The Old Rectory

Updated 21 February 2020

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 Care Act 2014.

Inspection team

This inspection was completed by one inspector.

Service and service type

The Old Rectory is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. 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.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We used the notifications we had received from the service and information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We observed care and support interactions as people were not able to or did not want to talk to us about living at The Old Rectory. We looked at records relating to people’s care, including their support plans, reviews and medicines. We spoke with seven members of staff, either through formal interview or informal conversation. These included the registered manager, team leader and support workers. We also looked at information relating to the management of the service, such as recruitment files for three staff members.

After the inspection

We asked the registered manager if they could provide contact details or statements from people’s family members, to share their feedback. We did not receive any details or feedback from people’s relatives. We received written feedback from one healthcare professional.

Updated 21 February 2020

About the service

The Old Rectory is a residential care home providing personal care to 8 people with autism and learning disabilities at the time of the inspection.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to eight people. Eight people were using the service. This is larger than current best practice guidance of six. However, the size of the service was not having a negative impact on people and was mitigated by the size of the home and building design fitting into the residential area.

The service was developed and designed in line with most principles and values that underpin Registering the Right Support and other best practice guidance. This guidance ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

The management of the service did not have a consistent oversight of how staff spent their time or if there were shortfalls in staffing. We received conflicting feedback from the registered manager and staff about why some people were missing out on opportunities to access the community. Reviews indicated these were long-standing issues and that some people were not prioritised over others because their needs were more demanding of staff time.

Medicines were not consistently managed safely. Some areas for improvement were identified in the leadership audits, but we found other shortfalls which had not been identified.

The registered manager recognised there were areas for improvement in the quality monitoring of the service. Also, in documenting how people were being supported to achieve positive outcomes.

Most areas of the home were clean and tidy, although there were some areas which would benefit from redecoration. This was partly due to the age of the building and continual maintenance was planned. One person’s bedroom had a strong odour, due to water on their carpet. Plans to address this were only considered when we raised concerns about the smell.

People had personalised support plans in place. These reflected people’s usual routines, what was important to them and what staff needed to know to support them.

People’s involvement in decisions about their care was promoted. Some people used advocacy services. Others were independent in making decisions and some people had involvement from their family members.

There was a range of different meals and drinks available for people. We saw people choosing different lunchtime meal options. People who could make their own food were encouraged to do so.

Staff received training in a range of different areas, including equality and diversity. People’s cultural identity needs were respected and supported.

People’s privacy was respected. People had access to different communal rooms to spend their time, as well as a large garden. There was also a hall which could be used for events and activities.

The home was in a good location for community access by foot or public transport. The registered manager had developed good relationships with the local resident’s group. People from the community were invited into the garden for annual garden parties.

People were supported to have 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 8 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Enforcement

We have identified breaches in relation to the leadership of the service and managerial oversight of how staff support people at this inspection.

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

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.