Allonsfield House

Allonsfield House is a residential care home providing personal and nursing care for up to 53 people. The service provides support to older people and those living with dementia. At the time of our inspection there were 48 people using the service.

Allonsfield House accommodates people across three separate units, each of which has separate facilities. Allonsfield Suite was the residential wing, Ashfield was the nursing wing and the dementia unit accommodated people living with dementia.

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

People were not always supported to take part in activities which were relevant to them, in particular people living with dementia. We observed people left unsupported for extended periods of time which meant they engaged in self-soothing activities.

The decoration and furnishing of the dementia unit was not designed to support people living with dementia. The decoration in the Allonsfield Suite was tired and in need of improvement. Improvements in this area were included in the service improvement plan.

There were sufficient staff to meet people’s needs. However, they were not always deployed effectively. We observed periods where people in the dementia unit were left without staff support. There was not always staff available in the dining rooms to support people if needed.

People were supported by safely recruited staff who had received training in how to support them safely and effectively. Staff were aware of the risks to people and were kept up to date with changes in people's care needs. Where accidents and incidents took place, appropriate actions were taken and reported on. Staff had received training in how to recognise signs of abuse and were aware of their responsibilities to report any concerns they may have. People were supported to receive their medication as prescribed.

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.

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 requires improvement (22 October 2022).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Allonsfield House is a residential care home providing personal and/or nursing care to up to 53 people. The service provides support to adults in one adapted building. At the time of our inspection there were 46 people using the service, some of these people were living with dementia.

The service is split into three units. Allonsfield provides residential care and support, Ashfield provides care and support to people living with dementia and Ashfield Suites which provides nursing care.

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

Since our last inspection, there was a new manager working in the service. The manager had submitted a registered manager application to the Care Quality Commission (CQC).

There were audits in place where the service had identified shortfalls and a service improvement plan to identify when the improvements would be made. However, we found shortfalls in recording, including in people’s care plans, risk assessments and the recording of when people had received their medicines prescribed for external use. There were plans for these shortfalls to be addressed but had not been implemented at the time of our inspection.

We received positive feedback about how the service was being led by the manager. People were asked for their views on the service and this was used to drive improvement. When incidents and accidents had happened, there were systems to learn lessons and reduce future incidents.

People and relatives told us they were happy with the service being provided and felt it was safe. There were systems in place designed to reduce the risks of abuse. Checks on the environment and equipment used reduced the risks to people. Medicines, such as tablets and liquids were provided to people when required safely.

Staff were available when people required assistance and recruitment of staff was undertaken safely. Staff received training to meet people’s needs. There were plans to access further training to enhance staff knowledge, such as supporting people with behaviours that may challenge others.

Prior to using the service people’s needs were assessed. People were supported to have access to health professionals where required and where concerns about people’s health were identified referrals were made by staff. People had access to food and drinks, and this was monitored to ensure people received sufficient amounts. 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.

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 (published 3 January 2020).

Why we inspected

This inspection was prompted by a review of the information we held about this service. Which raised concerns about governance, medicines and consent. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Allonsfield House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The home was clean, hygienic and free of unpleasant odours.

There was a designated central entry system into the home. Everyone was temperature tested, had their oxygen levels checked through a finger pulse oximeter and completed hand sanitisation before entry. Staff used a separate entrance to the service to minimise the risk of exposure to an infection.

Staff had received training in infection control and prevention and in donning and doffing of personal protective equipment (PPE). Additional training to support effective screening had been provided. This included the use of lateral flow tests (LFT) and finger pulse oximeter.

PPE stations were situated throughout the home. There were sufficient supplies of PPE and staff were observed to wear this appropriately.

The environment had been adapted to support social distancing. This included additional break out areas for staff.

In line with current guidance robust arrangements to safely facilitate indoor visits for people living in the home to see their family/friends was in place. This included a booking system, screening checks and appropriate use of PPE.

The registered manager confirmed that staff employed in the service did not work in any other care settings. This meant the risk of cross infection was reduced.

Arrangements for regular testing of Covid-19 for people living in the service and staff were in place. This ensured action could be taken swiftly to reduce the risk of exposure if a positive test was returned and in the event if anyone developed symptoms of the virus.

Risk assessments had been completed to protect people living in the service and staff. Where risks had been identified, for example staff who may be at higher risk of contracting Covid-19, measures were in place to mitigate the risk and to support them.

Consideration had been given to effective zoning and cohorting of staff in the event of an outbreak of Covid-19 in the home. This was underpinned by the provider’s risk assessment of the home.

Regular checks were in place to ensure effective infection prevention and control measures were followed.

Allonsfield is a residential care home providing accommodation and personal care for up to 42 people aged 65 and over. At the time of the inspection the home was supporting 31 people. The service does not provide nursing care

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

At this inspection we found that risk assessments designed to record how to keep people safe were reviewed and amended as necessary when people’s circumstances changed. There were clear procedures in place which were operated effectively for the purpose of protecting people from abuse. The manager had implemented a robust and effective governance system to monitor the service performance and act upon any issues identified.

People informed us they were happy living at Allonsfield House and there were enough staff both day and night to look after them. Senior staff had been trained in the administration of medicines and people received their medicines as prescribed. The manager reviewed events at the service with the staff to determine if any lessons could be learnt. Staff had been trained including in areas of infection control and received supervision and appraisals.

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’s specific communication needs were known, respected and met.

Staff supported people as needed to select meals of their choice. People informed us they were happy with the quality of the meals provided. Staff took time to monitor that people ate sufficient and weighed people as required to determine if they were losing weight.

Each person had a care plan which included person-centred information about them. People’s desired outcomes were known, and staff worked with people, relatives and relevant professionals to help achieve and review these with their consent. People were encouraged and supported to retain their independence, maintain or develop new interests and live their lives as they chose.

The service had a complaints policy which was known to the people using the service and their relatives. The manager arranged meetings and was available to discuss any issues with regard to resolving any problems identified. The service provided activities and entertainments in line with people’s interests.

The manager had recently joined the service and was actively promoting a supportive, open and transparent culture. Management and staff understood their roles and responsibilities. Staff informed us they enjoyed working at the service because they were well supported. Annual surveys gave people, relatives, staff and visiting professionals an opportunity to express their views and contribute to improvements.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was inadequate (published 07 August 2019) and there were three breaches of regulation. The provider completed actions after the last inspection to improve the service. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 07 August 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

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.

People’s experience of using this service:

Recommendations had been given to the provider by the Local Safeguarding Authority to implement following an alert of abuse being upheld by their team. The recommendations were developed to ensure people were kept safe and the same concerns were not repeated. The provider had not taken steps to ensure all the recommendations were implemented and the risks to people were reduced.

Risks to people’s health and wellbeing were not always identified and appropriately assessed to ensure care planning was effective to meet people’s needs.

The provider did not have suitable arrangements in place to ensure the effective management and implementation of required actions around fire safety, staff training in this area and appropriate assessment for fire evacuation.

Systems were not suitably developed to ensure lessons could be systematically learnt from areas of concern, including information to be taken to keep people safe from accidents and incidents and any complaints received.

Systems for the governance and oversight of service provision were being redeveloped and some gaps in auditing and monitoring of the service were evident. There was not an accurate picture of the quality of the support delivered to people.

There had been a high turnover of staff and agency staff were being used to cover the rota. Checks to agency staffs suitability to work with vulnerable people were limited.

An action plan had been developed specifically for the service but it did not include key improvements required following recent incidents.

The provider had an electronic system for managing and recording medicine administration and we found this worked well for keeping practice safe.

We reviewed rotas and found they were consistently covered with either permanent or agency staff. On the day of the inspection people’s needs were met in a timely way.

There had been steady improvement in the ethos and values base at the home since the new registered manager came to post with staff and people in the home sharing positive relationships.

The provider had been developing more positive relationships with local professionals including the local pharmacy and district nursing teams.

Rating at last inspection: The last inspection report which was published 15 December 2018 found the service to be requires improvement overall and required improvement in the effective, responsive and well led key questions. Following this focused inspection, the overall rating had deteriorated to inadequate.

Why we inspected: We completed this inspection following concerns in relation to support provided to people. Specifically, how and when external specialist support was requested. How the provider ensured the support provided by the specialist team was included within the risk assessments and risk management plans for the person and how the implementation of advice was both followed and monitored. A person had died and this is subject to an ongoing investigation. At this inspection we reviewed the areas which were required to improve, to reduce associated risks moving forward. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

Prior to our inspection we reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

Enforcement: We formally asked the provider for specific information in relation to the action they had taken to address concerns. We found the provider in breach of three regulations. Regulation 12, safe care and treatment, Regulation 13, safeguarding people from abuse, Regulation 17, good governance.

Follow up: Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Allonsfield House is a care home without nursing that provides a service for up to 42 older people living with dementia and/or a physical disability. On the day of our inspection visit there were 31 people living in the service. 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

After the last inspection on 29 August and 4 September 2017, we asked the provider to take action to make improvements to staffing levels and their governance procedure and we have seen a degree of improvement at this inspection. However this has not been as timely as it should have been and we were unable to assess that this had been embedded and effective over time. This report shows areas for further development.

People told us they felt safe living in the service and when receiving care and support. Our previous inspection had found that improvements were needed in staffing levels. At this inspection we found that this had improved but in some instances, there were still not sufficient staff to support people in a personalised way and a peak times of need.

Care files included a range of risk assessments such as moving and handling, nutrition and continence. These were regularly reviewed and updated according to people’s needs. However, we found that reporting of incidents was inconsistent which meant that risks to people were not being effectively monitored.

People were protected by the provider's recruitment processes. Safe recruitment practices were followed before new staff were employed to work with people. Required checks were made to ensure staff were of good character and suitable for their role.

People received effective health care and support. Medicines were stored and handled correctly and safely. There were infection control appropriate policies and procedures in place.

The service was not always working within the Mental Capacity Act 2005 (MCA). Where people had Deprivation of Liberty Safeguard applications authorised by the relevant authority these were not kept under the review. We found one which had expired. There was a lack of understanding of the decision-making process using relevant legislation and guidance. We have made a recommendation referring the service to the guidance available on the MCA and the decision making process.

Some of the building interior decoration had become shabby and tired. Decoration in the unit which specialised in supporting those living with dementia was not always appropriate. This had been recognised and there were plans in place to improve these areas. However, there were no firm timescales in place to achieve these improvements. Internally the service was clean and hygienic.

There were two new activities co-ordinators in post with plans in place to improve the experience of people with more person-centred activities. However, these plans were still being developed with some people still feeling disengaged with activities.

A range of audits were carried out by managers in the service. Whilst the provider told us that these were used to drive improvement we found that they were not always effective in identifying and addressing deficiencies at an early stage and taking immediate action.

The service used an integrated electronic care planning system. This had been introduced prior to our last inspection and we found staff understanding of the system required improvement. At this inspection we found this had improved and staff recorded day to day activities on the system. However, there was still inconsistencies with how some information was put into the system.

You can see what action we told the provider to take at the back of the full version of the report.

The service provides care and support for up to 42 people. On the dates of our inspection there were 40 people living in the service, some of who are living with dementia. It is divided into two units Allonsfield and Ashfield.

The service is required as a condition of registration to have a registered manager. On the dates of our inspection there was not a manager registered with the CQC in post. There was a manager who had applied to register. 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.

There were not always the number of staff on duty that the service had assessed as necessary to support people safely and effectively. This included the number of night staff and staff with a specialist role, for example activities staff.

Staff training was not effectively monitored to ensure staff had received the required training and that training was up to date. Staff had not all received effective training in areas in which the service provided care, for example, dementia care. Staff received supervision sessions where they could discuss concerns or development needs.

Staff had received training in keeping people safe from abuse and were confident they would be able to identify and respond to any concerns.

The provider had invested in a new care planning system. This was computer based with care staff inputting information via a smart phone. The amount of time it would take for care plans to be put onto the computer and for staff to become competent in the system had not been effectively assessed by the provider. This has resulted in care plans which did not always contain full information about the care to be provided and staff not being able to fully access information on the system.

Appropriate checks were carried out before staff started providing care to ensure they were suitable for the role.

Medicines were managed safely to ensure that people received their medicines as prescribed. The service did not comply with the Mental Capacity Act when administering covert medicines, that is when disguised in food.

People had mixed views on the quality of the food provided. Care plans contained information on people’s nutritional needs.

People were supported to maintain good health and access other healthcare professionals.

Staff respected people’s privacy and dignity when providing care and support. However, as an organisation dignity was not promoted with linen being old and tired and a lack of crockery.

The service did not have a planned programme of meaningful activities either for people as individuals or for the service as a whole.

The manager and the provider carried out a variety of audits. However, these had not always identified areas of concern. Where the audits had identified shortfalls action to address these had not always been put in place.

People we spoke with confirmed they were consulted about the care and support that they were provided with and understood the care and treatment choices available to them. One person told us, 'They (staff) are good. They tell me when it is time to take my medication and are quick to call the doctor if they think someone is poorly. They don't hang about. They got the doctor in the other day for me. I wouldn't have bothered as it was one of those things, an off day. But, they (staff) don't take a chance; shows they care.'

We looked at five people's care records. The records showed that people's needs were assessed and care and treatment was planned in line with their individual care plan. We saw evidence in the care records that people received safe and coordinated care, treatment and support where more than one provider was involved.

People said they were given a variety of meals that were, 'Very pleasant and well cooked,' and, 'Always appetising.' One person said, 'The food is nice. I enjoy what we have. There is plenty of choice and they (staff) are not stingy with the portions.'

We looked at staff records and spoke with four members of staff who told us they were being appropriately supervised and supported. Staff were knowledgeable about the people they supported and how to meet their needs.

During our inspection we saw that staff interacted with people in a caring, respectful and professional manner.

We followed up one area of non-compliance identified in a previous inspection. We reviewed evidence that demonstrated the provider's compliance in this area.

Care plans held information on all aspects of a person's care needs. We saw some examples of clear guidance to staff on how to support people with specific needs. Some plans could have been more person-centred.

The service had demonstrated that it raised safeguarding concerns in the correct way and dealt with them appropriately. Relatives had commented in a recent survey that their family members were well looked after, and any problems were sorted out promptly.

Staff were praised by people using the service and their relatives. One person told us, 'Staff are always willing to listen.' Another said, 'I feel I can always ask questions if I am unsure. Nothing is too much trouble.'

The service used several ways of monitoring the quality of care, especially the care of those living with dementia. The provider had introduced a project to improve staff knowledge about supporting those people. Care practices were audited regularly to ensure people received dignified and respectful care.