The inspection took place on 12 June 2018 and was unannounced.

Rectory House is a ‘care home’ for up to 15 people with a learning disability. People in care homes receive accommodation and 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. There were 14 people living at the service at the time of our inspection.

At the last inspection, on 9 June 2017, the service had an overall rating of ‘Good’. This inspection report is written in a shorter format because our overall rating of the service has not changed.

At this inspection we found the service remained ‘Good’.

A registered manager continued to be employed at the service. 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.

The service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities using the service can live as ordinary a life as any citizen.

There continued to be sufficient numbers of staff to meet people’s needs. Staff continued to be appropriately supervised and had the skills and knowledge they needed to support people with learning disabilities. New staff had been recruited safely and pre-employment checks had been carried out.

People continued to be protected from abuse. Staff had undertaken training in safeguarding and understood how to identify and report concerns. Medicines were managed safely and people received their medicines when they needed them. Risks were assessed and there were mitigations in place to minimise risk and keep people safe.

Peoples’ support met their needs. Support plans continued to accurately reflect people’s needs. People were supported to have choice and control of their lives and staff support them in the least restrictive way possible. Staff were aware of people’s decisions and respected their choices.

The service continued to support people to maintain their health and wellbeing. People had access to healthcare services when they needed it and were supported with nutrition and hydration. When people accessed other services such as going in to hospital they were supported by the service and there was continuity of care.

People were treated with respect, kindness and compassion. People were provided with emotional support and reassurance when they needed this. People were supported to maintain relationships with those who were important to them. People’s privacy was respected and they were supported to lead dignified lives.

People were supported to increase their independence and undertake activities of daily living. Where people had identified that they wanted to move to a more independent setting they were being supported to do so.

People were encouraged to express their views and were listened to. There were systems in place to seek feedback from people and their relatives to improve the service. Relatives told us that they were informed about the services’ plans and that communication was proactive.

The service was clean. The environment had been adapted to meet people’s individual needs. Staff were aware of infection control and the appropriate actions had been taken to protect people.

Staff, relatives and community health and social care professionals told us the service was well-led. The registered manager had a clear vision and values for the service which staff understood and acted in accordance with. The service was regularly audited to identify where improvements were needed and actions were taken.

Staff understood t

We carried out an unannounced comprehensive inspection of this service on 26 and 27 June 2016. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Rectory House on our website at www.cqc.org.uk”

Rectory House is a home that provides personal care and accommodation for up to 15 people with learning and physical disabilities. The home is currently used by male service users only.

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.

At our previous inspection on 26 and 27 April 2016, the provider was in breach of Regulation 17 of the Health and Social Care Act 2008 (regulated activities) Regulations 2014. We found that records were not complete, accurate or contemporaneous. At this inspection improvements had been made and the provider was no longer in breach of this regulation.

There were effective auditing systems in place to ensure that people’s records were kept up to date by staff. Audits were carried out in all aspects of the service to identify how the service could improve and action was taken as a result.

The registered manager was approachable and took an active role in the day to day running of the service. Staff were able to discuss concerns with the registered manager at any time and felt they would be addressed appropriately.

The registered manager had a good understanding of their responsibilities and was notifying the Care Quality Commission of any notifiable event.

People and staff were enabled to express their views on the running of the service. This included regular meetings, surveys and being involved with the interview process of new staff.

This inspection took place on 26 and 27 April 2016. Our inspection was unannounced.

Rectory House provides personal care and accommodation for up to 14 people who have physical disabilities and learning disabilities. All of the people living in the home were male. People had sensory impairments, epilepsy, limited mobility and difficulties communicating. Some people were on the autistic spectrum. One person was living with dementia. On the day of our inspection there were 14 people living at the home.

The home 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.

We received positive feedback from people, relatives and staff about all aspects of the service.

Records were not always complete, accurate or stored securely. People’s information was not always treated confidentially because personal records had not been stored securely.

Staff knew and understood how to safeguard people from abuse, they had attended training, and there were effective procedures in place to keep people safe from abuse and mistreatment.

Risks to people had been identified. Systems had been put in place to enable people to carry out activities safely with support.

The premises and gardens were well maintained and suitable for people’s needs. The home was clean, tidy and free from offensive odours. The home was not suitably decorated to meet everyone’s needs, we made a recommendation about this.

Medicines were appropriately managed to ensure that people received their medicines as prescribed. Records were clear and the administration and management of medicines was properly documented.

Staff and people received additional support and guidance from the behaviour support manager when there had been incidents of heightened anxiety. Staff received regular support and supervision from the management team.

There were suitable numbers of staff on shift to meet people’s needs. The provider followed safe recruitment procedures to ensure that staff working with people were suitable for their roles. Robust recruitment procedures were followed to make sure that only suitable staff were employed.

Procedures and guidance in relation to the Mental Capacity Act 2005 (MCA) was in place which included steps that staff should take to comply with legal requirements. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Where people were subject to a DoLS, the registered manager had made appropriate applications.

People had access to drinks and nutritious food that met their needs and they were given choice.

People received medical assistance from healthcare professionals when they needed it. Staff knew people well and recognised when people were not acting in their usual manner and took appropriate action.

Relatives told us that staff were kind, caring and communicated well with them. Interactions between people and staff were positive and caring. People responded well to staff and engaged with them in activities.

People and their relatives had been involved with planning their own care. Staff treated people with dignity and respect.

Relatives told us that they were able to visit their family members at any reasonable time, they were always made to feel welcome and there was always a nice atmosphere within the home.

People’s view and experiences were sought during meetings. Relatives were also encouraged to feedback by completing questionnaires.

People were encouraged to take part in activities that they enjoyed, this included activities in the home and in the local community. People were supported to be as independent as possible.

The complaints procedure was on d

The inspection team was made up of one inspector. Time was spent in the home looking at care records, talking to staff and people who lived in the service. We looked at people's plans of care, staffing records and quality assurance processes. We set out to answer our five questions;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, the staff supporting them and looking at records.

Is the service safe?

The service was safe because staff understood their roles and responsibilities in relation to infection control and hygiene.

People were protected from acquired infections because the home was kept clean and hygienic.

People and their belongings were safe because the service assessed and managed the risks associated with the environment.

Is the service effective?

The service was effective because people were involved in decisions about the environment they lived in.

People had access to appropriate space: to see and look after their visitors, participate in activities and to spend time alone if they wanted to.

There were quality assurance systems in place.

Is the service caring?

The service was caring because there were policies and procedures in place to ensure staff understood how to respect people’s privacy, dignity and human rights .

Is the service responsive?

The service was responsive because people who used the service knew how to share their experiences and felt comfortable doing so.

People, their relatives and friends were encouraged to provide feedback about the service.

Is the service well led?

The service was well led. Resources and support were available to the manager and the staff team to develop and improve the service.

The manager of the service been in post since the beginning of September 2014. They had been managing another home on the same site.

We undertook an inspection of this service to check compliance following our inspection of 14 June 2013.

We spoke with two people who lived in the home, one relative and three staff during our inspection. People told us "I do like living here, all the people are nice here"; "Some of my friends are here" and "It's alright".

The relative told us that "Staff are really good here, they are helpful and my brother is happy here".

Staff said that they had confidence in their manager and told us "It is quite a good place to work".

We toured the premises and saw that the dining room had been decorated and the spare bedroom and small hallway on the top floor were in the process of being decorated.

We found that the home had a schedule of cleaning, but we found that some areas had not been cleaned to an appropriate standard, which could place people at risk of infection.

We found that the premises were in a poor state of repair, even though we had highlighted issues surrounding the premises in several of our last inspection reports. The provider had reassessed priorities of work that had been on their action plan, which meant that some areas of work had not been completed. We had concerns about the health and safety of people, staff and visitors to the home.

Although regular audits had been carried out in the home, we found that actions had not been followed up to resolve the areas of concern.

We undertook an inspection of this service to check compliance with the warning notice issued following our inspection of 14 June 2013.

We found that a detailed programme of maintenance and repairs had been implemented since our previous visit.

Most of the people using the service had been taken on holiday while the works were carried out. We spoke with three people during our inspection. One person met us excitedly and said: “Come and see our lovely new house”.

We toured the premises and recorded that carpets had been renewed, the kitchen re-fitted and a range of remedial repairs and refurbishment had been completed.

Staff told us that the service had a “new feel” following the changes, and was a much nicer working environment.

We spoke with five people and five staff during our inspection. People told us:" I love it here" and "I like helping out and gardening". Staff said that they enjoyed working with the people living in the home.We found that care plans were personalised and contained a range of risk assessments designed to keep people safe but give them as much independence as possible.

People told us that they could speak to staff with any worries and staff had received training in protecting vulnerable adults.Staff were able to demonstrate to us a good understanding of how to recognise abuse. We checked recruitment records and saw evidence that staff had undergone all the necessary checks before being employed.

Peoples medicines had been stored, administered and recorded correctly by the home.

We found that the home had not been cleaned to an appropriate standard; which could place people at risk of infection.We recorded that the premises was still in a poor state of repair even though our last inspection report had highlighted this to the provider. An action plan to address the problems had not been completed and we had concerns about the health and safety of people, staff and visitors to the home.

Although regular audits had been carried out, the service had not always used the findings of these to improve the service.

People told us they liked their home and the rooms they had. Some people who use the service were unable to communicate and tell us what they thought of the quality of the care due to their communication difficulties. We were able to review pictorial quality reviews undertaken by the provider that identified that people were happy living in the home. We were able to observe staff supporting people in a respectful way. We noted that people were relaxed, dressed appropriately and able to move freely about the home.

People said that staff were kind and that if they had worries or concerns they could talk to them. People told us that they did a lot of activities which they really enjoyed, but sometimes there were not enough staff around and when this happens then it can be boring.

Some people told us that they were scared of other people living at the house, and sometimes they did not feel safe.