Archived: Almadene Care Home (Goodcare Limited)

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.

People's health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

The provider has taken steps to provide care in an environment that is suitably designed and adequately maintained. The home employed a handyman to carry out day to day maintenance of the home.

Staff received appropriate professional development. We saw evidence that regular staff training was provided by the organisation through in house training.

Care records were accurate and up to date and were held securely in a locked cabinet and only designated staff had access to the keys.

We looked at care plans which reflected the needs identified in the assessments and clearly documented the care and welfare needs of each person. We saw that plans were reviewed by the manager every three months.

People we spoke with told us they liked the food and one person stated 'food was excellent.' A relative told us that food was very good and that people could have snacks and drinks when they wanted through out the day. The cook confirmed this and we observed people being given tea and coffee and snacks during our visit.

The provider had clear policies and procedures in place that addressed safeguarding. However we saw that where there had been an allegation of abuse the provider had not always responded appropriately. We found staff we spoke to were still unclear about what actions they would take if they suspected abuse and lacked understanding about whistle blowing.

There was evidence that learning from incidents took place and appropriate changes were implemented. The manager and staff told us that although there were no formal analysis of incidents all incidents were discussed at team meetings to see if there was anything different that could have been done. We saw notes from team meetings to confirm this.