The Old Rectory Nursing Home

The Old Rectory is a care home providing nursing and personal care. It can accommodate up to 36 people. The service provides support to older people. Some people using the service were living with dementia. There were 22 people using the service at the time of the inspection.

People’s experience of using this service and what we found

Some relatives and staff told us they did not feel there were enough staff across the service and told us sometimes people were left waiting to receive support. We did not observe this during our inspection; The provider was regularly assessing staffing levels using a dependency tool.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Risks were managed in a safe way and staff knew how to protect people from the risk of harm and abuse. Medicines were managed safely, and systems were in place to ensure lessons were learned when things went wrong.

People received care and treatment from competent and skilled staff who had the relevant knowledge to meet people's needs. The provider had a system to ensure all staff had regular training and were kept up to date with best practice.

The management team had improved the governance systems to monitor the quality of the service and to ensure people received safe and effective care.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 6 October 2021) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check they had made improvements and had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Old Rectory Nursing Home on our website at www.cqc.org.uk.

The Old Rectory is a care home providing nursing and personal care. It can accommodate up to 36 people. Some people using the service were living with dementia. There were 27 people using the service at the time of the inspection.

People’s experience of using this service and what we found

There was a quality monitoring system in place. However, areas we found that required attention had not been identified by the provider's quality assurance systems. The registered manager had identified shortfalls in their audit process and were working to improve this.

We were not fully assured that infection prevention and control (IPC) systems were effective. We found the environment was not always maintained to a good standard of cleanliness. We also identified some areas were not well maintained and therefore could not be effectively cleaned. For example, storage units, chairs and missing and damaged wall tiles. The provider actioned this immediately and provided us with an action plan to ensure all areas were addressed.

Medication systems were in place for staff to follow. Medicines were stored correctly, and we observed safe administration of medicines by staff. However, we identified a lack of information to evidence people’s best interests were considered when decisions were made about their care and treatment, and they lacked the mental capacity to make the decision themselves. We discussed this with the general manager who agreed to address this with the registered manager.

We observed adequate staff on duty to meet people’s needs. Staff understood safeguarding procedures and whistleblowing, and all stated they would report any issues immediately. Risk assessments were in place and contained information to ensure risks were managed. Incidents and accidents were recorded appropriately, the registered manager was introducing a more robust overview to effectively analyse and monitor incidents in the home to ensure lessons were learnt.

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

Rating at last inspection

The last rating for this service was requires improvement (published 12 December 2019).

Why we inspected

We received concerns in relation to IPC and medicines management and governance. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has stayed the same.

The overall rating for the service is requires Improvement this is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We have found evidence that although the provider has made some improvements, these need to be sustained and embedded into practice. We have identified a breach in relation to governance at this inspection. Please see all sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Old Rectory Nursing Home is a residential care home providing personal and nursing care to people aged 65 and over. The care home accommodates 36 people in one adapted building, over two floors.

People’s experience of using this service and what we found

The provider had not ensured that all risks were effectively monitored and reduced.

Audits needed to be further developed and embedded into practice to ensure safe care and treatment was being delivered in line with best practice.

Staff were knowledgeable about how to recognise and report safeguarding concerns. There were sufficient numbers of suitable qualified staff deployed.

People told us they were happy and that staff were kind, caring and compassionate and all of our observations confirmed this The provider ensured that there were plenty of meaningful activities on offer to meet people’s needs. People’s physical and emotional needs were met.

End of life care was being provided to a high standard. Complaints were addressed according to the providers policy and procedures.

The provider had worked with external health and social care professionals to assess and review people's care in line with best practice guidance. People were supported to maintain their nutrition and hydration.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection

The last rating for this service was good (published 16 May 2017). At this inspection we found the provider was now rated as requires improvement. We have identified two breaches in relation safe care and treatment and the leadership and management of the home. You can see what action we have asked the provider to take at the end of this full report.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Old Rectory Nursing Home on our website at www.cqc.org.uk.

The Old Rectory Nursing Home provides personal and nursing care and is registered for 36 older people including those living with dementia. On the day of the inspection 27 people were receiving care at the service.

There was a registered manager in post. A registered manager is a person who has registered with CQC 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 and associated Regulations about how the service is run.

People were positive about the service and the staff who supported them. People told us they liked the staff and that they were treated with dignity and kindness.

There were safe practices in place to ensure people received their medications safely and on time. Medications were stored in a designated area of the home and were only given out to people by staff who were trained to do so.

There were recruitment checks in place to ensure that staff were safe to work with vulnerable people.

Staff were able to describe the course of action they would take if they felt someone was being harmed or abused in any way. This included raising and reporting safeguarding concerns. Staff also said the home's whistle blowing procedure was discussed regularly with them, and they would not hesitate to use this procedure if required.

Staff were well supported in their role and had access to training to enhance the skills they required for their role. There were opportunities for staff support and we saw effective teams at work. Staff were happy and motivated with good communication between shifts.

Staff had a good understanding of legislation relating to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty safeguards. (DoLS) The MCA ensures that where people have been assessed as lacking capacity to make decisions for themselves, decisions are made in their best interest according to a structured process. DoLs ensure that people are not unlawfully deprived of their liberty and where restrictions are required to protect people and keep them safe, this is done in line with legislation.

People told us they enjoyed the food. Mealtimes were a positive experience, which people told us they looked forward to. People told us meals were of sufficient quality and quantity and there were always alternatives on offer for them to choose from. People were involved in planning the menus and their feedback on the food was sought.

Care plans, with regard to people's preferred routines and personal preferences were well documented and plainly written to enable staff to gain a good understanding of the person they were supporting. Care plans contained a high level of person centred information. By 'person centred' we mean the service was tailored to meet the needs of the person, and not the service.

Complaints had been responded to by the registered manager and appropriately dealt with including any changes which needed to be implemented because of the complaint. There were no new complaints since our last inspection.

The registered manager had systems in place to monitor the quality of the care provided and to monitor events which took place in the home to assist keeping people safe. Risks to people's care and support were assessed and reviewed as needed. Quality assurance procedures were robust and identified when actions needed to be implemented to drive improvements. We saw that quality assurance procedures were organised and adopted an honest approach in identifying shortfalls in service provision.

The Old Rectory Nursing Home provides personal and nursing care and is registered for 36 older people including those living with dementia. On the day of the inspection 36 people were receiving the service, including three people receiving respite care.

The home had a registered manager who had been in post since January 2015. 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.

People told us they felt safe and well cared for and staff we met understood people's individual care needs and had received training. However we found that, some staff training, which was required to be updated annually had not been provided in timely way, to ensure people who used the service were safe at all times.

There were good links with health and social care professionals. However, we found a small number of instances when staff had not always acted upon the advice received, so that people's needs were not always met.

Although the registered manager, people and their visitors told us there were enough staff to keep people safe, some staff told us there were busy times during the day when it became difficult to meet everyone’s needs.

Pre recruitment checks were undertaken before staff started work in the service. However, there were occasions when the provider had accepted personal references, rather than pursuing references from applicants’ previous employers.

People and their visitors expressed very positive views about the staff and the care provided. Staff were kind and caring in their approach and interacted with people in a positive way.

People were cared for by staff that demonstrated knowledge of the different types of potential abuse to people and how to respond to actual or suspected abuse.

People told us they enjoyed meal times and were positive about the choice of food they received.

People said their privacy and dignity was maintained and our observations supported this.

People were encouraged to express their views and give feedback about their experience of the service. People said staff listened to them and they felt confident they could raise any issues should the need arise.

Staff spoke highly of the teamwork within the service.

The quality of service provision and care was monitored and actions taken to improve the service where required. However, the quality monitoring system had failed to identify and address the shortfalls we found at this inspection and some issues that had been identified had not been addressed in a timely a way.

The Old Rectory Nursing Home provides personal and nursing care and is registered for 36 older people including those living with dementia. On the day of the inspection 33 people were receiving care services from the provider. The home had a registered manager who had been in post since January 2015. 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.

People had positive views about the staff and the support they were given for their particular care needs. Staff were kind and caring in their approach and people and staff interacted in a positive way. People told us they found the staff to be approachable and relaxed in manner and they could speak to them at any time.

People told us they felt safe and well cared for and staff were able to demonstrate they had sufficient knowledge and skills to carry out their roles effectively to ensure people who used the service were safe. People were cared for by staff that demonstrated knowledge of the different types of potential abuse to people and how to respond to actual or suspected abuse.

The assessments of people's capacity to consent had been completed. People's rights and freedoms were respected by staff. Staff understood people's individual care needs and had received training so they would be able to care for people in the best way for them. There were good links with health and social care professionals and staff sought and acted upon advice received so that people's needs were met.

People using the service were positive in their feedback about the service. People told us they enjoyed meal times and were positive was about the choice of food they received. People said their privacy and dignity was maintained and we made observations that supported this.

People received care that met their individual needs. People were encouraged to express their views and give feedback about their time at the service. People said staff listened to them and they felt confident they could raise any issues should the need arise.

Staff spoke highly of the management team and felt supported. Staff spoke highly of the teamwork within the service. The quality of service provision and care was continually monitored and actions taken where required.

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

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

Is the service safe?

People were treated with respect and dignity by the staff, and staff were given support and guidance to ensure that they cared for people safely. People benefited from named staff to undertake their care. People were cared for in a clean, hygienic and well maintained environment. Systems were in place for managers to monitor the quality of the service and make sure it was run safely.

Is the service effective?

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care plans contained assessments of people's care and support needs. These assessments described the steps staff should take to ensure each person's needs were met. Staff received appropriate support to meet the needs of people living at the home. Audits and reviews took place to ensure that care was delivered in a way that met people's needs.

Is the service caring?

We observed that staff were caring and respectful towards people. Most care tasks we observed took place in a patient and kind manner. People spoke positively about their experience of receiving care at the home.

Is the service responsive?

Staff acted on people's needs and in accordance with their wishes. Where people needed specific support or care, we saw evidence that this was delivered in accordance with people's needs.

Is the service well-led?

There was a quality assurance system in place, where staff carried out a quality monitoring programme. This was detailed, frequent and thorough. Staff we spoke with believed they were well led and had confidence in the management team.

There were care plans in place to support people at the end of their life. The plans included areas such as people's wishes, pain management, fears and expectations. This ensured staff were aware of people's wishes and decisions relating to their end of life care and treatment. A relative we spoke with raised no concerns about the standard of care being provided. We observed people were being provided with nutrition and hydration and people's intake was being monitored by staff.

People were provided with a choice of suitable and nutritious food and drink. People confirmed the food was good and they had plenty of choice. They were supported to be able to eat and drink sufficient amounts to meet their needs.

There were effective systems in place to reduce the risk and spread of infection. We found the home was clean and well maintained.

There were enough qualified, skilled and experienced staff to meet people's needs. During our inspection we observed staff were able to meet people's needs in a timely way.

People were given support by the provider to make a comment or complaint where they needed assistance. People we spoke with confirmed they could raise any concerns with staff and these would be acted on. The service had a system in place to record and analyse all incidents, accidents and complaints. There was evidence that learning from incidents / investigations took place and appropriate changes were implemented.