The Old Hall

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.

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 spectrum disorder. The home is located in the village of Fiskerton in Lincolnshire. At the time of inspection there were 13 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 were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

People were protected from harm. Staff received safeguarding training and understood their responsibilities. People were supported to take positive risks. There were detailed risk assessments on how to support people and mitigate risk of harm. The home had enough staff and deployed them to meet the needs of the people. Medicines were monitored and administered safely. Staff followed infection control procedures and used personal protective equipment to prevent the spread of infection. Following incidents, the registered provider had a robust system to monitor trends and had acted to reduce reoccurrence.

People had their needs assessed prior to admission. There was a detailed support programme to ensure people would be supported to integrate in to the service. Staff were trained and skilled to support people effectively. People were supported to maintain a well-balanced diet. Staff worked collaboratively with internal teams and external organisations to provide people with the best outcomes. People had access to on-going health care services. People were encouraged to have active input into the development of their environment, which was adapted to meet people’s needs and promote person centred care. Staff promoted people's rights to make their own decisions wherever possible and respected the choices they made. 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.

Staff showed kindness and respect towards people living in the home. People’s views were valued and their feedback was continually sought. People’s dignity and privacy was respected, and people were encouraged to have as much independence as possible. People had 'a circle of support' which was unique to them. A circle of support involved core team members, relatives and health care professionals.

People received personalised care which was responsive to their needs. People had care and support records in place and people had an input for what was included. Relatives were listened to and felt they could raise any concerns they had with the registered manager. People with diverse cultural needs were supported to ensure equality within the service.

There was a positive, open culture in the home and staff were empowered to deliver a high quality of care and support to people. The registered provider and the registered manager understood their responsibilities and closely monitored quality. People, staff and relatives were encouraged to engage in the service and their care. The registered provider continually looked for ways they could improve the service and ensure sustainability. The service worked in partnership with other agencies.

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.

Rating at last inspection

The last rating for this service was good (published 17 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

The Old Hall is registered to provide accommodation and personal care for up to 13 people who have a learning disability or autistic spectrum disorder.

There was a registered manager in post at the time of our inspection. 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 the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act, 2005 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 them. The management and staff understood their responsibility and made appropriate referrals for assessment. Nine people living at the service had their freedom lawfully restricted under a DoLS authorisation and a further two were waiting on assessment.

Staff undertook appropriate risk assessments for all aspects of a person’s care to keep them safe from harm inside and outside of the service. Care plans were developed to support people’s individual needs. Staff knew what action to take and who to report to if they were concerned about the safety and welfare of the people in their care. People received their prescribed medicine safely from staff that were competent to do so. The registered provider ensured that there were always sufficient numbers of staff on duty to keep people safe.

People were supported to have a nutritious and balanced diet and hot and cold drinks and snacks were available throughout the day. People had their healthcare needs identified and were able to access healthcare professionals such as their GP and dentist. Staff knew how to access specialist professional help when needed.

People were at the centre of the caring process and staff acknowledged them as unique individuals. Relatives told us that staff were kind and caring and we saw examples of good care practice. People were always treated with dignity and respect. People were cared for by staff that were supported to undertake training to improve their knowledge and advance skills to enable them to perform their roles and responsibilities.

People were supported to have an active life and were encouraged to take part in hobbies and interests of their choice. Relatives commented that their loved ones were well looked after and their wellbeing had improved since moving into the service.

People where able were supported to make decisions about their care and treatment and maintain their independence. People had access to information in an easy read format about how to make a complaint. Relatives told us that they could approach staff with concerns and knew how to make a formal complaint to the provider.

The registered provider had robust systems in place to monitor the quality of the service and make improvements. Staff had access to professional development, supervision and feedback on their performance. People, their relatives and staff found the registered manager approachable.

We saw evidence the home had a deep clean throughout since our last inspection. We saw the home was clean throughout.

We saw the grounds were tidy and people were able to move about them safely.

We saw some areas had been decorated and unsafe furnishings had been replaced.

The people told us they were happy living in the home.

We saw people were engaged in a variety of activities in and out of the home. Some people went swimming and others were looking forward to watching a local football match that evening.

We spoke with families. One said, 'No concerns, everything is perfect.'

People who lived in the home told us they were happy.

We saw people were cared for, or supported by, suitably qualified, skilled and experienced staff.

All the staff we spoke with said it was a good home, people were safe and the manager was approachable.

We found some records were not securely stored.

We saw members of staff were effectively supported by the manager to deliver a high standard of care.

The home was kept clean. People were encouraged to act independently by helping to keep their rooms tidy and assisting with the preparation of meals.

People enjoyed a wide variety of daily activities ranging from visits to museums to voluntary work at a local hospice caf'.

We saw the home sought the opinion and comments of the people who lived there and their relatives. One person said, 'It's great living here, everyone's really nice.'