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Inspection carried out on 10 March 2021

During an inspection looking at part of the service

Alderwood is a residential care home providing personal and nursing care to 15 people. The home is split into two units; one for rehabilitation for younger adults living with enduring mental health conditions and the other unit provides assessments and short breaks for people living with dementia. The service can support up to 19 people in one large adapted building.

We found the following examples of good practice:

The home had sufficient supplies of appropriate PPE which was stored hygienically and kept safe and staff were provided with separate areas to put on and take off and dispose of PPE safely.

Staff were careful to maintain social distancing and wore appropriate PPE in line with current government guidance.

Staff demonstrated a good knowledge of how to support people that had tested positive or were showing symptoms of COVID-19.

The senior staff explained the quality systems they had in place to check the service was providing safe care.

All staff, including catering and housekeeping staff had undertaken training in infection prevention and control. This included putting on and taking off PPE, hand hygiene and other Covid-19 related training.

Further information is in the detailed findings below.

Inspection carried out on 11 December 2018

During a routine inspection

About the service: Alderwood is a nursing care home registered to provide accommodation for up to 32 people. The home is split into two units; one for rehabilitation for younger adults living with enduring mental health conditions and the other unit provides assessments and short breaks for people living with dementia. At the time of this inspection 15 people were living at the service.

On the upstairs unit the service can accept up to five people who require an assessment and seven people on short breaks. This floor also houses the Mental Health Concerns’ community team who work in partnership with the local Mental Health Trust to support people who are living with dementia and display severe behaviours that may challenge. The community team make the referrals for people who may benefit from accessing a further assessment at Alderwood.

What life is like for people using this service: Staff were making a difference to people’s wellbeing by working well as a team, in harmony with one another and by sharing the same values and principles. We saw copious amounts of evidence confirming this was the case.

On both units we found that staff were totally committed to delivering a service which improved people’s lives in fulfilling and creative ways. Their drive and passion had created a dynamic and vibrant service.

Staff focused fully on the goals and aspirations of the people who used the service. People on the downstairs unit told us that the staff had enabled them to rebuild their relationships with family members and this meant a great deal to them.

Staff took steps to safeguard vulnerable adults and promoted their human rights. Incidents were dealt with appropriately, which helped to keep people safe. People’s health needs were identified and external professionals involved if necessary.

People participated in a range of activities that met their individual choices and preferences. Staff understood the importance of this for people and provided the structured support people required. This enabled people to achieve positive outcomes and promoted a good quality of life.

The service was well run. The senior managers carried out lots of checks to make sure that the service was effective.

Rating at last inspection: Good (report published 13 June 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we revisit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Inspection carried out on 8 March 2016

During a routine inspection

We carried out an inspection of Alderwood on 8 and 16 March 2016. The first day of the inspection was unannounced. We last inspected Alderwood in May 2014 and found the service was meeting the relevant regulations in force at that time.

Alderwood is a care home that provides accommodation and care for up to 32 people with nursing and personal care needs related to their mental health or dementia. The home is split into two units; one for rehabilitation, the other for assessments and short breaks. At the time of the inspection there were 19 people accommodated there.

The service had a registered manager in post. A registered manager is a person who has registered with the 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 2008 and associated regulations about how the service is run.

People told us they felt safe and were well cared for. Staff took steps to safeguard vulnerable adults and promoted their human rights. Incidents were dealt with appropriately, which helped to keep people safe.

The building was safe and well maintained. The home was clean. Risks associated with the building and working practices were assessed and suitable steps taken to reduce the likelihood of harm occurring.

We observed staff act in a courteous, professional and safe manner when supporting people. At the time of our inspection, the levels of staff on duty were sufficient to safely meet people’s needs. New staff were subject to thorough recruitment checks. There was a low turnover of staff.

Medicines were managed safely for people and records completed correctly. People received the support they needed to manage medicines for themselves, so they were taken as prescribed.

As Alderwood is registered as a care home, CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found appropriate policies and procedures were in place and the registered manager was familiar with the processes involved in the application for a DoLS. Arrangements were in place to assess people’s mental capacity and to identify if decisions needed to be taken on behalf of a person in their best interests. Where necessary a DoLS had been applied for. Staff obtained people’s consent before providing care.

Staff had completed safety and care related training relevant to their role and the needs of people using the service. Further training was planned, including the use of psychological and physical interventions for people who displayed behaviour described as challenging. Staff were well supported by the registered manager.

Staff were aware of people’s nutritional needs and where people were at risk of dehydration or malnutrition appropriate support was provided. People’s health needs were identified and external professionals involved if necessary. This ensured people’s general medical needs were met promptly. People were provided with assistance to attend medical appointments.

Activities were offered within the home and people also accessed local community facilities and activities. Where able some people could leave the home independently. We observed staff interacting positively with people. We saw staff treated people with respect and explained clearly to us how people’s privacy, dignity and confidences were maintained. Staff understood the needs of people and we saw care plans and associated documentation was clear and person centred.

People using the service and staff spoke well of the registered manager and care provider and felt the service had good leadership. We found there were effective systems to assess and monitor the quality of the service, which included feedback from people receiving care and oversight from external managers.

Inspection carried out on 28 May 2014

During a routine inspection

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.

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. Equipment at the home had been well maintained and serviced regularly. There were enough staff on duty to meet the needs of the people who lived at the home and a member of the management team was available on call in case of emergencies. One person told us that they liked everything and said, "This is the nicest place to live in the world. I wouldn't want to be anywhere else."

Staff records demonstrated that mandatory training was up to date and that staff were trained to meet the needs of people who lived at the home. Staff were trained in caring for people with dementia, challenging behaviour and Deprivation of Liberty Safeguards. Staff had completed appropriate referrals for two people, which had resulted in Deprivation of Liberty Safeguards orders being authorised by the relevant authority.

Is the service effective?

People told us that they were happy with the care that they received and that their needs were met. It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew them well. People were cared for by staff who were supported to deliver care safely and to an appropriate standard.

Food was freshly prepared on site by catering staff who were trained to be able to meet the complex nutritional needs of people. In one area of the home food was delivered by a specialist independent catering company. This meant that people's nutritional needs could be met.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. Staff took into account the complex needs of people when planning activities so that they could participate safely. One person told us that they felt safe and cared for in the home. Staff said that they were very happy with the level of professional and emotional support they received from the management team.

Is the service responsive?

We saw where there were concerns over people�s capacity to make decisions, a formal process had been followed to determine what was in people�s best interests. This meant that where people did not have the capacity to consent, the provider had acted in accordance with legal requirements. Records confirmed people's preferences and interests and 'relationship maps' were used to help staff understand each person's personality and emotional state. People had access to activities that were important to them and were supported to maintain relationships with their friends and relatives. We found that care was delivered using recovery-focused outcomes which helped people to make progress towards personal goals such as living with independently.

Is the service well led?

Staff had a good understanding of the ethos of the home and robust quality assurance processes were in place. People told us that the managers were friendly and always around to talk or to discuss any issues. Staff told us that they were clear about their roles and responsibilities and that management support was of a high standard and helped them to do their job effectively.

Inspection carried out on 3 May 2013

During a routine inspection

We decided to visit the home between 4pm and 10:30pm to gain a wider view of the service provided. This was part of an out of normal hours pilot project being undertaken in the North East region.

Some people who used the service had complex needs which meant they were not always able to tell us about their experiences of living at the home. We used a number of methods to help us understand their experiences, including carrying out an observation and speaking with people who could talk with us.

We spoke with three people who used the service. People told us they were happy with the care they received. One person said, "I'm happy with everything the way that it is. I care about the home, and they care about me. The staff look after me really well." We reviewed four care records and saw that people's preferences and care needs had been well documented.

During our inspection we observed good care practices. Staff were knowledgeable about people's care needs and what they should do to support them.

People we spoke with told us they were involved in making decisions about how their care was provided. One person said, "This is a good home. The staff are good and we have a good manager. They listen to me. If I don't feel like going out or taking part in activities on a particular day, then the staff will check I'm ok, but they don't try and make me do anything I don't want to." We saw there were processes in place to involve people who used the service, and their relatives, in decisions made about their care.

There were enough staff to meet people�s needs and appropriate arrangements were in place to manage medicines.

We found there was an effective system in place to monitor and assess the quality of the service provided.

Inspection carried out on 30 May 2012

During an inspection looking at part of the service

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We carried out the SOFI in the dementia care unit of the home. We saw lots of good staff interactions with people. Staff used an activities box, which included games and books to engage with people. Staff had a good understanding people�s life histories and we saw staff use this knowledge to engage people in activities. For example we saw staff talked with people about where they had lived, and used this information to engage with people with a book on local history. During our observation staff spent time with all of the people in the unit. We saw staff talked with people and encouraged people to interact with other people on the unit.

Inspection carried out on 24 November 2011

During a routine inspection

The home is divided into three units. The downstairs nine bed unit provided nursing care for people who required long term care because of the nature of their mental health needs. The upstairs unit contained 13 beds for the long term nursing care of older people with dementia type illnesses. The remaining ten bed unit on this floor provided short break nursing care for older people with dementia type illnesses. At the time of our visit five people were living in this unit.

We met with people on each of the three individual units. We did not meet with any visitors or visiting professionals during our visit.

Very few people were able to converse with us due to their medical conditions, but those who could appeared relaxed and peaceful.

Comments made during brief conversations included, �They�re all nice people, very helpful if you need them�. Another person told us, �I like it here�.

Reports under our old system of regulation (including those from before CQC was created)