Inspection on 18/01/06 for The Old Hall Care Home

This inspection was carried out on 18th January 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Old Hall Care Home 17/04/07

The Old Hall Care Home 27/04/06

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 Mick Walklin Unannounced Inspection 18th January 2006 10:30 The Old Hall DS0000063061.V278286.R01.S.doc Version 5.1 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.V278286.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 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.V278286.R01.S.doc Version 5.1 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 Mrs Andrea Beaumont Care Home 7 Category(ies) of Learning disability (7) registration, with number of places The Old Hall DS0000063061.V278286.R01.S.doc Version 5.1 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 20th July 2005 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 one of two 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 wheelchair users. 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 Old Hall DS0000063061.V278286.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over a period of 6 hours. The main method of inspection used was called case tracking which involved tracking the care three residents receive, through the checking of their records, discussion with the care staff and observation of care practices and interactions. A tour of the premises was conducted with the manager. Documentation relating to the management of the home was also inspected. What the service does well: What has improved since the last inspection? What they could do better: Care plans still need to be more wide ranging, and it is hoped that the introduction of person centred plans, and ‘all about me’ books will assist this. There should be more educational and occupational opportunities for residents. Some records, including records of food, recruitment and fire checks were missing or not up to date, and steps must be taken to avoid confusion when administering medication, to prevent errors. The home needs a staff training plan, so that dates for all mandatory training and updates are identified. The Old Hall DS0000063061.V278286.R01.S.doc Version 5.1 Page 6 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 DS0000063061.V278286.R01.S.doc Version 5.1 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.V278286.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 4. Procedures for admitting new residents to the home ensure that their needs are clearly identified. EVIDENCE: The service user guide has been updated to make it more accessible to residents, and is now available in symbols format. There are clear admission criteria set out in the Statement of Purpose, which also sets out the admission process to the home. One resident has been admitted to the home recently. He was initially visited by the manager, and a comprehensive needs assessment was completed. He then visited with staff from his existing home. Staff from the Old Hall also worked with him for a week at his existing home to ensure a smooth transition. He did not have overnight stays, as it was felt that this could be disruptive for him, but overnight trial visits would usually be encouraged. The Old Hall DS0000063061.V278286.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 10. Resident’s care plans have improved since the last inspection, but they still do not cover a sufficiently wide range of needs to ensure that all needs are met. There is good consultation of residents to ensure that their decisions and wishes are reflected. EVIDENCE: The format for care planning is good, but those care plans inspected are still not wide ranging enough to reflect all support needs, and are not signed by the person completing them. It was not clear from daily records how care plans are being implemented, and review dates are annually, rather than sixmonthly. However, the manager explained that she and the deputy manager had recently undertaken training for the introduction of Person Centred Planning, and this will compliment existing care plans. A ‘Getting to know me’ book is also being introduced, which will provide concise information for new staff about residents. Staff demonstrated an excellent knowledge of the residents, and there are good behavioural guidelines for staff to follow. Staff receive accredited physical intervention training. A new reporting system has been introduced for reporting incidents, physical interventions and daily records, which ensures that they are better documented. The Old Hall DS0000063061.V278286.R01.S.doc Version 5.1 Page 10 Residents are consulted about household issues, and there are regular residents meetings to discuss menu preferences and forthcoming activities. All residents have a learning disability, and some degree of communication difficulties. Many staff have undertaken Makaton training, and staff were able to communicate effectively to ascertain choices using a variety of techniques, including signing and objects of reference. The company has purchased a computer package to transfer words into symbol format, to further aid communication with residents. Staff were clear about their responsibilities in maintaining the confidentiality of residents. Care plans are now stored securely in a locked drawer in the kitchen. The Old Hall DS0000063061.V278286.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 & 17. There are a range of activities for residents to participate in, ensuring that they have a varied timetable, but residents would benefit from a more structured educational and occupational timetable. Catering arrangements reflect resident’s choices. EVIDENCE: Staffing is usually on a 1-1 basis, so individual activities can be planned. Residents said that they enjoy swimming and horse-riding, and attend ‘Club 87’ every week. One person was looking forward to going bowling and then out for a curry that evening, and staff provided support and reassurance when he started to become anxious about the trip. The manager said that he had made a significant step, as previously he had refused to participate in outings. Residents are also involved in a local newspaper delivery round. One resident attends college two days per week, and it is hoped to enrol two other residents, but at present there is no structured educational or occupational timetable for residents to participate in. The manager said that she was meeting next week to discuss this further. The Old Hall DS0000063061.V278286.R01.S.doc Version 5.1 Page 12 Menu planning is done on a weekly basis with residents, and catering arrangements are of a domestic nature, giving flexibility to cater for individual choices. Residents said that they enjoy the food, and staff encourage healthy options where appropriate. New staff have not undertaken basic food hygiene training. This is usually done via distance learning, but the manager explained that some of the packs had not been returned from the last staff group to be trained, so there is a delay in starting new staff. Records of food actually served to one resident were not up to date. The Old Hall DS0000063061.V278286.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 20. There are satisfactory arrangements to ensure that resident’s health needs are met, but medication recording must be more robust to ensure that medication is administered safely. EVIDENCE: All residents are registered with the local GP practice. The last inspection identified problems in engaging specialist health care services for residents from out of county. Since then, all residents have been referred to the Consultant Psychiatrist, and appointments have been arranged. One resident with mobility problems has been assessed by the Occupational Therapist and Physiotherapist, to review his mobility aids, and a referral has been made to the Speech and Language Therapist. Residents do not have a Health Action Plan, and it is recommended that these be included in the care plan. Medication storage and stocktaking arrangements are satisfactory. Medication is administered by team leaders and seniors who have undertaken the safe handling of medication course. Administration records were satisfactory, except for one resident’s temporary medication administration record for antibiotics. This had been signed by staff with incorrect dates, which was misleading, and could have led to a medication error. The medication had commenced on the 12th January, but the administration record had commenced on the 1st January. The deputy manager had identified that there The Old Hall DS0000063061.V278286.R01.S.doc Version 5.1 Page 14 was a problem, and obtained a new record sheet from the pharmacy on the day of the inspection. Homely remedies are only administered after checking with the pharmacist. The Old Hall DS0000063061.V278286.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. There are good procedures for dealing with complaints and allegations of abuse, which ensure that residents are protected and able to raise concerns. EVIDENCE: There have been no complaints since the last inspection, and the complaints procedure is now available in symbols format in the service users guide. Staff have in-depth training in adult protection as part of their induction. Both new staff interviewed demonstrated a good knowledge of their responsibilities for reporting concerns, and the procedure to follow. The Lincolnshire Adult Protection Committee procedures were filed in an inaccessible position, and the manager agreed to make these more prominent. The Old Hall DS0000063061.V278286.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The home is decorated and furnished to an exceptionally high standard, providing a homely, comfortable and spacious environment for residents to live in. EVIDENCE: The home was completely re-furbished prior to registration, and this has been completed to an exceptionally high standard. There is ample communal space, comprising a kitchen/diner with a conservatory attached, a lounge and a quiet room. All bedrooms are en-suite, and residents commented that they liked the home. The gardens are enclosed, and have a patio with garden furniture. A vegetable garden is situated to the side of the house. Care staff involve residents in household tasks, and standards of cleanliness were satisfactory on the day of the inspection. There are satisfactory arrangements for the transport and disposal of foul laundry. The Old Hall DS0000063061.V278286.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 & 36. Staffing level allow high levels of support to be provided to residents. Staff are well supported, but training needs to be better co-ordinated to ensure that staff receive mandatory training updates. EVIDENCE: Staff have a clear understanding of their roles, and have job descriptions and GSCC codes of practice for guidance. Staffing levels are good, and reflect the support needs of residents, with 1-1 support usually offered. Staff are organised in 3 teams, and this enables each team to have a training day every 3 weeks. New staff said that their induction had been good, with sufficient time for them to shadow experienced staff. However, they had not undertaken some mandatory training, and there is no induction checklist to evidence what subjects had been covered during this period. The deputy manager is now responsible for co-ordinating training, and is currently identifying what training is required. However, there is as yet no training and development plan for this year, identifying when staff will undertake mandatory training and updates. More staff need to be enrolled on NVQ level 2 training to ensure the home meets the standard of 50 of staff holding this qualification. Staff said that they are well supported, and formal supervision usually occurs every six weeks. Staff also said that the manager and deputy are always The Old Hall DS0000063061.V278286.R01.S.doc Version 5.1 Page 18 available for informal support, and staff are well supported following any incidents in the home. The Old Hall DS0000063061.V278286.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38, 39, 41 & 42. There is good communication within the home, and documentation is well organised, but some documentation relating to recruitment and selection was missing. EVIDENCE: One member of staff said that teamwork and morale is very good. Everybody gets on well, and staff feel valued for the work they do. Monthly team meetings have been introduced from this month, with weekly seniors meetings. Arrangements have now been made for an external visitor to inspect the home every 4-6 weeks. A suggestions box is situated in the kitchen area for staff and residents to contribute ideas. Following the last inspection, inventories of resident’s possessions have been completed. Parents are responsible for resident’s benefits, and balances of money kept in the home corresponded with records. There have been significant improvements in recruitment and selection procedures, with most staff files inspected containing the documentation necessary for the protection of residents. However, one member of staff had The Old Hall DS0000063061.V278286.R01.S.doc Version 5.1 Page 20 been recruited with only one reference, and another file did not contain a photograph. All the health and safety requirements from the last inspection have been carried out. However, there is no evidence that fire alarms are checked on a weekly basis. The Old Hall DS0000063061.V278286.R01.S.doc Version 5.1 Page 21 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 3 2 3 3 x 4 3 5 x 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 x 29 x 30 3 STAFFING Standard No Score 31 3 32 2 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x x 3 LIFESTYLES Standard No Score 11 x 12 2 13 x 14 3 15 x 16 x 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 2 x x 3 3 x 2 2 x The Old Hall DS0000063061.V278286.R01.S.doc Version 5.1 Page 22 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 YA6 Regulation 15 Requirement The registered person must ensure that care plans and risk assessments cover service users care needs in sufficient detail to enable these needs to be met. Original timescale of 29/7/05 not met, but some progress has been made. The registered person must ensure that resident’s educational and occupational needs are catered for. The registered person must ensure that a record of food served is kept. Original timescale of 30/11/05 not met, but some progress has been made. The registered person must ensure that medication recording is robust to ensure that medication is administered safely The registered person must ensure that there is a training and development plan for the year The registered person must ensure that the documents outlined in Schedule 2 of the Care Homes Regulations 2001 DS0000063061.V278286.R01.S.doc Timescale for action 31/05/06 2. YA12 12(1)(b) 31/03/06 3. YA17 17(2) Schedule 4(13) 31/03/06 4. YA20 13(2) 31/03/06 . 5. YA35 18(1)(c) 31/03/06 6. YA41 19 31/03/06 The Old Hall Version 5.1 Page 23 7. YA42 13(4) are obtained prior to the commencement of employment. Original timescale of 5/8/05 not met, but some progress has been made. The registered person must ensure that weekly checks of the fire alarm are conducted. 31/03/06 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 YA6 YA20 YA32 YA35 YA41 Good Practice Recommendations It is recommended that care plans are signed by the person completing them, and that they are reviewed at least every 6 months. It is recommended that all residents have a Health Action Plan. It is recommended that more staff are enrolled in NVQ level 2 in order to meet the standard of 50 qualified. It is recommended that an induction checklist is used to document induction training undertaken. It is recommended that an inventory of service users possessions is kept. The Old Hall DS0000063061.V278286.R01.S.doc Version 5.1 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: 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. 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