Alsley Lodge

Alsley Lodge is a residential care home registered to provide accommodation and personal care for up to 33 people. At the time of the inspection 31 people were living in the service.

People's experience of using this service and what we found

We found the provider had not implemented systems to ensure risks to people’s health and safety were adequately promoted and the management of medicines could have been better. We have made a recommendation about staff competencies in relation to the management of medicines.

In general recruitment practices adopted by the home were satisfactory. However, the employment process for one member of staff could have been better. Therefore, we have made a recommendation about thorough employment checks being conducted for all new staff before they are appointed.

The approach of staff towards people was not always consistent and people were not always involved in the decision-making process. People were not always supported to have maximum control of their lives. Some daily routines did not support people’s choices and the policies of the home and these were not always followed in day to day practice. For example, some practices did not support people to have maximum choice of when they got up or when they had a bath or shower.

The governance of the service was not effective, as issues identified by the inspection team had not been recognised by the internal auditing systems and therefore the assessing and monitoring of the service was not robust.

Care plans varied in quality. Some needed to provide the staff team with clearer guidance about people’s current needs and how these needs were to be best met. However, others were well written and provided more detailed information.

The management of medicines could have been better. We made a recommendation about this.

Enough staff were on duty to meet the assessed needs of people who lived at the home. People looked relaxed in the company of staff and relatives confirmed they felt people were safe living at Alsley Lodge. A good range of training had been provided for the staff team. New employees were guided through an in-depth induction programme and processes were in place to ensure staff were supervised regularly. Community health and social care professionals had been involved in the care and support of people who lived at the home.

A range of activities were provided, which included visiting musicians and outings during the warmer weather. Some person-centred activities were also evident, such as visits to places of interest, based on individual preferences. There was confirmation of community engagement taking place.

We received positive feedback about the manager of the home and the staff team from people we spoke with and their relatives.

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

Rating at last inspection: The service was rated overall good at the last inspection (Published on 10 May 2017). However, the area of well-led was rated as requires improvement. We did not find any breaches of regulations and did not make any recommendations at that time. This was because the provider assured us they would implement a more robust auditing system and would display the CQC rating from the previous inspection more clearly within the home. At this inspection we found the CQC rating from the last inspection to be prominently displayed within the home. However, improvements to the auditing system were not evident.

Why we inspected: This was a scheduled inspection based on the previous ratings.

Enforcement: We have identified breaches in relation to safety, person centred care and good governance. You can see what action we have asked the provider to take at the end of this full report.

Follow up: The service will be re-inspected as per our inspection programme. We will continue to monitor any information we receive about the service. The inspection may be brought forward if any risks are identified.

We issued two requirement notices and asked the registered provider to tell us how they were going to make the improvements required. At this inspection we found that the registered provider and registered manager had made the changes and improvements needed to meet the requirement notices from the previous inspection.

Alsley Lodge provides care and support for a maximum of 33 older people. At the time of our inspection there were 31 people in residence at the home, as the dedicated respite room was vacant and one of the rooms could be used for double occupancy.

Alsley Lodge is in the village of Rufford, near Ormskirk and Burscough. The home, formerly a public house, has been developed to provide accommodation for older people who need assistance with personal care. The property is on one level within its own grounds. Bedrooms are mainly single occupancy but shared accommodation can be offered if required. Many of the rooms have en-suite facilities. Prices vary dependent on the size of the room, facilities and where the room is situated within the home.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 was run.

People told us they felt safe living at the home and this sentiment was replicated by relatives and visiting professionals we spoke with.

Staff knew how to keep people safe and how to recognise safeguarding concerns and detailed accident and incident records were kept. We discussed with the registered manager the possibility of discussing some issues with the local authority safeguarding team and we received confirmation that this had been done following our inspection.

The home was clean, tidy and decorated appropriately. There were no issues with infection control procedures.

The management of people's medicines had improved since our previous inspection and the home was compliant within this area. Nobody we spoke with raised any issues with regards to how their medicines were managed.

There were sufficient numbers of staff employed to meet the needs of people. The home had recently introduced an additional member of staff to assist with the transition from day to night shift.

People told us their care was delivered by a competent and caring staff team. We found evidence via training records to confirm this information as being accurate

We found the home was working within the principles of the Mental Capacity Act, although we did find some issues with how consent was gained from people using the service.

We found that people were referred to external health care professionals in a timely manner.

People we spoke with told us that the food and drink in the home was of a good quality. We observed lunchtime to be a pleasant and relaxed experience for people and that staff were attentive to people's needs.

People who lived at the home were very complimentary about the approach of the staff team and the care they received.

It was evident that staff knew people well and were able to describe people’s preferred routines, likes and dislikes.

People we spoke with told us they knew how to raise issues or make complaints and we saw that a policy was place and was readily available for people to access, if need be.

We found documentary evidence to show that people had their care needs assessed by the home and by external healthcare professionals prior to moving to the home.

We saw that some work had been done to gather information about people’s life histories including their personal and work life as well as social interests.

The home employed a full time activities coordinator. We found a good range of activities were on offer that were personalised to individuals in residence at the home.

People spoke highly of the management team at the home and the staff team in it's entirety.

We saw that some audits were carried out at the home but found that a more robust system was needed.

Whilst the home has sent in a number of notifications in line with their regulatory requirements we found an example of a police incident that should have been reported to the CQC.

Other external agencies, such as Lancashire Healthwatch and the local council's food hygiene team, had entered the home and their reports were positive for the areas they reviewed.

People who lived at the home told us they felt safe, One person said, "I feel safe here, I have my call buzzer to hand and when I use it staff come very quickly, they are very good".

People were supported by staff who were appropriately trained to deliver the assistance required by each individual.

Appropriate systems were in place to regularly assess and monitor the quality of services that people receive. Internal and external auditing systems were used.

Why we carried out this inspection

This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection.

This was an unannounced inspection.

How we carried out this inspection

We looked at the personal care or treatment records of people who use the service, carried out a visit on 16 November 2012, observed how people were being cared for and talked with people who use the service. We talked with carers and / or family members and talked with staff.

What people told us and what we found

People told us they were happy with the care and support they received. One person said, "I couldn't be treated better, staff couldn't be nicer”. Another person said “I am very happy, there's always something going on”. People told us they were treated with dignity and respect and they were asked for their consent before care was delivered. One relative said “Staff are patient with my Dad and chat to him, staff can't do enough for you".

During the visit, staff were seen to be interacting with people in a calm and considerate way. Activities were available for people and an activities co-ordinator is employed within the home.