Date of Assessment: 3 to 15 December 2025. The Old Rectory is a care home service providing accommodation and personal care for adults learning disabilities and autistic people. This inspection was carried out in response to the rating of requires improvement at the last inspection. At this inspection we found the provider had made improvements and was no longer in breach of regulations. We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it. Right support – people were kept safe from risks of harm. The service now had enough staff providing consistent care and support to people, which enabled them to access their community. The service had effective systems to manage risks people experienced, including risks during periods of anxiety and distress. Staff received good training and support to help them do their job well. The service was accessible for people and adaptations had been made to ensure the building met people’s needs. Work to support people to identify their wishes for the future, including end of life care, and plan out support they needed had not been completed. The registered manager was aware work was needed in this area and was looking to source specialist input to help staff support people with this. Right care – people had support plans which reflected their individual needs. People were now supported to take their medicines safely, although further improvements were needed to the guidance about variable doses of medicines. The registered manager took immediate action to make these improvements during the inspection. Relatives told us staff provided care for people in a person-centred way. The provider worked with health and social care professionals to ensure people had access to the care they needed. Feedback from professional partners was positive about the way the service worked with them to meet people’s needs. Right culture – people and relatives knew who the management team were and told us they would be able to raise concerns if needed. Governance systems were now effective in identifying areas for improvement and ensuring these improvements were made. Staff said they could raise any concerns with the management team and were confident action would be taken as a result.
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The Old Rectory, a care home for eight people with learning disabilities and autism, was rated Requires Improvement overall following an unannounced inspection in December 2015, with a regulatory breach found under Regulation 18 for insufficient staffing levels. While caring, effective, and responsive practice were rated Good, significant concerns were identified around staff shortfalls, unsigned medication administration records, incomplete daily records, and inadequate audit oversight.
Concerns (5)
criticalStaffing levels: “Insufficient staff were deployed to meet people's needs. Staff said the service was often short staffed. The registered manager said there had been a 27 percent turnover of staff.”
moderateMedication management: “Staff had not signed the MAR charts for two people on a few occasions when medicines were administered.”
moderateRecord keeping: “There were no daily report entries on 11, 12 and 15 November 2015 for one person. Activity planners were not up to date, keyworker notes on two occasions stated that daily reports had entries missing.”
moderateGovernance: “Medicine management audits had not identified staff were not signing MAR charts following the administration of some medicines and that staff were not following the cleaning schedules.”
moderateConsent / capacity: “The next of kin giving consent did not have power of attorney. This meant best interest decisions to share information was not made within the principles of the MCA 2005.”
Strengths
· Staff demonstrated good understanding of safeguarding procedures and knew signs of abuse and actions required.
· Comprehensive induction programme for new staff including shadowing and essential training.
· Risks were assessed with clear action plans developed to minimise risk to people.
· Staff received regular one-to-one supervision meetings with line managers to discuss performance and concerns.
· Support plans were developed to meet all aspects of people's care and treatment needs, monitored monthly by keyworkers.
The Old Rectory, a care home for 8 people with autism and learning disabilities, deteriorated from Good to Requires Improvement overall, with breaches of Regulation 17 (Good Governance) identified due to inadequate managerial oversight of staffing, medicines audit failures, and people consistently missing funded community access. Strengths included caring, respectful staff interactions, good MCA/DoLS compliance, improved person-centred support plans, and effective health and safety risk management.
Concerns (7)
criticalGovernance: “Medicines audits did not identify all areas for improvement. Where shortfalls were found, action was not taken.”
criticalLeadership: “There were shortfalls in the managerial oversight of the service, including overseeing how staff planned their time.”
moderateMedication management: “Areas for improvement were found which had not been identified in the home's medicine audits. Hand-written entries were not always signed by two staff.”
moderateMedication management: “Protocols to guide staff about when to administer medicines given on an 'as required' (PRN) basis were not always in place.”
moderateStaffing levels: “Records showed the actual staffing numbers were between three or five on duty, which meant people could not always go out into the community.”
moderatePerson-centred care: “Records confirmed people were not receiving their funded one-to-one support time to access the community consistently.”
minorRecord keeping: “There was a lack of evidence about the progress they were making in working towards these [goals and intended outcomes].”
Strengths
· Staff recruited following safe recruitment processes including DBS checks and reference checks
· Risk assessments and support plans included comprehensive guidance for staff to keep people safe
· Accidents and incidents recorded, analysed and used for staff de-briefing and learning
· People supported by staff trained in equality and diversity; cultural identity needs respected
· Person-centred support plans improved since last inspection, reflecting individual needs and routines
Quality-Statement breakdown (23)
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyRequires improvement
safe: Preventing and controlling infectionGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and management; learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced diet
The Old Rectory achieved an overall Good rating at this March 2017 inspection, with improvements in staffing deployment, safe medicines management, and a caring, person-centred culture. The Requires Improvement rating for responsive care reflects duplicated, inconsistent, and insufficiently person-centred care plans, alongside gaps in mandatory staff training completion.
Concerns (6)
moderateCare planning: “Care plans were not always updated following reviews; they were duplicated and inconsistent with each other.”
moderateCare planning: “As people's needs increased care plans were not updated with supplementary information instead an additional care plan was introduced.”
moderateStaff training: “77.8 percent had attended safeguarding of vulnerable adults training... Members of staff had not attended all mandatory training set by the provider.”
minorPerson-centred care: “Some care plans were not fully person centred because their ability to manage aspect of their care was not included.”
minorConsent / capacity: “For one person the agreement was signed in 2014 and was not reviewed to ensure the person continued to have capacity to take this decision.”
minorRecord keeping: “Best interest decisions reached were not always reviewed to ensure the decisions remained accurate. Action plans did not provide an audit trail of the actions.”
Strengths
· Staffing deployment had improved since the last inspection, enabling more one-to-one time and community access for people.
· Medicine management systems were safe, with MAR charts consistently signed and PRN protocols clearly documented.
· Staff demonstrated good knowledge of safeguarding procedures, types of abuse, and reporting responsibilities.
· Risk assessments were in place and staff showed strong understanding of actions needed to minimise identified risks.
· Staff were knowledgeable about individual communication needs and preferences, treating people with respect and dignity.
Quality-Statement breakdown (16)
safe: Staffing levels and deploymentGood
safe: Medication managementGood
safe: SafeguardingGood
safe: Risk assessment and managementGood
effective: Staff training and inductionRequires improvement
effective: Supervision and one-to-one meetingsGood
effective: Mental Capacity Act and DoLSGood
effective: Nutrition and hydrationGood
caring: Respecting dignity and privacy
Good
caring: Person-centred support and relationshipsGood
responsive: Care planningGood
responsive: Activities and community engagementRequires improvement
responsive: Complaints handlingGood
well-led: Record keeping and monitoringRequires improvement
well-led: Audit and governance systemsRequires improvement
well-led: Staff recruitment and retentionRequires improvement
well-led: Gathering people's viewsGood
Good
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Adapting service, design, decoration to meet people's needsGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Supporting people to develop and maintain relationships to avoid social isolation; support to follow interests and activitiesRequires improvement
responsive: Planning personalised care to ensure people have choice and controlGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: How the provider understands and acts on the duty of candourGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: Engaging and involving people using the service, the public and staffGood
caring: Person-centred and respectful care
Good
caring: Knowledge of communication needs and preferencesGood
responsive: Care plan currency and consistencyRequires improvement