CQC report explained · a residential care home
What the CQC found at The Old Rectory
Not yet rated: the CQC has not published a rated inspection for this home, which is usual for a new registration.
What inspectors found, February 2020
Rated Requires Improvement; inspectors found kind and effective care, but concerns about medicines, staffing, community access and management.
The unannounced inspection took place on 9 and 10 January 2020. One inspector observed care, checked care and medicines records, spoke with seven staff members and reviewed some recruitment files. No relatives provided feedback.
The home supported eight people with autism and learning disabilities. Inspectors found people were treated kindly, involved in decisions and supported with their health, food, communication and daily choices. Care plans had improved since the last inspection.
However, staffing levels varied and some people missed planned opportunities to go into the community. Medicines were not always managed safely. Management checks did not identify or resolve all problems, and records did not always show people's progress towards their goals.
The overall rating was Requires Improvement. Effective and Caring were rated Good. Safe, Responsive and Well-led were rated Requires Improvement. The previous overall rating was Good.
Kind and respectful support
Inspectors saw staff supporting people warmly and respectfully. People appeared comfortable with staff.
“We observed people being supported with kindness and respect.” from the report
Improved care plans
Support plans were personalised, easy for staff to follow and reflected people's needs and choices.
“At this inspection, we found improvements had been made and people's needs were reflected throughout their personalised support plans.” from the report
Choice and independence
People were involved in decisions, supported to use advocacy and encouraged to do things for themselves where possible.
“People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests.” from the report
Health and daily support
People were supported to choose meals and drinks, attend healthcare appointments and follow guidance from health and social care professionals.
“People were supported to attend appointments relating to their health needs.” from the report
Inconsistent staffing and community access
seriousStaffing numbers varied and some people missed planned opportunities to leave the home. Records showed one person received community access with one-to-one support only three times in December 2019 despite being funded for five hours each day.
“Records confirmed people were not receiving their funded one-to-one support time to access the community consistently.” from the report
Medicines checks
seriousMedicine storage temperatures were not consistently recorded. Some handwritten medicine entries lacked two staff signatures, some bottles were not dated correctly, and some as-required medicine instructions were missing.
“Some aspects of medicines management were not consistently safe.” from the report
Weak management oversight
seriousManagement checks did not identify all medicine problems or resolve known actions. There was also not enough oversight of how staff spent their time and whether people received community support.
“There were shortfalls in the managerial oversight of the service, including overseeing how staff planned their time.” from the report
Limited evidence of progress
needs fixingPeople had goals recorded, but records did not clearly show the progress they were making towards them.
“However, there was a lack of evidence about the progress they were making in working towards these.” from the report
Bedroom damp smell
minorOne bedroom had a strong damp odour caused by water on the carpet. Action was considered only after inspectors raised the concern.
“One person's bedroom had a strong odour, due to water on their carpet.” from the report
- 01How do you now make sure there are enough staff each day for every person's planned one-to-one community support?
- 02How often are medicine storage temperatures checked and reviewed, and who makes sure problems are acted on?
- 03What checks ensure handwritten medicine entries are completed and signed safely by two staff?
- 04How do you record and review each person's progress towards their goals?
- 05What action has been taken in response to the Regulation 17 breach?
This was an unannounced planned inspection covering all five key questions; the previous overall rating was Good, while Safe and Well-led had both deteriorated from Good and Responsive remained Requires Improvement. This explanation was written from the published report of 21 February 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, June 2017
The Old Rectory was rated Good overall, but inspectors found care records were not always up to date and rated Responsive Requires Improvement.
This was an unannounced inspection on 28 March 2017. One inspector spoke with the manager and staff, observed how people were supported, and reviewed records for three people. Seven people were living at the home.
The home was rated Good for Safe, Effective, Caring and Well-led. Inspectors found better staff deployment since the previous inspection, safe medicines systems, suitable support with food and healthcare, and kind care that respected people's communication and choices.
Responsive was rated Requires Improvement. Some care plans were duplicated, inconsistent or not updated when people's needs changed. Some best interest decisions also needed better review and recording. Not all mandatory staff training had been completed.
The overall rating of Good means the home met the expected standard in most areas at this inspection. It does not mean every part was without problems, particularly the quality and accuracy of care planning.
Improved staffing
Staff deployment had improved since the previous inspection. Inspectors found this gave people more opportunity for individual support and community activities.
“At this inspection we found better deployment of staff.” from the report
Safe medicines
Medicines were securely stored and records showed what had been given. People who could do so were supported to take their own medicines.
“The medicine management systems were safe.Where people were able the staff assisted people with the self-administration of their medicines.” from the report
Respectful care
Staff knew people's preferences and ways of communicating. Inspectors saw staff respond kindly and respect people's privacy, choices and rights.
“Members of staff were respectful and consulted people before they offered support.” from the report
Community activities
People were supported to take part in hobbies and activities and to visit places such as cafes and shops.
“We saw staff support people to leave the home and visit the local community throughout the inspection, for example, cafes and shops.” from the report
Management oversight
The home had systems for gathering views, checking care quality and tracking improvements. Accidents and incidents were analysed for lessons.
“Quality assurance arrangements in place ensured people's safety and well-being.” from the report
Care plans were not always current
needs fixingCare plans were sometimes duplicated or inconsistent, and were not always updated when people's needs changed. This could make it harder for staff to have one clear account of the support needed.
“Care plans were not always updated following reviews; they were duplicated and inconsistent with each other.” from the report
Best interest records needed review
needs fixingSome best interest decisions were not reviewed to check they were still accurate. Action plans did not always provide a clear record of what had been done, including DoLS applications.
“The registered manager had improved the information included within best interest action plans however the best interest decisions reached were not always reviewed to ensure the decisions remained accurate.” from the report
Some mandatory training incomplete
needs fixingThe training records showed that not all mandatory training had been completed. Safeguarding training had been completed by 77.8% of staff at the time of the inspection.
“Members of staff had not attended all mandatory training set by the provider and other specific training to ensure they had the skills needed to meet people's needs.” from the report
Some plans were not fully person-centred
needs fixingSome care plans described preferences but did not explain what the person could manage independently. One plan had also not been reviewed after certain behaviours stopped occurring.
“Some care plans were not fully person centred because their ability to manage aspect of their care was not included.” from the report
- 01How do you make sure care plans are updated promptly when a person's needs, behaviour or abilities change?
- 02How are duplicated or conflicting care plans identified and removed?
- 03What mandatory training is still outstanding, especially safeguarding training, and when will it be completed?
- 04How do you review best interest decisions and record DoLS applications and the actions taken?
- 05How are remaining staff vacancies affecting one-to-one support and community activities?
This was an unannounced inspection covering all five key questions, with detailed records reviewed for three people; seven people were living at the home. This explanation was written from the published report of 9 June 2017 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of The Old Rectory
3 rated inspections over 4 years: the service has held its Requires improvement rating throughout.
- February 2020Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- June 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Good
- April 2016Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- May 2014
Report published without a new overall rating.
- May 2013
Report published without a new overall rating.
- December 2012
Report published without a new overall rating.
- January 2012
Registered with the Care Quality Commission on 30 January 2012.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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