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Ingham Old Hall Care Home Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 20 June 2017

The inspection took place on 3 and 4 May 2017 and was unannounced.

Ingham Old Hall Care Home provides residential care for up to 25 people, some of whom may be living with dementia. The home is a converted period building, over two floors, set in extensive grounds. Some rooms have en suite facilities. At the time of our inspection, 24 people were living in the home.

At the time of our inspection, the service had a registered manager who had been in post for a number of years. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We last inspected this service in July 2016 where we found that the service was not meeting one requirement of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach related to the management of people’s medicines. The provider sent us information to tell us about the actions they were going to take to rectify the breach of the regulations. They gave no timescale for the completion of the actions they proposed. At this inspection, carried out in May 2017, we found that the service had not made the required improvements and were still in breach of this regulation. The service was also found to be in breach of the regulation associated with governance. In addition, we have made recommendations about staff training on the subject of the MCA and recording risks.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Records did not demonstrate that people had received their medicines safely, appropriately and as the prescriber had intended. Good practice guidance had not been consistently followed.

The system the provider had in place to assess and monitor the medicines management and administration within the home had not been effective at rectifying the issues found at this, and our previous, inspection. No formal audits were in place to help drive improvement in other areas of the service.

Processes were in place to help prevent and protect people from the risk of abuse and harm. Staff understood safeguarding procedures and any risks to those that used the service had been identified and managed. However, records did not always robustly demonstrate this.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. No overly restrictive practices were identified however the service did not demonstrate full compliance with the MCA.

The service had processes in place to help reduce the risk of employing staff not suitable to work within the home. New staff received an induction, were encouraged to gain health and social care qualifications and received ongoing training. They received regular support to assist them in their roles.

Good team work was evident and the home ran smoothly with a relaxed atmosphere. Staff told us that they were happy working at Ingham Old Hall Care Home. Those that used the service trusted the staff that provided them with care and support.

Staff respected each other and those that used the service. They demonstrated a patient, caring and considerate approach to all those they interacted with. Care and support was provided in an unhurried and relaxed manner suitable to each individual.

People had choice in how they spent their day and staff supported them in making decisions. Independence was supported and dignity considered and maintained. Care was delivered in a discreet manner.

The risks associated with the environment had been identified and managed. However, records did not consistently and robustly record what preventative measures the service was taking in regards to maintenance checks. Accidents and incidents were recorded and managed appropriately. An overview was in place to help mitigate future risk.

People liaised with staff over the planning of their care although this was not always evident from the care plans we viewed. Care plans were individual to people and had been regularly reviewed. The content varied between care plans but staff had a good knowledge of the needs and preferences of those they supported and had developed meaningful relationships.

The service provided activities and social interactions that people enjoyed. Activities were not always planned but we saw a number of informal, dedicated activities take place with people that were individual to their needs and wishes.

People had appropriate and prompt access to healthcare and community professionals were complimentary on how the service managed these needs. People’s nutritional needs were met and people who required specialist diets received this. Consideration was given to how those living with dementia could better maintain their nutritional wellbeing.

Feedback was sought on the service via meetings and questionnaires. Systems were in place to assess and monitor the quality of the service although these were mostly carried out on an informal basis.

People told us they saw the management team regularly and that they were accessible and visible. The provider’s representative made regular visits to the service, provided support and engaged with those who used the service, visitors and staff.

Inspection areas

Safe

Requires improvement

Updated 20 June 2017

The service was not consistently safe.

The risks associated with medicines management had not been fully mitigated.

Processes were in place to help protect people against the risk of abuse and harm.

There were enough safely recruited staff to meet people’s needs in an individual manner.

Effective

Good

Updated 20 June 2017

The service was effective.

Full compliance with the MCA was not consistently demonstrated by the service.

There were enough trained and supported staff to meet the needs of those that used the service.

People’s nutritional and healthcare needs were met in a person centred manner.

Caring

Good

Updated 20 June 2017

The service was caring.

Staff demonstrated a kind, empathetic and patient approach to those that used the service and others.

People’s dignity, privacy and confidentiality was respected and maintained. Staff encouraged and supported people’s choices and independence.

Staff sought consent to deliver care although records did not clearly demonstrate that people had been involved in the planning of their care.

Responsive

Good

Updated 20 June 2017

The service was responsive.

People received care that was individual to them and met their personal needs.

Social and leisure needs were met and people were happy with the level of stimulation they received.

There was a complaints policy in place should people raise any concerns.

Well-led

Requires improvement

Updated 20 June 2017

The service was not consistently well-led.

The systems the provider had in place to assess, monitor and improve the service were not fully effective.

The management team were visible and the provider supportive.

Staff worked well as a team and respected their colleagues abilities in providing a caring and considerate service.