Inspection on 21/08/06 for The Old Hall

This inspection was carried out on 21st August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Old Hall 28/05/08

The Old Hall 11/07/07

The Old Hall 02/02/06

The Old Hall 17/08/05

The Old Hall 20/01/05

The Old Hall 09/09/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Old Hall The Old Hall Malpas Nr Chester Cheshire SY14 8NE Lead Inspector Maureen Brown Key Unannounced Inspection 09:45 21st August 2006 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Old Hall DS0000054820.V291568.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Old Hall DS0000054820.V291568.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Old Hall Address The Old Hall Malpas Nr Chester Cheshire SY14 8NE 01948 860414 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Mary Kathleen Friend Mr Thomas Friend Mrs Mary Kathleen Friend Care Home 18 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (18) of places The Old Hall DS0000054820.V291568.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 18 service users to include:* Up to 18 service users in the category of OP (Old age, not falling within any other category) * No more than 3 agreed named service users in the category of DE(E) (Dementia aged over 65 years) 2nd February 2006 Date of last inspection Brief Description of the Service: The Old Hall is a care home providing care and accommodation for up to 18 older people. It is a privately owned family run business. The home is in a rural setting in the Cheshire village of Malpas, situated close to a small range of local shops and other village facilities and amenities. The Old Hall is a two-storey adapted building and residents are accommodated on both floors. Access between floors is via a stair lift or the stairs. Residents’ accommodation consists of ten single and four double bedrooms, all but one have en-suite toilet and bathroom facilities. There are separate lounge and dining areas and a conservatory that overlooks the garden. The Old Hall has gardens to the rear with steps leading down to the lower levels. Handrails are provided and the top level is fully accessible to service users. Car park spaces are available to the front of the property. The fees at The Old Hall are between £348.00 and £470.00 per week. Optional extras include hairdressing, chiropody and newspapers. The Old Hall DS0000054820.V291568.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit was carried out on 21st August 2006. The total time on site was seven and a half hours. The inspector spent an hour and half planning the site visit by reviewing previous inspection reports and the service history. The inspection included a tour of the home, inspection of records and discussions with residents, the owner/manager, care assistants and the cook. Twenty-three out of thirty-eight standards were assessed and most were met. At the time of the site visit fourteen residents were living at The Old Hall. Comment cards were received from nine service users, twelve relatives, eight GPs and other visiting professionals. Feedback was given to the owner/manager at the end of the site visit. What the service does well: What has improved since the last inspection? The Old Hall DS0000054820.V291568.R01.S.doc Version 5.1 Page 6 The room number has been included on the contract agreement for residents, so that any room changes are noted. This enables people to track the movement of a specific person within the home. The pharmacist had updated the sheets on the back of the monitored dosage system boxes. This ensures that accurate information is available for the staff when administering medication. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Old Hall DS0000054820.V291568.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Old Hall DS0000054820.V291568.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3. Standard 6 is not applicable. Quality in this area outcome is good. This judgement was made using available evidence including a visit to this service. Sufficient information is provided for residents to make a decision about moving into the home. Full assessments of needs are carried out. EVIDENCE: The statement of purpose was presented in a bound folder and included all the information necessary to make an informed choice about the home. This included aims and objectives, information about the home’s manager and owners, admission process, financial arrangements and fee, fire safety and complaints. A copy of the most recent inspection report was available. Residents and relatives confirmed that they had a copy of this document. Copies were available in the hallway and in each resident’s bedroom. The service users guide is also produced in a bound format and was produced in an A to Z format, which was easy to use, understand and read. It is recommended that both the statement of purpose and service users guide are reviewed annually with confirmation of this kept with copy. The Old Hall DS0000054820.V291568.R01.S.doc Version 5.1 Page 9 A sample of four care plans examined showed that assessments had been carried out with each person before moving into the home. Residents confirmed that they or their relatives had visited the home prior to admission and the manager said that admissions were planned. One resident commented “I would very much recommend this home” and another commented “prior to admission I visited the home and met some of the staff”. The Old Hall DS0000054820.V291568.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this area outcome is good. This judgement was made using available evidence including a visit to this service. The residents’ health, personal and social care needs are met by the staff team who enable them to maintain their privacy and dignity. EVIDENCE: Out of fourteen residents three care records were seen during this site visit. These were comprehensive and well presented in individual folders. Each contained basic information covering all areas of personal care, risk assessments, visiting professionals sheet and a copy of the daily report sheets. The care plans seen were drawn up in consultation with the residents and family and were based on their assessed needs and risks. The care plans were reviewed on a monthly basis, in conjunction with the residents. The residents or their relatives had signed the care plans to show that they agreed with the contents. It was noted that clients who were funded by the local authority had up to date annual reviews. However, privately funded clients did not have an annual review. It was recommended that a formal review be held annually for all service users. The Old Hall DS0000054820.V291568.R01.S.doc Version 5.1 Page 11 Daily record sheets seen showed day-to-day activities of each resident. They were written clearly, easy to follow and were signed by carers. Information regarding bathing and weights were recorded within the care plan. Medication records examined showed that this was recorded and administered appropriately. Medication was kept secure and appropriate storage for controlled drugs was available if required. No controlled drugs were stored on the premises at this time. The home used a monitored dosage system, which described the medication within the system by use of a sheet on the rear of the box. From a previous recommendation, these had now been brought up to date. The home had a medication policy and also had the Royal Pharmaceutical Society’s guide to control and administration of medicines for care homes and children’s services and also other books in relation to medication administration, which the manager said was used for reference purposes. During the lunch time the medication administration was seen. This was undertaken in an appropriate manner, changing the method of administration to suit the needs of each individual person, for example, giving soluble medication by a spoon to a person who has difficulty in swallowing. During discussions with the residents they commented, “The care was very good” and “it’s a very nice place” also “I am very contented and happy here”. Other comments included “The food is good” and a resident said their “privacy and dignity was respected by the staff”. Relatives spoken to said they were “very happy with the care and support given to their relative” and “the staff were good to the residents and to visitors”. The Old Hall DS0000054820.V291568.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this area outcome is good. This judgement was made using available evidence including a visit to this service. Residents’ were able to take part in a range of activities of their choosing. Personal and family relationships were encouraged by the home and the staff team supported people with this. EVIDENCE: A range of activities were undertaken which included playing cards, scrabble, manicures, painting, armchair exercises, reading and ball games. Staff chat and go for walks with residents and assist residents with choosing library books. Activity sessions are daily from 11.30 to 12.15 and 3.30 to 4.30. Outings include drives out in the countryside, afternoon tea in a local hotel, visits to the ice cream farm, garden centre, pantomime and Christmas lights. Staff shop for residents on a Monday and Friday each week and purchase items on their behalf from local shops. The manager and staff encourage visits from family and friends. Residents shared with the inspector the contact they had with family members and said they could choose to see visitors within their own room or in the shared lounge/dining area. Relatives said that they were always made very welcome by the staff and were offered refreshments. They said that they could visit their family in the privacy of their own bedroom, in one of the lounges or sit in The Old Hall DS0000054820.V291568.R01.S.doc Version 5.1 Page 13 the courtyard. Many of the residents had their own private phones, which helped them to keep in touch with family and friends. The menu was seen and these reflected people’s personal choices. Special diets were catered for such as diabetic, vegetarian and “soft” diets. The main meal of the day was observed being served and the food was hot, appetising and well presented. An alternative was always available. During the meal staff were assisting residents as necessary in a friendly and in obtrusive manner. After the meal residents said that “The meal was lovely”. One resident commented “I usually like the meals at the home” and another stated, “I would like more fresh vegetables on a daily basis”. The kitchen was clean and tidy and fridge, freezer and hot food temperatures were recorded. It was noted that one of the fridges were showing a consistently high temperature record. A recommendation was made to repair or replace this. The Old Hall DS0000054820.V291568.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this area outcome is adequate. This judgement was made using available evidence including a visit to this service. Policies are in place to ensure that residents are protected from abuse, neglect and self-harm, however none of the staff were trained in the Protection of Vulnerable Adults. EVIDENCE: The policy on complaints was seen and no complaints had been received at the home or by the Commission since the previous site visit. All relevant paperwork was available in the event of a complaint being received. Residents and relatives confirmed that they were aware of the complaints procedure and to whom they would direct their complaint. Residents and relatives were confident that any complaint would be dealt with swiftly. Residents also confirmed that they had received a copy of the complaints procedure and a copy was available in the statement of purpose and service users guide. The home had signed up to the Cheshire County Councils’ policy and procedure in line with the “No Secrets” guidance from the Department of Health. A copy of Cheshire’s Social Services policy on Adult Protection was available within the home and was accessible to staff. The manager or staff had not attended training on POVA. Staff must receive POVA training so that vulnerable service users are protected from abuse. During discussions with the staff team they were able to describe what the term abuse meant and if they had any suspicions they would contact the acting manager. However they were not The Old Hall DS0000054820.V291568.R01.S.doc Version 5.1 Page 15 fully able to describe the indicators of abuse or had knowledge of the POVA policy or “No Secrets” guidance. The Old Hall DS0000054820.V291568.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this area outcome is good. This judgement was made using available evidence including a visit to this service. The home provides a clean and comfortable environment for the people to live in. EVIDENCE: The Old Hall is furnished in a domestic style with additional equipment such as grab rails, raised toilet seats and hoists provided as necessary to meet the residents’ needs. The standard of décor was good. The heating and lighting was sufficient throughout the home. One bedroom had been redecorated. The garden was presented in a formal manner in a tiered style. Access to this area was through the lounge and patio furniture was available. Residents and relatives said they enjoyed using the garden in the good weather. New gates had been provided to the front and side of the building and garden. The home was clean, tidy and free from any unpleasant smells. Residents confirmed, “the home is usually fresh and clean” and “the home is lovely”. The Old Hall DS0000054820.V291568.R01.S.doc Version 5.1 Page 17 The manager had recently completed a Control of Substances Hazardous to Health file. This contained information on hazardous materials and assessments on particular products used at the home. This information was comprehensive, easy to read and understand and was available to the staff team. The Old Hall DS0000054820.V291568.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this area outcome is good. This judgement was made using available evidence including a visit to this service. Some staff need to complete mandatory training as required. Service users are protected by the homes recruitment policy and practices. EVIDENCE: Agreed staffing levels were being maintained and the duty rota showed two waking night staff were on duty, one of which acts in a senior capacity. Senior care assistants support the manager and ancillary staff support the care team. The manager stated that the rota was completed a week or two in advance. The manager said that eight staff members had obtained NVQ level II in care. Although significant improvement in staff qualified with NVQ II had been made the manager is aware she is still slightly below the expected level of 50 of staff trained to NVQ level II in Care. The manager continues to work towards this and a recommendation was made accordingly. All new staff completes a two day induction course which includes manual handling and fire safety awareness. The new staff member would work alongside a member of staff for a week to get to know the residents and the home’s procedures. An induction checklist would be completed. The Old Hall DS0000054820.V291568.R01.S.doc Version 5.1 Page 19 A significant improvement had been made with regard to core training since the previous site visit. Most staff had undertaken moving and handling, fire safety awareness and first aid training. Other courses that had been completed by some staff included food hygiene, oral health, continence promotion and dementia awareness training. A recommendation for this training to continue was made. The homes recruitment procedure ensures that the staff are suitable to work with vulnerable people. Two staff files showed that all pre-employment checks were carried out. Amongst the documentation available were application forms, Criminal Record Bureau checks, two references and health declarations. Comments from residents and relatives included “the manager and staff are always kind and helpful”, “what is particularly good is the standard of the care staff. They are extremely caring and show a lot of personal kindness and affection to the residents” and “the staff are very caring and helpful”. Staff meetings are held every three months. Minutes are kept and the issues that were discussed at the last meeting included home expenditure, quality assurance policy, energy conservation, staffing levels and care plan reviews. The last meeting was held on 25th May 2006. Staff stated that the “manager gave good support”, “relationships between staff and service users were good”, “nice family setting here” and “it’s a good home to work for”. During the site visit the staff handover was witnessed and during this session staff discussed each of the service users, visitors who were in the home and how the day had progressed in general. The Old Hall DS0000054820.V291568.R01.S.doc Version 5.1 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this area outcome is good. This judgement was made using available evidence including a visit to this service. The health, safety and welfare of the service users are protected. The views of service users are obtained to influence the running of the home. Staff are fully supervised. EVIDENCE: The manager is in the process of completing her Registered Managers Award. She anticipates it will be completed within twelve months. The manager is a co-owner of the home with her husband. She is a Registered General Nurse. Residents and relatives said that they felt the home was well run and that the manager and staff were very welcoming and friendly. This was confirmed during the site visit. Relatives said that the staff worked in a very professional manner. The Old Hall DS0000054820.V291568.R01.S.doc Version 5.1 Page 21 Residents’ surveys are conducted on an annual basis and information gathered is used to influence the future service provided. Copies of these were available. On discussion with residents and relatives they confirmed they had recently completed a questionnaire. The manager said that one to one staff supervision was given on a regular basis. Records seen were up to date and staff spoken to confirmed that supervision was given regularly. Observed day-to-day supervision of staff was good and the staff team confirmed they were supported by the manager and the senior staff in their delivery of care to residents. All records, policies and procedures seen were up to date and accurate. These were kept secure within the home. Residents confirmed that they had access to information kept about them. During discussions with the residents they said that the manager was easy to approach and that they saw her regularly. Residents said that they “liked living in the home”, they “liked their bedroom” also that “the home was run well”. The homes policy on race, sex, age and disability was seen and primarily related to recruitment and selection of staff. Although there were no specific policies on equal opportunities it was noted through observations that service users had choices on rising and retiring, for example, when the inspector arrived at the home at 9.45 many of the service users were still in their rooms either having a lie in or their breakfast in their rooms. Also service users were able to decide on types of meals taken, joining in activities or not, where to sit and going to their own bedroom. The Old Hall DS0000054820.V291568.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 The Old Hall DS0000054820.V291568.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP18 Regulation 13 Requirement The registered person must ensure that all staff have training in protection of vulnerable adults. Timescale of 31/03/06 had not been met. Timescale for action 30/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard OP1 OP7 OP15 OP28 OP28 Good Practice Recommendations The registered person should review the statement of purpose and service users guide annually with confirmation of this kept with copy. The registered person should undertake a formal review annually for all service users. The registered person should repair or replace one of the fridges, which showed a consistently high temperature record. The registered person should ensure that 50 of the staff team obtain NVQ level II in care by 2008. The registered person should ensure that all staff undertake mandatory training. DS0000054820.V291568.R01.S.doc Version 5.1 Page 24 The Old Hall 6. 7. 8. OP33 OP36 OP36 The registered person should ensure that resident meetings are undertaken. The registered person should ensure that supervision for care staff is brought up to date and maintained. The registered person should ensure that all other staff receive appropriate supervision. The Old Hall DS0000054820.V291568.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Old Hall DS0000054820.V291568.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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