Inspection on 17/04/07 for The Old Hall Care Home

This inspection was carried out on 17th April 2007.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Old Hall Care Home 27/04/06

The Old Hall Care Home 18/01/06

The Old Hall Care Home 20/07/05

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME ADULTS 18-65 The Old Hall Chapel Road Fiskerton Lincoln Lincs LN3 4HT Lead Inspector Wendy Taylor Key Unannounced Inspection 17th April 2007 09:30 The Old Hall DS0000063061.V334621.R01.S.doc Version 5.2 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 DS0000063061.V334621.R01.S.doc Version 5.2 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 Adults 18-65. 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 DS0000063061.V334621.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old Hall Address Chapel Road Fiskerton Lincoln Lincs LN3 4HT 01522 595395 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) Home From Home Care Ltd ** Post Vacant *** Care Home 7 Category(ies) of Learning disability (7) registration, with number of places The Old Hall DS0000063061.V334621.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered to provide personal care for service users aged 18-65, of both sexes whose primary needs fall within the following category: Learning Disabilities (LD) - 7 places 7th July 2006 Date of last inspection Brief Description of the Service: The Old Hall is a former childrens home, which has been completely renovated and now has the facilities to accommodate up to 7 people from 18-65 with learning disabilities. The home is owned by Home from Home Care Limited. The home has been refurbished to a very high standard. All bedrooms are spacious, with en-suite facilities. Three of the rooms are suitable for accommodating people who use wheelchairs. The home is in the village of Fiskerton, which has limited facilities, but it is situated close to Lincoln with public transport links. The home also has its own people carrier. The gardens are enclosed, with a patio area, and there is car parking to the front of the house. The current fees for the home are £2050:00 per week. The Old Hall DS0000063061.V334621.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection took place during April 2007. This is the third visit to the home since the last key inspection, the first of which took place in July 2006, and the second took place in October 2006. These visits were carried out to follow up requirements made at previous visits. Outcomes from the visits will be referred to in this report. Five people were living at the home on the day of the visit, during which, three service users went out on a day trip, one service user was at work and one service user was at home. Three service users came home from their day trip towards the end of the visit. The care received by three service users was followed in detail, and their personal records, general house records and staff records were looked at. Staff and the acting manager were spoken to and the care being provided was observed. Information already held by the commission was also used as part of the inspection process. One service user said that they liked living at the home, and others were able to express this as well by using a ‘thumbs up’ sign. One service user also said that they liked the staff. What the service does well: What has improved since the last inspection? The Old Hall DS0000063061.V334621.R01.S.doc Version 5.2 Page 6 Since the last two visit to the home, care plans have got better, and they now say everything that a person needs support with. Paperwork that shows when people have had their medication is now better as staff write down the times that it is given. There are now lots more activities for people to join in, and everyone has a timetable of what they are doing. 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 summary of this inspection report can be made available in other formats on request. The Old Hall DS0000063061.V334621.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Old Hall DS0000063061.V334621.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Comprehensive assessment processes ensure that needs are clearly identified. There is generally enough information about the home to help people make a choice of where to live, but out of date information could mislead people. EVIDENCE: There is a statement of purpose and service user guide in place, and both documents are available in picture formats. The statement of purpose still contains details of a previous manager. There are clear policies in place for referrals and admission. The statement of purpose sets out the admission criteria. There are also individual protocols in place for helping new service users to settle into the home. Individual contracts are also in place, which set out the terms and conditions for living at the home. Admission and on-going assessments are in place for service users and they cover needs such as health, communication, expressing emotion, personal care and activities. There are also specialist assessments in place where required, that have been carried out by Speech and Language services and nutritional services. Although staff said that service users are involved in their assessment processes, there is no evidence that they have been. The Old Hall DS0000063061.V334621.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Comprehensive care plans reflect the needs of service users, and they are protected by clear risk assessment and behaviour management processes. They are able to make decisions and choices in their daily lives, and be as independent as they are able. EVIDENCE: Care plans are available for service users and cover needs identified in assessments. These needs include personal support, behaviour management, communication and social needs. The plans refer clearly to developing independence, likes and dislikes, and making choices and decisions. The plans are written in the ‘first person’ and the name of the staff member who has written the plan is recorded, but there is still no clear evidence that service users are involved in developing them. There are risk assessments in place for needs such as using cleaning materials, being in crowds, falls, cooking and using public transport. The Old Hall DS0000063061.V334621.R01.S.doc Version 5.2 Page 10 Behaviour management plans are in place together with protocols for the use of physical interventions. The physical intervention plans are kept separately from care plans and they are not all cross-referenced with the plans. Staff described new behavioural monitoring and management systems that they are currently being trained to use, and there is evidence that they have started to use some of the techniques. Reports of incidents involving physical interventions are made on daily recording sheets and staff said that they now record the duration of specific interventions rather than the duration of a whole incident. Records show that there has been no use of physical interventions for some time. Monthly progress reports are carried out as a review of care plans and there is evidence of annual placement reviews. There is evidence that service users are involved in the annual reviews but not in the monthly progress reports. There is information available to staff about how to implement person centred approaches to care. Staff were observed to be very supportive towards service users, and they treated them with respect. They encouraged service users to be involved in all aspects of the daily routines, such as making the evening meal, answering the front door and going to the shops. They confidently used appropriate forms of communication to enable service users to express their needs and wishes. The Old Hall DS0000063061.V334621.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users enjoy a wide range of activities, through structured but flexible timetables. They are able to choose what they want to do, and they are encouraged to lead a healthy lifestyle. EVIDENCE: On the day of the visit three service users were spending the day at a park, and one service user was at a work placement. Records show that service users are supported to use community resources such as the local pub, shops and church. Staff said that the service users are integrated into the local community and they are known by their first names. Records also show that service users are able to engage in activities such as aromatherapy, using local sports centres and swimming pools, and going to the cinema. They also have access to an on site sensory room and an arts and The Old Hall DS0000063061.V334621.R01.S.doc Version 5.2 Page 12 crafts room. Staff described how service users are supported to take part in gardening with an allocated support worker, and take part in recycling activity. A service user expressed their agreement with this information. There are structured individual activity plans in place, which are flexible depending on the needs and wishes of the service users. This was in evidence on the day of the visit with one service user staying at home, whilst others went out. Care plans are in place to help service users keep up relationships with friends and family, and staff described a support network that they are looking into that provides help with understanding and developing relationships. Information about healthy eating and lifestyles is available within the home. Records show that service users meet every week and they discuss what they want to eat for the next week, and what activities they want to take part in. Staff said that service users help to do the shopping for food, and again a service user indicated their agreement with this by using a ‘thumbs up’ sign. There is evidence in records and from talking with service users and staff, that service users help to grow fruit and vegetables in the garden. There are raised growing beds so that every one can join in, and there is a green house. Service users were helping to prepare the evening meal during the visit, and risk assessments are in place for safety in food preparation. The Old Hall DS0000063061.V334621.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have access to a range of local healthcare services; and their personal healthcare needs are responded to in an individual manner by a knowledgeable staff team. EVIDENCE: Care plans are in place for health care needs such as epilepsy, nutrition and eye care. Health action plans have been completed for each service user, which records how they want their support to be given. There are records of the support provided by specialist health care professionals such as consultant psychiatrists, dentists and opticians; as well as records for GP visits. Records show that staff have received training in subjects such as epilepsy, medication administration and autism. There is evidence in records that service users have their medication reviewed regularly; and where indicated, their weight and dietary intake is also monitored regularly. Staff were observed to provide sensitive support and reassurance to a service user following a seizure, and demonstrated an in The Old Hall DS0000063061.V334621.R01.S.doc Version 5.2 Page 14 depth knowledge of the service user’s needs and wishes. They also made sure that the person’s privacy and dignity was maintained throughout the support. Medication records are completed in full, and there are guidelines in place for the use of ‘as required’ medication. The times when ‘as required’ medication is given, and the reasons for the administration is also now recorded. Records show that a monthly audit of medication procedures and records is carried out. Staff were observed to give clear and supportive guidance to service users during administration of medications; and administration procedures were in line with policies. Staff used good infection control procedures, including hand washing, during administration of medications. The Old Hall DS0000063061.V334621.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Comprehensive policies and procedures, and a knowledgeable staff team protect Service users. EVIDENCE: Policies and procedures are in place for safeguarding adults, making complaints and whistle blowing. There are also up to date local authority guidelines for safeguarding adults. The complaints procedure is available in an alternative communication format, so that service users can access the information. A service user indicated with sign language that they knew how to tell staff if they were unhappy with anything. The acting manager said that no one is using advocacy services at present, but there is information about these services contained in the service user guide. Staff demonstrated a very clear and detailed knowledge of safeguarding adult issues and procedures; and they were aware of risk assessments being in place to support service users in vulnerable situations, such as using public transport and using sharp implements. Records show that staff have received training in safeguarding adult issues and they confirmed this during discussion with them. There are no records of any complaints or safeguarding adult referrals being made since the last inspection visit to the home. The Old Hall DS0000063061.V334621.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 28, 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users enjoy a very high standard of comfortable, homely and safe surroundings, which meets their individual needs and wishes. EVIDENCE: On the day of the inspection the environment was very clean and tidy, and service users indicated with sign language that they help with housework. The gardens and patio area were also maintained to a high standard. Again the service users indicated that they help in the garden, including growing vegetables and fruit. All service users are able to engage in gardening if they wish, as there are raised beds with good access. Staff described household tasks that particular service users like to do such as cleaning the house vehicle and cleaning the arts and crafts room. The acting manager said that the washing machine is not working at present but there is evidence that it is being fixed on the day after the inspection visit. He also described the arrangements that have been in place to meet the laundry needs. The Old Hall DS0000063061.V334621.R01.S.doc Version 5.2 Page 17 Maintenance records are up to date, and the décor, furniture and equipment are in a good state of repair. Records show that the acting manager carries out a weekly audit of the building and outside spaces to ensure that any shortfalls are quickly addressed. The environment is homely and comfortable and there is ample space in communal areas for all service users; separate sensory and arts and crafts rooms complement the communal space. Bedrooms are very well personalised and the furnishings meet individual needs; and a service user said that they had chosen the colours in their bedroom. All bedrooms have en suit bathrooms. Environmental risk assessments are in place for issues such as use of electrical equipment, food preparation, use of cleaning materials and outdoor activities. There is information available about substances that are hazardous to health, and all of those substances were stored safely on the day of the visit. The Old Hall DS0000063061.V334621.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users receive high levels of support from a well-trained staff team; however they may be at risk if recruitment procedures are not followed consistently. EVIDENCE: Recruitment records are in place and generally contain application forms, criminal record bureau checks and two references. However one file did not contain an application form or references, and another did not contain an application form. Other records show that staff undertake an induction process based on a nationally recognised system, and they receive training in subjects such as record keeping, basic food hygiene, health and safety, fire safety, first aid and moving and handling. Records also show that they have received training in more specialised subjects such a behavioural management, epilepsy and nutrition. Staff said that they have good access to relevant training, including nationally recognised care qualifications at various levels. They also The Old Hall DS0000063061.V334621.R01.S.doc Version 5.2 Page 19 described an advanced training course relating to behavioural assessment and management that some staff are currently undertaking. Staff said that they receive regular supervision, and supervisors are trained to fulfil their role. Records confirmed this and show that they also receive annual appraisal sessions. Staff said that they find supervision useful and can plan their future training during the sessions. Rotas show that service users have an individual worker to support them throughout the day. Staff also described how extra hours are provided for one service user during the week, so that they have two support workers to help them fulfil their needs and wishes. There is also evidence in rotas that service users are able to spend at least one day a month with their key workers, doing whatever activities they wish to. Staff said that they enjoy working at the home, routines are flexible based on what service users want, and there is good communication and support within the team. The Old Hall DS0000063061.V334621.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is generally well managed, and service users are involved in the development of the home. Their health, safety and welfare needs are protected by clear policies and procedures, and detailed record keeping. EVIDENCE: Staff said that they get good support from the acting manager, who listens to them and helps them to develop their skills. They said that they, and the service users, are encouraged to air their views and be involved in the development of the home. Minutes of regular service user and staff meetings are available to demonstrate this, and they also show that service users can join staff meetings if they wish to. The acting manager said that he intends to The Old Hall DS0000063061.V334621.R01.S.doc Version 5.2 Page 21 submit his application for registration with the commission within the next week. There is now a deputy manager in post. Regular fire safety checks are documented, including fire alarm tests and emergency lighting tests. There is also an up to date fire risk assessment, and the evacuation procedure is available in picture format so that all service users can access the information. Daily notes regarding the support provided for service users are detailed and clear; they refer to care plans and cross-reference with incident reports. These notes were used to provide a detailed handover to the next shift of staff. Service users were encouraged to be involved in writing their daily notes and signing them. Records show that service users and staff are involved in satisfaction surveys. Outcomes from the most recent surveys indicate that service users all like living at the home, they think that staff are all very nice and they have lots of activities to do. There are regular weekly service reviews, which include checks for of care plan completion, medication records completion, staff files, environment maintenance and vehicle safety. Policies are in place for areas such as infection control, fire safety, emergencies and crises, record keeping, equal opportunities, general health and safety and service users finances. Service users have individual storage arrangements for their money, and individual records are kept for income and expenditure. Records matched money kept in the home on the day of the visit. One service user prefers to keep their money in their bedroom and safe arrangements have been made for this. Staff maintain good infection control practices such as hand washing and wearing gloves where appropriate, and there is easy read information around the home about good infection control practices The Old Hall DS0000063061.V334621.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 2 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 4 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 3 X 3 X The Old Hall DS0000063061.V334621.R01.S.doc Version 5.2 Page 23 Yes Are there any outstanding requirements from the last inspection? 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 YA34 Regulation 19, Schedule 2 (3)(6) Requirement All recruitment records must contain two written references, a full employment history, and a statement by the person as to his mental and physical state Timescale for action 18/06/07 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. Refer to Standard YA1 YA2 YA6 Good Practice Recommendations It is recommended that the statement of purpose be updated to include the details of the new acting manager. It is recommended that the involvement of service users in their assessment process be recorded. It is recommended that the involvement of service users in developing and reviewing their care plan be recorded. The Old Hall DS0000063061.V334621.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Lincoln Area Office Unity House The Point Weaver Road, off Whisby Road Lincoln LN6 3QN National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 DS0000063061.V334621.R01.S.doc Version 5.2 Page 25 - 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. 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