• Care Home
  • Care home

Archived: Alphington Lodge Residential Home

Overall: Inadequate read more about inspection ratings

1 St Michaels Close, Alphington, Exeter, Devon, EX2 8XH (01392) 216352

Provided and run by:
TN CARE LTD

Important: The provider of this service changed. See new profile

All Inspections

13, 21 and 23 January 2015

During a routine inspection

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.

18, 26 June and 10 July 2014

During an inspection looking at part of the service

The purpose of this inspection was to review compliance with a warning notice for outcome 4 Care and welfare of people using services. This was issued following an inspection of the home on 30 November and 3 December 2013. A follow up inspection took place on 11 February 2014 and 14 February 2014 during which we found the home had not fully achieved compliance. This meant the warning notice was not lifted. We agreed with the providers we would allow them further time to achieve full compliance.

During this inspection we also reviewed the following outcome areas because there were outstanding compliance actions, and because of information we had received since the last inspection '

' outcome 11: safety, availability and suitability of equipment

' outcome 13: staffing

' outcome 16: assessing and monitoring the quality of services provided

' outcome 21: records.

At the time of this inspection 24 people were accommodated at the home. The inspection was carried out by three inspectors over three days. We reviewed the care given to six people living in the home by reading their care records, by talking to people, relatives and staff and by observing staff interacting with people. We also spoke with nine people who lived in the home, 10 relatives and visitors a doctor, a community nurse, six members of staff and the registered manager. We also had e mail communication with a speech and language therapist. We carried out a short observational framework inspection (SOFI) during which we observed staff interaction with people at lunchtime, focussing specifically on three people. We carried out a short tour of the home, and checked records relating to the management of the home.

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

We found there were improvements in the way people's care needs were met since our last inspection. During the first two days of this inspection we found some records did not provide sufficient evidence to show how potential risks such as choking, moving and handling, and risk of falls had been assessed and reviewed. Actions to be taken to reduce the risks were not always clearly specified. The staff we spoke with demonstrated an understanding of each person's basic care needs but told us they had not read the care plans fully, relying on verbal handover. The manager told us they would take prompt action to improve the records and make sure staff read the care plans and understood the tasks they had to carry out. Therefore we returned to the home for a third day to see if this had been carried out. On this visit we saw checklists and new summary sheets had been put in place for each person explaining the care tasks to be undertaken, including tasks necessary to prevent or reduce risks. Despite these further improvements some records still contained conflicting information and had not been fully reviewed or not met consistently. Monitoring systems to check the records were improved, but there remained a risk some essential care needs may be missed.

Staffing levels had improved and at the time of this inspection we found there were sufficient staff on duty with the appropriate skills and experience required to ensure people's needs were safely met.

The manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Health and social care professionals had been involved appropriately where people may have been deprived of their liberty due to the nature of their care needs. This meant that the home had acted in line with Deprivation of Liberty Safeguards legislation (DOL's). This legislation protects people's rights when they are unable to make decisions about their own welfare.

Is the service effective?

On the first two days of our inspection staff told us that systems to make sure essential daily routines were carried out had improved since our last inspection. They said there was good teamwork and staff were working together and communicating well.

We saw daily reports were completed by staff throughout the day providing evidence of the care people had received.

Is the service caring?

People told us the staff team understood the care they needed. They had been asked about their needs and had agreed their care plans. Comments included 'A gentleman sat and spent a lot of time asking questions about my care needs. They were all sensible questions. I am happy that my care plan is correct," and 'It feels so much like home ' it's friendly ' you are made to feel important. We can't speak highly enough of it here.'

People were supported by staff who were understanding and sensitive to their needs. We saw that staff offered choice and waited for responses. Relatives told us 'To be surrounded by so much caring is good for both her and myself" and 'Very happy the staff were giving the correct care'. We heard a relative speaking with a senior member of staff about the care their mother received during a period of serious illness and they talked about their confidence in the care provided by the staff.

We observed friendly, warm exchanges between people, visitors and staff. Staff were kind and attentive. We saw staff supporting people to walk around the home safely, staff taking people out into the garden, and people participating in activities in a cheerful, friendly and supportive atmosphere.

Is the service responsive?

The service was not fully responsive to people's needs and wishes. We saw that where people's needs had changed their care plan information had not always been updated. However, we saw evidence to show that systems for reviewing and updating care plans were improving, although not yet fully embedded. The staff we spoke with were able to explain to us how they had recognised signs of illness or distress or changes in care needs.

The staff worked closely with local health professionals and specialist advice, assessment and treatment had been sought promptly and where necessary.

Is the service well-led?

Where we saw some weaknesses in the monitoring systems during the first two days of our inspection the manager and staff took prompt action to make further improvements. On the third day we saw some further actions had been taken. However, due to the newness of these systems it was too soon to be sure they were fully effective.

People, their relatives, outside professionals and the staff were encouraged to provide feedback on the service. A suggestion box in the entrance hall encouraged people and visitors to give suggestions and ideas for improvements to the service. People and their relatives had been asked to complete questionnaires seeking their views on the quality of the service. Meetings were held between people living at the home, their relatives and staff which provided opportunities for issues to be raised and information to be shared.

You can see our judgements on the front page of this report.

11, 14 February 2014

During an inspection looking at part of the service

In June 2013 we inspected this service and made compliance actions in seven outcome areas. In December 2013, we carried out another inspection and judged improvement was still needed in order for the service to be compliant with the Health and Social Care Act 2008 and further compliance actions were made. We also took enforcement action in connection with two outcomes relating to privacy and dignity, and care and welfare. In February 2014, we received an anonymous concern relating to staff attitude, poor care planning and the quality of the teatime meal.

This inspection took place on 11 and 14 February 2014 and was unannounced. The purpose was to follow up on our enforcement action. A further inspection will take place to check on the compliance actions made in December 2013.

There were 23 people living at the home, including one person on a short stay. We spoke with ten people living at Alphington Lodge and three relatives. We also spent time with people in communal areas of the home so we could make a judgement about how well people were cared for as some people were not able to comment directly on their care. We also spoke with five staff members and the manager. We looked at a selection of care records and staff communication records, and focussed on privacy and dignity, and care and welfare. We also contacted health and social care professionals who had recently visited the home to gain their views.

Based on our discussions with people living at the home, staff, relatives and visiting professionals, as well as on our observations and care records, we judged there had been improvements regarding ensuring people were treated with dignity and respect, and choice was promoted. However, there was not a significant improvement for people's care and welfare, with identified risks being poorly managed and changes to people's moving and handling needs not being met. The enforcement action remains in place and we will be inspecting the service again to check on compliance.

30 November and 3 December 2013

During a routine inspection

The purpose of this inspection was to check the service had addressed the compliance actions issued following the last inspection on 19 June 2013. At that inspection we found the service was not compliant in the following areas:

care and welfare, cleanliness and infection control, safety and suitability of premises, supporting workers, assessing and monitoring the quality of services, complaints, and records.

Since the last inspection we have also received concerns relating to standards of care, low staffing levels, and safety.

This inspection took place over two days. The first day of the inspection took place on a Saturday. We wanted to check staffing levels at weekends. On the second day of the inspection two inspectors spent 11 hours at the home observing care, looking at records, speaking with people who lived in the home, visitors, staff and the manager.

We found some improvements had been made in some areas. Most people had a care plan setting out their basic care and support needs. However, we found there was insufficient written information about the care needs of two people who had recently moved into the home. This meant there was a risk to their health if care staff did not carry out specific tasks.

We also found there had been a high staff turnover since the last inspection. The care staffing levels were low on both days of our inspection. We found care was poorly co-ordinated, call bells were ringing for long periods, and care was not always provided to people in a timely manner. The manager told us they hoped to increase the staffing levels when the recruitment of new staff is completed.

While most staff treated people with respect and dignity we saw examples where staff failed to offer choices or treat people in a respectful or dignified manner. Several people told us the staff were 'marvellous' or 'kind'.

On the first day of the inspection on Saturday no cleaning staff were on duty. We noted problems with odour control and one bathroom was left in an untidy state. On the second day of the inspection a cleaner was on duty and the home appeared clean and odour problems had been reduced..

Support systems for staff had been improved. We saw evidence of staff supervision sessions, staff, meetings, and plans for staff future training needs. We also saw evidence of staff handover sessions.

We saw people had been given information about the home's complaints system and who to contact if they wanted to make a complaint. There was a record of complaints showing complaints received since our last inspection been investigated and actions taken to address the issues that had been raised.

The quality assurance systems had improved. We saw evidence that there were greater checks carried out on management systems in the home. People and their relatives had been asked for their views on the services provided through meetings and questionnaires. However, the quality assurance systems had failed to identify areas of non-compliance found during this inspection.

Some records had improved. Most records were available when we asked for them although we found there had been problems with some maintenance records. We found filing systems had improved.

19 June 2013

During a routine inspection

At the time of this inspection there were 21 older people living at Alphington Lodge. During our visit we spoke with the manager, deputy manager and seven members of staff. We also spoke with ten people who lived in the home and seven relatives or people visiting the home at the time of our visit. We looked at the care records of six people living at Alphington Lodge.

We followed up three compliance actions from our previous inspection in November 2012 and February 2013. These related to the management of medicines, requirements relating to workers, and assessing and monitoring the quality of services. We saw some improvements had been made to address these compliance actions. However we also found further areas of non compliance.

Care plans had not been regularly reviewed or updated. Assessments of risks associated with personal care and health needs had not been regularly reviewed.

While the overall appearance of the home was comfortable and homely, some areas were in need of maintenance. We also found some aspects of the security of the home needed to be addressed. Some parts of the home were not completely clean or hygienic.

.

There were no records to show that staff had received regular formal supervision. We saw that levels of training had improved since our last inspection, but there were no systems in place to evaluate individual training needs or to plan future training needs of the whole staff team.

Systems to regularly assess and monitor the quality of service that people receive were not effective. There were no records of concerns or complaints received, or the actions taken to address them.

22 February 2013

During an inspection in response to concerns

This inspection was carried out in response to concerns we had received. The concerns related to respecting people who used the service, care and welfare, hygiene and infection control, recruitment, and staffing levels.

A new manager had started working in the home a few weeks before this inspection took place. A member of staff had been promoted to the post of head of care. We saw evidence to show they had worked closely to identify the areas where improvements were needed. Plans had been drawn up to address the problems they had identified and we saw actions were in the process of being carried out.

We found that people were treated with respect and dignity. One person told us ' I always get a choice. If I rang a call bell and asked to get up, then they will help me' and 'I have never seen the staff be grumpy with people; they are so patient with the people'.

People received care and support that met their needs. Some care plans did not provide sufficient information to staff about people's personal or health care needs but we saw that these were in the process of being reviewed and improved. People told us they were satisfied with the care they received.

All areas of the home were found to be clean and hygienic.

New staff had not always been recruited following safe recruitment methods.

27 November 2012

During a routine inspection

We spoke in some depth with nine of the 22 people living at the home when we visited, and with one person's visitor. We met others who were less able to give us their views in detail because of their physical or mental frailty. We observed some of the support people received, such as at lunchtime. We spoke with care and ancillary staff, and with the newly appointed manager (who was yet to apply to be registered with us).

The accommodation looked clean and orderly yet homely. Senior staff told us about recent improvements made to the d'cor, furnishings and fittings.

People's privacy, dignity and independence were respected. They experienced care and support that met their needs and protected their rights, with qualified, skilled and experienced staff available to meet their needs. People's comments about their care included 'They look after us very well.' One told us the night staff were 'very punctual', and that the service was much better than their recent experience of a stay in hospital. Another person said 'Everyone seems to be very kind.'

People's views and experiences were taken into account in the way the service was provided regarding their care. However, we found the provider did not have fully effective systems to regularly monitor the quality of the service that they received. We also found that people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements to manage medicines.

8 August 2012

During an inspection looking at part of the service

We carried out an inspection in March 2012 and found that the service needed to make improvements with regard to care and welfare of people, training of care workers and quality assurance systems.

We carried out an inspection of Alphington Lodge on 9 August 2012 to monitor whether improvements had been made. We looked at people's experiences with regard to care and welfare of people, training of care workers and quality assurance systems. In addition to these areas, we also looked at infection control systems and the management of people's medicines. The provider had achieved compliance in all of the outcomes that we previously had concerns about. This was supported by the comments people made about their experiences and what we observed.

There were 16 people living at the home when we visited. We looked at the records of four people in detail; and spoke with four people about their experiences at the service. However, most people were not able to comment directly on their care so we spent time with them to help us understand what life was like at the home. This meant we spent time observing care and people's interactions with care workers to see whether they had positive experiences. To do this we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us about their experiences of care. We used SOFI for one and half hours in the lounge and spent another hour with people there. We spoke with six care workers, two relatives, the manager and a professional who visited the home.

People were involved in all aspects of their care, treatment and lives at the home. For example, we saw care workers respond quickly to a person's request to have their hair washed. We saw that the team had found out a lot of information about people so that they gave person centred care.

We heard that people's needs were met. For example, one person said 'They meet my needs'. Another person told us 'I'm very comfortable here'. Two relatives told us they were happy with the care. For example, one person speaking about their relation said 'She's been cared for to both her and my satisfaction'. Another person told us 'He needs two people to help him and he gets that help'.

We saw that people were mentally stimulated and this had a positive effect on their wellbeing. For example, during the afternoon we saw people doing a range of activities: cake decorating, watching the Olympics, doing puzzles or being encouraged to join in conversations.

In terms of general cleanliness, people had mixed views. For example, two people told us they were satisfied with the level of cleanliness, with comments like 'My room cleaned at least once a day and the bed linen is spotlessly clean'. Conversely, two relations told us that an area for improvement was deep cleaning in the home and commented 'Attention to detail could be improved'.

People said that the manager had listened and was making changes to improve the service. Two relatives told us that they were 'Always made welcome' and 'Kept up to date with developments at the home' and about their relations wellbeing. They also remarked that in their opinion the management of the home would improve because 'The manager is hands on'.

At this inspection, we made a compliance action about record keeping to ensure that detailed evaluations of care delivered for people was documented and always accurate. We also made the provider aware of an area that they might improve, with regard to their own monitoring of maintenance and planned refurbishment of equipment for people to use.

29 March 2012

During an inspection looking at part of the service

This inspection of Alphington Lodge took place on 29 March 2012. The inspection was carried out by two Compliance Inspectors. The inspection was prompted by concerns we received about the health and welfare of some of the people living in the home that indicated that they may not have received adequate care.

During our visit we also followed up on compliance actions issued at the last inspection of the home that took place in October 2011. The compliance actions covered the following essential outcome areas '

' Outcome 4 ' Care and welfare of people who use services

' Outcome 7 ' Safeguarding people who use services from abuse

' Outcome 9 ' Management of medicines

' Outcome 14 ' Supporting staff

' Outcome 16 ' Assessing and monitoring the quality of service provision

At the time of this inspection there were 18 older people living in the home. When we arrived there was one senior care assistant and three care assistants on duty, plus a cook and a domestic. In the afternoon there was also a cleaner on duty.

Since our last inspection the registered manager had resigned. A new deputy manager had been recruited and the providers had started the process of recruiting a new manager. The deputy manager was not expected to be on duty on the day of our visit but, after being contacted by the staff, they arrived at the home shortly after we arrived. This meant they were available to provide us with the information we required and answer our questions. During the afternoon the person employed as the temporary acting manager (part time) also arrived.

During our visit we looked at how the care needs of seven people were managed. We wanted to find out if they had received care and support that met all of their health and personal care needs. One of the people we chose had recently been admitted to hospital and therefore we were unable to talk to them but we were able to talk to the other six people. We looked at their care plans and the records of the care they had received. We also talked to six members of staff plus the deputy manager and the acting manager.

Every member of staff we spoke to confirmed they thought the home had improved over the last few months. When asked to describe some of the improvements, one care worker told us that there were regular staff meetings where staff were encouraged to contribute ideas and those were acted on. Other improvements identified were changes to the care plans which have become simpler and more person centred, changes to the breakfast routine to free up staff to spend more time giving personal care to people. One care worker told us they would like to spend more time with people and would like more help in the office to answer the phone as that takes them away from caring for people.

Five people told us the staff were very kind and helpful and one person said 'people are treated quite well here'. Another person said 'The staff are lovely. They can't do more for you.'

Records we looked at showed there had been improvements made to the care planning system, including the introduction of new assessment forms to be used before new people move into the home. The staff team had received training and updates on all required health and safety topics, and on some important topics relating to people's health and personal care needs. Meetings had been held with relatives and with staff and we were given copies of the minutes of these meetings. The meetings had given people opportunity to raise concerns, and we saw evidence to show that the managers had taken the concerns seriously and had started to take actions to address some of the issues raised.

A new cook had recently been recruited and at the time of our visit she was in the process of drawing up new menus. Five people we spoke to told us the food was very good with lots of choice and fresh fruit and vegetables.

We were told that there had been a high staff turnover since the last inspection. New staff had been recruited and the deputy manager told us there was a positive atmosphere among the staff team. A range of staff training had already been provided and further training was planned for the near future.

Systems for storing and administering medicines had improved.

We found that there were improvements in the areas shown above. However, some people were still at risk of not receiving the care and support they needed. Some risks to people's health and care needs had not been fully assessed, and the planning and monitoring of those risks was not fully effective.

5 October 2011

During an inspection in response to concerns

We carried out this review because of concerns raised through safeguarding processes. These were regarding the meeting of people's health and welfare needs, particularly those who spent most of their time in their bedroom (rather than in the communal day rooms).

On the day we visited, there were 23 people living at the home. We spoke with 10 people who were sitting in their bedrooms when we first looked around the home, and with a visitor to another person. We followed up four of these people and looked at the support they received. We met other people in communal areas, who we spoke with more briefly.

One person we spoke with about the home told us 'I've no fault with it and I'm as happy as my ailment will let me be.' We asked another person if they felt that staff treated them as an individual and they replied 'The staff are very good here.' When we asked a third person if there was anything the home could do better, they replied 'If I wanted anything special, they would do it for me. For example, if I said someone was coming in to see me they'd help me get ready in time.' People told us that their visitors were made to feel welcome. A couple of people went out independently, and people were enabled to be part of a wider community in other ways.

All felt they got the support they wanted. They generally felt staff were respectful, although one person also commented that some staff could be off-hand, and another felt they were spoken to like a child on occasion. We heard some good interactions, and we saw that staff did not rush people when they engaged with them or assisted them to walk. We observed that people were given choices, and their decisions were respected - such as about when they retired for the night or got up in the morning, and if to join in the table games played during our visit. It was not clear, however, that the programme of activities was based on people's interests, previous hobbies and so on. There was little evidence of people's involvement in the planning of their daily or longer term care, and they said they hadn't been asked about their care plan.

People told us that the staff called a doctor if needed or if the person wanted to see one, and that a GP visited routinely every week who people could ask to see on such visits. People said staff were sympathetic regarding their disabilities and needs, allowing people time if they had mobility or communication difficulties and so on. However, risks to their health and welfare had not always been properly identified or assessed. We also found some issues relating to how people's health needs were being met, regarding hydration needs, catheter care and care of wounds. This appeared partly due to a lack of staff training and supervision. Most people told us that they got their medications on time, but we found medications were not managed well enough to ensure people would receive medications they were prescribed.

People said no-one asked them, as we were, how things were generally at the home or what they thought about the service they received. Two added that the home expected people to speak up. The manager told us she went around the home to speak with everyone each day she was on duty. One person remembered being given a survey to complete, and we saw completed copies of the 2010 survey. Many people had responded positively to the questions asked. Where three people had made suggestions or requests, we saw that the service had written a response to them, although this was not often positive in tone. For example, lack of a budget being given as a reason for a cleaning issue raised. The manager told us the home was currently recruiting, to increase staffing for all care shifts and for the housekeeping team. A visitor told us they had no issues with the home or the care provided to their relative. They added that if there was a problem, they just spoke to the staff about it and it was addressed.