We inspected the service on 20 November 2018. The inspection was unannounced. 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 service accommodates up to 24 older people with physical needs and those associated dementia.

On the day of our inspection 16 people were living at the service.

At our last inspection on 29 February 2016 we rated the service ‘good.’ At this inspection we found the evidence continued to support the rating of ‘good.’ There was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People continued to receive a safe service and were protected from avoidable harm, discrimination and abuse. Staff were safely recruited and available in sufficient numbers to meet people’s needs. Risks associated with people’s needs including those related to the environment, had been assessed and provided in ways which helped to minimise any risks identified. They had also been reviewed regularly and updated when changes were needed.

People continued to receive an effective service. Staff received all of the training and support they required to meet people’s individual needs, including meeting their nutritional needs. Staff worked well with external health care professionals and people were supported to access health services when required. People were supported to make their own choices and staff cared for people in the least restrictive way possible. The registered persons had processes in place which helped make sure that when needed, they acted in accordance with the Mental Capacity Act 2005 (MCA). This measure is intended to ensure people are supported to make decisions for themselves. When this is not possible the Act requires that decisions are taken in people’s best interests.

CQC is required by law to monitor the operation of the MCA and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. Through our discussions with the registered manager and staff we were assured that they understood the principles of the MCA and demonstrated their awareness of the need to obtain consent before providing day to day support and care to people. DoLS are in place where needed to protect people when they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection, none of the people who lived at the home were subject to an active DoLS authorisation and the registered manager informed us they were awaiting the outcome of five DoLS applications which had been submitted to the local authority for approval.

People continued to receive care from staff who were caring in the way they provided support. It was clear that staff approaches to people were based on understanding of people as individuals.

People continued to receive a responsive service. People were involved in planning for their care needs and regularly reviewing the care being provided. They were supported to pursue their individual interests and hobbies, and group social activities were planned and delivered in creative ways by a team of activity staff who provided opportunities for people to be stimulated and to express themselves.

There was a complaints procedure in place and people and their relatives knew how to raise any concerns or formal complaints if they needed to. Staff told us they felt well supported by the registered manager and provider and that they knew how to escalate any concerns they identified.

The service continued to be well led. There was an open and transparent and person-centred culture within the

The Old Rectory is situated in the village of Saxilby in Lincolnshire. The home provides residential care and support for up to 24 older people, some of whom live with memory loss associated with conditions such as dementia.

We inspected the home on 29 February 2016. The inspection was unannounced. There were 20 people living in the home at the time of this inspection.

At the time of our inspection there was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated regulations about how the service is run.

The registered provider had safe recruitment processes in place and background checks had been completed before new staff were appointed to ensure they were safe to work at the home.

Staff were well supported and had received training in order to enable them to provide care in a way which ensured people’s individual needs were met. Staff also knew how to recognise and report any concerns they had regarding people’s safety so that people were kept safe from harm.

Staff had ensured that people’s rights were respected by helping them to make decisions for themselves. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered manager had worked with the relevant local authorities to ensure that people only received lawful care that respected their rights.

Staff knew how to manage any identified risks and provided the care needed as described in each person’s care record. Care was supported through staff having access to a range of visiting health and social care professionals when they required both routine and more specialist help. Clear arrangements were also in place for ordering, storing, administering and disposing of people’s unused medicines.

Staff worked closely with people and their families to ensure each person was supported to maintain their individual interests and hobbies and to have a meaningful and enjoyable life. In addition staff provided a varied programme of communal activities for those who wished to participate in them.

People were provided with a good choice of nutritious meals. When necessary, people were given any extra help they needed to make sure that they had enough to eat and drink to keep them healthy.

The registered manager ran the home in an open and inclusive way and the provider encouraged people, their relatives and staff to speak out if they had any concerns. The provider and registered manager listened and took action to resolve any issues or concerns identified. More formal systems were also in place for handling and resolving complaints.

The provider and registered manager worked together consistently and maintained regular communication in order to regularly assess and monitor the quality of all the services provided. This approach ensured that any shortfalls in quality could be quickly identified and actions take to keep improving developing the service.

When we visited The Old Rectory there were 21 people living at the home. We spoke with six people and watched how staff provided care and support to others. This was because some people had problems with their memory and could not tell us their experiences of the care they received. We also spoke with a relative and the manager.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service and staff told us.

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

Is the service safe?

People we spoke with told us they felt safe living at the home. One person we spoke with said, “They [staff] make sure we’re safe and comfortable.”

We saw staff used the right ways to move people around the home with equipment such as hoists and wheelchairs. Up to date risk assessments were in place for issues such as falls, fire evacuation and nutrition.

Accidents and incidents were appropriately recorded and body charts were in place to identify any injury to a person.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. There were no applications needed or made by the home under this legislation since our last inspection. People’s personal records contained a check list for DoLS which showed whether an application was needed or not. Records showed staff had received training about this subject.

Staff demonstrated a good understanding of how to support people to make decisions and how the Mental Capacity Act (2005) should be used to protect people’s rights.

Good infection control arrangements were in place throughout the home. People we spoke with told us the home was always clean and tidy, and staff took good care of their bedrooms. One person said, “It’s [the home] always spotless.”

There were arrangements in place to monitor whether staff members were suitably immunised against infectious diseases for their own protection and that of the people they cared for.

Disclosure and Barring service (DBS) checks were carried out before staff started work at the home. The Disclosure and Barring service makes sure people are safe to work with vulnerable children and adults and an employer is required to complete those checks prior to commencement of employment.

Maintenance and repair records showed regular checks were carried out for things like water temperatures and general fixtures and fittings. They also showed repairs were carried out in a timely way.

People’s personal records were not always fully secured which meant that people’s confidentiality was not fully protected. The manager took immediate action to better protect information.

Is the service effective?

People were involved in an assessment before they moved into the home and when they had moved in. Care plans were developed with people based on the assessment information. Assessments and care plans were up to date and regularly reviewed.

Guidance about people’s privacy, dignity, well-being, culture, religion and independence were referred to in the plans. One person we spoke with told us their cultural and religious needs were always met and staff understood what they needed and wanted in regard to this.

People told us they thought staff were well trained and looked after them very well. One person said, “They [staff] know what they’re doing and they do it well.” From watching staff provide care for people it was clear they understood people’s needs and wishes and provided care and support in the way people wanted. A relative told us staff knew their family member’s needs and wishes very well.

People had their health needs met through support from their GP’s, district nurses and local hospitals. Records of healthcare support were up to date.

Is the service caring?

People told us things like, “I love it here, it’s so homely and caring” and “Don’t think I could get much better than here.” A relative told us their family member was very happy and comfortable living at the home. They told us staff treated them with respect and dignity.

Staff encouraged people to make decisions and choices for themselves. People could choose to have their breakfast in bed, what they wanted to eat and drink and what activity they wanted to join in with.

Assessments and care plans included people’s likes, dislikes and preferences. Staff were polite and friendly in their approach to people. They used respectful voice tones when talking with people and discussed personal issues in a private manner.

Is the service responsive?

People were asked for their views and opinions about the home through things like satisfaction surveys and meetings. Regular meeting dates were displayed so that people could choose to attend or not. Meeting minutes showed people were encouraged to talk about things like activities and meal planning. One person said, “They [staff] always listen to what I’ve got to say and they help me to get what I want.”

The satisfaction survey results for 2013 showed people who lived at the home, their representatives, staff and other professionals who were involved in their care were happy with the care and support provided. The action plan from the survey showed the provider had listened to people. For example, a better range of snacks and drinks had been provided.

People and a relative we spoke with said they knew how to make a complaint. They all said they had never had cause to make a formal complaint. One person said, “The staff would listen to me if there was something I wasn’t happy with, I know they’d put it right.”

There was an up to date complaints policy available for people and records showed no complaints had been made about the home since our last inspection visit.

Is the service well-led?

There was a system in place which helped to assure the provider and manager that the quality of the service provided within the home was of a good standard.

A range of audits were carried out regularly by the provider and manager, and action plans were in place to address any issues highlighted.

People who lived in the home were consulted about how they liked their care to be delivered and were asked for their views about how the home was run. Staff and other professionals were also asked for their views about how the home was run.

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with five people who used the service and a relative and asked them for their views. We also spoke with three care workers, a team leader, the cook and the registered manager. We looked at some of the records held in the service including the care files for seven people. We observed the support people who used the service received from staff and carried out a brief tour of the building.

People told us they were happy with the care they received and felt they were able to decide what care they had. A person who used the service told us, “They (staff) don’t impose care on me I don’t want. They encourage me to set my own pace.” People told us their healthcare needs were responded to. A person told us, “I have very good healthcare.” Another person said, “I am given my tablets every day.” People told us there were sufficient staff to respond to their needs. On person commented, “There are enough staff on duty, I have a buzzer, they answer pretty promptly at night.”

We found the provider could improve their systems to involve people in planning their care, and obtaining people’s consent for this to be provided. There were occasions when people did not receive care and support that met their needs. Risks people faced were not properly assessed to ensure their safety. Some records were not accurate and fit for purpose.

We found there were suitable arrangements to manage people’s medication and ensure they received any medication they needed. There were sufficient staff on duty to meet people’s needs.

During our visit we spoke with four people who lived at the home, four relatives who visited the service, four staff members, and the registered manager of the home.

We looked at records. These included care records and information about how the service operated. We also spent some time in communal areas of the home. We spoke with people and observed how staff interacted with, and supported people to do what they wanted to.

We observed staff provided positive support and engaged with people who lived at the home. People appeared relaxed and comfortable in the presence of their support staff. In discussion, it was evident staff understood the needs of people they supported.

One relative we spoke with told us, "We visit the home a lot. I think the whole staff team ensure people are cared for safely and I think that people are safe here."

We found people were cared for in a clean, well presented home. People's care was based around their individual needs. The staff provided care in a pleasant and professional manner.

One person living at the home said, "They (staff) are very helpful and always willing to provide what I want."

We found staff had time to interact with people and support them with activities. We saw the cook provided a choice of hot and cold foods at each mealtime and snacks throughout the day. A relative told us, "They have helped to really build our relative up with nutrition and help make them feel better."

The people we spoke with told us the home was a nice place to live and they praised the staff, who they said were helpful. One person told us, “They are a good support to me.” Another person who was visiting the home said, “I think this home is great, we always feel welcome.”

People told us that they were asked about their views about the running of the home by the manager and staff and that they felt confident taking any concerns to the manager direct if needed.

People also said they felt safe living at the home and raised no concerns about the way they were cared for. They told us they felt comfortable speaking to any of the staff about any worries or issues they might have.

People were complimentary about the meals provided. One person told us, “The food is nice and they come to ask us what we want in the morning so I know I can pick something from the menu then.”

There was a basic programme of activities available in the home and people and their family visitors told us about things they had done and had planned. One person said, “The staff talk to us lots and there are a few things going on that I like, we really had a good Christmas party.”