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 home is registered to provide personal care to 29 older people with a physical and/or sensory disability. People are accommodated in the main house and a separate annexe next door to the main house. People living in the separate annexe, known as 'the cottage' were living more independently than those in the main house.

At the time of the inspection 27 people were living at the service. The inspection took place on 23 January 2019 and was unannounced.

There was a registered manager in post. 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.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing 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.

Staff understood their responsibilities to keep people safe from harm. Care plans contained risk assessments and guidance for staff on how to keep people safe.

There was enough staff on duty to meet people’s needs.

Medicines were managed safely. Some changes were required, which the registered manager was in the process of doing.

Staff were trained and supported in their roles.

People were supported to have enough to eat and drink.

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

We saw and heard positive, caring interactions between people and staff. People spoke highly of the staff and staff told us they enjoyed their roles.

Regular feedback was sought from people and their relatives.

People received care that were responsive to their needs and preferences

There was a positive caring culture and the provider’s values were embedded in the service. People and their relatives all spoke highly of the registered manager.

There were quality assurance processes in place and an ongoing quality improvement plan; all of which were being reviewed and updated.

Further information is in the detailed findings below.

This inspection took place on 28 and 29 June 2016 and was unannounced. The Old Rectory provides personal care to 29 older people with a physical and/or sensory disability. At the time of our inspection 29 people were living in the home and of these 25 people were living with dementia. Accommodation was provided in the main house over two floors with shaft lifts to access the first floor and an annexe for five people. All bedrooms had en suite facilities and there were additional bathrooms and shower rooms. People in the main house had access to a large lounge with dining facilities as well as a garden room and other quiet areas.

There was a registered manager in post, who was also the owner of the company. 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 and associated Regulations about how the service is run.

People had developed exceptional relationships with staff which were caring, compassionate and sensitive. People were treated with the utmost respect and their dignity was promoted. When upset or anxious they were reassured by staff who understood them really well. Staff gently touched or spoke with people tenderly encouraging them. Music and singing were used creatively to engage with people to brighten their day and to help them express themselves. People’s communication needs had been considered and staff knew how to interpret their feelings and emotions, helping them to engage positively with their environment. People were helped to retain their independence whether eating, drinking, walking around or helping with the gardening or housework. People’s feedback was sought on a day to day basis so that any changes to their activities or meal choices could be made quickly. People said they enjoyed both their meals and activities telling us “It’s excellent, it’s like a hotel. The standard is very high.”

People’s care was individualised and reflected their unique needs. Their care and support was discussed with them and care records stated how they wished to be supported as well as their wishes and lifestyle choices. People had access to meaningful activities which they had chosen. They enjoyed music and singing, arts and crafts, themed events and going out on trips. People felt safe living in the home and staff protected their rights. Any risks had been assessed and hazards reduced to keep people safe. People were confident expressing their views and knew if they had any complaints these would be listened to.

People’s views and those of their relatives and staff were sought to monitor the quality of care provided. The registered manager and provider were open and accessible and strove to sustain the quality of care by making improvements to the service. Quality assurance audits monitored the quality of care provided and health and safety systems. External audits confirmed the high standard of care provided. The Old Rectory had been chosen as a case study reflecting best practice for music and singing in care homes by a national organisation. They had also received an award from local commissioners for being proactive and developing excellent person centred care plans.

During our visit we spoke with five people living in the home, a relative and two visiting district nurses. We also spent time with people in the lounge and dining room and observed people having lunch. People we spoke with told us they enjoyed living in the home and could choose how they wanted to spend their time. People told us, “Couldn’t ask for a nicer place” and “they (staff) do all they can for us”.

We looked at the care records for four people and spoke with or observed these people to see if records accurately reflected their needs. We found care plans were informative and personalised to the individual, reflected people’s needs and were regularly reviewed.

Care plans detailed people’s needs, likes and dislikes and how they communicated their wishes. We saw that staff had a good understanding of people’s needs and used this knowledge to enable people to make their own day-to-day decisions about their care.

Appropriate arrangements were in place in relation to obtaining and the recording of medicine. There were effective recruitment and selection processes in place. The provider sought the views of people who used the service and used these comments to improve and develop the service.

During our visit we spoke with ten people living in the home, a relative and a visiting GP. We also spent time with people in the communal areas. People we spoke with told us they were very happy living in the home and were able to make choices about their daily living. One person told us “They let you get up and go to bed when you want”. A relative told us “the home is wonderful, can’t criticise anything”. The GP told us “The home is very good; I trust what they tell me about people. They are very good at keeping people hydrated”.

Care plans were personalised to each individual's needs and from the people we spoke with we were able to see that they accurately reflected their needs and wishes.

Staff we spoke with and observed showed that they had good knowledge of the people they supported. They were seen responding to each person respectfully, with good humour and in a manner appropriate to each individual’s needs.

The home regularly asked people who used the service, their representatives and other professionals for their views about the care and support the home provided. When feedback was given by people the home acted on it and used these comments to improve the service.

People told us about living at The Old Rectory "its a happy place", "I am certainly well cared for I feel we are cared about". One individual said "you couldn't do better with a first class hotel" and another "I am extremely fortunate to be here".

When we asked about staff people told us "always there when you want them" "very friendly" and "very caring notice the little things you require". A relative we spoke with said staff were "very welcoming" and another said "couldn't ask for better staff". In relation to staffing arrangements some people felt there was not enough staff "sometimes very short of staff" "don't have time they need to spend with people".

There was mixed views about the quality and amount of activities provided in the home: "something everyday" "alot of entertainment". Others were not so positive "occasional trips out would be good" "staff never sit and chat..too busy" "don't won't to do group activities".

People told us about the quality of food though this was not a standard we have commented on in this report: "always a choice" "absolutely super you couldn't do better" "staff know what I like" . Other people said the food "could be better" "supper could be improved".

From the comments we received from people there was a real sense that individuals had control over their lives and were able to make choices about their daily routines; "I please myself" "I absolutely have control over my life" "no real restrictions do as you want" "can do as I wish".