We carried out a review of the data available to us about The Old Hall Residential Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The Old Hall Residential Care Home, you can give feedback on this service.
We found the following examples of good practice.
¿ The provider ensured there was sufficient stock of Personal Protective Equipment (PPE) in place including masks, gloves, aprons and hand sanitiser. PPE stations were located throughout the service. Staff had access to PPE and were observed wearing this in line with national guidance.
¿ There was a system in place for staff entering the building. Staff used a separate external dwelling to change clothing, use handwashing facilities and don Personal Protective Equipment (PPE) before entering the main building.
¿ The service was clean with no offensive odours. The housekeeping team used an in-depth cleaning programme, including regular cleaning of high touch points throughout the day. Additional cleaning took place during the evening and night to ensure continuous cleaning was maintained.
¿ A recent outbreak of COVID 19 at the service had been managed well and the plans in place to support people had been utilised safely. Core staff had moved into the service to reduce the risk of spread of infection.
¿ The service followed the current guidelines for care home testing, an enhanced testing regime was implemented during the outbreak. This was to ensure if people or staff had contracted COVID 19, it was identified, and measures put in place in a timely way.
¿ Staff were trained in infection prevention and control (IPC). This included donning and doffing training, this is how to put on and remove PPE. Staff had also accessed Coronavirus Awareness training via an online course.
¿ Infection control policies had been updated to reflect current national guidance. Information and guidance were available to staff, relatives and people living in the service relating to COVID 19 and infection control.
¿ The provider put in place risk assessments clearly identifying people at high risk of COVID 19 and the measures in place to support them. This meant staff had clear guidance, how to support people during COVID 19.
¿ People were supported to keep in touch with their relatives. The provider had set up a visiting room to facilitate visits between people and their relatives. This included an outside access point to the room.
¿ Arrangements were in place to support people who were receiving end of life care to ensure relatives could access the home, including full PPE supplied. These measures meant people and their relatives could safely spend time together.
Further information is in the detailed findings below.
The Old Hall Residential Care Home is registered to provide accommodation and support for up to 25 people, including people living with dementia. There were 15 people living in the home on the first day of our inspection.
In December 2017 we rated the home as Inadequate and placed it in Special Measures, reflecting the registered provider’s failure to address regulatory breaches identified at previous inspections. We also imposed an additional condition of registration to prevent the registered provider from admitting anyone to the home without our prior permission. When we inspected the service again in August 2018 we were disappointed to find little evidence of improvement. The service was again rated as Inadequate and remained in Special Measures.
People’s experience of using this service:
Since our last inspection in August 2018 the registered provider (‘the provider’) had appointed a new manager who was now registered with the Care Quality Commission. Under the leadership of the new registered manager, all of the regulatory breaches identified at previous inspections had been addressed. Aside from one administrative shortfall in the provider’s staff recruitment system, significant improvement had also been made in other aspects of service provision.
Staff worked together in a mutually supportive way and communicated effectively, internally and externally. Training and supervision systems were in place to provide staff with the knowledge and skills they required to meet people’s needs effectively. There were sufficient staff to meet people’s care and support needs without rushing. Staff provided end of life care in a sensitive and responsive way.
Staff were kind and attentive in their approach and were committed to promoting people’s dignity, privacy and respect. People were provided with food and drink of good quality which met their individual needs and preferences. There was a programme of regular activities and events to provide people with physical and mental stimulation. There was an ongoing programme of improvement to the physical environment and facilities in the home.
Staff worked alongside local health and social care services to ensure people had access to any specialist support they required. Systems were in place to ensure effective infection prevention and control and people's medicines were managed safely. Staff were aware of people’s rights under the Mental Capacity Act 2005 and supported people to have maximum choice and control of their lives, in the least restrictive way possible. The policies and systems in the home supported this practice.
People’s individual risk assessments were reviewed and updated to take account of changes in their needs. Staff knew how to recognise and report any concerns to keep people safe from harm, although improvement was required to ensure staff recruitment procedures were consistently safe.
The registered manager provided strong but supportive leadership and in her five months in post had won the respect and loyalty of her team. A range of audits was in place to monitor the quality and safety of service provision. To help ensure the improvement in service quality was sustained, the registered manager maintained a hands-on role in all areas of the home and the owner had increased his involvement. Systems were in place to promote organisational learning from significant incidents and events. Formal complaints were rare and any informal concerns were handled effectively.
Rating at last inspection:
Inadequate (Published November 2018)
Why we inspected:
This was a planned inspection based on the rating at the last inspection. As described above, at this inspection we were pleased to find significant improvements in service quality. As result, the rating of the service is now Good and the service is no longer in Special Measures. We have also advised the provider we plan to remove the additional condition of registration imposed following our December 2017 inspection.
Follow up:
We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.
A registered manager was not in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. A new manager had started working at the service in XXXX and was intending to register with us.
This is the fourth inspection carried out by the CQC at the service since August 2015. The standards of care during this time have fallen and at our last inspection we imposed a condition on the provider’s registration preventing them from admitting people to the service. At that inspection the provider had not complied with a warning notice we had issued and we found they were in breach of four regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014, (HSCA) and one regulation of the CQC Registrations Regulations 2009. The service was rated as Inadequate and placed in special measures.
At this inspection we found although the provider had made some improvement to the management of medicines, responding to people’s need for greater mental and physical stimulation and addressed some infection control issues we had raised at our last inspection. They had not complied with other ongoing issues such as the quality monitoring of the service and staff training and supervision. We also found further serious issues of concern and as a result we have been unable to lift the restriction we placed on the provider at our last inspection. The provider was in continued breach of three of the HSCA regulations identified at the previous inspection and in breach of a further HSCA regulation.
The risks to people’s safety were not always assessed and appropriate measures were not in place to reduce the risks to people’s safety. This had resulted in increased falls and unplanned weight losses for some people who lived at the service. Staffing levels did not always meet the needs of people at busy times. People were protected from potential abuse as safeguarding issues were dealt with appropriately by staff who understood their roles and responsibility toward the people in their care. Medicines were managed safely and people were protected from the risks of cross infection.
Staff were not supported with appropriate training for their roles and they were not receiving supervision in line with the provider’s own policy. People’s needs were assessed using nationally recognised tools but the assessments were not always used to guide staff to provide effective care. People’s nutritional needs were not always well managed. People had not always been referred to appropriate health professionals to manage their health needs.
People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in the service did not support this practice. The environment people lived in was well maintained. However, although there had been improvement to the outside of the building people were still not able to access the outside areas if they chose to as they were not safely enclosed.
Details of people’s specific preferences, choices and views were not always recorded in their care plans. People were supported by a staff group who were caring, and treated them with dignity and respect. Their privacy was maintained.
People’s care plans lacked sufficient detail to guide staff to provide personalised care. Information in essential areas such as end of life care was sometimes generic and some areas of the care plans were incomplete. There was a lack of accessible information to support people at the service who had communication issues. Complaints and concerns were dealt with effectively.
Although there was a new manager in post who had been making some gradual improvements. There was a continuing failure by the provider to effectively monitor the quality of the service and this had affected a wide range of issues relating to the care people received at the service.
The home continues to be rated inadequate and remains 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 provider's registration of the service, will be inspected again within six
months.
The expectation is that 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 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 provider from operating this service. This will
lead to cancelling their registration or to varying the terms of their registration.
We carried out a first comprehensive inspection of the home in August 2015. At this inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (HCSA). This was because there were shortfalls in the monitoring of service delivery. We rated the service as Requires Improvement.
In January 2017 we undertook a second comprehensive inspection. We found the quality of service had deteriorated and people were not receiving the safe, effective, responsive and caring service they were entitled to expect. We found six breaches of the HSCA. This was because the registered provider had failed to properly assess and mitigate risks to people's safety; staffing levels were insufficient; staff did not always respect people's privacy and dignity; people's legal rights under the Mental Capacity Act 2005 were not fully protected; people did not receive person centred care that met their needs and personal preferences and the registered provider had failed to establish systems and processes to assess, monitor and improve the quality of the service. We also found one breach of the Care Quality Commission (Registration) Regulations 2009.This was because the registered provider had failed to notify us of issues relating to the safety and welfare of people living in the home. Following our inspection, we issued a Warning Notice requiring the registered provider to be compliant with the requirements of the HSCA Regulation 17 – Good governance by 31 July 2017. The rating of the service remained as Requires Improvement.
We conducted this third comprehensive inspection of the home on 5 and 7 December 2017. The inspection was unannounced. There were 25 people living in the home on the first day of our inspection.
At this inspection we found the registered provider had not achieved compliance with our Warning Notice and was in continuing breach of four of the seven breaches of regulations identified at our previous inspection. This was because the registered provider was still failing to properly assess and mitigate risks to people's safety; to respond effectively to people’s need for greater mental and physical stimulation; to notify us of significant incidents and to assess, monitor and improve the quality of the service. We also found one further breach of the HSCA. This was because of the registered provider’s continuing failure to ensure all staff had the training and supervision necessary to support people safely and effectively. In areas including medicines management, the provision of mental and physical stimulation and organisational governance the registered provider had failed to secure the necessary improvement for three consecutive inspections.
The overall rating for the home is 'Inadequate' and the home is therefore in 'Special Measures'.
We have taken action against the registered provider to ensure that they make the necessary improvements to become compliant with legal requirements. You can see details of the action we have taken at the back of the full version of this report.
In some areas the registered provider was meeting people’s needs.
Staffing levels had been increased and were sufficient to meet people's care and support needs; action had been taken to improve the promotion of rights to privacy and dignity and staff reflected the requirements of the Mental Capacity Act 2005 in their practice. Although further work was required in each of these areas, legal requirements were now met.
Staff worked well together in a mutually supportive way and communicated effectively, internally and externally. Staff knew people as individuals and supported them to have choice and control over their lives. Staff were kind and considerate in their approach and provided end of life care in a sensitive way. People were provided with food and drink of good quality which met their individual needs and preferences. The provider maintained a rolling programme of refurbishment.
Care plans were well-organised and provided staff with guidance on how to meet people’s individual care needs and preferences. Staff worked closely with local health and social care services whenever this was required. Staff knew how to recognise and report any concerns to keep people safe from harm. Any concerns and complaints were managed effectively. There was evidence of some organisational learning from significant incidents and events.
The home had a registered manager in post. A registered manager is a person who has registered with CQC to manage the service. Like registered providers (‘the provider’) 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.
The registered manager had a hands-on style and was liked by everyone connected with the home. However, some people expressed concerns about the way the service was managed under her leadership.
CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection, the provider had been granted a DoLS authorisation for one person living in the home and was waiting for a further two applications to be assessed by the local authority.
We inspected the home on 31January and 6 February 2017. The inspection was unannounced. There were 24 people living in the home on the first day of our inspection.
The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers (‘the provider’), 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.
During our inspection we found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had failed to properly assess and mitigate risks to people’s safety; staffing levels were insufficient; staff did not always respect people’s privacy and dignity; people’s legal rights under the Mental Capacity Act 2005 were not fully protected; people did not receive person-centred care that met their needs and personal preferences and the provider had failed to establish systems and processes to mitigate risks relating to people’s health, safety and welfare and to assess, monitor and improve the quality of the service.
We also found one breach of the Care Quality Commission (Registration) Regulations 2009.This was because the provider had failed to notify us of issues relating to the safety and welfare of people living in the home.
We have taken action against the registered provider to ensure that they make the necessary improvements to become compliant with legal requirements. You can see what action we have taken at the end of the full version of this report.
We also found other areas in which improvement was required to ensure people received the safe, effective, caring and responsive service they were entitled to expect.
The systems for the induction and training of staff were not consistently effective. Additionally, staff were not provided with supervision in line with the provider’s policy.
At times, staff supported the people who lived in the home in a task-centred way.
In a small number of areas, we found the provider was meeting people’s needs effectively.
The provider had assessed each person’s individual support needs in the case of a fire or other emergency that required the building to be evacuated. There was also an effective system in place to ensure that fire safety and other equipment was serviced regularly in accordance with the manufacturers' instructions and the law.
People were provided with food and drink of good quality that met their needs and preferences and their healthcare needs were supported through the involvement of a range of professionals.
People and their relatives were comfortable raising any concerns with senior staff and formal complaints were rare.
CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection, the provider had sought a DoLS authorisation for three people living in the home and was waiting for these to be assessed by the local authority.
The inspection took place on 12 August 2015 and was unannounced.
The Old Hall Residential Care Home is located in the small village of Halton Holegate. It is registered to provide accommodation and personal care for 25 people some of who may be living with a dementia. There were 18 people living in the home on the day of our inspection.
There was a registered manager at the home. 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.
There was a breach in relation to the systems around good governance. Systems in place to identify, monitor and improve the quality of the care provided and to reduce the level of risk in the service were not always effective and did not always identify or correct issues. The provider had not updated the fire procedures to take account of a new extension that had been built.
Individual risks to people while receiving personal care were identified and appropriate equipment was in place. Staff knew how to raise concerns if they were worried that a person was at risk of harm and the registered manager worked with the local safeguarding authority to ensure people were safe.
The provider had systems in place to ensure staff were safe to care for people who lived at the home. Staff were kind and caring with the correct skills, training and support to meet people’s needs. At busy times people had to wait for care and there were not enough staff to fully monitor people’s safety.
People received their medication safely. However, care plans did not support staff to use medicines prescribed to be taken as required. In addition, gaps in the medication administration record made it difficult to see if medicine had been administered correctly.
The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect
themselves. The registered manager was aware of their responsibilities under the Mental Capacity Act 2005. However, they had not always involved all the relevant people when making decisions in a person’s best interest.
People were supported to access drinks on a regular basis. They were also supported to make choices around their food. However, where people liked to eat with their fingers the information in care plans did not support staff to make appropriate food choices.
People were involved in planning their care, however, care plans did not contain information about people’s lives and other information was not always easy to find There was no set activity schedule and activities only happened if staff had time.
People told us they were happy with the care they received and while they knew how to raise a complaint no one had done so. People were able to feedback their experiences of care and if any changes were needed to the service.
We saw people's bedrooms were personalised and most had items of furniture they had brought from home and photographs of their families on display.
People told us they were well looked after. One person said, 'The staff are pleasant and I have a choice of what to do.' Another person said, 'They give me a choice and I feel involved. I'm very well looked after.'
We saw people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.
We saw all areas of the home were clean. All furniture and equipment was in a good state of repair.
People told us the home was always clean. One person said, 'It a very nice home. It's clean, they keep my toilet clean.'
We saw there was effective recruitment and selection processes in place and all necessary checks had been made prior to staff being appointed into post.
We saw a copy of the complaints policy. Guidance on how to make a complaint was on display in the main reception area. People were made aware of the complaints system.This was provided in a format which met their needs.
We did not speak with people who used the service. This was because we were mainly checking records and speaking with staff.
Care records had improved since we visited in July 2012 and reflected all the care needs of people in the home. They were reviewed regularly or when changes were needed.
The manager recognised further improvements were needed to the care records to make them easier to follow and prevent duplication.
We also sat and watched care staff delivering care to people in the home. This helped us to understand the needs of people who could not talk with us.
We found that people who could speak with us were respected and involved in their care. One person said, 'I like it here and I'm looked after very well.'
Another person told us, 'They're very kind here and I get the help I need.'
Although care staff knew about the needs of people, the care plans did not reflect those needs.
People were complimentary of the food they had and said they always had a choice at mealtimes.
People told us they felt safe in the home and if they didn't, they felt the manager would do something about it. Care staff knew how to protect the people in the home and who to contact if they had concerns.
We saw evidence that care staff had received training and support to do their jobs
People felt they were asked about their opinions about the running of the home by the manager and felt confident taking any concerns directly to staff members or the manager if needed. The home had quality assurance systems in place to ensure they monitored the quality of service that people received. However, these could have been more robust.
The care plans did not show people's involvement or always reflect people's needs.