The Old Hall

Updated 4 November 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection was carried out by two inspectors. An Expert by Experience made calls to seven relatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

The Old Hall is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Old Hall is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

We gave a short period notice of the inspection. This was because the service is small, and people are often out, and we wanted to be sure there would be people at home to speak with us.

Inspection activity started on 31 March 2022 and ended on 31 May 2022. We visited the location’s service on 31 March.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority, and we used the information the provider sent us in their provider information return. (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all

During the inspection

We reviewed a range of records. This included three people’s care records and multiple medication records. A variety of records relating to the management of the service, including policies and procedures were also reviewed.

We are improving how we hear people's experience and views on services, when they have limited verbal communication. We have trained some CQC team members to use a symbol-based communication tool. We checked that this was a suitable communication method, and that people were happy to use it with us. We did this by reading their care and communication plans and speaking to staff or relatives and the person themselves. In this report, we used a picture exchange system with symbols with one person to tell us their experience.

Talking mats can be used to support communication with anyone who may have difficulties communicating their experiences of care. This includes people who live with dementia, people who have had a brain injury, people who have a mild to moderate learning disability, deaf people, people who do not have English as their first language and people with mental health conditions. We spoke with eight members of staff including the registered manager, the quality assurance compliance manager, and the behaviour support specialist. We observed interactions between people who lived at the home and staff.

After the inspection

Following the inspection, we continued to seek clarification from the provider to validate evidence found and spoke with seven relatives, and three professionals.

Updated 4 November 2022

About the service

The Old Hall is registered to provide accommodation and personal care for up to 13 people who have a learning disability or autistic people. The home is made up of one adapted building and also includes three self-contained mews houses. At the time of inspection there were 12 people living in the home.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them. The service was a large home, bigger than most domestic style properties. This is larger than current best practice guidance. However, the size of the home having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins, or anything else outside to indicate it was a care home. Staff did not wear uniforms and were discouraged from wearing anything that suggested they were care staff when accessing the service or going out with people.

People’s experience of using this service and what we found

Staff, relatives, and professionals were overwhelmingly positive about the leadership of the service, which centred around the experience of people.

Staff were motivated to make a difference to people’s lives. The culture of the service encouraged inclusivity for people.

Staff worked collaboratively with internal teams and external organisations to provide people with the best possible outcomes. Staff were passionate about promoting people’s rights to make their own decisions wherever possible and respected the choices they made.

Staff were extremely well skilled and provided person centred care which achieved outcomes for people that far exceeded expectations. Care, support, and guidance was informed by the most current, evidence-based practice.

There was a strong focus on supporting people to be as independent as possible and to lead healthy and fulfilled lives. Staff knew people extremely well and used their expertise to care for people in a way they preferred. They were creative in how they supported people to maintain their hobbies and interests and to keep in touch with their loved ones.

People lived in an environment that was designed and equipped to support them to live as independently as possible. People were fully involved in the development of the service. They had active input in ongoing adaptations to ensure the service met people’s needs and promoted person centred care.

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

People were supported to take positive risks to support their development and promote their independence. There were extremely detailed risk assessments in place describing how to support people and mitigate risks.

People and relatives told us they felt extremely safe with staff. Staff received safeguarding training and thoroughly understood their roles and responsibilities. The home had sufficient staff and deployed them to meet the individual needs of the people.

People had their needs assessed prior to admission and there was a comprehensive, well planned transition into the service to ensure people would be supported to integrate into the service.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice, and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence, and inclusion.

People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence, and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The model of care promoted within the service maximised people’s choice and promoted their independence. Care was extremely person centred and promoted people’s dignity, privacy, and human rights. Distinctive leadership at location and provider level had achieved a service that was outstandingly effective and responsive. The service was innovative and dedicated to ensuring continuous quality improvement to make a real difference for people. Highly person-centred care truly enriched people’s lives empowered them and helped them to achieve their aspirations which led to extremely positive outcomes. One relative told us, “We work as a team, they know our input is important, they listen to us. They welcome our suggestions.”

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was outstanding.

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.