Background to this inspection
Updated
3 March 2017
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 5, 9 and 11 January 2017. The first day of the inspection was unannounced. The inspection was completed by one inspector.
Before the inspection feedback was requested from local authority commissioning teams and the local Healthwatch. Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed the information we already held about the service, including statutory notifications we had received.
During the inspection we reviewed six people’s care files including care plans, risk assessments, medicines records and records of care received. We reviewed three staff recruitment files and six staff supervision records as well as staff training records. We spoke with eight people who lived in the home and one relative of a person who lived in the home. We spoke with seven members of staff including the business manager, the interim home manager, the chef and four care workers. 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 also viewed various documents, policies and records relevant to the management of the service.
Updated
3 March 2017
The inspection took place on 5, 9 and 11 January 2017. The first day of the inspection was unannounced.
Almadene Care Home is a care home for older adults many of whom are living with dementia. At the time of our inspection 14 people were living in the home. The home was a converted property consisting of two terraced houses that had been joined together to become one large property.
The home had a 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 our inspection the registered manager was absent from the service. The provider had submitted the required notification to CQC to inform us of this and had appointed an interim manager to run the service during the absence.
The home was last inspected in October 2014 when it was rated Good overall.
People told us they felt safe at the home. The home had policies and procedures in place to ensure that people were protected from avoidable harm and abuse. Staff had a good understanding of safeguarding adults processes and knew how to raise any concerns they had.
People’s care plans and risk assessments lacked details regarding the exact nature of support to be provided and the regular meetings people had attended to discuss and provide input into their care and support had lapsed in recent months. People who had recently moved into the service did not have care plans in place. The provider took action to update care plans and risk assessments in response to feedback.
People were supported to take their medicines as prescribed, and were encouraged to take their medicines independently where it was safe for them to do so. Systems to ensure the safe management of medicines through regular audit and stock counts had not been sustained. The provider took immediate action to address these issues.
The service had enough staff to meet people’s care and support needs. However, staff told us they did not have enough staff to provide activities to people. People gave us mixed feedback about activities provision within the home and observations showed people were not provided with stimulation or engagement for long periods during the day. The provider placed an advert to recruit an activities coordinator during the inspection. We have made a recommendation about activities provision.
People told us the staff were kind and caring. Staff spoke about people with kindness and affection. Staff recognised the importance of supporting people as individuals. Where people followed a religious faith this was recorded and a priest regularly visited the home and met with people who wished to see them. Needs assessments and care plans did not include information about people’s sexuality and this meant there was a risk that people who identify as lesbian, gay, bisexual or transgender (LGBT) were not having their needs met as there was a presumption of heterosexuality. We have made a recommendation about supporting people who identify as LGBT.
People told us the food was tasty. We saw people were supported to have their dietary needs met and people’s dietary preferences were respected. People were offered drinks and snacks throughout the day as well as a freshly cooked main meal at lunchtime.
Care plans contained details of people’s health needs and the support required to maintain their health. However, input from health professionals was not always recorded.
Where people could consent to their care this was appropriately recorded. However, two people who had recently moved to the home were being unlawfully deprived of their liberty as appropriate applications to deprive them of their liberty had not been submitted in line with the requirements of the Mental Capacity Act 2005.
Records of training were incomplete as they did not include staff who had recently joined the service. Staff supervisions had not been completed in line with the provider’s policy. The provider implemented a new training programme and supervision schedule in response to this feedback.
The home had systems in place to monitor and improve the quality of the service through various audits. These had not been maintained in the registered manager’s absence. Although the provider responded positively to feedback regarding this and immediately put systems in place to monitor and improve the quality of the service, this had not been identified or acted upon until the inspection took place.