The Hall

The Hall provides accommodation, nursing and personal care for up to 19 people diagnosed with a mental illness. There were 15 people using the service at the time of our inspection.

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

Staff knew the people they supported well and were caring and compassionate towards them. A person said, “I like living here because the staff work hard and are nice and kind.” Staff involved people in decisions about their care and supported them to be independent and achieve their potential.

People felt safe using the service and staff understood where people were at risk and what to do to minimise this. The home was well-staffed to ensure people’s needs were met. People had their medicines on time and how they wanted them. All areas of the home were clean, tidy and fresh. Accidents and incidents were analysed and the findings used to improve the care provided.

Staff completed a range of essential and specialist training courses to enable them to support people effectively. They worked closely with healthcare professionals to ensure people’s physical health needs were identified and met.

People’s liked the food served and their dietary needs were met. A person said, “The food is good, we get a choice.” The home catered for a variety of diets including vegetarian and gluten-free.

People had activity care plans and the opportunity to take part in group and one-to-one activities. People said they enjoyed the exercise classes run by the home’s occupational therapists. People’s diversity needs were met and the home celebrated cultural and religious festivals and events.

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.

The home provided good-quality personalised care that achieved positive outcomes for people. A person said, “This place gets you better both mentally and physically.” The register manager was well-organised, effective and approachable. The provider and senior staff carried out a range of quality assurance checks and audits to ensure the home was running safely and effectively.

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 Good (based on an inspection on 21 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Hall provides accommodation, nursing and personal care for up to 19 people who have a mental illness. There were 9 people receiving support at the time of our inspection.

The service had a registered manager. 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.

People told us that they felt safe. Staff understood how to keep people safe and report concerns if needed. The registered manager had ensured that all staff had undergone relevant employment checks.

Risks had been assessed and measures put in place to support people to remain safe. The environment had been considered and where people displayed behaviours which may harm themselves or others staff supported them to manage their anxieties.

People received their medicines as and when they needed them and medicines were managed safely.

People made decisions about their care and the support they received. People were involved and their opinions sought and respected. The registered manager understood their responsibility to ensure people were supported in line with the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

Staff felt supported by the registered manager. There received training and guidance to carry out their role. Staff had a clear understanding of their role and how to support people who used the service as individuals.

People’s health needs were met and when necessary, outside health professionals were contacted for support. Staff understood how to support people to maintain their health. People were supported to have sufficient to eat and drink.

People were treated with kindness and respect. Their independence was promoted and their opinions asked. People were clear on what support they could expect to receive and had access to independent professionals who could help them ensure they received the care they wanted.

People received care and support that was tailored to their individual needs. Professionals with expertise in their conditions were involved in planning people’s care with them. People’s needs were kept under review and plans were changed to reflect changing needs.

The registered manager and staff team were working to support people to engage in activities that were meaningful to them.

People who used the service felt they could talk to the registered manager and had confidence concerns would be acted upon. Staff were clear of their role.

There were effective systems for gathering information about the service, identifying areas of concern and to drive improvement. The provider demonstrated a drive for improvement through lessons learnt and best practice.

The registered manager was aware of their responsibility to report events that occurred within the service to CQC and external agencies.

At our last inspection carried out on 27 August 2014 the provider was not meeting the requirements of the law in relation to the care and welfare of people who use services and staffing. Following that inspection the provider sent us an action plan to tell us about the improvements they were going to make.

During this inspection we looked to see if these improvements had been made. We found that whilst some improvements had been made, some issues of concern remained.

Bhajan Kaur Rai Hall provides accommodation for up to 20 older people. There were 20 people using the service on the day of our inspection including people living with dementia.

The person managing the service was an acting manager. They were in the process of applying to be the 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.

Some of the people using the service and their relatives felt there were not enough members of staff to support them properly. We observed occasions when people were required to wait to have their needs met as there were not always staff available to support them.

We saw that there was a policy in place that provided staff, visitors and people using the service with details of how to report safeguarding concerns. Staff were aware of this policy and how to report and escalate concerns if required. The provider followed safe recruitment practices.

People could not be fully assured that they would receive their medicines as prescribed by their doctor. Clear guidance about how staff should administer ‘as required’ medicines and creams was not available to staff.

We saw that staff received appropriate training to enable them to meet the requirements of their role and they felt supported by the acting manager.

Systems were in place to monitor the health and wellbeing of people who used the service. People’s health needs were met and when necessary, outside health professionals were contacted for support.

The service catered for individual dietary needs and staff were aware of how to provide these. People told us that they enjoyed the food provided. We saw that when people required support to eat their meals this was not always provided in a dignified manner and one person was required to wait for over an hour in the dining room before they were assisted with their meal.

The provider could not be sure that staff had given people the correct amount of fluids they needed to keep them well because recommended fluid intake was not clear and the total amount people drank was not tallied.

Where people lacked capacity to make decisions, records did not to show that decisions had been made for them in their best interest or in consultation with others.

Consideration had been given to the responsibility of the service to meet the requirements of the Deprivation of Liberty Safeguards (DoLS).

Staff treated people with kindness and respect but there were times when staff were rushed and task orientated. People told us that they felt listened to and their opinions sought.

People were not always supported to follow their interests and limited activity or stimulation was provided.

We saw that people’s needs had been assessed and care plans had been put in place for staff to follow to ensure people’s needs were met. People had been referred for specialist input and advice received had been followed. Staff were made aware of people’s changing needs so that they were able to meet them.

People who used the service felt they could talk to the acting manager and had faith that they would address any issues if required. Relatives found the staff and the acting manager to be approachable. Feedback from residents or relatives was not consistently asked for.

Staff were clear of the service’s vision and values. Systems were in place to monitor the quality of the service being provided but these were not always effective. The acting manager understood their role in reporting events to outside agencies.

We also spoke with the registered manager, senior manager and eight staff this included a variety of both care staff and non care staff such as domestic and maintenance staff. We looked at some of the records held in the service, including the care files for three people who used the service.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask. This is a summary of what we found.

Is the service safe?

The provider assessed and reviewed people's needs to ensure plans of care, and associated risk assessments were up to date and reflected people's needs.

People were supported in an environment that was maintained to a safe, clean and hygienic standard. We also found equipment at the home had been maintained and serviced on a regular basis.

People's dependency needs had been assessed. However, we had concerns that there were not sufficient staff available at all times to meet people's assessed needs and keep people safe.

Is the service effective?

We saw the provider completed a pre-assessment of people's need prior to moving to the service. Care staff had information available to them that instructed them of how to meet people's needs.

People's care and welfare needs were monitored and we saw appropriate action had been taken when changes to people's health had occurred.

The provider had a detailed and structured induction programme for new staff. Staff received formal opportunities to discuss their training and development needs.

Is the service responsive?

People we spoke with told us they felt they had their needs met and that they were confident the provider acted appropriately to any changes in need.

People received support to practice their faith where they had requested it. Whilst we were told that an activity coordinator was employed at the service, people raised concerns about the lack of activities and stimulation. The lack of meaningful activities and stimulation impacted on people's welfare needs.

Is the service caring?

We found the service to have a warm, welcoming and relaxed atmosphere. Staff were observed to interact with people in a caring manner, showing dignity and respect at all times.

People using the service and relatives spoken with, talked positively about the staff. Comments included, 'Staff are very good, helpful and friendly.'

Is the service well-led?

We found the provider had systems in place that enabled them to monitor the quality and safety of the service.

Information from the analysis of accidents and incidents had been used to identify changes and improvements to minimise the risk of them happening again.

The provider had a complaints policy that promoted people's rights and choices. This was easily accessible to people who used the service.

People had a range of assessments and care plans in place to inform staff about how to support people and meet their daily needs. People were supported to take their medicines. Arrangements were in place to ensure people's care and health needs were met safely and risks were managed.

People were supported by staff that underwent a robust recruitment process to ensure they were suitable and qualified to work with vulnerable people. People were comfortable with the staff that supported them. One person said: 'Staff seem to be very nice here.'

People were aware of how to make a complaint and provided with a copy of the complaint procedure. One person said: 'I haven't got any complaints. I would complain if I had a problem.'

Information about the people who used the service was kept in their individual care files and stored securely. Staff were aware of their responsibilities to maintain accurate records. Other records relating to the staff and the management of the service were accurate, kept secure and could be easily accessed when required.