The Old Hall is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to provide accommodation for up to 20 older people and people living with dementia. There were 20 people living in the home at the time of our inspection. The registered provider also offers day care support in the same building as the care home although this type of service is not regulated by CQC.

We inspected the home in the period 29 January to 5 February 2019. The first day of our inspection was unannounced.

At our last inspection we rated the home as Outstanding in four of the five key questions and overall. At this inspection we were pleased to find the registered provider had made many further improvements in pursuit of an ever more safe, effective, caring, responsive and well-led service. As a result, the home is now rated Outstanding in all five key questions and overall.

People were at the very heart of the service and everyone with we spoke with told us of the exceptional kindness they had experienced at The Old Hall, and how good this made them feel. One person said, “I have been here for four years now and have never regretted it. You feel as though you are not only cared for but really loved. I want to spend the rest of my days here as I couldn’t wish for anything more.” Staff promoted people’s right to make choices in every aspect of their lives and actively supported them to maintain their independence for as long as possible. People were treated with the utmost dignity and respect and end of life care was provided in an exceptionally person-centred and compassionate way.

There was 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 was deeply involved in all aspects of the running of the home and provided her team with principled, person-centred leadership. She had created an exceptionally open and positive organisational culture and staff worked closely together, internally and externally, to provide people with highly personalised care and support. The registered manager gave a very high priority to the learning and development of both herself and her team. As a result, staff had all the skills and knowledge necessary to meet people’s individual needs and expectations. The provider had a highly selective approach to recruitment to ensure new staff were suitable to work in the home.

Under the registered manager’s research-led leadership a number of innovative changes had been made, all of which had proved extremely effective in maintaining and improving people’s physical and mental health. These included establishing a new team of well-being therapists; the introduction of Lady – an affectionate Cavalier King James Spaniel; the ongoing development of an internal ‘token economy’ and the creation of the Welcome Bar.

The provider had a meticulous and exceptionally person-centred approach to assessing and reviewing people’s individual needs and preferences. Staff had a deep and holistic understanding of each person living in the home, derived in part from the strong relationships they had forged with people’s relatives. People were actively involved in many aspects of the running of the home and had the opportunity to participate in a rich variety of one-to-one and communal activities and to maintain personal interests and hobbies.

The provider placed a very high emphasis on ensuring people were properly nourished and hydrated. People were completely satisfied with ev

The Old Hall is registered to provide residential care for up to 20 older people, including people living with dementia. The service also provides day care support although this activity is not regulated by the Care Quality Commission (CQC).

We inspected the home on 28 October 2015. The inspection was unannounced. There were 19 people living in the home at the time of our inspection.

The service had a registered manager in post. A registered manager is a person who has registered with 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.

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 the inspection the manager had submitted DoLs applications for two people living in the home and was waiting for these to be assessed by the local authority.

People were at the heart of the service. Staff understood what was important to the people living at The Old Hall and worked closely with each other and with families to ensure each person had a meaningful and enjoyable life. People played an active part in the running and development of the home

Innovative approaches such as ‘30 second activities’ and ‘Daisy’s Shop’ enhanced people’s quality of life and provided therapeutic benefit to people living with dementia.

People were supported to retain an active presence in the local community and to maintain their personal interests and hobbies. A specialist activities team organised a rich programme of communal activities for those who wished to participate.

The manager and staff undertook outreach work in the local community to promote greater awareness and understanding of the needs of people living with dementia.

The provider regularly assessed and monitored the quality of care to ensure national and local standards were met and maintained. A culture of continuous improvement was in place to promote further enhancement of the service.

The manager demonstrated an open, reflective management style and provided strong values-based leadership to the staff team.

There was a warm, homely atmosphere and staff cared for people with kindness, patience and understanding. Staff had time to meet people’s needs and to interact with them individually, without rushing.

People and their relatives were closely involved in planning and reviewing the care and support they received. Staff listened to people and had a detailed understanding of their needs and preferences. Staff understood the issues involved in supporting people who had lost capacity to make some decisions.

People felt safe living in the home and staff understood how to identify, report and manage any concerns related to people’s safety and welfare. The provider had systems in place to assess and manage risks to people’s safety. An innovative ‘traffic light system’ was used to alert staff to particularly important risks.

Staff received regular training from specialist agencies that provided them with the knowledge and skills to meet people’s needs in an effective and person-centred way. Sound recruitment practice ensured that the staff employed were suitable to work with the people living in the home.

Staff had developed strong relationships with local healthcare services which meant people received any specialist support required. Medicines were managed safely.

Food and drink were provided to a high standard and people could choose what to eat and drink and when.

People and their relatives could voice their views and opinions. The manager listened to what people had to say and took action to resolve any issues. The provider reviewed untoward incidents and concerns to look for opportunities to improve policies and practices for the future. There were systems in place for handling and resolving complaints. 

Below is a summary of what we found when we inspected The Old Hall on 26 August 2014.

The summary is based on our observations during the inspection, speaking with four people who used the service, one relative, the registered manager and four staff. In addition, we looked at care records, the arrangements to keep people safe from abuse and quality assurance.

We considered our inspection's findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

If you want to see the evidence supporting our summary please read the full report.

Is the service caring?

We found that the service was caring. We observed that staff were respectful, kind and attentive. People we spoke with told us that staff were kind and helpful. One person we spoke with told us; “I have nothing but good things to say about the home. I would describe it as home from home.”

Relatives we spoke with told us that staff were polite and courteous to people who used the service.

Is the service responsive?

We found that the service was responsive. We observed that people’s individual needs for care had been assessed. Staff knew about each person’s care needs, choices and preferred routines.

People told us that their care needs were met and that staff listened to what they said and provided care in line with their changing needs and wishes.

The provider had a complaints policy in place and staff had received training in how to manage complaints. They were able to tell us how they would escalate any concerns raised.

Is the service safe?

We found that the service was safe. Systems were in place to make sure the manager and staff learnt from events such as complaints, concerns and investigations. This reduced the risks to people and helped the service to continually improve.

Safeguarding procedures were in place and staff we spoke with and records we looked at confirmed that staff were trained and understood how to safeguard the people they supported.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. The Mental Capacity Act (2005) and Deprivation of Liberty Safeguards is law which protects people who are unable to make decisions for themselves.

Is the service effective?

We found that the service was effective. People’s health and care needs were assessed. People, and where appropriate, their relatives, were involved in reviewing their care plans. Specialist dietary requirements, mobility and equipment needs had been identified in care plans where required.

Records showed people had access to a range of healthcare professionals some of whom visited people at the home.

Is the service well led?

We found that the service was well led.This was because people had been consulted about their experience of using the service When suggestions were made we saw evidence that these were considered and used to improve the service that people received.

There was a clear line of management. This meant that important decisions about organising someone’s care were made by senior staff while carers could use their own judgement to provide a flexible service.

We used a number of different methods to help us reach a judgement on the quality of the service provision. These included talking with three people who used the service and two visitors to the home. We also spoke with the registered manager, the housekeeper, three care staff , the cook and one of the owners.

We looked at records. These included care plans and information about how the service was managed. We conducted a tour of the building and observed the interactions between the care staff and people residing at the home.

The records we looked at showed that people’s needs had been assessed and appropriate support provided to care for their needs.

We found that people were provided with a choice of suitable and nutritious food and drink in sufficient quantities to meet their individual needs and preferences. One person who lived at the home told us, “The food’s excellent. Can’t fault it and plenty of it.”

We saw that the building was well furnished and in excellent decorative condition. It was well maintained and free of any unpleasant odours.

A visiting healthcare professional said, “It’s fantastic. Improved, improved, improved. I would put my mum in here. Or myself.”

We found that people were cared for in a safe and caring environment and the service was well led and managed.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not always able to tell us their experiences. These methods included observation and speaking to relatives of people using the service.

One person living at the home who we spoke with said, “I made the decision to come and live here myself. I’ve never regretted it.”