensure people received the best care possible. People were supported with their health care needs effectively.

People were supported to eat and drink safely. They were offered a choice of different food at meal times, and meals appeared home cooked and appetising.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. These safeguards protect the rights of people using services by ensuring that if there were any restrictions to their freedom and liberty, these had been agreed by the local authority as being required to protect the person from harm. DoLS applications had been made to the relevant supervisory body and renewed in line with guidance.

Staff were checked before they started working with people to ensure they were of good character and had the necessary skills and experience to support people effectively. They received induction, training, and supervision to support people effectively. There was an on going training programme to ensure that staff had the skills and knowledge to meet people's needs. Staff knew how to recognise and respond to abuse. The provider and deputy manager were aware of their responsibilities regarding safeguarding and staff were confident the management team would act if any concerns were reported to them.

Regular health and safety checks were undertaken to ensure the environment was safe and equipment worked as required. Regular fire drills were completed.

People, their relatives and staff all commented on the approachability of the provider and told us that they felt the service was well-led. The CQC had been informed of any important events that occurred at the service, in line with current legislation.

People’s relatives, staff and other stakeholders were regularly surveyed to gain their thoughts on the service. There was a complaints policy in place and people and their relatives said they knew how to complain if they needed.

As this service is no longer rated as inadequate, it will be taken out of special measures. Although we acknowledge that this is an improving service, there are still areas, which need to be addressed to ensure people's health, safety and well-being is protected. We identified a number of continued breaches of Regulations. We will continue to monitor The Old Rectory to check that improvements continue and are sustained.

We carried out an unannounced comprehensive inspection on 21 and 22 March 2016. After that inspection we received concerns in relation to the safe care and treatment of people living at The Old Rectory. As a result we undertook a focused inspection to look into those concerns and to follow up on our previous enforcement action of three warning notices.

This report only covers our findings in relation to those requirements. 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'.

The provider had made some changes. However, the provider had not met the requirements of the warning notices served following the last inspection.

The Old Rectory provides accommodation and personal care for up to 40 people who have physical disabilities and learning disabilities. People’s needs varied and included sensory impairments, epilepsy, reduced mobility and communication difficulties. Accommodation is set out over three floors. On the day of our inspection there were 38 people living at the service.

People’s medicines were not managed safely. Fridge and room temperatures were not taken and recorded so staff did not know if medicines were being stored at a safe temperature. Some people stored medicines in their rooms or took them out for the day. Staff had not undertaken any form of risk assessment to ensure that this was safe and that appropriate support was in place to check people’s personal stocks of medicines and to ensure they were not taking too much medicine. There were no guidelines in place for when ‘as and when’ medicines (PRN) should be administered for some people. One person had not received the correct amount of their medicine used to thin their blood. Two medicines with specific storage requirements were missing. We informed the local safeguarding authority about this.

One person was at high risk of choking and did not have any risk assessments in place relating to this. They were regularly eating foods they had been advised not to, by a speech and language therapist. A speech and language therapist told staff to encourage the person to eat similar, less high risk foods and put in place a risk assessment and choking policy around this. This had not been done. We informed the local safeguarding authority about this.

Staff did not consistently manage people’s behaviours safely. We saw one person become distressed and push another person over. There were known triggers identified for these behaviours and staff did not intervene to de-escalate the situation effectively. People had suffered a negative impact of other people’s problem behaviour.

People were not asked about what they wanted to eat. Information about meals was not presented in a format which people understood so they were not able to make informed choices about what they wanted to eat. One person said that they did not want to eat their lunch and they were not offered or given an alternative meal.

People’s guidelines from speech and language therapists were not consistently followed or shared with staff. People with diabetes did not receive support to manage their diets appropriately. People’s weights had not been monitored consistently when they were at risk of losing weight.

The environment was not always safe. Flooring in some bedrooms was not suitable for people’s needs and smelt of urine. People were using a bathroom that the provider had deemed unsafe.

The provider said that the maintenance schedule had ‘slipped’ due to staff sickness. Some jobs had not been completed within the timeframe the provider had given us. There were loose and cracked tiles in the entrance hall and a hole in the wall in the hall way.

The kitchen had been redecorated, the cupboards had been painted and the insides of the cupboards were in the process of being lined with easier to clean material. Mop heads were cleaner and suitable for use. The cellar had been cleaned, redecorated and all food stored was in date.

People were supported and helped to maintain their health and to access health services when they needed them, however staff had not always followed advice from health professionals.

Staff had received safeguarding training and knew how to recognise and respond to most types of abuse. However, staff and the provider did not recognise the issues we found during our inspection as safeguarding concerns. People were at risk of harm from improper treatment.

Staff received supervisions and appraisals and their competency was assessed with regards to administering medication. Staff did not receive all the training they needed to support people effectively. There were sufficient numbers of staff on duty to respond to people’s needs.

Two people had Deprivation of Liberty Safeguards (DoLS) in place. Staff had followed the process with regards to these. Three people had moved to the service since our last inspection and no consideration had been given to their capacity. People could make day to day choices about their lives, such as declining meals.

People knew who the provider was and they were at the service most days. Staff and the deputy manager said they felt well supported by the provider. The provider told us they had made changes after our last inspection, these changes had not happened as they described.

Records were missing, incomplete and inaccurate. Two people that had moved in since our last inspection did not have care plans and staff did not fully know their care and support needs. Food and fluid charts had not been consistently completed, daily records were incomplete, some had gaps and others were not signed by the staff member making entries. Medicines information in health action plans did not tally with prescribed medicines found in stock. Some medicines records conflicted with others. Some audits were carried out by the provider and deputy manager but they had not identified these issues.

We found that the provider had exceeded the maximum amount of people that could live at the service between the 31 March 2016 and the 4 April 2016. We spoke with the deputy manager about this and they confirmed that this had happened.

The provider had not displayed their rating, as required, following our previous inspection, which meant people, relatives and visitors were not aware of the service’s rating.

We found continued 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.

This focused inspection has been carried out within six months of a comprehensive inspection. In line with CQC methodology the rating has been reviewed.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures 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.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The Old Rectory provided accommodation and personal care for up to 40 people who have physical disabilities and learning disabilities. People had sensory impairments, epilepsy, limited mobility and difficulties communicating. Accommodation is set out over three floors. On the day of our inspection there were 40 people living at the home.

At our previous inspection on 25 September 2014, we followed up on the enforcement action we had taken against the provider. We checked that the regulations were being met. We found that the provider had made improvements to Regulation 10 (quality monitoring), Regulation 21 (records) and Regulation 21 (staff recruitment records) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. However, further work was required to meet Regulation 21 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These correspond with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which came into force on 1 April 2015.

During the inspection on 25 September 2014 we did not follow up the breaches of Regulation 9 (care and welfare), Regulation 11(safeguarding), Regulation 18 (consent to care and treatment) and Regulation 23 (support to workers) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which were found during the previous inspection that took place on 26 and 27 June 2014. These correspond with Regulation 9, Regulation 11, Regulation 13 and Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action in relation to person centred care, safeguarding people, obtaining consent and providing training/support to staff.

The provider sent us an action plan on 20 August 2014 stating they would meet the regulations by 30 August 2014.

During this inspection we found that the provider had not maintained improvements to the service.

Effective recruitment procedures were not in place to ensure that potential staff employed were of good character and had the skills and experience needed to carry out their roles. Infection control procedures and practice were not effective.

Staff did not have all the information they needed to safeguard people from abuse. However staff knew how to report concerns to the deputy manager and provider, records showed that safeguarding concerns had been reported. We made a recommendation about this.

Risk assessments lacked detail and did not give staff guidance about any action staff needed to take to make sure people were protected from harm.

Medicines administered were not adequately recorded to ensure that people received their medicines in a safe manner.

The training staff received did not give them the skills to support people effectively

People did not have a choice of meals each time. Food prepared and cooked did not meet everyone’s dietary needs to maintain good health.

The home had not been suitably maintained. Areas of the home, including the kitchen was not clean. Food had not been appropriately stored. We reported this to the local council’s food safety department.

Effective systems were not in place to enable the provider to assess, monitor and improve the quality and safety of the service. Records were not always accurate and complete.

People knew to complain to the provider if they were unhappy about their service. The complaints procedure was not on display in the home. The complaints procedure within the service’s guide gave incorrect information about who to contact if people are unhappy with the provider’s response to a complaint. We made a recommendation about this.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Deprivation of Liberty Safeguards (DoLS) applications had been made to the local authority and had been approved.

People were supported and helped to maintain their health and to access health services when they needed them.

People and their relatives knew who to talk to if they were unhappy about the service.

Staff were positive about the support they received from the deputy manager and provider. They felt they could raise concerns and they would be listened to.

Relatives told us that they were able to visit their family members at any reasonable time, they were always made to feel welcome and there was always a nice atmosphere within the home.

People’s view and experiences were sought during meetings. Relatives were also encouraged to feedback through quality questionnaires.

People were encouraged to take part in activities that they enjoyed. People were supported to be as independent as possible.

Communication between staff within the home was good. They were made aware of significant events and any changes in people’s behaviour. Handovers between staff going off shift and those coming on shift were documented.

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.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

Is the service safe?

People were safe because the service made sure that they had safe recruitment procedures in place. There were enough staff with the skills competencies and experience to make sure that people's individual needs were met. One person said 'I feel safe and the staff make sure I am safe' another person told us 'The staff help me to keep safe when I go out and about'.

There were systems in place to make sure that the staff learned from accidents and incidents. When people had accidents the most appropriate and safe action was taken to make sure they received the treatment they needed. Assessments were undertaken to ensure that people received safe and appropriate care.

Is the service effective?

The service was effective as there were up to date plans to continue to develop staff knowledge and training. Staff were able to demonstrate that they communicated effectively with the people who used the service.

Is the service caring?

The service was caring because their confidentiality was respected by staff and they told us they had the privacy they needed. One person said 'The staff respect me and my space'. Another person told us 'I am listened to when I am not happy and the staff change things for me'.

Is the service responsive?

The service was responsive because the service sought feedback from friends and family of the people who used the service, staff and the people themselves in the form of surveys. The results of the surveys were analysed and action was taken as a result. One person said 'I got help to fill in the form and they listened to me'.

Is the service well led?

The service was well led because the manager had an understanding of the concerns and risks associated with the service and was meeting the challenges of improving the service.

We spoke with the people who used the service, the provider, the deputy manager, the head of care and care staff. We also observed staff supporting people with their daily activities.

The Old Rectory can provide accommodation for up to 40 people who have a learning disability. There were 37 people using the service at the time of our inspection.

We considered our inspection findings to answer questions we always ask:

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found. This summary is based on our observations during the inspection, discussions with people using the service, staff supporting people and the management team:

Is the service safe?

The service was not safe. There were no systems in place to make sure that the staff learned from accidents and incidents.

When people had accidents the most appropriate and safe action was taken to make sure they received the treatment they needed.

Assessments were not undertaken to ensure that people received safe and appropriate care.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. The relevant people were consulted with regard to people's mental capacity and the deprivation of people's liberty was taken into account.

People using the service told us that they felt safe.

Care and support plans detailed each person's individual needs. When risks to a person were identified the home carried out a risk assessment. However, care plans relating to continence needs were not always followed by staff.

Recruitment processes were not safe. This was because there were not robust procedures in place. There was no evidence that potential risks had been assessed when people had criminal convictions or poor references. The provider had not taken action to protect people who used the service from risks posed by staff that were not honest or of good character.

Is the service effective?

The service was not effective. Some care and support plans referred to out of date information so were not current.

Staff had not filed some people's records correctly so they were not easily accessible. There were loose documents and paperwork which could get lost or damaged.

Some people were unable to communicate verbally and used signs and gestures. Staff were able to tell us what signs were displayed if someone was agitated and what they could do to reassure them. We observed staff communicating effectively with people throughout our inspection.

The provider did not operate an effective system to regularly assess and monitor the quality of the service provided. The service had a complaints process in place and information had been given to people about how to make a complaint. The easy read version of this process had recently been updated, but had not been shared with people using the service.

There were no structured systems in place to ask relatives and staff for their views about the service. There were no staff meetings. This meant that people's representatives and staff did not have opportunities to air their views and opinions.

Is the service was caring?

The service was caring. People were supported by kind and attentive staff. Staff showed patience and gave encouragement when supporting people. People we spoke with said they felt staff respected their privacy and dignity and said that staff were polite and caring. People we spoke with said they liked the staff.

We found that people were supported to attend health appointments, such as, doctors or dentists. We saw records to show that the service worked closely with health and social care professionals to maintain and improve people's health and well-being. However, we found that action was not always taken when recommendations had been made by health professionals.

We saw positive interactions from staff when supporting people throughout our inspection.

Is the service responsive?

The service was responsive. People told us that they were happy with the service. It was clear from observations and from speaking with staff that they had a good understanding of the people's care and support needs.

We saw records to show that the service worked closely with health and social care professionals to maintain and improve people's health and well-being.

Staff were attentive to people using the service and responded promptly when needed.

Regular meetings were held with people who use the service to express their views on the day to day running of the service. However, there was limited participation with people who were less assertive or who had communication difficulties.

Is the service well-led?

The service was not well led. The provider was not in day to day control of the service.

There was a management structure in place. The provider and the management team knew about some of the shortfalls at the service but no action was taken to address these. They did not take responsibility for things that happened in the service and did not implement changes to address the shortfalls and concerns.

The provider did not operate an effective system to regularly assess and monitor the quality of the service provided. This meant that the people could not be confident that their health, safety and welfare would be protected.

Audits of the care plans and other systems used at the service had been not been completed to assess the quality of the care being provided. The service had not identified the shortfalls in the care plans found at the inspection. Therefore the systems in place to audit the care plans and risk assessments was not effective to make sure people were receiving the care they needed.

Staff told us they were clear about their roles and responsibilities and that they felt supported by the management team.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, the staff supporting them and looking at records. We also had information from our partner agencies including the local authority safeguarding and commissioning teams.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

The service is not safe. People were not safeguarded from the risk of harm and abuse. The provider had not taken reasonable steps to identify the possibility of abuse and prevent it before it occurred. The provider did not always respond appropriately to allegations of abuse.

Safeguarding procedures were not robust and staff did not understand their role in safeguarding the people they supported.

People who use the service were not protected against the risk of unlawful or excessive control or restraint because the provider had not made suitable arrangements.

People could not be confident that they would be safeguarded from the risks posed by staff with criminal records.

Is the service effective?

The service is not effective. People's health and personal care needs were not always assessed with them, and they were not always involved in writing their care plans. Not all care plans were up to date so did not contain information about people's current needs.

Some of the care plans had not been reviewed regularly. Care plans were, therefore, not able to support staff consistently to meet people's needs.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing people's needs and involving people in planning their care.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

People were at risk of not having their concerns and needs properly taken into account because care plans were not up to date and regularly reviewed.

People's preferences, interests, aspirations and diverse needs had not always been recorded. Because of this care and support could not always be provided in accordance with people's wishes and on an individualised basis.

Is the service responsive?

The service was not responsive. Health records were not up date so there was no evidence that the service was responding to people's changing needs.

Raising concerns and complaints was not encouraged and people's views and experiences not taken into account when planning their care.

Is the service well-led?

The service was not well led. There was a lack of audit and monitoring of the service. Care plans had not been audited which meant that the overdue updates had not been noticed.

Events that affected people's health, welfare and safety had not been reported to the Care Quality Commission (CQC). We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to reporting incidents that affect people's health welfare and safety to CQC.

The provider had not taken steps to ensure that people received safe and effective care.

None of the staff we spoke with had a good understanding of the whistleblowing policy. There was a lack of an open, inclusive culture.

We found evidence that the provider may be operating an unregistered service which is an offence. We have written to the provider about this and asked the provider to tell us what they are going to do to meet the requirements of the law in relation to operating a service which needs to be registered with CQC.

To help us to understand the experiences people had, we used our Short Observational Framework for Inspection (SOFI) tool. The SOFI tool allows us to spend time watching what is happening in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences. We found that overall people had positive experiences. The staff supporting them knew what support they needed and they respected their wishes The support we observed being given to people matched what their care plan said they needed. Care and support was delivered in a person focused manner and we saw that staff created opportunities for people to make daily choices and decisions.

Staff we spoke to confirmed that they had worked at the service for a number of years. One member of staff told us they had been with the service for 25 years whilst another staff member had been with the service for 15 years. Staff knew the people who used the service well. We found that staff regularly attended training and that they were encouraged to obtain vocational qualifications. In addition staff received regular supervision and yearly appraisals. We found that the quality of the service was regularly audited and monitored.

We observed people receiving safe and effective care that was based on detailed care plans and risk assessments that met their individual needs. We spoke with two care staff who demonstrated a good understanding of the support needs of people who used the service and were clear about their responsibilities in keeping people safe and reporting suspected abuse.

The head of care told us staff received ongoing training and supervision that provided them with the skills and knowledge to meet the needs of the people they were supporting. Staff told us they were encouraged and supported to attend regular training and had regular supervision.