About the service: The Old Rectory provides care for up to 16 people with learning disabilities, who may also live with an attached diagnosis such as autism, diabetes, Down's Syndrome or epilepsy. There are two properties set within large grounds, one accommodating up to 13 people and the other up to three people. The ages of people who lived in the Old Rectory currently, ranged from 30 years up to 75 years old.
Rating at last inspection:
The rating of this service at our last inspection was "Requires Improvement.” (Report published 28 December 2017)
At our last inspection, there were four breaches of the regulations.
Why we inspected:
This was a planned inspection based on the rating at the last inspection and aimed to follow up on concerns we found in August 2017. In addition, we had received some information of concern received anonymously prior to the inspection. We explored the areas of concern as part of our inspection.
People’s experience of using this service:
Whilst the provider had progressed quality assurance systems to review the support and care provided, there was a need to further embed and develop some areas of practice that the existing quality assurance systems had missed. This included updating care plans when an identified need or directive of care changed. For example, management of diabetes. We also found the cleaning audits had not identified shortfalls in the cleanliness of the premises.
There was still a need to improve the provision of meaningful activities for people to prevent isolation and boredom. Plans were in place but there had been delays in implementing the changes due to staffing changes.
People spoke positively of the home and commented they felt safe. Our own observations and the records we looked at reflected the positive comments people made. Most care plans reflected people’s assessed level of care needs and care delivery was person specific, holistic and based on people's preferences. Risk assessments included falls, skin damage, behaviours that challenge or cause distress, swallowing problems and risk of choking, and mobility. The care plans also highlighted health risks such as diabetes and leg ulcers. People said they felt comfortable and at ease with staff and relatives felt people were safe. Staff and relatives felt there were enough staff working in the home and relatives said staff were available to support people when they needed assistance. Pre-employment checks for staff were completed, which meant only suitable staff were working in the home. All staff had attended safeguarding training. They demonstrated a clear understanding of abuse; they said they would talk to the management or external bodies immediately if they had any concerns.
The manager and staff had completed training on the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. They had assessed some restrictions were required to keep people safe for example, some doors were locked. Where this was the case referrals had been made to the local authority for authorisations. People had access to healthcare professionals when they needed it. This included GPs, dentists, community nurses, and opticians. Staff received regular support from management which made them feel supported and valued. They were encouraged to develop their skills and take on additional responsibilities. Staff spoke positively about the changes made to the running of the home and the way the home was managed.
Staff were kind and caring, they had developed good relationships with people. They treated them with kindness, compassion and understanding. Staff supported people to enable them to remain as independent as possible. They communicated clearly with people in a caring and supportive manner. We received positive feedback from relatives and visiting professionals about the care provided. The service worked well with allied health professionals. A number of audits had been developed, including those for accidents and incidents, care plans, medicines and health and safety. Maintenance records for equipment and the environment were up to date, such as fire safety equipment and hoists. Staff said they were encouraged to suggest improvements to the service.
Follow up:
The service remains Requires Improvement. The service had met the breaches of regulation, however further time was needed to ensure the improvements were continued and sustained.
As the service remains rated as requires improvement, we will request an action plan from the registered provider about how they plan to improve the rating to good. In addition, we will monitor all information received about the service to understand any risks that may arise and to ensure the next planned inspection is scheduled accordingly.