The Old Hall is a privately owned care home providing accommodation and personal care for up to 39 elderly people. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

This unannounced inspection took place on 10 and 13 July 2018. At the time of our inspection 36 people were living in the home.

There was a registered manager in post. 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. As the registered manager was on annual leave during our first day of inspection we were assisted by the registered provider. We made a second visit to the service in order to speak with the registered manager.

The Old Hall was last inspected in 2015 when we had no concerns. However, at this inspection we found some shortfalls at the service. We found staff were not following best practice in relation to medicines. Staff did not carry out routine in-house fire evacuation drills. Although accidents and incidents were recorded, there was a lack of information included to evidence the outcome of an accident and what action was taken.

Staff did not always follow the principals of the Mental Capacity Act in relation to decisions made for people. We received positive feedback about the food people were served. Although people’s care plans covered their care needs, there was little personal information about people and their past lives and some information in care plans did not reflect people’s current needs. We have made a recommendation to the registered provider in this area.

People lived in a suitably adapted environment and had access to healthcare professionals when they needed it. People’s needs were assessed before moving in to the service and they were cared for by a sufficient number of staff who had been recruited through a robust process.

People told us they felt safe living at The Old Hall and staff were able to describe to us what they would do should they suspect any abuse taking place. Staff followed good infection control processes and the environment people lived in was clean.

People were cared for by staff who showed kindness, dignity, respect and attention towards them. People could have privacy when they wished it and make their own choices in how they received their care. People were seen receiving visitors and being enabled to remain as independent as possible.

People were protected from the risk of social isolation as activities were provided which they enjoyed. People told us they were happy living at The Old Hall, but should they have a complaint they would have no hesitation in speaking to management.

People gave us positive feedback about staff and management and in turn staff were enabled to contribute towards the running of the service through regular staff meetings.

During our inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made four recommendations to the registered provider. You can see what action we told the provider to take at the back of the full version of the report.

The Old Hall is a privately owned care home providing accommodation and personal care for up to 39 older people. There were 39 people living at the service on the day of our inspection. Bedroom accommodation is arranged over two floors. A passenger lift provides access to both floors. Bedrooms are single occupancy and have en suite facilities. Several lounge and dining areas are located throughout the home. There is a large landscaped garden to the rear of the service and a car park is provided at the front of the service.

This inspection took place on 10 December 2015 and was unannounced.

The home was run by a registered manager, who was present on the day of the inspection visit. ‘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.

There were sufficient numbers of staff who were appropriately trained to meet the needs of the people.

Staff recruitment procedures were robust to ensure that people had appropriate checks undertaken before they commenced employment.

Risk assessments were in place for identified risks. Risks were well managed and reviewed and updated on a regular basis. These had been reflected in people’s care plans.

Staff had received training in safeguarding adults and were able to evidence to us they knew the procedures to follow should they have any concerns. One staff member said they would report any concerns to the registered manager. The staff we spoke to knew of types of the different abuse and where to find contact numbers for the local safeguarding team if they needed to raise concerns.

Procedures were in place for medicine administration. People received their medicine as prescribed. All medicines were administered and disposed of in a safe way.

We checked whether staff were working within the principles of the Mental Capacity Act 2005, and whether any conditions on authorisations to deprive a person of their liberty were being submitted appropriately and found that they were.

People had access to a range of health care professionals, such as the GP, district nurse, dentist and opticians to ensure that their health was maintained.

People told us the food was very good and there was lots of choice. We saw people had access to drinks and snacks at any time during the day or night.

People were treated with kindness, compassion and respect, and their privacy and dignity was respected at all times. People told us they could participate in activities of their choice which were planned every day by an activities coordinator.

People had individual care plans. They were detailed and updated regularly. We saw staff had the most up to date and appropriate information to enable them to respond to people effectively.

People were encouraged and supported to be involved in their care. People’s bedrooms had been decorated to a good standard and were personalised with their own possessions.

The registered manager operated an open door policy and we saw several examples of this throughout the day when staff, relatives and people who used the service sought their support and advice. People were aware of the complaint procedures and told us they would know how to make a complaint.

The registered manager had maintained accurate, complete and detailed records in respect of people and records relating to the overall management of the service.

The registered manager had systems in place to record and monitor the quality of the service provided and to make improvements where necessary.

Accidents and incidents were recorded and acted upon by the registered manager.

Staff were aware of the home’s contingency plan, if events occurred that stopped the service running. They explained actions that they would take in any event to keep people safe. The premises provided were safe to use for their intended purpose.

On the day of our visit there were 38 people residing in the home. We were met by the registered manager and briefly met the owner of the service.

We found that people who used the service were always being asked by staff if they consented to their care, and their right to refuse care was being respected. The people we spoke with said that care was never forced upon them.. We also found the provider had a process in place to deal with situations where decisions had to be taken in a person’s best interest.

We found that people were happy with their care and that staff engaged with people in an appropriate and sensitive manner. People said things like: “It couldn’t be better”; “The staff are very thoughtful, kind and generous”; We also found that people’s needs were being properly assessed, managed and reviewed.

We found that people were being properly protected against abuse and staff were able to identify, respond to, and report abuse. All the people we spoke with said they felt safe from harm in the home.

We found that there were enough staff to provide proper staffing cover at all times. However, some people and staff we spoke with said they thought staffing was an issue on occasions.

We found that the provider was regularly obtaining feedback from people and staff. We also found that the provider monitored and assessed the whole service on a regular basis, although most of this was not being recorded.

At the time of our inspection 38 people were living in the service. Our inspection was facilitated by the registered manager.

We saw that people had their individual needs assessed before admission and that they or their relatives had been involved in planning their care and support.

We noted that staff treated people who used the service with politeness and respect. We observed that people looked well cared for and that those who wished to were engaged in group activities with staff. One person we spoke with told us, “The staff are unfailingly generous with their care and support”.

We noted that guidance regarding safeguarding people from abuse was available to staff and that they had received recent relevant training. One person that we spoke with told us, “This is a very safe community and we are lucky to be so well looked after”.

We saw that the building was being equipped with double glazed lockable windows and doors. We also saw that the general security of the premises and gardens was appropriate and adequate. The registered manager told us that a programme of en suite shower replacement was underway.

We saw that staff recruitment processes were thorough and that required checks had been carried out before staff were engaged.

We noted that there was an effective complaints system in place. A person we spoke with told us, “I can’t think of anything I might wish to complain about. They want us to be as happy and comfortable as possible”.