The Old Rectory is a residential care home for 10 people, including people living with dementia and people requiring personal care. The home is a large detached property in Standish and has eight single rooms on the first floor, of which four have en suite facilities and on the ground floor, there is a shared room. Bathrooms and toilets are situated on the first floor and toilets are available on the ground floor.

At our last inspection on 11 October 2015 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 on-going 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; at this inspection conducted on 16 and 17 April 2018 we found the service remained Good.

There was a registered manager at the home. 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 told us they felt safe living at the home and were supported to have 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.

There were sufficient staff available to ensure people's wellbeing, safety and security was protected. An appropriate recruitment and selection process was in place which ensured new staff had the right skills and were suitable to work with people living in the home.

Staff had a good understanding of systems in place to manage medicines, safeguarding matters and behaviours that are challenging to others. People's medicines were managed so they

received them safely.

Relatives we spoke with said they felt welcome to visit at any time; they felt involved in care planning and were confident that their comments and concerns would be acted upon. The provider took account of complaints and comments to improve the service.

Risk assessments were in place for a number of areas and were regularly updated, and staff had a good knowledge and understanding of people’s health conditions.

Feedback received from people who used the service and their relatives was overwhelmingly positive and people were encouraged to contribute their views. People were positive about the staff who supported them and told us they liked the staff and were treated with dignity and kindness. People told us they felt safe living at the home.

People were satisfied with the food provided at the home and the support they received in relation to nutrition and hydration. There was an open and transparent culture and encouragement for people to provide feedback.

People told us they were aware of how to make a complaint and were confident they could express any concerns and these would be addressed.

Staff told us they enjoyed working for the organisation and spoke positively about the culture and management of the service. They also told us that they were encouraged to openly discuss any issues.

Further improvements had been made to the design and decoration of the environment. There was a homely and peaceful atmosphere with due consideration given to the needs of people with dementia.

We carried out this unannounced comprehensive inspection on 12 October 2015. This inspection was undertaken to ensure improvements had been implemented by the service following our last inspection on 08 January 2015.

At the previous inspection on 08 January 2015 the home was found to have five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to: the provision of sufficient staffing numbers; the provision of appropriate food in relation to people’s requests; the management of medicines; the provision of appropriate training, personal development; supervision and appraisals for staff; seeking the views of people who used the service and people acting on their behalf. At the comprehensive inspection on 12 October 2015 we found that improvements had been made to meet the relevant requirements previously identified at the inspection on 08 January 2015.

The Old Rectory provides personal care and accommodation for up to ten people. At the time of our inspection there were nine people using the service. The home has eight single rooms on the first floor, of which four have en-suite facilities and one shared room on the ground floor. The first floor is accessible by a passenger lift. There is a garden area to the rear of the home and a small car park within the grounds.

There was a registered manager at the home. 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 the time of the inspection there was also an acting manager who had been in post since July 2015, who was gaining experience.

The provider told us that it was their intention for this manager to become the registered manager for the service and an application to become the registered manager would be submitted to CQC in due course. The home was also supported by an area manager who worked a few hours each week to provide support within the home.

People who used the service and their relatives told us they felt the service was safe. There were appropriate risk assessments in place with guidance on how to minimise the risks. We observed good interactions between staff and people who used the service during the day. People felt staff were kind and considerate.

Safeguarding policies were in place and staff had an understanding of how to report concerns.. Recruitment of staff was robust and there were sufficient staff to attend to people’s needs. Rotas were flexible and could be adjusted according to changing needs.

Medication policies were appropriate and comprehensive and medicines were administered, stored, ordered and disposed of safely. We saw that people’s nutrition and hydration needs were met appropriately and they were given choices with regard to food and drinks.

Care plans included appropriate personal and health information and were up to date. We saw evidence within the records of appropriate assessments and risk assessments being undertaken, which were reviewed regularly.

The environment was not consistently effective for people living with dementia and provided little stimulation. There was insufficient signage to aid people’s orientation and help them to be as independent as possible. The environment was also in need of some refurbishment.

Staff responded and supported people with dementia care needs appropriately. People’s health needs were responded to promptly and professionals contacted appropriately. Records included information about people’s likes and dislikes and we observed that people had choices, for example, about when to get up and when and where to eat. There was an appropriate complaints procedure and complaints were followed up appropriately.

There was a staff training matrix in place, but there were some gaps in staff training records.

There was a staff supervision cycle in place in addition to an annual appraisal. This meant that the home was now meeting the schedule identified in their supervision policy.

There was a four week menu cycle in use with at least two daily choices and two vegetable choices. Fresh fruit was also available and drinks and biscuits/cakes were served in between meals People could choose the time of their breakfast and could have a drink or snack whenever they wished.

There were appropriate records relating to the people who were currently subject to the Deprivation of Liberty Safeguards (DoLS.) There was documentation of techniques used to ensure any restrictions placed on people were as minimal as possible. There were appropriate Mental Capacity Act (MCA) assessments in place, which were linked to screening tools and restrictive practice tools which outlined the issues and concerns.

Staff sought verbal consent from people prior to providing support to them. This ensured that people gave their consent to the care being offered before it was provided. People’s health needs were recorded in their files and this included evidence of professional involvement. Relatives we spoke with told us they were kept informed of all events and incidents and that other professionals were called upon when required.

People’s bedrooms were personalised with individual items such as family photographs and personal objects. The home had a Service User Guide and Statement of Purpose which was given to each person who used the service. There was a monthly schedule of activities on display which included a wide range of activities

People using the service were treated with kindness and respect. Care staff spoke with people in a respectful manner, knocking on people’s bedrooms doors and waiting for a response before entering. There was a ‘privacy and dignity’ policy, which was up to date and recently reviewed in March 2015.

There was also an up to date ‘human rights’ policy, a residents ‘charter of rights’ and a policy on autonomy and choice, which helped staff to understand how to respond to people’s different needs. Staff were aware of these policies and how to follow them.

Care plans were easy to understand, person-centred in their format and contained a personal profile which identified personal relationships and family history.

Meetings with people who used the service were taking place regularly and information was shared with those people unable to attend and their families.

The home had procedures in place to receive and respond to complaints. There was a complaints policy and procedure in use and this was up to date reviewed in March 2015. Details of how to make a complaint were available and on view in the home on a notice board.

The service undertook a range of audits which were competed each month. There was also a business continuity plan in place.

Records of staff competency assessments via observations were carried out and these included individual feedback to staff on their performance.

Accident and incident forms were completed correctly and records included the action taken to resolve the issue and the corresponding statutory notification form required to be sent to the Care Quality Commission. The service had notified the CQC of all significant events which had occurred in line with their legal responsibilities. Policies and procedures were all up to date, having been reviewed in March 2015.

The service worked in partnership with a variety of other organisations in order to facilitate access to the local community.

The home undertook a range of audits and information from these was shared at staff meetings.

There was a staff meeting and staff supervision schedule in place.

We carried out this unannounced inspection on 08 January 2015.

The Old Rectory provides personal care and accommodation for up to ten people. The home was fully occupied at the time of our inspection. The home has eight single rooms on the first floor, of which three have ensuite facilities and one shared room on the ground floor. The first floor is accessible by a passenger lift. There is a garden area to the rear of the home and a small car park within the grounds.

The last inspection of The Old Rectory took place on the 14 March 2014. The provider was not meeting the required standard relating to records and this was judged as having a minor impact on people who used the service. At our insepection on 08 January 2015 we found this had improved .

The provider of the home is also the 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 and associated Regulations about how the service is run.

On 08 January 2015 we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we took at the back of the full version of this report.

We looked at three care records and found that these contained risk assessments, which identified how people were to be protected from the risk of harm. The care records we looked also showed that people’s health was monitored and referrals had been made to healthcare professionals when required.

On the day of our inspection the providers were at the home. There were two care staff on duty. The care staffing levels would have been sufficient to care for people living at the home if they had been supported by ancillary staff. We observed that the care staff were expected to carry out domestic tasks which took precedence over spending time with people living at the home. We had been at the home for two hours before we saw any staff interaction with the four people in the lounge.

We looked at the staffing rotas. There was only one member of staff on waking night duty. Rotas indicated that there was sometimes a ‘sleep in’ member of staff who could be woken during the night if a person required assistance. On other shifts there was an ‘on call’ which meant staff had to telephone the named person to come to the home and assist them. This could result in people who used the service having to wait for the care and support required.

We observed that when the care staff spoke with people living at the home this was done in a kind and caring way.

We saw no meaningful activities were offered for people during the day. There was no evidence recorded in the care files on how people had spent their day.

On checking the food supplies we saw that there was no fresh produce within the home including fresh milk. The home used powered milk. We saw that people were offered drinks during the day, however there were no snacks for example biscuits, cake or fruit available within the home should people require them.

We reviewed the training matrix for staff at the home. Staff had received induction training for the service on commencing work at the home. We noted that staff had not received training in the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS), equality and diversity and not all staff had received current safeguarding of vulnerable adults training.

We looked at the staff files and saw that the service had suitable recruitment procedures in place. However staff had no written contracts which detailed their benefits and entitlements.

We spoke with one visitor who told us they were happy with the care their relative received. They had no cause for any worries or concerns.

One person who lived at the home told us they were well cared for by the staff.

We discussed the quality assurance systems with the manager. Whilst the service performed some audits we found no evidence that an audit resulted in an accompanying action plan. We reviewed documents which the provider used to monitor the quality of the service by seeking feedback from people who use the service, their families, staff and visitor to the service. We found that only two questionnaires had been obtained from people who used the service during 2014. All other questionnaires reviewed were relevant to 2013.

The manager told us there was a procedure to receive and respond to complaints. However we did not see a copy of the complaints procedure displayed within the home.

We saw that the home was cluttered for example hoists and wheelchairs were stored in the foyer. The dining room had a new commode stored in there and a container of detergent stored behind the couch. The manager was unaware the detergent was there and removed it immediately.

When we conducted the inspection we found the home to be very quiet as all of the people living there, except for one, were in their bedrooms. This was because the lift was out of order and people could not access the ground floor. We have discussed the situation within the body of the report.

We met with people in their bedrooms and also spoke with three visitors to the home. They all told us that they had been made aware that the lift was expected to be out of order prior to the event.

Two visitors told us that they were happy with the care for their relative as it was culturally sensitive to the persons needs. They were also able to tell us that the providers were able to assist with any language difficulties.

Another visitor told us that the person they were visiting was well cared for.

The people living at the home were settled, comfortably dressed and appeared well cared for. There were no concerns raised with us although there was some confusion as to what discussions had taken place in relation to the use of bed rails and their protective covers for some of the people who were living there.

We saw that the provider had taken action to rectify issues that had been raised at our previous inspection and that a refurbishment programme had begun.

However we also identified an area of concern and have asked the provider to take action.

When we conducted the inspection we found that there was a relaxed and informal atmosphere in the home and that the people living at The Old Rectory were well presented.

We saw that people were being supported by staff throughout the day and at mealtimes in an appropriate way. The tables were set with flowers and menus and people were assisted to eat their meal in a respectful manner. Items to assist people such as plate guards were available and in use.

There were two members of staff on duty and the deputy manager in charge told us that staffing levels were sufficient.

We spoke with a visiting health professional, six residents, a visitor and two members of staff.

They told us comments such as ''I have no issues with the home, the staff are good as is the care.'' ''The food is very nice but a bit monotonous'' and ''We are always made welcome.''

However, despite the positive comments we found several areas of the home and care provision that gave us cause for concern and required improvements. These included the safety of the environment and the safe and proper use of equipment. Our concerns are referred to in the body of this report

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The service users that we spoke to told us that they were happy living at The Old Rectory.

The relatives and representatives that we spoke with supported that view.

We were told by a person using the service that they could join in activities and mixing with others if they wanted to or they could enjoy the privacy of their own room. A visitor told us that the person they visited spoke very highly of the staff, the food was very good and any issues were always dealt with straight away.

Another person told us that their relative was well dressed and that their clothes always matched. On the day of the inspection all of the people living at The Old Rectory were well presented.

The staff members that we spoke with told us that they were supported in their roles.

“I find that the staff are very respectful and caring”

“The staff here are very nice and friendly, they care for me very nicely”

“I have a nice room with all my things around me".

“ I do feel safe and the staff are very caring “.