Background to this inspection
Updated
13 June 2018
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.
The inspection of Alderlea – Care Home took place on 6 and 9 April 2018 and was unannounced. One Adult Social Care inspector carried out the inspection. Information had been gathered before the inspection from notifications that had been sent to the Care Quality Commission (CQC). Notifications are when providers send us information about certain changes, events or incidents that occur. We also received feedback from local authorities that contracted services with Alderlea – Care Home and reviewed information from people who had contacted CQC to make their views known about the service. We had not requested a ‘provider information return’ (PIR) from the provider since our last inspection, but we had requested and received an ‘action plan’ to show when and how the service would improve. A PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.
We spoke with five people that used the service, two relatives and the registered manager. We spoke with three staff that worked at Alderlea – Care Home. We looked at care files belonging to four people that used the service and at recruitment files and training records for four staff. We viewed records and documentation relating to the running of the service, including the quality assurance and monitoring, medication management and premises safety systems that were implemented. We also looked at equipment maintenance records and records held in respect of complaints and compliments.
We observed staff providing support to people in communal areas of the premises and we observed the interactions between people that used the service and staff. We looked around the premises and saw communal areas and people’s bedrooms.
Updated
13 June 2018
Alderlea – Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection, which was unannounced and took place on 6 and 9 April 2018.
At the last inspection in February and March 2017 the service did not meet all of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. At that inspection the service was rated ‘Requires Improvement’. This was because the provider had not ensured people’s safety with regard to management of medicines and assessment and treatment following accidents. It was also because they had not always reported incidents and events of importance and did not always use the quality auditing system effectively. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the rating of the key questions ‘Is the service safe?’, 'Is the service effective?' and ‘Is the service well-led?’ to at least good.
At this inspection the provider had improved practice so that the management of medicines was safely carried out. All aspect of the management of medicines was found to be safe. Accidents and incidents were appropriately managed, risk assessed and mitigated. They had improved practice and people received assessment of their needs following accidents and incidents. They had also ensured that all significant events had been reported to the Care Quality Commission and that audits were more effective.
Alderlea – Care Home provides personal care and accommodation for up to 40 people, who may be living with dementia. The service has single bedrooms and bathrooms situated at ground floor and first floor levels. All the bedrooms have a sink and some have en-suite toilet facilities. There are communal sitting and dining areas on the ground floor. The service is situated in a residential area and has a small car park or on-street parking. On the day of the inspection, there were 27 people living there.
The provider was required to have a registered manager in post. On the day of the inspection there was a manager that had been in post for eleven months and registered for the last two. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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.
People were protected from the risk of harm because systems were in place to detect, monitor and report potential or actual safeguarding concerns. Staff were appropriately trained in safeguarding adults from abuse and understood their responsibilities in respect of managing potential and actual safeguarding concerns. The premises were safely maintained and there was evidence in the form of maintenance certificates, contracts and records to show this. Equipment was safely used in the service.
Recruitment policies, procedures and practices were carefully followed to ensure staff were assessed as suitable to care for and support vulnerable people. Staffing numbers were sufficient to meet people’s needs. People were protected from the risks of infection and disease because good infection control management systems and practices were in place. The provider had systems in place to acknowledge and record when things went wrong and from which lessons could be learnt by the registered manager and staff. These were documented and discussed to ensure problems or mistakes were not repeated.
Staff encouraged people to make choices and decisions wherever possible in order to exercise control over their lives. People were cared for and supported by qualified and competent staff who were themselves regularly supervised and received annual appraisals of their personal performance. Staff respected the diversity that people presented and met their individual needs. People’s nutrition and hydration needs were met to support their health and wellbeing. The provider worked collaboratively with other health and social care professionals and supported people with their health care needs.
The premises were suitable for providing care to older people and measures had been taken when developing the service to include features which ensured the environment was appropriate for those people living with dementia. People’s mental capacity was appropriately assessed and their rights were protected. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Everyone that worked in the service had knowledge and understanding of their roles and responsibilities in respect of the Mental Capacity Act (MCA) 2005 and they understood the importance of people being supported to make decisions for themselves.
People received compassionate care from kind staff that knew about people’s needs and preferences. People were involved in all aspects of their care and their right to express their views was respected. The management team set good examples to the staff team with regard to attitude and approach, which meant staff had good role models to follow. People’s wellbeing, privacy, dignity and independence were monitored and respected.
We saw that people were supported according to their person-centred care plans, which reflected their needs well and which were regularly reviewed. There were opportunities to engage in pastimes and activities if people wished. People maintained family connections and support networks and their communication needs were assessed and met. We found that there was an effective complaint procedure in place and people’s complaints were investigated without bias. The service sensitively managed people’s needs with regard to end of life preferences, wishes and care.
The provider was now meeting regulation in respect of quality assurance systems and these were effective. Audits, satisfaction surveys, meetings, handovers and the provider’s own internal quality monitoring tools ensured there was effective monitoring of service delivery. The culture of the service was person-centred, open, inclusive, empowering and ensured good outcomes for people. The registered manager understood their responsibilities with regard to good governance and practiced a management style that was open, inclusive and approachable. Engagement and involvement of people, public and staff was fostered. The registered manager strove for continuous learning around best practice, updated their learning and practice at every opportunity and searched for innovative ways to deliver the service. The service fostered good partnerships with other agencies and organisations. Data protection underpinned the management of records.
Further information is in the detailed findings below.