About the service:

The Old Rectory provides care for up to 16 people with learning disabilities, who may also live with an attached diagnosis such as autism, diabetes, Down's Syndrome or epilepsy. There are two properties set within large grounds, one accommodating up to 13 people and the other up to three people. The ages of people who lived in the Old Rectory currently, ranged from 30 years up to 75 years old.

Rating at last inspection:

The rating of this service at our last inspection was "Requires Improvement.” (Report published 28 December 2017)

At our last inspection, there were four breaches of the regulations.

Why we inspected:

This was a planned inspection based on the rating at the last inspection and aimed to follow up on concerns we found in August 2017. In addition, we had received some information of concern received anonymously prior to the inspection. We explored the areas of concern as part of our inspection.

People’s experience of using this service:

Whilst the provider had progressed quality assurance systems to review the support and care provided, there was a need to further embed and develop some areas of practice that the existing quality assurance systems had missed. This included updating care plans when an identified need or directive of care changed. For example, management of diabetes. We also found the cleaning audits had not identified shortfalls in the cleanliness of the premises.

There was still a need to improve the provision of meaningful activities for people to prevent isolation and boredom. Plans were in place but there had been delays in implementing the changes due to staffing changes.

People spoke positively of the home and commented they felt safe. Our own observations and the records we looked at reflected the positive comments people made. Most care plans reflected people’s assessed level of care needs and care delivery was person specific, holistic and based on people's preferences. Risk assessments included falls, skin damage, behaviours that challenge or cause distress, swallowing problems and risk of choking, and mobility. The care plans also highlighted health risks such as diabetes and leg ulcers. People said they felt comfortable and at ease with staff and relatives felt people were safe. Staff and relatives felt there were enough staff working in the home and relatives said staff were available to support people when they needed assistance. Pre-employment checks for staff were completed, which meant only suitable staff were working in the home. All staff had attended safeguarding training. They demonstrated a clear understanding of abuse; they said they would talk to the management or external bodies immediately if they had any concerns.

The manager and staff had completed training on the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. They had assessed some restrictions were required to keep people safe for example, some doors were locked. Where this was the case referrals had been made to the local authority for authorisations. People had access to healthcare professionals when they needed it. This included GPs, dentists, community nurses, and opticians. Staff received regular support from management which made them feel supported and valued. They were encouraged to develop their skills and take on additional responsibilities. Staff spoke positively about the changes made to the running of the home and the way the home was managed.

Staff were kind and caring, they had developed good relationships with people. They treated them with kindness, compassion and understanding. Staff supported people to enable them to remain as independent as possible. They communicated clearly with people in a caring and supportive manner. We received positive feedback from relatives and visiting professionals about the care provided. The service worked well with allied health professionals. A number of audits had been developed, including those for accide

The Old Rectory provides care for up to 16 people with learning disabilities. There are two properties set within large grounds, one accommodating up to 13 people and the other up to three people. The smaller property reflected the needs of a quieter group and the larger property was more lively and spacious. At the time of inspection the service was full.

We previously inspected this service in July 2014 when the provider was found to be meeting all the required standards.

This was an unannounced inspection. The newly appointed manager who has been registered with the Care Quality Commission (CQC) was present during the inspection. 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.

Systems were in place for the safe management of medicines but these were not always followed; there was a risk people might not receive their medicines appropriately. Staff understood their responsibilities to report and respond to accidents but there was an under reporting of incidents and this could place people at risk of continued incidents. A risk assessment process was in place but this was not always effectively monitored to ensure risk management strategies were working. The provider was not ensuring that the information gathered about prospective staff was to the required standard to inform recruitment decisions.

Fire prevention arrangements were in place but Not all staff had received training in this area. There was a comprehensive training programme in place to provide staff with basic core skills and specialist training, however the turnover in staff meant that nearly 50% of staff were still to complete infection control, moving and handling and first aid training with a third of staff still to complete safeguarding and mental capacity training.

The quality assurance processes did not provide the provider with regular oversight of the service. Internal checks within the service to monitor care plan content and risk management and medicines were not being completed robustly to be effective. Staff felt supported but their involvement in staff meetings was limited. People and relatives feedback was not specifically used to influence the service development.

There were enough staff to meet people’s care needs but their availability to spend time with people was limited and staffing levels and deployment were an area for improvement. People had activity planners to reflect their individual interests, hobbies and preferences but some people went out more than others and those who stayed in the house lacked stimulation. A pre-admission process was in place to assess the needs of new people and ensure their needs could be met, but records of the assessment and transition arrangements for a newer person could not be found.

People’s health was monitored by staff that supported them to access routine and specialist health care appointments. People were given choices about what they ate and special dietary needs were supported. Staff sought peoples consent for everyday care and support tasks; staff understood and were working to the principles of the mental Capacity Act 2005 and DoLS to ensure the least restrictive measures were in place.

People liked the staff that supported them, they showed they were comfortable and relaxed around staff and enjoyed a laugh and a joke with them, staff appeared to be kind and respectful towards people.

There had been investment in the premises to make this a more comfortable place to live; this was on going and there were further improvements that the registered manager had identified and had received permission to progress. People who needed special equipment for their everyday needs had been provided with this a

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This was an unannounced inspection. The Old Rectory provides care for up to 16 people with learning disabilities. There are two properties set within large grounds, one accommodating up to 13 people and the other up to three people. The smaller property reflected the needs of a quieter group and the larger property was more lively and spacious.

People’s needs were varied, some people had communication difficulties, a number displayed behaviours that challenged and a number were on the autism spectrum. The rear garden was secure which meant that people could use this area safely. Specialist equipment was available for those who required this and the property had been adapted in areas to accommodate people’s individual needs. To the rear of the property there was day centre and some people chose to spend time there each day.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. The manager provided good leadership and support to the staff. In addition to speaking with the manager we spoke with six people who use services, a senior care worker and two care workers. Throughout our inspection, staff were positive about the home, they said there was good teamwork and they felt supported. A staff member said that the manager, “Listens and values our opinions.”

Staff treated people with respect and dignity. They had a clear understanding of people’s individual needs and aspirations and could tell us how each individual liked to be supported. Each person had a keyworker who they spent time with. A keyworker is a named staff member who has specific responsibilities to assist the person in meeting their individual needs and wishes. People told us that if they had any concerns or worries they could speak with their keyworker or the manager of the home.

One person raised a number of concerns/worries with us during the inspection. By the end of the inspection the home had taken action to address the concerns and the person told us that they were happy with the actions taken and the outcome.

At one to one meetings with their keyworkers and at the monthly residents ‘your voice’ meetings people were supported to choose what activities they wanted to do the following month. Activities were flexible and people could change their mind if they wanted to opt out of an activity. Monthly meetings were also used to keep people informed about a range of matters for example, staff changes or upcoming maintenance of the home. In addition, they were opportunities for people to have a say in the running of their home.

Staff attended regular supervision meetings and received an annual appraisal of performance. Staff meetings were used to ensure that staff were kept up to date on the running of the home and to hear their views on day to day issues. Staff were also able to feedback their views through annual questionnaires. All staff received training to fulfil the duties of their role and more specialist training was also offered to ensure that staff met the needs of people.

Staff received training on the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and they had a good understanding of the legal requirements of the Act. They were aware of restrictions posed on some people in the home and why they were in place.

Care plans were comprehensive and were written in a way that meant that any new carer would have been able to read the care plan and know how to support the person including specific information about their personal preferences. They had been reviewed regularly and people confirmed that staff had read the care plans to them and made sure they understood the contents.

Within each person’s care plan there was detailed information about how best to communicate with the person. Staff were knowledgeable about people’s needs and were clearly able to explain how they made sure they understood the choices made by people with limited verbal communication skills.

This was a routine inspection but we also used this opportunity to follow up on compliance actions made on 13 February 2013. Those who could speak with us told us that the care was good. People were pleased with the redecoration of the house and in particular their bedrooms. One person told us, “I like the colour I chose.” Another said, “My bed is comfy.”

We found that care plans clearly documented the needs of people and how they should be met. Staff ensured that consent was obtained prior to providing care and support. Where appropriate, specialist advice and support was obtained to meet people's individual needs.

We looked at measures in place to ensure the risk of infection was minimised and found that procedures were clear, the home was clean and it was free from odours. Staff received regular training to meet the needs of people. Systems in place ensured that all staff attended regular supervision and appraisal meetings. There were detailed systems to ensure that the quality of care provided was monitored and reviewed on a regular basis.

We used a number of different methods to help us understand the experiences of people using the service. Some people using the service had complex needs, which meant they were not able to tell us their experiences. One person told us that they were very happy with the care provided. Another person said, "I have been here a long time. Staff are good, they look after me.”

We observed staff interacting positively with people. Care plans were reviewed regularly but they were not sufficiently detailed and fully reflect people’s needs. Where appropriate, specialist advice and support was obtained and included in care plans.

The environment both internally and externally was in need of redecoration and plans were in place to commence refurbishment in June 2013.

There were sufficient numbers of staff on duty and staff felt well supported. Staff were clear about what they should do if they suspected abuse.

There were systems in place to monitor the quality of the care provided. These identified that improvement was needed in many areas. Close monitoring was in place but the new systems and procedures were not fully embedded into everyday practice.