The inspection took place on 04 November 2018 and was unannounced. We last inspected The Old Rectory in May 2017, during that inspection we found people’s legal rights were not always understood and upheld. This was because the service did not work in accordance with the Mental Capacity Act 2005. We also found risks around the environment were not being managed effectively and the governance systems were not fully effective. At the last inspection in May 2017, we found three breaches of the Health and Social Care Act 2018. This inspection evidenced that the required improvements had been made and the service was meeting their legal requirements.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective and Well Led to at least good. We found the provider had made the required improvements and the service is now rated as Good.

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 Old Rectory accommodates 10 people who have a learning disability and/or autism. 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 the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service did not have a registered manager. 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. The previous registered manager had left the service in September 2018. The provider had placed an interim manager at the service whilst a new manager was recruited. The interim manager informed us the new manager was due to start work at the service the day after our inspection. They would then start the application process to become the registered manager.

Staff had been trained to administer medicines safely. The previous registered manager, interim manager and staff had worked with health professionals to review people’s medicines and ensure they were not being over-medicated. They had done this by working with the professionals to find alternative strategies to support people when they displayed behaviours that could challenge others.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the providers policies and systems supported this practice. The interim manager and staff understood and followed the requirements of the Mental Capacity Act 2005. They were committed to supporting people to achieve as much independence as possible, whilst ensuring each person was safe.

We found there were adequate numbers of staff working at The Old Rectory to support people effectively. The staff were well trained and supported well by the interim manager and provider.

The atmosphere of The Old Rectory had a friendly, calm atmosphere and people living in the home told us they got on well with both staff and other people at the home. People accessed the community regularly and were supported to plan their days and activities.

Risks to people were assessed and measures taken to keep people safe, without impacting on their rights to make choices and take some risks.

The home was clean and tidy and effective infection control procedures were in place to keep people safe. We did note that the decoration o

This inspection took place on 8 and 9 May 2017 and was unannounced. Two adult social care ¿inspectors carried it out.¿

The Old Rectory provides accommodation and personal care for up to 10 adults who have a ¿learning disability. The service is located in a large house in the rural village of Chewton Mendip.¿

A registered manager was responsible for the service. This 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.¿

People were protected from abuse and avoidable harm; risks to people were not always fully ¿assessed or planned for. People received effective support to help them manage their ¿behaviour. Staff recruitment and people’s medicines were managed safely. ¿

Staff were well supported and well trained. Staff knew people and understood their care and ¿support needs. One staff member said, “I know people well, it takes time building their trust.” ¿People made choices about their own lives, although their legal rights in relation to decision ¿making and restrictions were not always upheld.

People’s diverse needs were well supported; they chose a range of activities and trips out.

People were part of their community and were encouraged to be as independent as they could ¿be. People interacted well with staff. Staff had built trusting relationships with people over time. ¿One person said, “The staff are very nice people. They’re here to look after us.”

¿

People had benefitted from reductions in the medicines they took. People, and those close to ¿them, were involved in planning and reviewing their care and support. Some care planning ¿needed to be reviewed and improved.

¿

There was a management structure in the home, which provided clear lines of responsibility and ¿accountability. All staff worked hard to provide the best level of care possible to people. The aims ¿of the service were well defined and adopted by the staff team.

¿

The quality assurance systems in place were not fully effective. There were systems in place to ¿share information and seek people's views about their care and the running of the home. People ¿knew how to complain if they were unhappy.

¿

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) ¿Regulations 2014. You can see what action we told the provider to take at the back of the full ¿version of the report.¿