Archived: Alston Lodge Residential Home Limited

Updated 17 May 2019

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

This inspection was conducted by two inspectors and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Alston Lodge Residential Home Limited is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

Our planning took into account information we held about the service. This included information about incidents the provider must notify us about, such as abuse; and we looked at issues raised in complaints and how the service responded to them.

We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.

We obtained information from the local authority commissioners and safeguarding team. We used all this information to plan our inspection.

During the inspection, we spoke with four people who lived at the home and three family members to ask about their experience of care. We spoke with the registered manager, the owner, and three members of staff. We looked at five people’s care records and a selection of other records including quality monitoring records, recruitment and training records for three staff and records of checks carried out on the premises and equipment.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

After the inspection, we received further feedback through email from three relatives. We continued to seek clarification from the provider to corroborate evidence found. We looked at training data and quality assurance records. We spoke with two professionals who regularly visit the service.

Updated 17 May 2019

About the service

Alston Lodge Residential Home Limited is a care home that was providing personal care and accommodation to 13 people aged 55 and over at the time of the inspection. The service can support up to 16 people some who may be living with dementia, physical or mental health needs.

People’s experience of using this service

People and their relatives told us that they received safe care and treatment. They spoke positively about the care and support provided. The registered manager had reported safeguarding concerns to the local authority. However, the reporting procedures were not robust to ensure all safeguarding concerns were reported to allow independent investigations. Our findings showed improvements were required in a number of areas to ensure the care delivered was consistently safe, reliable and person-centred.

The registered manager had assessed people’s needs and, in some cases, provided staff guidance on how these needs were to be met. However, this was not consistent as we found three people had no care plans and people who had experienced falls and people who received medicines covertly did not have care plans for this. This meant staff did not have adequate guidance on meeting people’s needs effectively. Care records were generic and not person-centred. We made recommendation about care planning.

People did not always receive their medicines in a safe and effective manner. Practices for the management of covert medicines and ‘as required’ medicines were not robust. In addition, medicines storage practices and medicine records had not been managed in line with best practice and national guidance.

Staff showed a good understanding of their roles and responsibilities for keeping people safe from harm. Staff showed a motivation to deliver care in a person-centred way. However, individual risks to people and the environment had not been adequately monitored to minimise the risk of avoidable harm re-occurring. People were not adequately observed for injuries that may appear after a fall and the provider did not show how they had learned from incidents, events or near misses in the home. The registered manager and the provider had maintained the premises and any faults were timely rectified.

Staff supported people to have maximum choice and control of their lives however staff’s understanding of mental capacity principles needed improvements. Consent records were signed by family members without mental capacity assessments to show why people could not consent on their own. Some authorisations for restrictions on people’s liberties had been considered or applied for where required. However, we found up to four people who required applications for authorisation did not have this in place. The registered manager took action after our inspection.

Staff had received a range of training and support to enable them to carry out their role safely. This included the care certificate. However, staff training arrangements at the home needed to be reviewed to ensure staff were provided training by a recognised and competent training provider and to ensure training arrangements were consistent with best practice. We made a recommendation about staff training.

Governance arrangements were in place to monitor and improve the care delivered. However, we found the audits and quality checks had not been adequately implemented to support the registered manager and the provider in identifying shortfalls.

The provider had made improvements to the staffing levels since our last inspection. They had also made improvements to ensure people were supported with meaningful day time activities.

People received support to maintain good nutrition and hydration and their healthcare needs were understood and met.

People were not adequately supported with to discuss their end of life preferences. We made a recommendation about end of life care planning.

People and family members knew how to make a complaint and they were confident about complaining should they need to. They were confident that their complaint would be listened to and acted upon quickly. Previous complaints had been dealt with appropriately.

The leadership of the service promoted a positive culture within the staff team. People, family members and staff all described the registered manager as supportive and approachable. The registered manager showed they were committed to improving the service and displayed knowledge and understanding around the importance of working closely with other agencies and healthcare professionals where needed.

Rating at last inspection

At the last inspection the service was rated requires improvement (published 11 April 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

At the last inspection the provider was in breach of regulations because they had not provided adequate numbers of staff and people were not supported with meaningful day time activities.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider is no longer in breach of these two regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the management of risks to people’s health and well- being including the management of falls, safe management of medicines. We also found breaches in relation to seeking authorisations for care that involved restrictive practice. We have also made recommendations in relation to person centred care records and the environment at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. In addition, we will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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