Archived: The Old Hall Residential Home

The Old Hall residential service is registered to provide accommodation and personal care for up to 16 older people. At the time of our inspection there were 11 people living at the service.

The service had a registered manager in post. 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.

At the last comprehensive inspection on 24 and 25 January 2017 we found a continued breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as the registered provider's quality assurance systems were not effective. We asked the registered provider to take action to make improvements in this area.

After the inspection, the registered provider wrote to us to say what they would do to meet legal requirements in relation to the breach identified. They informed us they would meet all the relevant legal requirements by 31 May 2017. This inspection found a continued breach of Regulation 17 and in addition a breach of Regulations 10, 12 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The CQC are now considering the appropriate regulatory response to the concerns we found. We will publish the actions we have taken at a later date.

Staff had been employed following appropriate recruitment checks that ensured they were suitable to work in health and social care. Since our last visit the needs of people living at the service had significantly changed. However, staffing levels in place at the service were not sufficient to protect people from the risk of harm. When we arrived at the service there were only two staff on duty. People were left unsupervised and with no access to staff for periods of up to 40 minutes. Inspectors were required to intervene with one person to prevent them from the risk of falling. The registered manager confirmed that the staffing levels were too low. We asked the registered provider to take immediate action to address safe staffing levels during our visit.

Quality assurance systems in place were not effective, they failed to identify areas of concern we highlighted during our inspection. Where action plans had been put in place to address the improvements needed, we found no evidence that these had been completed by the registered manager or registered provider. There was a lack of management oversight to ensure that robust checks were carried out as required across the different areas of the service. Records were not properly maintained to make sure they were accurate and fully complete. Care plans did not always contain accurate information regarding people’s care needs and failed to clearly record the care people had received.

Accidents and incidents were recorded by staff, however there was a lack of evidence within audits to demonstrate that a robust analysis of falls, patterns or trends were identified. There were no recorded actions completed for people who had experienced multiple falls to state what had done to prevent and minimise the risk of further harm/occurrences.

People were not always protected from the risk of malnutrition and dehydration. There was a lack of action taken when it was identified that one person had lost a significant amount of weight over a short period of time. Weight monitoring charts showed that they had lost 4.7kg between June and August 2017. There was no evidence that the person was referred onto a dietician for their input. Supplementary charts required to monitor food and fluid intake could not be found by the registered manager. Care records relating to the monitoring of peoples skin integrity were not always kept up to date.

People told us and we observed that they received their medication at their preferred times. However, we found that the management of medicines was not always safe. Medication stock checks were not always accurately recorded on people’s medication administration records (MARs). This meant that the registered person would not be able to clearly identify from the stock levels if people had received their medicines as prescribed. The registered manager confirmed that she was responsible for the management and recording of stock received and leaving the service. Care plans for PRN (as required) medication were not always in place for staff guidance. Appropriate guidance from relevant health professionals had not always been sought where changes to medication had been required. We asked the registered manager to take immediate action to address these concerns.

Risks to people’s health and safety were not always safely managed. Where people had required the use of equipment to assist with moving and handling, the registered manager had not sought advice or guidance from relevant professionals. Where people had been assessed as requiring the use of assistive technology to minimise any risk of harm, we found that the relevant equipment was not always working or in place. Care plans contained out of date information relating to the current care needs and risks to people’s health and safety.

Staff received supervision and attended team meetings as required. However, the registered provider training matrix identified that training in relation to moving and handling was not up to date for all staff working at the service. In addition training in areas such as safeguarding adults from abuse and the Mental Capacity Act 2005 required updating. The registered manager confirmed that as of now only staff that had up to date moving and handling training would carry out this practice at the service. We asked them to take action to ensure staff were provided with relevant training.

People’s privacy was not ensured as records were not held securely at the service. People’s rights to choice, privacy and dignity were not always respected.

The registered provider had not displayed their ratings from the previous inspection.

People were supported throughout our visits to make a number of choices regarding how they received their care. Staff understood the importance of seeking consent from people and we observed this on most occasions where support was offered. Care plans contained decision specific capacity assessments and where required, best interest meetings had been held. However the review dates for these assessments set by the registered manager had not been met. Family members confirmed that were appropriate they had been consulted on any decision making regarding their relatives care.

People knew how and who to raise any complaint to. People were complimentary about the service and the support they received from staff. Staff were described as “Kind”, “Caring” and "Patient.” Family members described the service as “Warm”, “Welcoming” and “Homely".

The CQC were notified as required about incidents and events which had occurred at the service.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the registered provider’s registration of the service, will be inspected again within six months.

The expectation is that registered providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the registered provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the registered provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

The Old Hall residential home is registered to provide accommodation and personal care for up to 16 older people. The service provides single room accommodation based over two floors of the building. Each bedroom has a private en-suite bathroom. Communal areas include a dining room, a lounge and a conservatory. The home is located on the main high street of Malpas in Cheshire and is within reach of the local community and services and public transport network. At the time of our inspection there were 12 people living at the service.

The service had a registered manager. 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.

At the last comprehensive inspection on 15 September 2015 we found a breach of regulation 11, 15 and 17 of the Health and social care Act 2008 (Regulated Activities) Regulations 2014 and found that a number of improvements were required at the service. People were not always protected from the risk of infection and the premises were not safe. Consent to care and treatment was not always sought and the registered provider’s quality assurance systems were not effective and failed to seek the views of people living at the service. The registered provider was issued with a warning notice for Regulation 15. We asked the registered provider to take action to address these areas.

After the inspection, the registered provider wrote to us to say what they would do to meet legal requirements in relation to the breaches identified. They informed us they would meet all the relevant legal requirements by 28 January 2016.

We followed up on the warning notice in February 2016 and found that the registered provider had made the necessary improvements required. This inspection found that further improvements had been made at the service.

The registered provider had undertaken some checks in relation to the safe management of Legionella. However there were insufficient records to determine whether these met Health and Safety requirements. We contacted the Health and Safety Executive following the inspection who confirmed they would provide advice to the registered provider.

Fire safety management records at the home were not always kept up to date and accurate. Information relating to checks on door closures and heat and smoke seal testing had not been recorded since March 2016. We have requested the Fire authority to visit the service to complete an inspection. Records showed that staff had received training in effective evacuation in the event of a fire.

The registered provider had introduced a number of quality assurance audits since our last inspection visit. Further improvements were needed to make sure that they were effectively used in accordance with the registered providers own timescales to ensure the quality and safety of the care provided to people.

Staff understood what was meant by abuse and they were aware of the process for reporting any concerns they had and for ensuring people were protected from abuse. Family members told us that they felt reassured by staff and that their loved ones were safe living at the service.

There were sufficient levels of suitably trained staff to support people. When new staff were appointed, recruitment checks were carried out to make sure they were suitable to work with vulnerable people.

People received their medication as prescribed and staff had completed competency training in the administration and management of medication. Medication administration records (MAR) were appropriately signed and coded when medication was given.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service supported this practice.

Discussions were held with family members and people were referred onto the appropriate services when concerns about their health or wellbeing were noted. Staff worked well with external health and social care professionals to make sure people received the care and support they needed.

The mealtime experience was positive and engaging. People were provided with appropriate dietary options and received good levels of support from staff. Staff were patient in their approach and encouraged people to eat and drink in a discreet and respectful manner. Staff respected individual choices and where required alternative meal options were offered and sourced. People made positive comments about the quality of the food available.

Staff attended regular training sessions to update their knowledge and skills. Team meetings were held to ensure staff were kept up to date with any changes occurring at the service.

Staff were caring and they always treated people with kindness and respect. Observations showed that staff were mindful of people’s privacy and dignity and encouraged people to maintain their independence. Relatives and visitors told us that they had no concerns about the care. They said they had always been made to feel welcome and part of a family when visiting.

Care plans contained detailed information on each person and how their support was to be delivered. Information was regularly reviewed with people living at the service. This meant that people received personalised care in line with their wishes and preferences.

Family members told us that they felt confident in raising concerns to the staff and management acted that they would be acted upon immediately. People and their family members knew how and who to raise complaint too.

People were provided opportunities to give their views about the care they received from the service. Relatives were also encouraged to give their feedback on how they viewed the service. This showed that the registered provider valued the views of people living at the service.

.The Old Hall is registered to provide accommodation and personal care for up to 16 older people. The home has single room accommodation over two floors. Communal areas include a dining room, a lounge and a conservatory. The home is located on the main high street of Malpas in Cheshire and is within reach of local services, community and public transport.

At the time of this inspection 13 people were living at the service.

The service had a registered manager. 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 and associated Regulations about how the service is run.

We carried out an unannounced comprehensive inspection of this service on 15 September 2015. A breach of legal requirements was found for which we issued a warning notice.

We undertook this focused inspection to check that they now met the legal requirement. This report only covers our findings in regards to that topic.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Old Hall on our website at www.cqc.org.uk.

At our focused inspection on the 18 February 2016, we found that the registered provider met all the requirement of the warning notice and legal requirements had been met.

Our visit on the 18 of February 2016 found that many improvements had been made to the environment. These included remedial work carried out to fixtures and fittings, the purchase of new furniture, improved cleaning schedules and the complete refurbishment of the laundry facilities.

We found that hazards identified during our last visit had been addressed. We observed that the environment was home-like in appearance with people who used the service being able to relax in main communal areas without any disruption from any remedial work being undertaken.

While improvements had been made we have not revised the rating for this key question; to improve the rating to ‘Good’ would require a longer term track record of consistent good practice. We will review our rating for safe at the next comprehensive inspection.