We completed an unannounced inspection at The Old Rectory on Thursday 18 May 2018. At the last inspection in October 2016 the service was rated as ‘Good’ overall and was meeting the required standards of care. We had found there were some improvements needed under our ‘Effective’ domain to ensure the provider supported people to make informed choices in line with legislation.

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 27 people in one adapted building. People who use the service may have a physical disability and/or a mental health condition such as; dementia. At the time of the inspection there were 23 people using the service.

The service had 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.

At this inspection we identified 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.

We found that some medicines were not always managed in a consistent and safe manner.

People were not protected from the risks of abuse because staff had not always recognised and reported possible signs of abuse, which meant investigations had not been carried out as required.

There was a lack of effective systems in place to assess, monitor and improve the quality of care. This meant that areas of concern had not always been identified and rectified.

Records were not always an accurate reflection of people’s needs.

Risks to people’s health and wellbeing were not always managed and people were at risk of inconsistent care.

Improvements were needed to ensure that people received the least restrictive care and treatment to keep them safe and staff understood and followed the Mental Capacity Act 2005.

Improvements were needed to ensure staff were adequately trained to carry out their role and there was system in place to check their competency.

Improvements were needed to ensure that people’s past lives, cultural and diverse needs were assessed and considered to enable individualised care that met all aspects of people’s needs.

Improvements were needed to ensure people’s end of life wishes were taken into account.

There were sufficient suitability recruited staff to provide support to people. People were protected from the risk of infection because the provider had policies and systems in place to control infection risks at the service.

The provider had a plan in place to ensure the environment was of a good standard and met people’s needs.

People were supported with their nutritional needs and action was taken to ensure people at high risk of malnutrition were supported effectively.

Advice was sought from health and social care professionals when people were unwell, which was followed by staff.

People had the opportunity to be involved in interests and hobbies and their social needs were met.

People received support from staff that were kind and compassionate. People’s dignity was respected and their right to privacy upheld. People were supported top make choices in line with their individual communication needs.

People and their relatives knew how to complain. Complaints received had been investigated and responded to in line with the provider’s policy.

The provider had recognised some areas of improvement within the service and had implemented an action plan to improve.

People, relatives and staff felt able to approach the registered manager and the man

This inspection visit took place on 19 August 2016 and was unannounced. At our last inspection on 18 March 2014 the provider was meeting all of the legal requirements.

The Old Rectory is a care home registered to provide accommodation and personal care for up to 27 people including those living with dementia. 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.

Some people did not receive the level of support they needed with their decision making as relatives had been asked to make choices on their behalf.

There were arrangements in place to keep people safe from harm. Staff understood how to recognise potential abuse and the actions they should take in response to their concerns. People’s individual risks associated with their care were identified, assessed and managed to reduce the risk. Staff received training and support to gain the skills and knowledge to provide care for people and completed pre-employment checks to ensure they were suitable to work in a caring environment. People received their prescribed medicines correctly and there were arrangements in place to ensure all medicines were stored and recorded correctly.

People were provided with food and drinks in the most appropriate way to meet their needs. People’s health and wellbeing was monitored and the support of healthcare professionals was sought whenever specialist advice was required. Staff spoke to people politely and provided kind and compassionate care. People’s privacy and dignity was maintained. Relatives and visitors were welcomed by staff and could visit whenever they wished.

People were asked about their likes and dislikes to ensure the care they received met their preferences. People enjoyed a varied programme of entertainment and support with their hobbies to prevent them from becoming socially isolated.

There was a complaints procedure in place and people and their relatives felt that any concerns they raised would be treated appropriately. People, relatives and staff were happy with the management arrangements in the home and felt the managers and the provider were approachable. The quality of the service was monitored to ensure any required improvements were addressed.

We inspected The Old Rectory to follow up on previous non-compliance identified in Regulation 13, management of medicines.

In September 2013 we reviewed the administration of medicine in the home, including the documentation, storage and guidance. We found that some medication was stored incorrectly; the medication room was in need of redecoration and some guidance was out dated.

At this inspection we met and spoke with the registered care manager and the deputy care manager. We found that all the issues had been addressed and the home was now compliant.

We inspected The Old Rectory on 10 September 2013 as part of our scheduled inspections to check on the care and welfare of people using this service. The visit was unannounced, which meant that the registered provider and the staff did not know we were coming.

During the inspection we spoke with the provider, deputy manager, two carers, five people that use the service and three relatives.

We looked at the care records of three people and reviewed their care plans and risk assessments. We saw that people's care and support needs were well documented and up to date. We reviewed the administration of medicine in the home, including the documentation, storage and guidance. We found that some medication was stored incorrectly, the medication room was in need of redecoration and a general tidy was required. Some documentation issues were also identified.

We looked at the recruitment of staff and the safety checks that the provider completed to ensure suitable staff were employed. Three staff files were found to be in order.

We looked at the complaints procedure and spoke with people that used the service about making a complaint. People and relatives we spoke with told us they had not had cause to formally complain. One person told us: “The staff are very friendly and approachable and they do change things if issues arise. The communication is good, which probably avoids a complaint occurring”.

On the day of the inspection we met and spoke with the provider, the deputy manager and with care staff. We spoke with seven people that used the service and one relative.

Some of the people that lived in the home had dementia and therefore not everyone was able to tell us about their experiences. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences. Some people using the service were able to tell us about their experiences and we also spoke with other health professionals.

People told us they were very happy with the care and attention they received. One person told us, “I have settled in well and I enjoy the meals and all the company”.

We saw care staff interacting with people and their relatives.

We found the home to be warm and inviting. The building was well maintained and homely. People told us they felt safe in the home and well respected by the staff. The provider told us that staffing levels were high to ensure that’s people’s needs were met. We looked at the staff training matrix and saw that staff had completed the mandatory training.

The provider asked the people who used the service and their relatives to complete an annual questionnaire and give feedback about their experience.

We carried out this review, as our records showed that there had been no recent inspection of this service. Therefore, we visited The Old Rectory Care Home in order to up date the information we held and to establish that people's needs were being safely met.

There were 27 people living at The Old Rectory when we visited on 26 January 2011. The visit was unannounced which means the provider and the staff did not know we were coming. The provider, the manager and her deputy were in the home for this inspection.

We spoke with people living at the home, visiting family members and staff. People living at the home told us “It’s lovely here, I was made welcome straight away, the staff are very friendly and most have worked here a long time. The food is lovely but if I don’t want the meal on the menu they get me something else to eat.”

Relatives were encourage to play an active role and support people and provide care if they so wished. Family and friends attended social events and were involved in supporting people using the service where appropriate. One visitor told us "The staff are very good at communicating with all families.” Another relative told us “We are very happy with the home, can’t fault it. The staff are all very attentive and kind.”

People could choose to sit in either of the two lounges, in the conservatory or if they preferred they could remain in their own room. The home sits within beautiful grounds in a rural part of Stafford and has a wealth of stunning countryside views.

One person told us “We all enjoy the gardens very much, especially in the summer when we can sit outside. I like to watch the birds on my bird table and we have some chickens too.”