03 December 2014 and 06, 09, 11, 12, 16, 20 February 2015
During a routine inspection
The inspection was unannounced and took place on 3 December 2014. However in the course of finalising and analysing the information, we became aware of more serious information therefore we extended the remit of the inspection. Further visits took place on 06, 09, 11, 12, 16, and 20 February 2015.
The previous full inspection at the Alders Residential Home was carried out on 07 November 2013. The service was judged to be non-compliant in two outcomes, management of medicines and supporting workers. The home was re-visited on 25 March 2014 and the registered provider had made the necessary improvements to meet the relevant requirements.
The Alders Residential Home is registered to provide care for up to 32 older people who do not require nursing care. At the time of our visit there were 26 people who lived there. Accommodation is on two floors with a stair lift for access between the floors. There are several lounges, two dining rooms and a central courtyard for people to enjoy. The home is situated close to shops, buses and the local facilities of Morecambe.
When we visited the home on 03 December 2014 we met with the manager. The manager wasn’t registered with the Care Quality Commission (CQC). 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. The manager informed us that he had submitted an application.
Prior to our inspection on 06 February 2015 we were aware the manager had received their registration with CQC on 23 December 2014. We visited the home on six occasions in February 2015. The registered manager was not present during this time. At each visit we met with a director of the company that operated the service.
During our visit in December 2014, people told us they were happy living at home. The atmosphere was friendly and routines were relaxed. We observed staff and people who lived at the home had time to spend together and enjoyed each other’s company. People who lived at the home and family members we spoke with, were complimentary about the care they received from staff who they felt were knowledgeable and competent and treated people as an individual. Comments included, “Staff are very particular, they keep everything to a very high standard and they all treat me like a friend.” “The staff are caring.” And, “There has been a difference in the last few months for the better.”
However in response to serious information we received we undertook further unannounced visits in February 2015. We were informed incidents had occurred that resulted in the suspension of staff and were being investigated by external agencies.
Through our observation and discussions with people we noted that a number of systems to monitor the quality of the service and keep people safe had failed. There were numerous breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which meant the service was not safe, effective, caring, responsive or well-led. You can see what action we told the provider to take at the back of the full version of the report.
Suitable arrangements were not in place to ensure people were safeguarded against the risk of abuse by means of responding appropriately to any allegation of abuse. There was no evidence that the registered manager had responded to concerns raised with them about care practices. You can see what action we told the provider to take at the back of the full version of the report.
Recommendations made to the registered manager and provider during our inspection in December 2014 about the maintenance at the home had not been acted upon. Work had not been undertaken to secure the building and the electrical certificate had not been renewed. Immediate requirements made by Lancashire Fire and Rescue Service had not been acted upon. Fire doors were wedged open or not effectively closing into their frames. You can see what action we told the provider to take at the back of the full version of the report.
The staffing levels at night were inadequate to keep people safe. There were two members of staff on duty. A number of people had disturbed sleeping patterns and a there had been a high number of unwitnessed falls. One member of staff told us, “If we are dealing with somebody else or getting residents up, people are left to wander.” You can see what action we told the provider to take at the back of the full version of the report.
The provider did not have appropriate arrangements in place to manage medicines. There was not a clear audit trail of medicines administered. Records were signed, but the tablets had not been given to the person. You can see what action we told the provider to take at the back of the full version of the report.
Thorough recruitment practices were not followed so that the provider was assured staff were suitable for their role. You can see what action we told the provider to take at the back of the full version of the report.
Suitable cleanliness standards were not in place for keeping the service clean and hygienic to facilitate the prevention and control of infections. You can see what action we told the provider to take at the back of the full version of the report.
Suitable arrangements were not in place to ensure staff received appropriate training to carry out their role and responsibilities. Training requirements for staff members had been identified but not delivered. You can see what action we told the provider to take at the back of the full version of the report.
We observed that one person’s liberty was deprived without the authorisation of the appropriate supervisory body.
Where people had been assessed as at risk of poor nutrition and hydration, arrangements for monitoring people’s weight, diet and fluid intake was not regular or consistent. We observed staff support at mealtimes was minimal for those people who needed oversight and assistance to eat their meals. You can see what action we told the provider to take at the back of the full version of the report.
We found that people did not experience care, treatment and support that met their needs and protected their rights. This was because plans and procedures were not in place for dealing with changes in peoples` care and how best to support and protect people. We also found that the planning and delivery of care did not always take account of how best to meet people`s individual needs. You can see what action we told the provider to take at the back of the full version of the report.
Recommendations made to the registered manager and provider during our inspection in December 2014 about improving the assessing and monitoring of the quality of service had not been acted upon. The systems to monitor the quality of the service and keep people safe had failed. You can see what action we told the provider to take at the back of the full version of the report.
It is a requirement of the Care Quality Commission (Registration) Regulations 2009, that the provider must notify the Commission without delay of the death of a person who lived at the home. In addition the provider should notify the Commission of other incidents including the serious injury to a person or allegations of abuse towards a person or any incident which is reported to or investigated by, the police. This is so that we can monitor services effectively and carry out our regulatory responsibilities. We noted during our inspection in February 2015 that incidents which took place at the home in December 2014 and January 2015 should have been submitted to CQC. The registered manager or provider should have notified us. Our systems showed that we had not received any notifications.