Archived: Alphin House

We carried out a further planned unannounced review on 19 May and 9 June 2011 to check on the compliance actions that we had made after our inspection in February 2011. We found that there had not been adequate improvement, which was reported to the safeguarding team. Devon County Council provided us with an action plan which detailed the improvements that had been made.

We visited the home again on 4 October 2011 to monitor the quality of the care and to check if the compliance actions made on the previous visits had been met. This report relates to this visit to Alphin House. This time we found significant improvement, which made Alphin House compliant under the Health and Social Care Act. We have reported these improvements to the safeguarding team.

Our visit was unannounced and took place over eight hours. We spoke with seven people living at the home, one visitor and five staff members. An eighth person said they were too tired to speak to us. . We introduced ourselves to other people as we met them during our visit. During our visit, we focussed on meeting people, looking at the environment, and checking on whether the action plan had been completed.

We met with people either in their rooms or in communal areas, and we spoke to them individually or in pairs when they were sitting with friends. We spent time in communal areas, which enabled us to observe people's care and conversations between staff and people living at the home.

We used pathway tracking to see how three people's care and social needs were met. Where possible, we met with the person, visited their room, looked at their medicine records and spoke to staff about how they met their care needs.

We also looked at records relating to medication, staff training and induction, as well as service records and quality assurance records.

We were told by the manager that there was nobody living at the home receiving end of life care. We were told that one person had regular visits from the district nursing team to support them with skin care needs and that people with nutritional needs were being monitored.

The home does not currently have a registered manager but an application has been submitted by Devon County Council, which is currently on hold. From 7 June 2011, there has been an interim manager working at the home, who is an experienced registered manager for another Devon County Council.

During this inspection, 18 people were living at the home and two people in hospital. We were told that since our last visit nobody had moved to the home on a permanent basis, which was a decision made by the provider. We were told this was still the case on 4 October 2011.

During this inspection, six people told us that they were happy with the quality of the care provided and how the staff interacted with them. A seventh person found it difficult to comment on specific issues. We saw staff being sensitive to people's different needs and providing reassurance.

We wanted to find out if people living at the home had been asked about their care and treatment. We asked people if they had been involved in the content of their care plans and whether they had been asked about how their care was provided. Five people told us they had been involved in their care plan.

Seven people living at the home told us that they felt their care needs were met by staff. People told us that staff knew what to do and provided care in a manner that was acceptable to them and met their care needs. None of the people that we spoke to raised concerns about how their health care needs, and were able to give us examples of good staff practice. They told us the staff knew them well.

People told us that since our last visit, there had been more activities, including a garden fete, quizzes and trips out.

We asked four people about their contact with health professionals. Two people said they had been well in the last year and had not needed to see a GP. We checked with the four people that they were not in pain and they said they were not. Two people who told us that they needed regular health care support told us this was well managed and there were no delays.

All the people that we met during our visit told us that staff knew how to care for them and we observed that people generally looked relaxed in their surroundings and in their interactions with staff. People that we met told us that they were not in pain and were happy with the way their medication was administered because they said it was given at the right time.

People living at the home were not asked directly about staff recruitment but people told us that they were satisfied with the quality and skills of the staff. Six people told us that they were happy with the staffing levels and the skills of the staff team. They told us that agency staff were still used but they said they were regular people so they knew them, which meant staff knew how to care for people.

The people that we spoke to had not made a formal complaint since out last visit but they told us they knew how to make a complaint and who they would go to. We asked the people that we met if they were kept up to date with the running of the home. People told us they were involved. For example, four people told us about the residents' meetings that had taken place and one person mentioned a survey that had recently been sent out to them. We saw the outcome of this survey which took place in July 2011 and provided positive feedback about the quality of the care.

We found that two people had come to live here without having their needs assessed by the home. The information provided by the placing authority for one of these people led to the home believing this person's needs were lower than they were. The manager and staff had been praised by a health care professional for managing this person's needs so well. The second person's respite placement had broken down after one night. People who come to stay here for intermediate care have the final decision about their placement decided by another authority. This means that the service cannot guarantee that their needs can be met. Staff report that some of these people have high care needs, and that staffing levels at the service are minimal. Care records we looked at show that some concerns about people's health are not always being followed up in a timely manner and that there has been a delay in obtaining one person's prescribed medicine. In addition, care records are not all up to date.

People told us that their medication is managed well. However, we saw some medicines left in an unoccupied and unlocked bedroom, although staff had signed to say that these had been given. These medicines belong to a person who, according to records, is likely to forget to take them. Records showed that some medication records were not up to date and some hand written records had not been checked by a second person as they should be. Records also show that two people have received the wrong medicines.

One person told us that they were happy with the standard of cleanliness at this home and another that it was 'not too bad'. We found that some bedrooms we visited had an odour of urine and two bedrooms had stained carpets.

People say that staff are 'good' and that they generally know what to do to support them. They told us they were concerned at the delays in answering call bells. We were told by staff that the number of permanent staff had been reduced at team leader and deputy manager level. We were also told that over Christmas the majority of team leaders shifts had been covered by agency staff. The manager explained that they tried to always have the same three agency staff who have the correct skills. However, the manager also reported that arranging agency staff is very time consuming.

We found that systems and records connected to monitoring that people receive the care they need are not audited. This includes the monitoring of medicines, care planning, Mental Capacity Act and Deprivation of Liberty legislation. In addition, staff report that there are delays in receiving feedback from the provider's quality assurance visits and that feedback contains little information. Where issues are identified by these visits, action plans are not always put into place