• Care Home
  • Care home

Archived: The Old Rectory

Overall: Requires improvement read more about inspection ratings

70 Risley Lane, Breaston, Derby, Derbyshire, DE72 3AU (01332) 874342

Provided and run by:
Allen Heath

Important: The provider of this service changed. See new profile

All Inspections

14 April 2016

During a routine inspection

This inspection was unannounced and took place on 14 April 2016. The service was registered to provide accommodation for up to 26 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection 13 people were using the service.

There was 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 18 August 2015 we asked the provider to make improvements to ensure people who used the service were protected from avoidable harm or risk of harm. This was specifically in relation to the environment. At this inspection, we found that the provider had made, and was in the process of making improvements to the home. By doing this, the risks identified previously were minimised.

We had also asked the provider to make improvements in how individuals care needs were planned and assessed. At this inspection we saw that some improvements had been made however we saw information was missing that would have assisted staff to understand and respond to people’s care needs better.

The provider had not been effective in the use of the audits to identify improvements that were needed. We asked them to make improvements so they had an effective and consistent way of analysing incidents and accidents to identify emerging trends. At this inspection we saw that some improvements had been made. However we did not see that an overall analysis of trends took place which would have brought each piece of individual information together.

People were not always supported to make choices. When they were unable to make decisions, it was not clear how the provider had acted in their best interests. The home environment lacked signage to enable people to find their way around the home. People enjoyed the food and were supported with their nutritional needs, but the meal time experience was not a positive one for everyone.

People’s interests and hobbies were not always considered and there was little stimulation for people. Not everyone was aware how they could raise concerns and the way of doing this was not accessible to all the people who lived there.

We found that people were protected from harm and staff were aware of the different types of abuse that could happen and were confident in how to raise any concerns. Risks were managed and there were enough staff to keep people safe. Medicines were managed safely. Staff had the knowledge they needed to support people and people were supported to maintain their health.

People were treated with kindness and their dignity and privacy were promoted and respected. People were encouraged to be independent and when possible were enabled to make choices and have some involvement with the planning of their care. Visitors were made to feel welcome.

There was a visible management presence and people spoke positively about the overall culture of the home.

You can see what action we told the provider to take at the back of the full version of the report.

18 August 2015

During a routine inspection

We inspected The Old Rectory on 18 August 2015. This was an unannounced inspection. The service was registered to provide accommodation and care for up to 26 older people, with a range of medical and age related conditions, including arthritis, frailty, mobility issues, diabetes and dementia. On the day of our inspection there were 21 people living in the care home.

The registered manager was not present on the day of the inspection, as they were out of the country. 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.

Present throughout the inspection was the provider and a senior care worker, with extensive managerial experience, who had recently been appointed as acting manager. The provider confirmed that the intention was for this member of staff to become the registered manager “hopefully before the end of the year.”

People’s needs were assessed and their care plans provided staff with guidance about how they wanted their individual needs met. However care plans were not ‘user friendly’, they were cumbersome, disorganised and poorly maintained and the lack of structure meant that information was not readily accessible. This was an area that we considered required improvement and we have asked the provider to address the identified shortfalls.

People were at potential risk from unprotected radiators, a lack of accessible call bells (or relevant risk assessments) and inconsistent standards of hygiene. This also was an area that we considered required improvement.

People were happy, comfortable and relaxed with staff and said they felt safe. One person spoke about the kindness of the staff. They told us “They bend over backwards for us.” Relatives also spoke positively about the home and the care provided. One relative told us “The staff here go that extra mile…..they are very patient.”

People received care and support from staff who were appropriately trained and confident to meet their individual needs and they were able to access health, social and medical care, as required. There were opportunities for additional training specific to the needs of the service, such as diabetes management and the care of people with dementia. Staff received one-to-one supervision meetings and annual appraisals were also in place.

There were policies and procedures in place to keep people safe and there were sufficient staff on duty to meet people’s needs. Staff told us they had completed training in safe working practices. We saw people were supported with patience, consideration and kindness and their privacy and dignity was respected.

Safe recruitment procedures were followed and appropriate pre-employment checks had been made including evidence of identity and satisfactory written references. Appropriate checks were also undertaken to ensure new staff were safe to work within the care sector.

Medicines were managed safely in accordance with current regulations and guidance by staff who had received appropriate training to help ensure safe practice. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals, where necessary.

There was a formal complaints process in place. People were encouraged and supported to express their views about their care and staff were responsive to their comments. Satisfaction questionnaires were used to obtain the views of people who lived in the home, their relatives and other stakeholders.

We found one breach 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 this report.

18 September 2014

During an inspection looking at part of the service

Our inspection was unannounced and in response to concerns raised. Two inspectors visited this service on 18 September 2014. There were 17 people using the service on the day of the inspection. One person was in hospital. We spoke with five people who used the service, five staff and three relatives. We also spoke with the provider. There was no registered manager in post when we visited.

During our inspection we wanted to understand people's experience of the service they were using. We did this by spending time sitting and talking with people. We used a Short Observational Framework Inspection (SOFI) to observe care. SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We read care records and spoke with staff about people's needs.

In September 2013 we made compliance actions in the following areas: Assessing and monitoring the quality of service provision, Consent to care and treatment, Meeting nutritional needs, Safety, availability and suitability of equipment, and Staffing. At this inspection we followed these up and found they were still not fully met.

In August and September 2014 concerns were raised about practices at the home. This included moving and handling methods, and untidy and unsafe premises.

Below is a summary of what we found.

Is the service safe?

There were areas of potential risks to people who used services. This was because not all pipes were guarded in an area where people could be at risk from burns because of this.

Communal areas were sometimes cluttered. The registered person had not taken sufficient steps to promote people's safety following accidents in the home.

Systems were in place to ensure staff were recruited so that they were safe to work with people who used the service. When staff shortages were identified the provider would find cover whenever possible.

The was an odour in some areas of the service and staff did not always remember to wash their hands in between giving eye medicines. This showed that staff did not always follow the provider's infection control measures.

Is the service effective?

Staff were trained to enable them to carry out their roles. However, when they communicated with people this was not always evident. There were times when staff did not listen to people's wishes therefore they were not respecting their dignity.

Staff did not demonstrate an understanding of the relevant requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards. This is a law that protects people's right to consent to care and treatment and to their freedom.

People were not always involved in decisions about what they ate and drank. This was because the mealtime experience did not always support their needs.

Is the service caring?

We observed a meal left outside a bedroom. The staff member did not return to check if the person had collected it. We found that staff did not always give consideration to people's dignity and well- being.

Is the service responsive?

We observed people to take part in the activities provided by a staff member who motivated them and engaged with people throughout the day. People told us they were encouraged to take part in activities that they preferred and found interesting.

Concerns and complaints procedures were provided for people and their family representatives to use. The provider was able to use their comments, compliments and concerns to improve the service. For example, people wanted to participate in activities during the day and these were now provided as group and individual activities.

Is the service well led?

At our last inspections in July 2013 and September 2013 there was no registered manager for the service. The provider was aware that the service required a manager to be registered with us. At the time of this inspection, a registered manager was still not in post although the provider told us they had started the process of a registered manager for the service. Staff told us that the management team provided them with support.

There were systems in place to check the quality and safety of the service but these were not always effective. Not all shortfalls identified during our inspection had been identified by the provider and some issues had not been acted on.

20 September 2013

During an inspection looking at part of the service

We visited The Old Rectory on 20 September 2013 and again on 23 September 2013.

We found that there was no registered manager in place at the home. The provider told us that he was in the process of recruiting a new manager to work at the home.

We found that the provider had put systems in place to ensure that people who used the service were protected against the risks associated with the unsafe management of medicines.

We found that the provider had introduced a quality monitoring system to identify discrepancies and gaps in people's care records. However, we found that the system was not effective in addressing and managing the risks to people's health and welfare. Care plans did not always reflect people's current treatment needs.

We found that the provider had commenced a programme of monthly quality monitoring audits. However we found that risks identified in these audits were not always addressed.

We found that there was a continued lack of provider oversight to ensure the effective operation of systems designed to ensure that service users benefitted from safe, quality, care, treatment and support. People were at risk of receiving unsafe treatment and support due to the lack of effective management of the risks to their health, welfare and safety.

29 July 2013

During a routine inspection

We found that people were not protected against the risks of inappropriate or unsafe care as the provider was failing to operate effective systems to identify, assess and manage risks relating to the health, welfare and safety of service users.

We found that people were not protected from the risk associated with the unsafe management of medicines.

People and relatives we spoke with told us that food at the home was provided in sufficient quantities but the quality had recently declined. One person told us 'It's below par now'. We found that the provider was failing to protect people from the risks associated with poor nutrition.

We found that there were not always enough suitably qualified and skilled staff to meet people's needs. Relatives we spoke with told us 'staff never have enough time, because there aren't enough of them' another relative told us some staff are willing to do anything, but some of them don't have the right knowledge and skills to do the job properly'.

People could not be assured that decisions were made in their best interests because staff lacked sufficient knowledge of the Mental Capacity Act and the Deprivation of Liberty Safeguards which meant that people could not be assured that decisions were made in their best interests. We also found that staff did not always ensure people's choices were respected.

3 September 2012

During an inspection looking at part of the service

When we last inspected the home on 26 June 2012, people we spoke with told us that they liked living at the home and that they felt safe and cared for. One person we spoke with told us "I feel like I have been able to make this our home within our room".

26 June 2012

During a routine inspection

People we spoke with told us that they liked living at the home and that they felt safe and cared for. One person we spoke with told us 'I feel like I have been able to make this our home within our room'.

We observed that staff were aware of people's individual needs and knew how to best to

communicate with and support people make choices for themselves regarding their daily

routines.