The Old Rectory

Updated 24 June 2022

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. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection team consisted of two inspectors.

Service and service type

The Old Rectory is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us.

The Old Rectory is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.

At the time of our inspection there was a manager, but they were not registered with the Care Quality Commission. An application had been received and was being processed.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with four people who used the service about their experience of the care provided and spent time with others observing interactions with staff. We spoke with five members of staff, the manager, locality manager and the providers behaviour specialist. We spoke with three relatives and contacted three health and social care professionals about their experience of the service.

We reviewed a range of records. This included three people's care records, daily records and medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

We continued to seek clarification from the provider to validate evidence found. We looked at training data, staff rotas and quality assurance records.

Updated 24 June 2022

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance the Care Quality Commission (CQC) follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

The Old Rectory accommodates 10 people who have a learning disability and/or autistic people. The service is located in a large house in the rural village of Chewton Mendip. Despite being a large service, it was operated in line with some of the values that underpin the Right support, right care, right culture guidance and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autistic people using the service can live as ordinary a life as any citizen.

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

Based on our review of the key questions safe and well-led, the service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right Support

The home was reliant on agency staff that did not always know people well or were confident to support people when out of the home. This meant at times the service could not fully meet the underpinning principles of Right support, right care, right culture and we could not be assured that people who used the service were able to live as full a life as possible and achieve the best outcomes.

People were supported to have some 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.

Staff did everything they could to avoid restraining people. The service recorded when staff restrained people, and staff learned from those incidents and how they might be avoided or reduced. The provider’s behaviour specialist was supporting the staff to ensure appropriate support was being delivered.

People were supported by a key worker who met with them to seek their views about how they wanted to be supported. People relied on staff to enable them to go out in the community to ensure their safety and that of others.

Right Care

People’s medicines were mostly managed safely. Other health and social care professionals were involved in the care and support of the people living in the home. Referrals had been made to the local community learning disability team.

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

People received care from staff that had been through a thorough recruitment process. Staff were caring in their approach towards people.

Right culture

Not everyone was happy with the care and support and the relationships within the home. Two people said they did not like all the staff or the people living in The Old Rectory. They said they had raised this with the manager and were being supported to find alternative accommodation. The person said some of the staff had left. Relatives were mostly positive and said since the new manager had been in post, they had seen improvements in communication.

There had been a lack of leadership in the home. There had been no registered manager at the service since January 2021. The new manager started working in the home in October 2021. They had an improvement plan they were working towards. However, due to workforce pressures they had not managed to address many of the areas for improvement due to supporting people themselves because of the lack of permanent staff and high agency usage.

Staffing was not always planned in respect of people’s individual needs which meant they were not always receiving their one to one support.

The provider and the manager had failed to implement a robust system to monitor the quality of the service. Improvement in areas of risk management had not been fully implemented in respect of the property, fire and cleanliness.

The home was in a rural area, however, there was good public transport links to Bristol, Bath, Wells and other neighbouring towns. There was a shop, a café and public house in the village.

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 good (published 12 December 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service. The inspection was prompted in part due to concerns received about an increase in incidents within the home, staffing and governance arrangements. A decision was made for us to inspect and examine those risks.

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.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this report. You can see what action we have asked the provider to take at the end of this full report. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to systems to monitor risks in relation to fire and infection control, staffing and the governance arrangements.

We recommend the provider consider current guidance on supporting people with a learning disability and autistic people to improve people’s experience.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.