The inspection was unannounced and carried out by one inspector on 02 December 2014 and 04 December 2014. Hale Place Farmhouse is a period property that is registered to provide care and accommodation for up to ten older people living with dementia. Ten people were living there at the time of our inspection. The home is situated on the same site as a second home which is also owned and managed by the same provider. The two homes that share the same grounds also share other facilities including an office outbuilding, garden and laundry room. Staff work as one team across both locations during the day.
People had varied communication needs and abilities. Some people were able to express themselves verbally; others used body language to communicate their needs. Some of the people’s behaviour presented challenges and was responded to with one to one support from staff.
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 2008 and associated Regulations about how the service is run.The registered manager was supported by two managers and each specialised in specific areas relevant to the management of the service. The registered manager was the owner and oversaw the quality assurance of the service. Another manager oversaw care and treatment and relevant documentation that were specific to people’s individual needs. Another manager oversaw the recruitment, training and management of staff. The managers worked closely together to ensure the smooth running of the service.
Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual and included risks when people were out in the community. Staff followed clear guidance to reduce the risk of harm whist ensuring people’s freedom was not unnecessarily restricted in any way.
There were sufficient staff on duty to meet people’s needs. Staff had time to spend supporting people in a meaningful way that respected individual needs. Staffing levels were calculated and adjusted according to people’s changing needs.
There were safe recruitment procedures in place.All staff were subject to a probation period and disciplinary procedures if they did not meet the required standards of practice.
Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.
People lived in a clean and well maintained, warm and welcoming environment that was suited to meeting their needs. People’s own rooms were personalised to reflect their individual tastes and personalities. There were clear signs displayed to help people find their way around. Staff had a thorough understanding of infection control practice that followed the Department of Health guidelines which helped minimise risk from infection.
Staff knew each person well and understood how to meet their support needs. Each person’s needs and personal preferences had been assessed before they moved into the service and were continually reviewed. This ensured that the staff knew about and responded to their particular needs and wishes when they moved in and during their stay.
Staff used their training and skills to communicate with people in ways they could understand. Interaction between people and the staff showed that staff promoted people’s independence and protected their rights.
Staff’s training was renewed annually and staff received further training specific to the needs of the people they supported. Staff received regular one to one supervision sessions and an annual appraisal to ensure they were supported to carry out their role. Staff were supported to study and gain qualifications in health and social care.
The Care Quality Commission (CQC) is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS). All care staff and management were trained in the principles of the MCA and the DoLS and were knowledgeable about the requirements of the legislation.
Staff sought and obtained people’s consent before they helped them. One person told us, “The staff always check with me that it’s OK before they do anything”. When people declined, their wishes were respected and staff checked again a short while later to make sure people had not changed their mind.
The staff provided meals that were nutritious, in sufficient quantity and well balanced. People were able to have wine, beer, water or fruit juice with their meals. One person told us, “The food is really good”. One relative told us, “The food is unbelievable”. Staff knew about and provided for people’s dietary preferences and restrictions. People were supported by staff with eating and drinking whenever they needed this help.
Staff communicated effectively with people, responded to their needs promptly, and treated them with kindness and respect. People told us they were satisfied with the way staff cared for them. One person told us, “I really like the girls (Staff); they are like my own family”. Two relatives said, “We could not ask for better staff”.
People were able to spend private time in quiet areas when they chose to. People’s privacy and dignity were respected and maintained at all times.
Clear information about the service, the management, the facilities, and how to complain was provided to people and visitors. Menus and the activities programme were displayed in communal areas. A relative told us, “We got all the information we needed”.
People’s care had been planned and this was regularly reviewed with their or their relative’s involvement. A relative told us, “We feel involved, they listen to us”. One of the managers told us, “It is vital to know the whole person who may no longer know themselves, to talk with all the people who know them, their likes and dislikes, so we can connect with them”. People were referred to health care professionals in a timely way. A G.P. told us, “They provide excellent care in all categories”.
People were at the heart of the service. The staff promoted people’s involvement with their community and took groups or individuals on outings and ensured they took part in attending special events to minimise social isolation.
A wide range of activities and outings that included innovative ideas was available. This had a positive impact on people’s wellbeing. People were kept occupied, entertained and their interest in what was going on outside of their routine was stimulated. “The activities on offer are fantastic, our Mum has never been so alert and stimulated by all that is going on, we don’t recognise her since she has moved in Hale Place”. The registered manager told us, “Our goal is to keep people as active as possible and prevent social isolation to enhance their wellbeing”.
People’s views were sought and acted on. People’s relatives were asked about their views when they visited the home and via an internet website. The service sent annual questionnaires to people’s relatives or representatives, analysed the results and acted on them.
Staff told us they felt valued and inspired under the registered manager’s leadership. The provider, the registered manager and staff had won several Great British Care Awards which are a series of regional and national awards throughout the UK.
The service notified the Care Quality Commission of any significant events that affected people or the service and promoted a good relationship with stakeholders.
The registered manager kept up to date with any changes in legislation that may affect the service, and participated in monthly forums with other managers from other services where good practice was discussed. They pro-actively researched specialised publications and websites to identify innovative ways to enhance people’s quality of life and introduced these to the service.
The registered manager and two other managers carried out comprehensive audits to identify how the service could improve. They acted on the results of these audits and made necessary changes to improve the quality of the service and care.