Archived: Alphington Lodge Residential Home

During this inspection we also reviewed the following outcome areas because there were outstanding compliance actions, and because of information we had received since the last inspection '

' outcome 11: safety, availability and suitability of equipment

' outcome 13: staffing

' outcome 16: assessing and monitoring the quality of services provided

' outcome 21: records.

At the time of this inspection 24 people were accommodated at the home. The inspection was carried out by three inspectors over three days. We reviewed the care given to six people living in the home by reading their care records, by talking to people, relatives and staff and by observing staff interacting with people. We also spoke with nine people who lived in the home, 10 relatives and visitors a doctor, a community nurse, six members of staff and the registered manager. We also had e mail communication with a speech and language therapist. We carried out a short observational framework inspection (SOFI) during which we observed staff interaction with people at lunchtime, focussing specifically on three people. We carried out a short tour of the home, and checked records relating to the management of the home.

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

We found there were improvements in the way people's care needs were met since our last inspection. During the first two days of this inspection we found some records did not provide sufficient evidence to show how potential risks such as choking, moving and handling, and risk of falls had been assessed and reviewed. Actions to be taken to reduce the risks were not always clearly specified. The staff we spoke with demonstrated an understanding of each person's basic care needs but told us they had not read the care plans fully, relying on verbal handover. The manager told us they would take prompt action to improve the records and make sure staff read the care plans and understood the tasks they had to carry out. Therefore we returned to the home for a third day to see if this had been carried out. On this visit we saw checklists and new summary sheets had been put in place for each person explaining the care tasks to be undertaken, including tasks necessary to prevent or reduce risks. Despite these further improvements some records still contained conflicting information and had not been fully reviewed or not met consistently. Monitoring systems to check the records were improved, but there remained a risk some essential care needs may be missed.

Staffing levels had improved and at the time of this inspection we found there were sufficient staff on duty with the appropriate skills and experience required to ensure people's needs were safely met.

The manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Health and social care professionals had been involved appropriately where people may have been deprived of their liberty due to the nature of their care needs. This meant that the home had acted in line with Deprivation of Liberty Safeguards legislation (DOL's). This legislation protects people's rights when they are unable to make decisions about their own welfare.

Is the service effective?

On the first two days of our inspection staff told us that systems to make sure essential daily routines were carried out had improved since our last inspection. They said there was good teamwork and staff were working together and communicating well.

We saw daily reports were completed by staff throughout the day providing evidence of the care people had received.

Is the service caring?

People told us the staff team understood the care they needed. They had been asked about their needs and had agreed their care plans. Comments included 'A gentleman sat and spent a lot of time asking questions about my care needs. They were all sensible questions. I am happy that my care plan is correct," and 'It feels so much like home ' it's friendly ' you are made to feel important. We can't speak highly enough of it here.'

People were supported by staff who were understanding and sensitive to their needs. We saw that staff offered choice and waited for responses. Relatives told us 'To be surrounded by so much caring is good for both her and myself" and 'Very happy the staff were giving the correct care'. We heard a relative speaking with a senior member of staff about the care their mother received during a period of serious illness and they talked about their confidence in the care provided by the staff.

We observed friendly, warm exchanges between people, visitors and staff. Staff were kind and attentive. We saw staff supporting people to walk around the home safely, staff taking people out into the garden, and people participating in activities in a cheerful, friendly and supportive atmosphere.

Is the service responsive?

The service was not fully responsive to people's needs and wishes. We saw that where people's needs had changed their care plan information had not always been updated. However, we saw evidence to show that systems for reviewing and updating care plans were improving, although not yet fully embedded. The staff we spoke with were able to explain to us how they had recognised signs of illness or distress or changes in care needs.

The staff worked closely with local health professionals and specialist advice, assessment and treatment had been sought promptly and where necessary.

Is the service well-led?

Where we saw some weaknesses in the monitoring systems during the first two days of our inspection the manager and staff took prompt action to make further improvements. On the third day we saw some further actions had been taken. However, due to the newness of these systems it was too soon to be sure they were fully effective.

People, their relatives, outside professionals and the staff were encouraged to provide feedback on the service. A suggestion box in the entrance hall encouraged people and visitors to give suggestions and ideas for improvements to the service. People and their relatives had been asked to complete questionnaires seeking their views on the quality of the service. Meetings were held between people living at the home, their relatives and staff which provided opportunities for issues to be raised and information to be shared.

You can see our judgements on the front page of this report.

This inspection took place on 11 and 14 February 2014 and was unannounced. The purpose was to follow up on our enforcement action. A further inspection will take place to check on the compliance actions made in December 2013.

There were 23 people living at the home, including one person on a short stay. We spoke with ten people living at Alphington Lodge and three relatives. We also spent time with people in communal areas of the home so we could make a judgement about how well people were cared for as some people were not able to comment directly on their care. We also spoke with five staff members and the manager. We looked at a selection of care records and staff communication records, and focussed on privacy and dignity, and care and welfare. We also contacted health and social care professionals who had recently visited the home to gain their views.

Based on our discussions with people living at the home, staff, relatives and visiting professionals, as well as on our observations and care records, we judged there had been improvements regarding ensuring people were treated with dignity and respect, and choice was promoted. However, there was not a significant improvement for people's care and welfare, with identified risks being poorly managed and changes to people's moving and handling needs not being met. The enforcement action remains in place and we will be inspecting the service again to check on compliance.

care and welfare, cleanliness and infection control, safety and suitability of premises, supporting workers, assessing and monitoring the quality of services, complaints, and records.

Since the last inspection we have also received concerns relating to standards of care, low staffing levels, and safety.

This inspection took place over two days. The first day of the inspection took place on a Saturday. We wanted to check staffing levels at weekends. On the second day of the inspection two inspectors spent 11 hours at the home observing care, looking at records, speaking with people who lived in the home, visitors, staff and the manager.

We found some improvements had been made in some areas. Most people had a care plan setting out their basic care and support needs. However, we found there was insufficient written information about the care needs of two people who had recently moved into the home. This meant there was a risk to their health if care staff did not carry out specific tasks.

We also found there had been a high staff turnover since the last inspection. The care staffing levels were low on both days of our inspection. We found care was poorly co-ordinated, call bells were ringing for long periods, and care was not always provided to people in a timely manner. The manager told us they hoped to increase the staffing levels when the recruitment of new staff is completed.

While most staff treated people with respect and dignity we saw examples where staff failed to offer choices or treat people in a respectful or dignified manner. Several people told us the staff were 'marvellous' or 'kind'.

On the first day of the inspection on Saturday no cleaning staff were on duty. We noted problems with odour control and one bathroom was left in an untidy state. On the second day of the inspection a cleaner was on duty and the home appeared clean and odour problems had been reduced..

Support systems for staff had been improved. We saw evidence of staff supervision sessions, staff, meetings, and plans for staff future training needs. We also saw evidence of staff handover sessions.

We saw people had been given information about the home's complaints system and who to contact if they wanted to make a complaint. There was a record of complaints showing complaints received since our last inspection been investigated and actions taken to address the issues that had been raised.

The quality assurance systems had improved. We saw evidence that there were greater checks carried out on management systems in the home. People and their relatives had been asked for their views on the services provided through meetings and questionnaires. However, the quality assurance systems had failed to identify areas of non-compliance found during this inspection.

Some records had improved. Most records were available when we asked for them although we found there had been problems with some maintenance records. We found filing systems had improved.

We followed up three compliance actions from our previous inspection in November 2012 and February 2013. These related to the management of medicines, requirements relating to workers, and assessing and monitoring the quality of services. We saw some improvements had been made to address these compliance actions. However we also found further areas of non compliance.

Care plans had not been regularly reviewed or updated. Assessments of risks associated with personal care and health needs had not been regularly reviewed.

While the overall appearance of the home was comfortable and homely, some areas were in need of maintenance. We also found some aspects of the security of the home needed to be addressed. Some parts of the home were not completely clean or hygienic.

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There were no records to show that staff had received regular formal supervision. We saw that levels of training had improved since our last inspection, but there were no systems in place to evaluate individual training needs or to plan future training needs of the whole staff team.

Systems to regularly assess and monitor the quality of service that people receive were not effective. There were no records of concerns or complaints received, or the actions taken to address them.

A new manager had started working in the home a few weeks before this inspection took place. A member of staff had been promoted to the post of head of care. We saw evidence to show they had worked closely to identify the areas where improvements were needed. Plans had been drawn up to address the problems they had identified and we saw actions were in the process of being carried out.

We found that people were treated with respect and dignity. One person told us ' I always get a choice. If I rang a call bell and asked to get up, then they will help me' and 'I have never seen the staff be grumpy with people; they are so patient with the people'.

People received care and support that met their needs. Some care plans did not provide sufficient information to staff about people's personal or health care needs but we saw that these were in the process of being reviewed and improved. People told us they were satisfied with the care they received.

All areas of the home were found to be clean and hygienic.

New staff had not always been recruited following safe recruitment methods.

The accommodation looked clean and orderly yet homely. Senior staff told us about recent improvements made to the d'cor, furnishings and fittings.

People's privacy, dignity and independence were respected. They experienced care and support that met their needs and protected their rights, with qualified, skilled and experienced staff available to meet their needs. People's comments about their care included 'They look after us very well.' One told us the night staff were 'very punctual', and that the service was much better than their recent experience of a stay in hospital. Another person said 'Everyone seems to be very kind.'

People's views and experiences were taken into account in the way the service was provided regarding their care. However, we found the provider did not have fully effective systems to regularly monitor the quality of the service that they received. We also found that people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements to manage medicines.