Alicia Nursing Home

This report contains information about 2 different properties that are registered at the same location. They are Alicia Nursing Home and Atwell House.

Alicia Nursing Home is a residential care home providing accommodation and nursing care to up to 61 people across 2 buildings. The service provides support to older people, people living with dementia and people with a mental health diagnosis. At the time of our inspection only 1 building was in use, there were 34 people using the service.

Atwell House is a residential care home providing accommodation and nursing care to up to 7 people. The service provides support to people with a learning disability and autistic people. At the time of our inspection there were 6 people using the service.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: People were at risk of harm because risks were not always fully assessed. Risks in relation to the environment, medical equipment and medicines were not always managed safely. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care: Staff understood how to protect people from poor care and abuse. People’s needs were assessed, and their care regularly reviewed. People were treated with kindness, dignity, and respect. We observed positive interactions between people and staff. The provider worked in partnership with other professionals.

Right Culture: Audits and checks were not always effective to ensure quality of records and minimise risks. Feedback was gathered through questionnaires and meetings, however the action taken from this feedback was not always communicated. Feedback was overall positive about the management of the service.

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

Rating at last inspection

The last rating for this service was good (published 27 October 2017)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Alicia Nursing Home on our website at www.cqc.org.uk.

Enforcement and recommendations

We have identified breaches in relation to equipment safety and governance systems at this inspection.

We have made recommendations around recruitment processes, medicines, and least restrictive practices.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Systems were in place to support safe visiting at the service. All visitors were required to produce a negative lateral flow COVID-19 test prior to visiting their relative or friend. In addition, visitors were required to have their temperature taken and complete screening questions.

Personal protective equipment (PPE) was required to be worn by all staff and visitors to the service. Training had been provided to staff advising of the safe putting on, taking off and wearing of PPE. All staff were observed wearing PPE correctly during the inspection. The registered manager told us the service had adequate supply of PPE stock and were able to replenish stocks when required.

People had been supported to maintain contact with their family and friends during the COVID-19 pandemic through use of video and telephone calls. In line with government guidance the registered manager had promoted window visits, use of a dedicated visiting pod and the role of the essential care giver. Visiting restrictions were reviewed in line with government guidance. Risk assessments were in place to support people accessing the community in line with easement of the COVID-19 pandemic restrictions.

On the day of inspection, the home was visibly clean with no mal odours. A compliment of housekeepers were employed at the service who completed cleaning of the environment including frequently touched surfaces such as door handles and light switches.

Alicia Nursing Home is a nursing home that provides personal care and nursing care to 42 people at the time of the inspection. This includes a separate building down the road known as Atwell House that accommodates seven people with a learning disability and physical disability.

Alicia Nursing Home consist of three floors. The three floors have this includes people’s individual bedrooms, lounges and shared bathrooms. On the ground floor there is a day centre which is attached to the home.

People’s experience of using this service and what we found

People were supported by staff who knew their support needs and were able to address any changes or concerns they had with the manager. The service had systems in place to safeguard people in the home. The management team dealt with any issues reported to them promptly.

Care plans and risk assessments identified people’s needs, however there were gaps in the detail of some of the care plans. The management team were proactive in adding this information. Medicines were managed safely, however there were concerns that the time between people receiving their medicines was not adequate.

The service had procedures in place to ensure they managed the infection control in the home.

The management team was approachable, and staff felt supported. Overall, we observed staff engaging in conversations with people. Staff told us they felt like it was a family feel to the home.

Quality audits were completed. However, some of the audits did not identify particular areas of risk, how to manage these risks and any pattern emerging. In addition, there was no clear action plan which could be shared with staff for lessons learnt and improvements.

We recommend the manager reviews their quality assurance systems and ensure there is clear analysis and action plans to identify improvements within the home.

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

Rating at last inspection

The last rating for this service was Good (published 27 October 2017).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about the culture of the service and overall systems in relation identifying and actioning potential health concerns. The overall rating for the service has not changed following this targeted inspection and remains Good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

When we inspected the service in June 2016, there was not always sufficient numbers of staff to support people safely, and mental capacity assessments were generic and did not always identify what specific decisions the assessments related to. Additionally, staff did not feel supported, valued and listened to. At this inspection we found improvements had been made and the service provided to people was now safe, effective, compassionate and of good quality.

The service provides care and support to people with a range of care needs including those with chronic health conditions, physical disabilities, dementia, learning disabilities and mental health conditions. At the time of the inspection, 38 people were being supported by the service.

There was a registered manager in post. 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 were safe because the provider had effective systems to keep them safe, and staff had been trained on how to safeguard people. There were individual risk assessments that gave guidance to staff on how risks to people could be minimised. People’s medicines were managed safely and administered in a timely way by trained staff. The provider had effective recruitment processes in place and there was sufficient numbers of staff to support people safely.

Staff received effective training, support and supervision that enabled them to provide appropriate care to people who used the service. The requirements of the Mental Capacity Act 2005 were now being met because people’s ability to make decisions about their care and support was appropriately assessed. People were supported to have enough to eat and drink, and to access various health services when required.

Staff were kind and caring towards people they supported. They treated people with respect and as much as possible, they supported people to maintain their independence. People were happy with how their care was provided and they valued staff’s support. People made decisions and choices about how they wanted to be supported and staff respected this.

People’s needs had been assessed and they had care plans that took account of their individual needs and preferences. Care plans were reviewed regularly or when people’s needs changed. Staff were responsive to people’s needs and where required, they sought appropriate support from healthcare professionals. The provider had an effective system to manage people’s complaints and concerns.

There was now stable leadership of the service, and staff felt well supported and their contributions recognised. The provider had systems to assess and monitor the quality of the service and they explored ways of further improving the quality of the service in order to enhance people’s experiences of care. They also encouraged feedback from people, relatives and staff to enable them to continually improve the service.

The service provides care and support to people with a range of care needs including those with chronic health conditions, physical disabilities, dementia, learning disabilities and mental health conditions. At the time of the inspection, 41 people were being supported by the service.

During our inspection in May 2015, we had found the provider needed to improve the cleanliness of the home and equipment, and their quality monitoring processes had not always been used effectively to drive continuous improvement. We found they had made the required improvements during this inspection.

There was no registered manager in post, but a new manager had started the process to register with the Care Quality Commission. 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.

There were risk assessments in place that gave guidance to staff on how risks to people could be minimised. There were systems in place to safeguard people from risk of possible harm. The provider had effective recruitment processes in place, but some staff said that there was not sufficient numbers of staff to support people safely. They felt that they had to rush how they supported people and were not able to spend quality time with each person.

Staff received regular supervision and they had been trained to meet people’s individual needs. They understood their roles and responsibilities to seek people’s consent prior to care being provided. However, staff did not always ensure that the care of people who did not have capacity to consent to their care or make decisions about some aspects of their care was managed in line with the requirements of the Mental Capacity Act 2005 (MCA).

People were supported by caring, friendly and respectful staff. They were supported to make choices about how they lived their lives. People had adequate food and drinks to maintain their health and wellbeing. They were also supported to access other health services when required.

People’s needs had been assessed, and care plans took account of their individual needs, preferences, and choices. They were involved in reviewing their care plans and were supported to pursue their hobbies and interests.

The provider had a formal process for handling complaints and concerns. They encouraged feedback from people who used the service, their relatives, staff and other professionals, and they acted on the comments received to improve the quality of the service.

The provider’s quality monitoring processes were now being used effectively to drive continuous improvements. Although staff told us they had seen positive changes in how the service was being managed, they did not feel well-supported and valued.

We spoke with five people living at the service, one relative and five staff on duty during our visit on 8 April 2013. Due to some people's dementia needs, not everyone was able to tell us about their experiences. We therefore used a number of methods to help us understand the experiences of people using the service, including observation and talking with people's relatives and care staff. The relative that we spoke with told us, " I can't fault it. They provide great care. It's second to none."

We found that people's capacity to consent was recognised where appropriate and where people lacked capacity, this was identified appropriately and formally recorded. One person told us, " I'm free to enjoy myself in my own way, staff give me a choice and ask what I want."

We saw there were careplans and relevant risk assessments in place and these were updated or reflective of the care delivered in practice. This meant that people were consistently receiving the support that they needed.

We saw that staff had a good awareness of the Safeguarding of Adults and knew the correct process for reporting any issues or concerns they had. We noted that this practice was backed up with formal training and education.

Due to the complex needs of some people, we also spent some time observing people and saw that they were actively engaged in activities of their choice and at a level that was appropriate to them. On the day of our visit, some people had been supported to attend the day centre to participate in making Christmas cards or engage in art and craft activities. One person said, " I really enjoy what is on offer."

Staff were respectful in their approach to people and treated them with dignity and respect, addressing people in a manner that was appropriate to them. People told us that they were content with how staff treated them and that there was a friendly atmosphere within the home. Relatives were encouraged to be involved in people's care reviews and were kept updated with any changes in conditions. There was evidence of joint working within care planning so that individual and cultural needs were respected.