About the service: The Old Rectory is registered to provide accommodation and personal care for up to 41 people. At the time of inspection, 38 people were using the service.

People’s experience of using this service: People continued to receive safe care. Staff understood safeguarding procedures that should be followed to report abuse and incidents of concern. Risk assessments were in place to manage risks within people’s lives, whilst also promoting their independence.

Staff recruitment procedures ensured that appropriate pre-employment checks were carried out. Staffing support matched the level of assessed needs within the service during our inspection.

Staff training was provided to ensure they had the skills, knowledge and support they needed to perform their roles. Specialist training was provided to make sure that people’s needs were met and they were supported effectively.

Staff were well supported by the manager, and had one to one supervisions. The staff we spoke with were all positive about the senior staff and management in place.

People's consent was gained before any care was provided. 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

Staff continued to treat people with kindness, dignity and respect and spent time getting to know them. Care plans reflected people’s likes and dislikes, and staff spoke with people in a friendly manner.

People were involved in their own care planning and were able to contribute to the way in which they were supported. People and their family were involved in reviewing their care and making any necessary changes.

A process was in place which ensured people could raise any complaints or concerns. Concerns were acted upon promptly and lessons were learned through positive communication.

The service continued to be well managed. The provider had systems in place to monitor the quality of the service. Actions were taken and improvements were made when required.

Rating at last inspection: Good (report published 23/02/2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained rated Good overall.

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

We inspected The Old Rectory on 29 October 2015. This was an unannounced inspection. The service provides care and support for up to 44 people. When we undertook our inspection there were 42 people living at the home.

People living at the home were older people. Some people required more assistance either because of physical illnesses or because they were experiencing memory loss. The home also provided end of life care.

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.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to deprive their freedom in some way, usually to protect them. At the time of our inspection there was one subject to such an authorisation.

We found that there were sufficient staff to meet the needs of people using the home. The provider had taken into consideration the complex needs of each person to ensure their needs could be met through a 24 hour period.

We found that people’s health care needs were assessed, and care planned and delivered in a consistent way through the use of a care plan. People were involved in the planning of their care and had agreed to the care provided. The information and guidance provided to staff in the care plans was clear. Risks associated with people’s care needs were assessed and plans put in place to minimise risk in order to keep people safe. Medicines were stored and administered safely.

People were treated with kindness, compassion and respect. The staff in the home took time to speak with the people they were supporting. We saw many positive interactions and people enjoyed talking to the staff in the home. The staff on duty knew the people they were supporting and the choices they had made about their care and their lives. People were supported to maintain their independence and control over their lives.

People had a choice of meals, snacks and drinks. The meals could be taken in a dining room, sitting rooms or people’s own bedrooms. Staff encouraged people to eat their meals and gave assistance to those who required it.

The provider used safe systems when new staff were recruited. All new staff completed training before working in the home. The staff were aware of their responsibilities to protect people from harm or abuse. They knew the action to take if they were concerned about the welfare of an individual.

The provider was addressing issues of staffing in the domestic department to ensure the home was clean and safe to live in.

People had been consulted about the development of the home and quality checks had been completed to ensure services met people’s requirements.

Our inspection team was made up of one inspector. We considered our evidence to help us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, the staff who supported them and from looking at records. We took into consideration the views of other health and social care professionals and from commissioners of the service by talking with them and looking at their reports.

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. People told us they felt safe.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve. Regular checks were undertaken to ensure the environment was safe.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. When applications had needed to be submitted, proper policies and procedures were followed. The provider kept CQC informed of any applications.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly. Therefore people were not put at unnecessary risk.

The registered manager ensured the needs of people were reviewed at least monthly and staffing levels adjusted to meet those needs.

Is the service effective?

Care plans we looked at reflected people's care needs and they said that were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

People's needs were taken into account with signage and the layout of the service enabling people to move around freely and safely.

People told us they could express their views on a one to one basis with staff and by completing surveys.

There was a complaints process in place and people told us all staff were approachable and they would be able to raise concerns if they wanted too. Where this had happened staff had reacted quickly and outcomes reached for the satisfaction of all parties.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

People commented, "Staff are brilliant here" and "Staff meet my needs every day and ask me what I want to do each day."

People who used the service, their relatives, friends and other professionals involved with the service attended meetings throughout the year. Where shortfalls or concerns were raised these were addressed. People told us they felt their opinions were valued.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People told us they could speak with staff each day and share their concerns. They told us staff acted quickly. Relatives told us they could speak with staff about their family member's needs, when that person could not make decisions for themselves.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system. Records seen by us showed that identified shortfalls were addressed.. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes that were in place. This helped to ensure that people received a good quality service at all times.

When we inspected The Old Rectory on 19 April 2013 we found the training matrix did not fully record the training staff told us they had done. The provider sent us an action plan and told us they would review the records for training.

We saw there was a now an up to date training matrix which identified all training staff had received that could be verified with a certificate. Where attendance at training could not be verified staff were required to complete further training.

We received some information of concern a person submitted to our website. This recorded that people were at risk of not having their care needs met due to low staffing levels.

We asked people who used the service if the care available met their needs. One person told us, “There are normally staff about in the lounge during the day and I get on well with them.”

We asked people if care workers responded to the bell when they ring for help One Person told us, “There is no bother there.” We also asked people if their medication was administered on time. One person said, “Always.” Another person said, “They are good with meds we get them at the right time… they [staff] sit and make sure I take them.”

We reviewed the staff rotas for three weeks and could see there were enough staff to meet people’s needs.

We reviewed all the information we held about this provider before we visited the home. This included information from other agencies and other people who wanted to share information about the service, for example relatives. Other agencies who gave us information included the Local Authority.

We spoke with a number of people within the home, and we also used a range of different ways to help us understand their experiences. This was because some people had complex needs which meant they were not able to tell us about their experiences. For example, we looked at records, including personal care plans, we spoke with relatives, we spoke with the managers and staff who were supporting people, and we observed how they provided that support.

We saw people were supported to make choices and decisions about their lifestyles, and they were treated with dignity and respect.

We saw that people were supported by a knowledgeable care team, and they received the care and support they wanted and needed. However, we found some issues with the management of staff training and supervision records.

People told us things like, “I’m very happy hear, I’ve made it just like home”, “They’re good staff, you don’t wait long for them to come and help and they speak to you nicely” and “I’m quite happy here thanks, I’m comfortable.”

The Old Rectory provided rehabilitation services in joint working with the local community NHS Trust, short term respite care and long-term care.

During our visit we looked at records. These included care plans and minutes of meetings. We spoke with care staff, people who use the service and people who visit the service. We also sat and watched care staff delivering care to people in the home. We found people were respected and involved in their care.

People we spoke with told us the home was a nice place to live. They told us the care staff provided the support and care they needed. One person said, “I have choices about everything I do here. I only get up when I want to and the same when I go to bed. I also choose the clothes I wear.”

People told us they liked the food they had and said they always had a choice at meal times. They also had the opportunity to take part in activities if they wanted to.

People told us they felt safe in the home and if they didn’t they felt the manager would do something about it. Care staff knew how to protect the people in the home and who to contact if they had concerns.

We saw evidence that care staff received training and support to do their jobs and people felt the care staff knew what they were doing.

People felt confident about taking any concerns directly to the manager.

The Old Rectory provided rehabilitation services in joint working with the local community NHS Trust, short term respite care and long-term care.

During our visit we looked at records. These included care plans and minutes of meetings. We spoke with care staff, people who use the service and people who visit the service. We also sat and watched care staff delivering care to people in the home. We found people were respected and involved in their care.

People we spoke with told us the home was a nice place to live. They told us the care staff provided the support and care they needed. One person said, “I have choices about everything I do here. I only get up when I want to and the same when I go to bed. I also choose the clothes I wear.”

People told us they liked the food they had and said they always had a choice at meal times. They also had the opportunity to take part in activities if they wanted to.

People told us they felt safe in the home and if they didn’t they felt the manager would do something about it. Care staff knew how to protect the people in the home and who to contact if they had concerns.

We saw evidence that care staff received training and support to do their jobs and people felt the care staff knew what they were doing.

People felt confident about taking any concerns directly to the manager.

The people we spoke with told us that The Old Rectory was a nice place to live and they praised the staff, who they said were helpful. One person told us, “They are are all lovely, I can’t say nothing wrong against them.” Another person who was visiting the home said, “I think they look after people well.”

People told us that they were asked for their views about the running of the home by the manager and staff and that they felt confident taking any concerns to the manager or home owners directly 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, “We have our own menu. I know what I like. We are having scampi and chips, just what I want.”

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, “There are things to do as and when we want to. I like computers and I go on the Wii game in the activity room.”