Inspection on 27/04/06 for The Old Hall Care Home

This inspection was carried out on 27th April 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 3 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 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 Mick Walklin Unannounced Inspection 27th April 2006 10:30 The Old Hall DS0000063061.V291730.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.V291730.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.V291730.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.V291730.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 18th January 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 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.V291730.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was undertaken using a review of all the information available to the inspector regarding the service history of The Old Hall, and through undertaking a visit to the home. The fieldwork visit took place over 7 hours. The main method of inspection used was called case tracking which involved selecting three residents and tracking the care they receive through the checking of their records, discussion with them, the care staff and observation of care practices. A tour of the premises was conducted with one of the Team Leaders. Other documents connected with the running of the care home were also inspected. What the service does well: What has improved since the last inspection? What they could do better: There has been limited progress in addressing the requirements from the last inspection. 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. 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.V291730.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.V291730.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.V291730.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Procedures for admitting new residents to the home ensure that their needs are clearly identified. EVIDENCE: There are clear admission criteria set out in the Statement of Purpose, which also sets out the admission process to the home. One person has been admitted to the home since the last inspection. A detailed pre-admission format is used by the home, but a copy of the assessment could not be located at the time of the inspection. There were copies of assessments and care plans compiled his placing authority on file, but it was not clear how old these were. A review had been held 8 weeks after admission to discuss his progress, and the resident confirmed that he had been fully consulted and involved in this. The Old Hall DS0000063061.V291730.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans still do not cover a sufficiently wide range of needs to ensure that all needs are met, but improvements are being made. There is good consultation of residents to ensure that their decisions and wishes are reflected. EVIDENCE: Progress has been made on the introduction of a ‘Getting to know me’ book, which provides a good range of information about preferred routines, likes and dislikes, hobbies, behaviours, communication and medical needs. The manager has also completed a course on Person Centred Planning, which will enable residents wishes and aspirations to be better reflected in care plans. The manager explained that a new care planning format is being introduced, and an example was seen. This system will be an improvement over the existing system, although it is not implemented as yet Existing care plans are still not wide ranging enough to reflect all support needs of residents. For example, one residents care plan for the management of his epilepsy only gave staff general guidance on keeping him safe during a The Old Hall DS0000063061.V291730.R01.S.doc Version 5.1 Page 10 seizure, but did not outline emergency procedures. Another resident, who has epilepsy, did not have a care plan for this. Care plans are not signed by the person completing them or by the resident or their representative. It is difficult to track from daily records how care plans are being implemented, and some have not been reviewed for nearly a year. Individual daily records are kept, and there is provision for residents to record how they feel about the care provided. There are good guidelines for staff about how to prevent and manage challenging behaviours, and staff receive accredited physical intervention training. During the inspection, there were a number of incidents, which staff either defused, or dealt with effectively and professionally. The manager said that the introduction of Person Centred Planning will improve how residents wishes relating to their lifestyle are identified. Residents confirmed that they make day-to-day decisions, and staff were observed to be encouraging decision making and choice during the inspection. One resident said, “We have tenants meetings, where staff ask us about things, and we can tell them what we want”. Another said that he has had an advocate involved, and said that staff had respected his wishes about his timetable. He said, “I’m a 35 year old man, and all I want to do is to lead a quiet life doing my hobbies”. Staffing is on a 1-1 basis, which enables staff to respond to residents requests for support with activities. Some residents have communication difficulties, and staff were observed to communicate effectively to ascertain choices using signing. The Old Hall DS0000063061.V291730.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, 13, 15, 16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are a range of activities for residents to participate in, ensuring that they have a varied timetable, but a more structured educational and occupational timetable has not yet been introduced. Catering arrangements reflect resident’s choices. EVIDENCE: One resident said that there were lots of activities, but he preferred to stay at home to pursue his interests relating to classic TV programmes, which he said staff help him with. He keeps scrapbooks, and staff were assisting him with cutting and pasting pictures into these. Another resident described how he enjoys gardening, and had been assisting with the planting of raised beds in the garden, and mowing the grass. Building work on a sensory room and arts and crafts room in a separate building on site has recently completed, and residents said that they enjoy sessions there. Although residents said that there is plenty to do, there is a lack of a structured educational or occupational timetable for residents to participate in, The Old Hall DS0000063061.V291730.R01.S.doc Version 5.1 Page 12 which was identified during the previous inspection. A draft activity timetable has been devised, but this has not been implemented yet. The manager explained that they have had limited success in enrolling residents with the local college. At present, only one resident attends, two days per week, doing horticulture and metalwork. Another resident explained, “I don’t go to college – they (staff) are sorting it out – I did go before”. He said that he had written a letter of complaint to his MP. Staff identified the lack of college places or employment opportunities as an issue for residents, but are continuing to make efforts to improve the situation. One resident described how he is participating the same infection control distance learning pack that the staff are also studying towards. 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 are encouraged to be as independent as possible, and staff were observed to encourage them to participate in all tasks associated with meal preparation. Residents interviewed said that the quality of the meals is good, and that personal choice is accommodated. One said, “I don’t like beans, so staff give me something else – but we’ve got Pizza today, and that’s my favourite”. Records of food served to residents were up to date. The Old Hall DS0000063061.V291730.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): 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are well supported, and arrangements for healthcare are good, but medication recording must be more robust to ensure that medication is administered safely. EVIDENCE: Residents said that they are well supported by staff, and a number of examples of this were observed during the inspection. One resident was well supported during a seizure, and staff negotiated with him when he wanted to go shopping straight afterwards, before he was fully recovered. There was also a fault with the fire system following a flood, which led to the fire panel bleeping, and the alarm going off at intervals whilst repairs were made. Two residents were particularly anxious about this, but staff went to great lengths to support and reassure them. Routines in the home are flexible, and residents confirmed that they can exercise choice over their day-to-day activities. A key worker system is in place, and staff are allocated to individual residents each shift so that residents have an identified support person. The Old Hall DS0000063061.V291730.R01.S.doc Version 5.1 Page 14 All residents are registered with the local GP practice. Health Action Plans have been introduced since the last inspection, which assess and identify any health needs. There is better liaison with secondary healthcare services, and one resident attended an appointment with a Consultant Psychiatrist at the time of the inspection. Medication is administered by team leaders, seniors who have undertaken the safe handling of medication course. The home uses pre-packed cassettes for medication administration, and storage facilities are satisfactory. However, there were some discrepancies in medication administration records for two days in April, with the code ‘V’ being used for one residents administration, but staff were unable to explain what this meant, and another residents medication was not signed for on one day, following the commencement of a new recording sheet. The Commission were also notified of an incident in January, where 3 doses of an antibiotic were not administered. The Old Hall DS0000063061.V291730.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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. One newly recruited member of staff confirmed that she had in-depth training in adult protection as part of their induction. All staff interviewed demonstrated a good knowledge of their responsibilities for reporting concerns, and the procedure to follow. The organisation has a 24-hour senior manager on-call system. Staff were also aware of the procedure to follow if they received a complaint. Both residents interviewed said that they would talk to the manager or other staff, if they had any issues, and that they would have confidence in staff to act on their concerns. The Old Hall DS0000063061.V291730.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): 24 & 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. 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 continues to provide an environment of a very high standard for residents, although some wear and tear is beginning to show. One downstairs bedroom had been flooded by a resident, so he had moved to the staff sleep-in room whilst repairs were carried out. (This room is not currently used by staff). However, he had now flooded this room, which, as previously mentioned, had caused a fault with the fire alarm system. 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. One said “Its nice here”, and another said “I really like living here – I’m happy here”. The gardens are enclosed, and have a patio with garden furniture. Raised flowerbeds have been constructed and planted since the last inspection for residents to enjoy, and one of the beds will be accessible to residents who use wheelchairs. The Old Hall DS0000063061.V291730.R01.S.doc Version 5.1 Page 17 The home was very clean at the time of the inspection, and residents are encouraged to assist with household tasks according to their abilities. The Old Hall DS0000063061.V291730.R01.S.doc Version 5.1 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 at least once during a 12 month period. 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. Staffing levels 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: The home currently has five staff vacancies, so staff from a neighbouring home, and agency staff are being used. However, three new staff are awaiting CRB clearance before commencing employment. Staff said that the shortages have had an impact on training opportunities, and residents, in that there have been ‘new faces’ working. The home also does not have a deputy manager at the moment, but the manager confirmed that this is currently being addressed. Examination of staff rotas confirmed that the home was maintaining 1-1 staffing, and residents said that there were enough staff on duty to meet their support needs. Previous inspections have highlighted that recruitment and selection procedures are not robust enough to protect residents. The files of three newly recruited staff were inspected, and all contained the necessary documentation. The Old Hall DS0000063061.V291730.R01.S.doc Version 5.1 Page 19 A training and development plan was not available for inspection. Staff confirmed that they had received a range of training, but that some mandatory training was overdue for updating. Although the manager confirmed that they have received fire training, there was no record of this in the fire prevention file. An induction checklist has been introduced, and a newly recruited member of staff confirmed that this had been useful, although she commented that it had been “a bit in at the deep end”, with residents challenging behaviours. A member of staff from an agency confirmed that she had received an induction to the home, which had been satisfactory. Staff confirmed that they usually receive supervision every 6 weeks. Staff complete a supervision feedback form, and all those examined stated that staff had found the supervision helpful. The Old Hall DS0000063061.V291730.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally well organised, and health and safety documentation inspected was satisfactory. EVIDENCE: The manager was not present during most of the inspection, but a Team Leader in charge at the time was able to provide key documentation. The home does not have a deputy manager at present, and therefore support for the manager is less effective. She explained that a deputy is being employed to work across this home and a neighbouring home. The Commission receives periodic Regulation 26 reports about the home, and the manager explained that an annual quality assurance questionnaire has been sent to residents, relatives and other stakeholders, but the results have not yet been collated. The Old Hall DS0000063061.V291730.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 x 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 x 32 3 33 x 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 x LIFESTYLES Standard No Score 11 x 12 2 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 x 3 x x 3 x The Old Hall DS0000063061.V291730.R01.S.doc Version 5.1 Page 22 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 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 still within the extended timescale of 31/5/06). The registered person must ensure that resident’s educational and occupational needs are catered for. (Original timescale of 31/3/06 not met). The registered person must ensure that medication recording is robust to ensure that medication is administered safely. (Original timescale of 31/3/06 not met). Timescale for action 31/05/06 2. YA12 12(1)(b) 31/07/06 3. YA20 13(2) 31/07/06 The Old Hall DS0000063061.V291730.R01.S.doc Version 5.1 Page 23 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. Refer to Standard YA6 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. (This recommendation is carried forward from the previous inspection). The registered person must ensure that there is a training and development plan for the year. (This recommendation is carried forward from the previous inspection). 2. 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