Archived: Alphington Lodge Residential Home

Updated 13 May 2015

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

This inspection took place on 13, 21 and 23 January 2015 and the first two days of inspection were unannounced. Two inspectors were accompanied by an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone living with dementia who uses this type of care service.

Prior to the inspection we reviewed a range of information to ensure we were addressing potential areas of concern and to identify good practice. This included the Provider Information Record (PIR), which asks the provider to give some key information about the service, including what the service does well and improvements they plan to make. We also reviewed previous inspection reports and other information held by CQC, such as notifications. A notification is information about important events which the service is required to tell us about by law.

During the visit we met with people living at the home and 12 of these people shared their views on living at Alphington Lodge Residential Home. 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 comment directly on their experiences of living at the home.

We spoke with eight visitors at the home; a ninth visitor contacted us after the inspection. We also spoke with eleven staff including the registered manager; five staff members spoke to us in detail about their roles. We contacted the district nursing team, four other health professionals and the local commissioning and contracting team. We observed care and support in communal areas and visited people’s bedrooms and two bathrooms. We reviewed a range of records about people’s care and how the home was managed. These included the care plans for six people, the training overview for staff employed at the home, the recruitment files for three staff working at the home and medication records. We also discussed the quality assurance audits systems in place and walked around the home with a staff member.

Updated 13 May 2015

We visited the home on 13, 21 and 23 January 2015. The visit was unannounced and was carried out by two inspectors. The service provides accommodation without nursing care and is registered for 28 people to live at the home.

There was a registered manager. 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.’

No-one living at the home was subject to a Deprivation of Liberty Safeguards (DoLS). However, during the inspection, the lead inspector identified several people who required an application based on information provided by the registered manager and senior staff. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes.

People living at the home were not protected against the risks of unsafe management of medicines. Risk assessments were poorly completed for people whose actions or care needs put them and/or others at risk. Staffing levels were inconsistent and therefore did not meet the required levels that had been assessed by the registered manager and providers to meet people’s care needs. People living at the home were not protected against the risks of an unsafe building.

Poor auditing arrangements for people’s finances and a lack of clear information for staff meant people were not protected from abuse. Improvements were needed to the home’s recruitment procedure to ensure staff were suitable to work in a care home setting. Suitable arrangements were not in place to obtain, and act in accordance with, the consent of people living at the home. People living at the home were cared for by staff who had not been appropriately supported through training and supervision.

Staff practice did not always maintain people’s dignity and privacy. Care planning did not people’s individual needs and did not ensure the welfare and safety of people. There was not an effective complaints system to address people’s concerns.

There was not an effective system to regularly monitor and assess the quality of the service and the risks to the people living there. The provider is required by law to notify the Commission of any allegation or instance of abuse. Notifiable incidents should have been reported and were not.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

People were positive about the quality and range of food at the home. They said the food was well cooked and they enjoyed their meals. People living at the home shared the following comments about staff “they feed me and look after me well” and another person said some staff were “extremely nice”. Some visitors praised the quality of the care at the home but others raised concerns. They told us they felt these concerns were not always listened to by the registered manager.

Our findings do not provide us with any confidence in the provider’s ability to bring about lasting compliance with the requirements of the regulations. We are taking further action in relation to this provider and will report on this when it is completed.