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Inspection carried out on 10 May 2019

During a routine inspection

About the service: Alinthia House is a residential care home registered to provide accommodation for up to seven older people who require personal and nursing care. The home does not provide nursing care. People who live in the home receive nursing care through the local community health team. The home provides both short and long-term care. The home accommodates up to seven people in one adapted building. Accommodation is provided over two floors, with a stair lift giving access to the first floor. Seven people were living at the home at the time of the inspection.

People’s experience of using this service:

We received very positive feedback about the care and support provided at the home. People felt safe and well cared for. This was reflected in the comments we received from a relative and a friend of a person living at the home. Staff were aware of their responsibilities to safeguard people.

People were protected from avoidable harm associated with their care needs, such as developing pressure ulcers or not eating enough to maintain their health. Since the previous inspections in July 2018, improvements had been made in how the home assessed and mitigated risks.

Some improvements were required in how the home recorded people's capacity to consent to care and for authorisation to restrict people's liberty to keep them safe.

There were sufficient numbers of staff employed to ensure people’s needs were met. However, some improvements were still required to ensure the suitability of staff employed.

People’s preferences were respected and staff were attentive to people’s needs. Staff were seen to be kind, caring and friendly and it was clear staff knew people well.

The home organised social activities which people enjoyed.

People received their medicines safely and as prescribed. Medicine management practices were safe.

The environment was safe and equipment regularly serviced to ensure it remained in safe working order.

Quality assurance processes undertaken by the providers ensured people received care that was safe and which met their needs and respected their preferences. People and their relatives were involved in making decisions about their care.

We made two recommendations for the providers to improve the information they obtain from staff prior to them starting work at the home, and to seek guidance in relation to mental capacity assessments, best interest decision making and the Deprivation of Liberty Safeguards.

More information is in the Detailed Findings below.

Rating at last inspection: At the last comprehensive inspection in April 2018, the home was rated 'Requires Improvement' overall, with the key questions of effective, caring and responsive rated 'Good'. (report published May 2018). A focused inspection took place in July 2018 where the ratings for the key questions of safe and well-led, remained 'Requires Improvement'.

At this inspection we found the home met the characteristics of ‘Good’ for all key questions: The home’s overall rating has improved to ‘Good’.

Why we inspected: This was planned inspection based in the previous rating.

Follow up: We will continue to monitor information and intelligence we receive about the home to ensure good quality care is provided to people. We will return to visit in line our re-inspection programme.

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

Inspection carried out on 30 July 2018

During an inspection to make sure that the improvements required had been made

Alinthia House is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. People who live in Alinthia House receive nursing care through the local community health team. The home provides both short and long-term care. The home accommodates up to seven people in one adapted building. Accommodation is provided over two floors, with a stair lift giving access to the first floor.

This focused inspection took place on 30 July 2018 and was unannounced. At the time of our inspection, six people were living in the home.

Alinthia House was previously inspected in April 2018 and was rated requires improvement. We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We identified improvements were required in how the providers managed risks to people’s health and safety, how they recruited staff, their quality assurance processes and notifying the Care Quality Commission (CQC) without delay of significant events within the home. We asked the providers to complete an action plan to show what they would do and by when to improve the key questions of safe and well-led to at least good. Before and since that inspection, the providers have been working with the local authority’s quality assurance and improvement team (QAIT) to make the improvements needed.

Prior to this inspection in July 2018, we received information from the providers and the local authority’s safeguarding team that two people had fallen and had sustained an injury. At the time of this inspection the safeguarding team were undertaking an investigation into the circumstances of one person’s injury. We undertook this unannounced focused inspection of Alinthia House to look at how people’s risk of falls was being managed and whether people were receiving safe care and treatment. We also checked that improvements to meet the legal requirements, planned by the provider, had been made.

We inspected the home against two of the five questions we ask about services; is the home safe and is the home well led? This was because the home was not meeting some legal requirements. No risks, concerns or significant improvements were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

One of the registered providers held the position of registered manager. A registered manager is a person who has registered with the Care Quality Commission 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.

At the time of this inspection, in July 2018, the home was continuing to work with QAIT. They were supporting the providers to review the quality and effectiveness of the home's documentation and systems to monitor and protect people's safety and well-being. We found some progress had been made with the home’s quality assurance processes and some of the information in people’s care records. However, further improvements were required with how staff were recruited and the level of detail included in people’s care plans and risk assessments. These required more information to fully describe people’s care needs and associated risks as well as more detailed guidance for staff about how to minimise these risks.

People told us they felt safe living at Alinthia House. A relative told us they were confident with the care their relation received and felt they were safe. We found that although care records were insufficiently detailed to provide

Inspection carried out on 11 April 2018

During a routine inspection

This inspection took place on 11 April 2018 and was announced.

Alinthia House was rated good at our previous inspection in April 2016. Incidents had been brought to the attention of the local authority and the home was in a whole service safeguarding process from February 2018 until 4 April 2018. Concerns identified related to lack of detail in care plans and risk assessments, response to incidents, and issues not being identified and escalated to relevant professionals. The provider and registered manager were working with the local authority to make the improvements needed.

Alinthia House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. People who live in the home receive nursing care through the local community health team. The home provides both short and long term care. The care home accommodates up to seven people in one adapted building. At the time of our inspection, five people were living in the home.

One of the registered providers was the registered manager. A registered manager is a person who has registered with the Care Quality Commission 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.

At the time of this inspection, the home was working with the local authority's quality assurance and improvement team (QAIT). They were reviewing the quality and effectiveness of the home’s documentation and systems to monitor people’s safety and well-being. The process had not been fully completed and some risk assessments were not in place to reflect people’s needs. The registered manager had started to update care plans to show how people’s care and support needs should be met. Whilst there had been improvements to the care plans, further detail was needed to ensure people’s needs were met consistently.

Recruitment and selection processes for new staff had not always been fully completed. Following our inspection, the required information was obtained. As the provider had not carried out all the checks prior to new staff working with people, there was a risk people may be cared for by unsuitable staff.

The provider had recently introduced a quality assurance tool which was provided by the QAIT team. They told us they were going to use this tool to monitor the quality and safety of the service. Areas for improvement had not been identified and recommendations made by another agency had not been completed. This quality assurance system was not yet in place and embedded.

People told us they were supported by staff who were kind and caring. Comments included “I’m very happy here” and “The staff are very kind”. The atmosphere in the home was warm and welcoming and we saw laughter and warmth between people and staff. People told us staff knew how to meet their needs and did things the way they liked. People told us they enjoyed their meals and their preferences were respected. Each person we spoke with told us they were happy with everything and didn’t need to complain about anything.

People told us they felt safe living at the home. Staff told us they felt able to report any concerns and were confident that if they raised concerns, action would be taken to make sure people were safe. There were enough staff to meet people’s needs and to spend time socialising with them.

People received their medicines safely and medicines were stored securely.

The premises were clean and smelt fresh throughout. The premises had been adapted to meet the needs of people. A new stair lift had been fitted so people with limited mobility could get up and downstairs.

We found breaches of the Health and Social Care Act 2008 (Regulated Activi

Inspection carried out on 14 April 2016

During a routine inspection

Alinthia House is a family run care home. It provides accommodation and personal care for up to seven people. People who live at the home receive nursing care through the local community health team. The home provides both short and long term care. This inspection was unannounced and took place on 14 April 2016. Six people were living at the home at the time of the inspection, and a seventh person was receiving short-term respite care.

One of the registered providers was also registered as the manager of the home. A registered manager is a person who has registered with the Care Quality Commission 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 at Alinthia House and with the staff who supported them. One person said “goodness me, yes” and another said “yes, I feel very safe here” when asked if they felt safe. They spoke very highly of the care they received. Several people described Alinthia House as a “home from home.” They told us the staff were always kind, caring and friendly. Their comments included, “It’s lovely here, they’re very good to me”, “Everybody is wonderful, I’m looked after right, left and centre” and “The staff are absolutely wonderful.” Staff treated people with respect and protected their dignity when providing personal care. Staff told us how much they enjoyed working in such a small home where they knew people well, one member of staff said, “I love my job, doing something positive and making their day easier.” They described the home as friendly and welcoming and a “real home.”

People told us they saw and spoke with the providers every day and they were always asked if everything was alright for them. They said they had no complaints but if they did the providers and staff were approachable. They felt any concerns would be responded to. Their comments included. “You can’t find fault”, “I’m very comfortable here, I have no complaints.”

Staff were knowledgeable about the people they supported and each person’s care needs were recorded in an individual care plan. Although these were personalised to each individual they did not contain the same detail of information staff described to us. For example, people’s preferred routines and how they liked to be supported were known by staff but not recorded in the care plan. The providers said they would review the informational in the plans and ensure they fully reflected people’s preferences. There was evidence people had been involved in a monthly review of their care plan and were asked at each review if they had any requests or wished for any changes to be made.

There were sufficient staff on duty to meet people’s care needs. People told us they required some assistance with their personal care needs and mobility, such as using the stair lift to go up and down stairs, and that staff provided this assistance promptly. At the time of the inspection, no one was living with dementia or had nursing care needs. The providers spent most of their time, day and night, in the home. In addition there were two care staff on duty during the morning until 2pm and one care staff from 2pm until 6pm. There were no waking night staff as the providers slept-in every night. People told us they had few night time needs and they were able to call for assistance if they needed to. They said the providers responded quickly.

Staff were knowledgeable about safeguarding people from abuse, people’s rights under the Mental Capacity Act 2005, as well as risks to people’s health and welfare resulting from their care needs. Staff knew how and to whom to report any concerns they may have. Where accidents and incidents had taken place, the providers reviewed how these had come about to ensure risks were minimised. Recruitment procedure for new staff wer

Inspection carried out on 12 June 2014

During a routine inspection

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? We also checked to see if the improvements required from our inspection in February 2014 had been implemented.

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. If you want to see the evidence that supports our summary please read the full report.

At the time of our visit there were seven people living at the home. We spoke with all seven of the people who lived there as well as two staff and the Registered Providers. One of the Registered Providers is also the Registered Manager.

Is the service safe?

We heard staff offering personal care in a discreet manner. People living at the home told us that staff were always polite and respectful. One person told us “The staff are very kind, always very nice to me”.

We saw some evidence on people’s care plans about how they liked their care to be delivered. People living at the home told us that staff always asked them what they wanted staff to do for them. One person said “Whatever you want, they do”.

We saw and heard positive interactions between care workers and people who lived at the home. Any directions that were given to people were done so in a sensitive and discreet manner. Staff spoke kindly with people, listened carefully to their responses and did not hurry them. This showed that staff had an awareness of the needs of people they cared for.

There were some arrangements in place to deal with foreseeable emergencies. For example, staff had received training in first aid and there were first aid boxes available around the home. However, the Registered Provider may wish to note that no-one had a Personal Emergency Evacuation Plan (PEEP). This meant that staff did not have important information about how everyone should be safely evacuated from the premises in the event of an emergency.

People living at the home told us that they felt safe from harm. Comments included “I feel very safe because all the staff are marvellous”. Another said “I don’t feel nervous about anything”. Staff were able to tell us about different types of abuse and what they would do if they suspected abuse was occurring. This included contacting people outside of the home if needed.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

Staff supported people to make choices and decisions about their daily lives. For example, people told us they were able to get up and go to bed when they chose.

We saw that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. For example, we saw that where people had been assessed as needing help with personal care, there was evidence in the daily records that this help had been given.

Is the service caring?

People living at the home told us that staff always asked them what they wanted staff to do for them. One person said “Whatever you want, they do”.

We spent time chatting to people in their rooms and the dining room. People told us: “You won’t get any better”; “Staff very kind - no complaints”. One of the visitors we spoke with told us there was “Always plenty of staff and they are always very pleasant”. We saw and heard positive interactions between care workers and people living at the home. Any directions that were given to people were done so in a sensitive and discreet manner.

Is the service responsive?

People we spoke with told us that they were supported to make their own decisions and were able to make choices about how they spent their day. We saw some evidence on people’s care plans about how they liked their care to be delivered. We spoke with people about their involvement in their care and choices they made. Most people said that they had talked about what care they needed. Information about visits from and to health care professionals had been recorded in individual care plans, showing clear evidence that people were supported to maintain access to specialist medical services.

Is the service well-led?

The Registered Provider regularly assessed and monitored the quality of the services provided. Most of the system was informal, this was due to the size of the home and the fact that the Registered Providers spoke with people living at the home, visitors and staff on a regular basis. This enabled the Registered Providers to identify and deal with any issues quickly. One person told us “Staff are in here (their bedroom) all the time asking what I need and what I want”. People living at the home told us they had “No complaints” and “No complaints about anything at all”.

We saw that people living at the home had recently completed a questionnaire on how they were respected and involved in the running of the home. Everyone had stated that they felt staff respected them and that they had been involved in decisions about their care.

Inspection carried out on 3 February 2014

During a routine inspection

There were six people living at Alinthia House at the time of our inspection. During our inspection we spoke with five people who lived at the home. We looked around the home, and spoke with care staff as well as the providers one of which is the registered manager of the home.

Care and treatment had been delivered in a way that was intended to ensure people's safety and welfare. We saw no evidence to confirm that people were asked for their consent or how the provider acted in accordance with their wishes before they received any care or treatment.

People we spoke with were positive about the support they received. People who live at the home told us they were well looked after and were happy. One person said “we’ve got everything we want, very good staff, cheerful too”.

People had been protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

The home had not operated a robust recruitment procedure to ensure suitable and properly qualified people had been employed by the home.

People told us that they felt safe and knew what to do if they had concerns. One person said "I would feel comfortable making a complaint if I was unhappy about anything and I am sure I would be listened to."

Inspection carried out on 23 October 2012

During a routine inspection

When we visited the home six people were living there. We spoke with all of these people and they were positive about the care they received. Comments included, “I‘ve been very content here and well looked after” and “It’s not hospitalised, more like a family. The carers are all very nice.” People who lived at the home told us that they felt safe. We spoke with three relatives of people who lived at this home. They were particularly positive about the homeliness of Alinthia House. One relative told us, “They are always very welcoming and it feels and smells like an ordinary home.”

Staff at the home showed a good knowledge of how to meet the needs of individuals, for example, in situations where people needed additional reassurance. We observed staff engaging people in a friendly but respectful way, talking about day to day events. We saw people who lived here chatting and enjoying each other's company in the dining room. People’s wishes for privacy were respected. People were supported to access health services and their decisions in respect of treatments were respected.

Staff who worked at the home told us they enjoyed their work and valued working in a small personal home where they got to know people. They received a range of training to support them to deliver care. Some training needed updating but this had been scheduled.

The home had a quality assurance policy and used surveys to obtain feedback from people who use the service.