About the service: The Old Rectory is registered to provide accommodation with personal care for up to 23 older people, who may be living with dementia. There were 18 people living at the home at the time of our visit, one person was in hospital. Care is provided across two floors and communal areas were located on the ground floor. Not all bedrooms were ensuite.

People’s experience of using this service:

People told us that they were happy living at The Old Rectory and were supported by staff who were kind, caring and supportive. Staff understood people’s concerns and were quick to offer reassurance which helped reduce people’s anxiety.

Risk assessments managed risks within people’s lives and staff knew how to keep people safe from those risks.

People’s dietary needs, preferences and nutritional needs were assessed and known by staff and when needed, people were referred to other professionals to support their healthcare needs.

People received their medicines safely from trained and competent staff.

There were sufficient numbers of care staff on duty to keep people safe, with staff continually present in the main communal lounge to ensure people had support available to them when needed. The registered manager and deputy manager could support staff on the floor if emergencies happened.

Staff had training in relevant subjects and they knew their roles and responsibilities, such as safeguarding people from poor practice.

People continued 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.

Staff knew people well and supported people in line with their care plan. Care plan records were reviewed but in some cases, needed ‘the small’ but more personalised information for staff to provide the person-centred care, staff told us about.

People pursued opportunities to engage in activities and interests that kept them stimulated and involved in what they enjoyed. Plans to improve outdoor garden space would further enhance opportunities.

Since the last inspection visit, the registered manager had changed and had managed this service for 18 months. The registered manager had implemented and improved a number of quality assurance systems and checks that gave them confidence, people received a good service.

People, relatives and staff said the registered manager and deputy manager were visible and approachable. Staff said changes particularly over the last 12 months were for the better. Staff felt they worked better as a team which helped ensure people received good and consistent care.

The registered manager had further plans to improve upon the changes already made. The registered manager was working with other organisations and healthcare professionals to improve outcomes for people.

We found the service met the characteristics of a “Good” rating in five areas. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Good. (The last report for The Old Rectory was published on 7 September 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection. The previous ‘good’ service provided to people continued. The overall rating continues to be Good.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

We inspected this service on 11 and 12 August 2016. The inspection was unannounced.

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.

The service provides accommodation and personal care for up to 23 older people who may live with dementia. Twenty people were living at the home on the day of our inspection.

People were safe from the risks of harm, because staff understood their responsibilities to protect people from harm and were encouraged and supported to raise concerns under the provider’s safeguarding and whistleblowing policies. The registered manager assessed risks to people’s health and welfare and wrote care plans that minimised the identified risks.

There were enough staff on duty to meet people’s care and support needs. The registered manager checked staff’s suitability to deliver care and support during the recruitment process. The premises were regularly checked to ensure risks to people’s safety were minimised. People’s medicines were managed, stored and administered safely.

People’s needs were met effectively because staff had the necessary skills and experience and received appropriate training and support. Staff understood people’s needs and abilities because they worked with experienced staff until they knew people well. Staff were encouraged to reflect on their practice and to develop their skills and knowledge, which improved people’s experience of care.

The registered manager understood their responsibility to comply with the requirements of the Deprivation of Liberty Safeguards (DoLS). They had applied to the Supervisory Body for the authority for to restrict people’s rights, choices or liberty in their best interests.

People were offered meals that were suitable for their individual dietary needs and met their preferences. They were supported to eat and drink according to their needs. Staff ensured people obtained advice and support from other health professionals to maintain and improve their health.

People were cared for by kind and compassionate staff who knew their individual preferences for care and their likes and dislikes.

People and their representatives were involved in planning and agreeing how they were cared for and supported. Care was planned to meet people’s individual needs and abilities and care plans were regularly reviewed and updated when people’s needs changed.

The provider’s quality monitoring system included consulting with people and their relatives to ensure planned improvements were focussed on people’s experience.

Quality audits included reviews of people’s care plans and checks on medicines management and staff’s practice. Accidents, incidents, falls and complaints were investigated and actions taken to minimise the risks of a re-occurrence. Staff were guided and supported in their practice by a registered manager they liked and respected.

This inspection was a scheduled inspection. During this visit we also followed up on concerns we identified at the last inspection of this service in December 2013

This inspection was completed by one inspector. During our visit we spoke with four people who lived in the home and four visitors. We also spoke with the manager, the cook and the care staff on duty. The evidence we collected helped us to answer five key questions; is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and staff told us.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

Staff had received training in the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). The manager understood their responsibilities under this legislation and told us they had sought advice and guidance from the appropriate body as necessary.

Routine maintenance checks and tests were carried out at the recommended intervals to ensure the building and environment remained safe for people.

Is the service effective?

People had personal care plans in place which identified their needs. Consent to care had been sought from individuals, their relatives or official representatives to ensure the care to be provided was appropriate to people's needs. People's care was regularly reviewed to ensure it was still current and appropriate. Staff were aware of people's care and support needs.

Is the service caring?

Staff were observed to be kind and caring to people. Staff responded to people's requests for support quickly and discreetly.

People told us the staff were nice. One person said, "The staff are lovely, very kind."

We saw staff carried out care and support at the preferred pace of the person concerned. They explained what they were intending to do and waited until the person was ready for them to start.

Is the service responsive.

We saw staff were quick to respond to people's requests for help or support. For example, if people sought a member of staff's attention because they required personal support, we saw that staff responded immediately to their request.

We saw that when people requested a drink during the morning or an alternative meal at lunchtime staff responded quickly and positively.

People were supported to maintain their health with routine appointments to appropriate healthcare professionals.

There was a lack of scheduled activities for people to participate in on a daily basis which we have highlighted for the provider's attention in this report.

Is the service well led?

The manager had a process in place to seek the views of people's relatives or representatives about the quality of the service provided. These views were used to make improvements to the service people received.

People's care was reviewed on a regular basis to ensure that it was appropriate to their needs.

The health, safety and welfare of people was maintained as routine maintenance checks and tests were carried out at the specified intervals.

When we visited The Old Rectory Care Home we found that 19 people used the service. Due to their health conditions or complex needs, not all people were able to share their views about the care that they received. We observed their experiences to support our inspection.

We met and spoke with five people who used the service, the registered manager, three care staff and spoke with a GP on the telephone during our visit. We looked at four care records and four staff files.

We found that the provider did not have systems in place to gain the consent to care and treatment of people who used the service. We found that people did not have choice about daily activities.

We found that staff had an understanding of the needs of people who used the service. We found that care and treatment was planned and delivered in a safe way, which met people's individual care needs. One person told us, "The manager is very kind and the care is adequate."

We found that the provider worked well with other services to ensure the health and wellbeing of the people who used the service.

We found the provider had appropriate arrangements in place to manage medicines.

We found that there was an effective recruitment process in place to ensure that staff had the skills to meet people's needs.

We spoke with seven people who use the service. They told us that they felt safe living at the home and had no concerns about how staff treated them. One person told us, “I’ve made some good friends since I moved here.”

People told us that the staff were caring and made sure they were looked after. One person said, “The girls are marvellous; you can have a laugh and a joke with them.”

We also spoke with five visiting relatives and a health professional. They were positive about the home and the care people received. One visiting relative told us, “The home came highly recommended by several people. It was head and shoulders above other homes we visited.”

We looked at the care records for three people to check how well their needs were assessed and planned for. We saw everyone had an assessment of their care, which included information about their needs.

We observed that staff were courteous and treated people with respect. The staff supporting people knew what support they needed and they respected their wishes. The support that we saw being given to people matched what their care plan said they needed.

There was an ongoing training programme provided for all staff. We spoke to three members of care staff. They were all positive about working at the home. One staff member told us, “It’s hard work, but I enjoy coming to work.”

We carried out this review to check on the care and welfare of people using this service.

On the day of our visit, we spoke with three people living in the home, one visiting family member, the manager and care staff.

We used a range of methods to gather evidence about how well the service met the needs of people living there. Some people living in the home were very frail and found it difficult to verbally communicate. We spent time sitting with people in the lounge watching to see how people were supported by staff. We found that staff treated people with kindness; they knew people as individuals and understood their personal needs and ways of communicating those needs.

We asked people about the care and support provided to them and looked at the care planning documentation to see what guidance was given to staff, to ensure that people received their care as they required to meet their needs. We looked to see if systems were in place to offer this in a safe way. Care plans seen gave a good level of information; were regularly reviewed to ensure they were up to date and assessed risk areas

People spoken with told us that the care provided was “good. “ One person told us, “I get on with all the staff.”

We asked people about the quality of the food. People said that the food provided was very good. We saw that people had home cooked food that was balanced to be nutritious and that people with special dietary needs had these catered for.

A visiting family member told us that the staff always make them welcome. They told us their relative's needs are fully met and that they always look well cared for. They stated they have no concerns about the home.

People told us they felt safe and able to report any concerns they may have. One person told us, “I would let the manager know if I wasn’t happy about anything.”

When we looked around the home we saw people's rooms were clean and suitably furnished. People had been able to personalise their rooms and bring in small items of their own furniture if they wished. One person told us, “I am very comfortable here.”