This unannounced inspection took place on 3 and 5 December 2018.

The Old Rectory provides accommodation and personal care for up to 25 people. There were 19 people living in the home at the time of our visit, some of whom were living with dementia.

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.

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.

There was 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.

People felt safe. They were supported by staff who demonstrated a good understanding of how to safeguard people from experiencing harm or abuse. People had personalised risk assessments which helped minimise risks to their health and well-being.

There were enough staff to meet people’s needs and respond flexibly. Recruitment checks were in place and demonstrated that staff employed had satisfactory skills and knowledge needed to care for people. This included carrying out checks to make sure they were safe to work with vulnerable adults.

Medicines were managed safely, and people got their prescribed medicines on time and at the correct dosage. Accidents and incidents were reported, investigated and the learning shared with the staff to reduce the chance of them happening again.

People had thorough pre-assessments which supported their move to the home and identified their needs, abilities and achievable outcomes. Staff received training and received an induction on starting. Staff had supervision which was used as an opportunity to reflect on practice, performance issues and discuss career aspirations.

People were supported to eat a well-balanced diet and could choose from a variety of fresh foods on offer. Where people required extra support at meal times this was provided in line with guidance from health professionals.

People were supported to attend appointments to maintain their health and well-being. Where people’s health needs changed there was timely contact with relevant health professionals such as GP, chiropodists and district nurses.

The home was decorated in a way that gave it a homely feel and people liked this. People could move around the home freely and could enjoy spending time with those important to them.

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. Where people lacked capacity to make particular decisions they were supported by staff who were trained and worked in line with the principles of the Mental Capacity Act 2005.

People were supported by staff who were consistently kind, caring and attentive. Staff knew people and their relatives well which supported natural, easy conversation. People told us they were supported and encouraged to express their views about the care they received and could live their lives how they wished to live them. People’s privacy and dignity was supported.

People’s care plans were personalised and regularly updated. They included details of people’s communication needs and preferences.

There was a wide range of activities supported at the home and in

This unannounced inspection took place on 15 June 2016.

The Old Rectory provides accommodation and personal care for up to 31 people. There were 29 people living in the home at the time of our visit, some of whom were living with dementia.

There was 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.

There was a friendly and welcoming atmosphere in the home. People, relatives and healthcare professional told us staff were kind and supported people as individuals. Personalised care plans were developed so that staff were able to support people in a way that met their needs. People’s risks were assessed and plans developed to ensure that people’s risks were managed in a way which minimised restrictions for them. Staff were creative in how they supported people and used technology as a way of supporting one person safely.

The registered manager was committed to making improvements in the home and staff were valued and supported. There were incentives to recognise staff achievements and staff were supported to plan fun out of work activities. The home was undergoing improvements to bedrooms so that smaller rooms were enlarged to accommodate ensuite facilities. There were also plans to move from paper care plan recording to an electronic system.

There were active community links. The registered manager was a Dementia Champion and was involved in increasing awareness of dementia within the local community and the home was undergoing checks to be a safe haven for vulnerable people with dementia or related conditions who may be lost in the local community.

People were supported to continue with community activities and there were various activities which they attended such as Memory Café, Singing for the Brain and the local theatre. During our inspection people were visiting a flower display in a local church. There were activities provided for people within the home and some specific activities aimed at people living with dementia such as memory boxes.

People were supported by staff who had received the appropriate training and who were supported through regular supervision. Staff received an annual appraisal and one member of staff told us they had identified goals which they were working towards. Staff told us they had enough training and felt supported and valued by management.

People were supported by enough staff which was planned based on the assessed needs of people. The registered manager told us they used regular staff as they wanted people to be supported by staff who knew them; they told us they did not use agency staff. Staff were recruited safely; the relevant pre-employment checks had been carried out.

The home was accredited with the Gold Standard Framework training which is a nationally recognised training to ensure people received excellent end of life care. People were invited to have an advanced care plan which would enable them to identify what was important for them at the end of life. This included a box which was known as a travel box and contained items such as poetry, hand creams or any item which the person may get comfort from at the end of life.

There were systems and processes in place to ensure there was good communication with people, their families and staff. The provider welcomed feedback either through surveys or suggestion boxes. There were quality monitoring systems on different aspects of the service such as care plans, health and safety and first aid. We saw areas for improvement from feedback or quality checks were identified and actions taken.

In this inspection we considered five key 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 using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Effective assessment of risks showed how the service maintained its duty of care and took appropriate steps to ensure people’s safety.

The service had taken steps to ensure people’s care and welfare needs would continue to be met in the event of foreseeable emergencies.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. Medicines were safely administered, and appropriate arrangements were in place in relation to the secure storage and safe disposal of medicines.

Staff received adequate training and appropriate professional development. People using the service received care and support from staff who were properly trained and supported to carry out their work safely.

Is the service effective?

People’s health and care needs were assessed with them, and they and their representatives were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. Effective planning of care helped ensure that the service met people’s fundamental care and support needs.

People who used the service and their representatives were asked for their views about their care and treatment and they were acted on. People benefited because their views were sought and the provider took steps to act on feedback to improve the service. This helped ensure that the care and support provided was also in line with people’s wishes.

Is the service caring?

People were supported by kind and attentive staff. Care was observed to be respectful and responsive to individuals’ needs. We saw that care workers showed patience and gave encouragement when supporting people. People told us they were happy and liked living at the home. One person commented, “I don’t think you’ll find much fault with them [staff].” Another person told us staff were “very helpful, friendly”. A relative said, “The staff are lovely.”

Is the service responsive?

People using the service, their relatives, friends and other professionals involved with the service completed regular customer satisfaction surveys. Where shortfalls or concerns were raised these were addressed.

We looked at how complaints had been dealt with, and found that the responses had been open, thorough, and timely. People told us whenever they had raised issues they were dealt with swiftly and to their satisfaction.

Staff worked to meet people’s individual and specific needs, but also focused on allowing people to do as much for themselves as they could. One member of staff explained it was the service’s ethos to make sure “people keep their independence as much as possible.”

We found the provider had taken full and appropriate action in response to a number of minor issues we had identified previously in relation to records.

Care plans were reviewed monthly and updated as and when required. The service responded to people’s changing needs. Effective systems for the ongoing review of people’s care needs enabled staff to deliver continuous care according to those changing needs.

Is the service well-led?

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns and investigations. This reduced the risks to people and helped the service to continually improve.

The service had a quality assurance system, and records showed that identified shortfalls were addressed promptly. As a result the quality of the service was continually improving.

Staff told us they were clear about their roles and responsibilities and spoke positively about the support they received from the manager and their peers.

The manager and senior staff had appropriate experience of care provision and were knowledgeable about the systems and processes required for a care home’s effective operation. Strong leadership meant staff followed those systems and processes, which helped to ensure people’s care and support needs were met.

We spoke with people about their daily lives in the home. People told us they had visits from relatives, sat in the garden, walked into the village centre and participated in activities as they wished. One person told us, "Staff ask me if I want to join in but they never make me, I like that."

Care plans were updated when changes had occurred to people's health.

People were supported to be able to eat and drink sufficient amounts to meet their needs. People we spoke with said the food was very good, there was always enough and they were offered a variety of choices.

People feel safe in the home. We spoke with five people who told us they felt safe when staff were supporting them. One person said, "Staff are gentle with me, they know I get anxious."

People we spoke with told us that they were not rushed by staff when they were being assisted. One person said, "The girls are very good."

Poor recording of information could lead to the person's care and welfare being at risk.

People’s agreement was sought before support and care was provided. One person told us, “I don’t need a lot of help. They always ask if you need any help, if you don’t they leave it at that.”

People experienced care which met their needs in premises which were maintained and of a suitable design and layout. We saw that drinks were available in people’s bedrooms and in communal lounges. One person told us, “They will get you a doctor. They don’t hang around, they always help with the medical problems that crop up from time to time.”

Accurate records were maintained both in respect of the management of the home and in relation to the care and support provided.

The provider operated effective recruitment procedures and conducted appropriate pre-employment checks.

This inspection was carried out to check on a compliance action made at the inspection in October 2011, relating to infection control within the home.

We did not speak with people at this visit, as we checked on infection control procedures in the home.

People who live in the home told us that they considered that the home was good and they were looked after. We saw care needs being met in an unhurried manner and people were given choices about what they wanted to do and eat. People were assisted with their meals if needed and had a choice of menu.

One relative told us that they were involved in the person’s care and were able to comment on how support was given. They said that the home was responsive to any concerns and took action.

We saw people going out to the local community and receiving visitors in private if they wished. People were able to participate in a range of activities according to their interests.

People did not have to wait long to be assisted and call bells were answered in a timely manner.

People living in the home commented positively on the service provided and considered that their needs were met. They thought that staff were attentive to their needs. One relative told us that the home kept them informed of any changes in their relative’s condition.

We found that care plans did not always accurately reflect the care that people required to meet their needs.

The home was clean and tidy, but we found that infection control practices did not always protect people from the risk of infection.

We saw that medicines were handled, administered and stored in a safe manner and there were clear audit trails of medicines into and out of the home.