We served a warning notice on Flollie Investments Limited on 16 October 2024 for failing to meet the regulations related to Good Governance and Safeguarding at Alice House.
We carried out a review of the data available to us about Alice House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Alice House, you can give feedback on this service.
Part of the house had been sectioned off to provide 10 assessment placements. This is where people can come following a hospital stay, the provider will assess the persons needs prior to them returning home or moving on to longer term accommodation. At the time of the inspection there were seven people in the assessment unit and 19 people living in the main part of the home.
The home has communal spaces such as lounges and a dining room on the ground floor. There is a garden area for people to spend time outside. Everyone had their own individual bedroom, most rooms had handwashing facilities and a toilet, rooms with handwashing facilities only shared communal bathrooms.
We found the following examples of good practice.
The provider had previously had an outbreak of COVID-19 in the home. At the time of the inspection all residents and staff had tested negative.
When staff came on shift, they were expected to record their temperatures, take their oxygen levels, sanitise their hands and put on their personal protective equipment (PPE) before entering the building. Staff used a separate entrance and got changed before they started their shift. Staff working in the assessment unit also wore protective suits as additional protection because people were being regularly admitted and discharged.
Staff had good knowledge of infection prevention control (IPC). All staff had received IPC training, including how to safely put on and take off PPE such as gloves, aprons, and face coverings. A staff member said, “We do IPC training online, we do part one and part two, they are very strict with that.” We also saw several posters around the home with reminders of how to maintain good infection control processes.
The home was clean and tidy. The provider employed a team of housekeepers to provide cleaning duties over a seven-day period. There was a robust cleaning schedule that included disinfecting touch points, and steaming areas, several times a day.
We saw staff wearing appropriate PPE. When changing their PPE between rooms staff removed it inside the room and placed it in a yellow bag then took their yellow bag to the nearest clinical waste bin. Staff then put on fresh PPE. Not all rooms had foot operated bins to dispose of clinical waste. We discussed this with the provider who agreed to place foot operated waste bins in each bedroom for staff to remove and dispose of their PPE prior to leaving the room. This will further reduce the risk cross contamination.
During the recent lockdown the provider had stopped all visitors coming into the home. One staff member told us, “We connect people to their families with phone calls, we also sent pictures to families of people having fun.” The providers visitor’s policy was clear and in line with national guidance. Visitors were required to follow the homes infection control procedures. The provider had created a visitor’s pod and encouraged garden visits.
The home was split into two floors. The registered manager explained how they would implement zoning as the corridors were able to be closed off in the event of another outbreak. There was a contingency plan where one area of the home would be blocked off if they had any further positive cases. The registered manager said they had support from Public Health England and the local commissioning team when they did have an outbreak in the home.
The provider was admitting people to the home, mainly on the assessment unit as this was for short periods of stay. The registered manager told us, "No-one would be admitted without a negative test first and their belongings would go into isolation for 72 hours prior to the person moving in." Once people came in, they were isolated in their rooms for 14 days, this was made clear through signage on doors, and staff allocated to this unit did not work in the main home. The providers admissions policy confirmed this was the correct process for the home.
The registered manager ensured regular testing was carried out, weekly for staff and monthly for people living in the home. This was in line with COVID-19 testing guidance. However, whilst people did not refuse to be tested, the registered manager had not recorded consent in line with the Mental Capacity Act 2005. We discussed this with the registered manager who assured us they would review this and ensure all care records are updated.
Alice House is a residential care home providing personal care and support to 18 people living with conditions associated with dementia at the time of the inspection. The service can support up to 32 people.
Alice House is a large detached adapted house with accommodation over two floors and access via a passenger lift. The environment has been adapted for people living with dementia. Bright contrasting colours and clear pictures and signage has been used throughout the home to assist people to be independent and find their way around.
People’s experience of using this service and what we found
People said they felt safe, happy and well cared for at Alice House. One person said, "It’s very nice here, I feel very safe, it’s homely."
Most people were unable to give an informed view of their experience of living at Alice House. However it was clear from our observations people were comfortable and moved freely around their home. Staff interactions with people were kind, caring and considerate. For example when one person became agitated, staff quickly defused the situation.
Some improvements were needed in the recording of medicines. We have made a recommendation in respect of this.
There were sufficient staff with the right skills and support to meet people’s needs and wishes. Staffing had been reduced due to a decision to reassess some people who needed additional support. This meant the number of people using the service had decreased in recent months. This was a planned strategy to ensure Alice House was offering the right support to people. In recent weeks the numbers of people using the service had increased and the registered provider agreed they did now need to review staffing and increase care staff by at least one. They did not currently use a dependency tool to help them review staffing levels. Following feedback, they agreed to research this to find a dependency tool which they could utilise.
People enjoyed a variety and choice of meals. Their healthcare needs were closely monitored and the service worked in partnership with other professionals to achieve good outcomes for people, including end of life care.
Staff provided a varied programme of activities taking into consideration peoples past and their hobbies and interests. Staff were skilled at engaging people throughout their day. They tried to involve people with everyday tasks such as washing up, folding laundry and prepping vegetables. This was offered alongside engaging people in hobbies and interests. There was a dog who lived on site. People enjoyed taking the dog out for walks.
Staff had training, support and mentoring to enable them to do their job effectively and safely. Staff felt valued and believed their views and opinions were listened to.
The service had a relatively new manager, who had previously worked at the home as a senior then a deputy manager.
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 (Report published 18 August 2017)
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.
There was no registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run. A new manager had been appointed. They had submitted their registered manager’s application for consideration to the Commission.
At our previous inspection we found that people were not protected from the risk of infection. At this inspection we found sufficient improvements had been made. Staff were aware of safeguarding procedures and had received training in safeguarding. Discussions with staff demonstrated that they knew how to put these procedures into practice and staff described how they would report concerns if they suspected or witnessed abuse. Staff told us they felt confident to speak directly with the manager. However, the service had failed to notify the Commission of statutorily notifiable incidents; we have made a recommendation about this.
There were sufficient numbers of suitably qualified staff employed at the service. The provider's recruitment process ensured that only staff deemed suitable to work at the home were employed. Staff did not commence working in the home until all pre-employment checks had been satisfactorily completed.
The staff had a clear knowledge of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). These safeguards aim to protect people living in care homes from being inappropriately deprived of their liberty. These safeguards can only be used when a person lacks the mental capacity to make certain decisions and there is no other way of supporting the person safely. We have made a recommendation around how the service records people’s best interest decisions for people.
People’s needs were regularly assessed and resulting care plans provided guidance to staff on how people were to be supported. Care plans reflected people’s preferences and personalities.
People were supported to maintain good health as staff had the knowledge and skills to support them. There was prompt access to external healthcare professionals when needed. There were processes in place for the safe storage and management of medicines.
People's care was provided by staff in a caring and compassionate way. People's interests had been identified and they were supported in a way which prevented them from becoming socially isolated. Each person was supported to access and attend a range of activities and local community facilities.
Staff had confidence in the leadership of the manager. There were audits systems in place to assess, monitor and improve the quality and safety of the service. Feedback from people and their relatives confirmed they were happy with the service and the support received.
Further information is in the detailed findings below.
This inspection took place on 3 March 2015 and was unannounced Alice House provides accommodation for up to 23 people who require nursing or personal care. There were 19 people on the day of our inspection. The home specialises in providing a service to older people who are living with dementia. At our last inspection on 12 December 2013 there were no breaches of the legal requirements identified.
There was a registered manager in post at the time of our visit. 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 and associated Regulations about how the service is run.
There were systems in place to reduce the risk and spread of infection. However these were not followed .This had resulted in some areas of the home not being satisfactorily cleaned and people were at risk of acquiring infection and cross contamination. You can see what action we told the provider to take at the back of the full version of this report
People told us they felt safe and well cared for. We saw risks to people were identified and plans put in place to monitor and reduce risks. Staff attended to people’s needs quickly and were patient, caring and understanding in their approach. Staff were available in different parts of the home to provide support to the people who used the service. Relatives told us they were happy with the care provided. People and their relatives told us there were enough staff.
Appropriate recruitment checks were made on staff and there were enough staff to meet people’s needs. Medicines were administered safely. There were checks on the equipment at the service.
People’s needs were assessed and their preferences identified across all aspects of their care to provide them with appropriate care. People could see relevant health professionals when they needed. Specialist support was sought for staff to help improve their understanding and management of aspects of people’s dementia.
The service complied with requirements of Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The MCA and DOLS provide a legal framework that protects people who lack the mental ability to make decisions about their life and welfare.
A range of suitable activities were organised that considered people’s varied needs. The people who lived at Alice House had complex health and care needs and were supported to choose or join in group activities. We observed that staff spent one-to-one time with people throughout the day.
Care plans had been reviewed and audited. These provide a clear detailed guide for staff with the involvement of people, or their relatives if appropriate. There was a clear system of audits to monitor the quality of the service and actions identified were addressed.
We saw that people who used the service had their individual needs fully assessed and that their care was planned and reviewed regularly. We saw that staff treated people with respect and that people had their dignity maintained.
One relative told us "I know all of the staff by name, I know my relative is safe here" and a member of staff told us "I would be happy for any of my relatives to be here".
We saw procedures that were in place to protect vulnerable people from abuse and we spoke to staff and to the manager who confirmed that they had been trained and felt confident and competent to identify and report any safeguarding concerns.
We saw that staff had received training relevant to their role and that they had received regular appraisals and supervision.
We saw how the manager monitored the quality of the service provided and relatives of people who used the service told us that they felt able to raise any concerns with any member of staff.
People who were able to express an opinion said that they were happy with the care that they received. One person said 'We are here to be helped and that's what they do.' We saw that people were able to make choices about how they spent their time and whether or not they joined in with activities.
There was a relaxed and calm atmosphere in the home. Interactions between staff and people were kind and friendly. One person said 'They greet me as a friend in the morning and we go through the whole day like that.'
We saw that some people's bedroom doors were locked when they were unoccupied during the day. This meant that people were unable to access their rooms without staff support which could restrict their freedom of movement around the home.
Staff spoken with felt there were adequate staff on duty at all times. This ensured that people's physical needs were met and everyone was able to take part in activities. At lunch time we saw that staff were not always appropriately organised to meet the needs of people who lived at the home.
There was a complaints policy which gave people information about how to make a complaint and contact details for outside agencies if they were unhappy with the home's response to a complaint.
On our visit, we observed care and support delivered with patience and kindness from caring members of nursing and support staff. The home was clean and tidy and well appointed with a mix of carpet and laminate flooring, and a lift between floors. The home had recently been redecorated in communal areas and has a new large conservatory area. The rear garden is paved and safe for people to enjoy. All of the people who live at Stanton Nursing Home are able to sit together in one of three different areas which are interlinked, and can be seen if they are sitting in the garden. The home also has a separate dining area where people are able to sit and eat together at mealtimes, and can carry out activities and tasks when the room is not in use for serving food.
People's rooms were clean and tidy and fixtures and fittings of a good standard. Medicines and clinical equipment was safely stored and secure. The home has a professionally appointed kitchen and provides a variety of choice of food, drinks and snacks to people and members of staff who live and work at Stanton Nursing Home.