Archived: The Old Rectory

Updated 26 October 2018

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 31 July 2018, 01 and 08 August 2018. The inspection was unannounced on 31 July and 08 August 2018 and announced on 01 August 2018. The inspection team on 31 July and 01 August 2018 consisted of three inspectors, and two inspectors returned to the service on 08 August 2018. The inspection was brought forward due to a number of concerns shared with us by the local authority in relation to people being unsafe, possible abuse and poor standards of care.

Due to technical problems, the provider was not able to complete a Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. Before the inspection we looked at previous inspection reports and notifications about important events that had taken place at the service, which the provider is required to tell us by law. We took account of recent safeguarding information. We checked that the provider had followed their action plan.

We observed the care provided for people. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with five people about their experience of the service. We spoke with seven staff including the registered provider, the deputy manager, two senior care workers and three care staff. We received feedback from two health and social care professional.

We looked at records held by the provider and care records held in the service. This included 13 care plans, daily notes; safeguarding, medicines and complaints policies; the staff recruitment records; the staff training programme; the staff rota; medicines management; complaints and compliments; meetings minutes; and health, safety and quality audits.

Updated 26 October 2018

The inspection was carried out on the 31 July 2018, 01 and 08 August 2018. The inspection was unannounced on 31 July and 08 August 2018 and announced on 01 August 2018.

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