Archived: The Old Rectory

Updated 24 July 2019

The inspection:

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

Inspection team:

Two inspectors carried out this inspection.

Service and service type: The Old Rectory is a residential care home for older people who may also be living with dementia. There were 17 people living in the home at the time of our inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection:

The inspection was unannounced.

What we did:

Before our inspection we reviewed information that we held about the service including statutory notifications that had been submitted. Statutory notifications include information about important events which the provider is required to send us. We reviewed the provider information return (PIR). This is information that the provider is required to send to us, which gives us some key information about the service and tells us what the service does well and any improvements they plan to make.

During the inspection we spoke with six people who used the service, three relatives, five staff members, the deputy manager, the administrator and the registered manager. We also received feedback from the local authority commissioning service. We looked at care plans relating to five people and reviewed records relating to the management of the service. We asked the provider to send us information relating to how they completed quality monitoring audits as there was a technical issue with their computer during the inspection. We received this information on 21 March 2019 as requested.

Updated 24 July 2019

About the service: 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. At the time of the inspection there were 17 people using the service.

People’s experience of using this service:

The provider had failed to act to ensure improvements had been made within the service. This is the third consecutive time the service has been rated ‘Requires Improvement’ or ‘Inadequate’. Providers should be aiming to achieve and sustain a rating of ‘Good’ or ‘Outstanding’. Good care is the minimum that people receiving services should expect and deserve to receive and we found systems in place to ensure improvements were made and sustained were not effective.

Systems to monitor the service had not been effective in identifying the improvements that were still needed. People were not always protected from harm as action had not been taken where risk had been identified. People’s support was not provided in line with current legislation and best practice guidelines; this had resulted in people being placed at risk of harm. People did not always have a care plan which reflected how to minimise risks and record how they wanted to be supported. Staff had not received training to support people with complex behaviour.

There were not always sufficient staff to support people safely. Where people needed additional support to stay safe or prevent harm to others, staffing was not arranged to ensure people’s safety. The lack of staff support through the day meant some people did not receive individual respectful care and did not enable people to be involved with activities outside of the home. People had limited opportunities to engage with activities that interested them. Improvements were needed with how medicines were recorded, and accurate audits were not completed for the medicines kept in the home.

A new electronic care planning system had been developed, although people’s care plans did not always include information about how to provide their support or how to reduce identified risks. The system was not accessible in all parts of the home due to limited internet connection.

People could make everyday decisions. However, some people were not always supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service did not support this practice. Where restrictions required an urgent referral to support any restriction, this had not been recognised. CCTV had been installed in the home and although this was not currently in use, people had not been consulted and their consent had not been obtained for its use.

People’s dignity was not always respected. Where people needed supported to eat and drink, staff did not support people in a respectful and dignified way.

People were able to stay in touch with people who were important to them as visitors could come to the home at any time.

Staff understood how to support people with individual preferences and recognised and valued people’s diverse needs. People knew who to speak with if they had any concerns. People had access to healthcare services and felt they received the support they needed from staff. People knew who the registered manager was and were able to share their views about the service.

Rating at last inspection: Requires improvement. (Published January 2018)

Why we inspected: This was a planned inspection based on the previous rating.

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

Follow up: 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.

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