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Archived: Alston House Good

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Inspection carried out on 28 September 2017

During a routine inspection

This inspection took place unannounced on 28 September and we returned announced on 6 October 2017.

Alston House provides accommodation and personal care for up to 19 older people some of whom are living with dementia. It is located in Aylestone close to Leicester city centre. The service has bedrooms, some of which have ensuite facilities, on two floors accessed by a passenger lift and a garden at the rear. At the time of our inspection there were 17 people using the service.

The service has a registered manager. This 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 the staff were caring and kind. Staff communicated with people in a positive and compassionate manner. The atmosphere in the home was friendly and inclusive. People and staff listened to music together and one person enjoyed dancing with a staff member. Visitors were made welcome and staff spoke with them about how their family members were getting on.

Staff provided people with responsive and personalised care. Staff knew the people they supported well and understood their needs. We saw staff talking with people and making sure they had what they wanted. Staff told us that because their service was small they had the opportunity get to know the people they supported and how they liked things done.

All the people we spoke with said they felt safe at Alston House. Staff knew where people were at risk from falls or other accidents and took action to reduce the risk of harm. The premises were adapted to help keep people safe, for example people had call bells within reach and mobility and walking aids available to them. Staff were trained in safeguarding [protecting people from abuse] and understood their responsibilities to keep people safe.

People had mixed views about staffing levels at the service. Some people thought they were satisfactory whereas others felt there should be more staff on duty. Records showed staffing levels to be acceptable, given people’s needs, but the managers agreed to keep them under constant review and make changes where necessary to ensure people’s needs were always met in a timely manner.

People told us they had their medicines on time. Medicines were administered by trained senior carers. The managers carried out weekly medicines audits and took advice for their pharmacist and the local health authority to ensure people’s medicines were safely managed.

People said they thought most of the staff were well-trained. Staff completed a range of courses to help ensure they had the skills and knowledge they needed to provide effective care. The managers and staff had a working knowledge of the Mental Capacity Act and understood the importance of people consenting to their care.

People were positive about the food provided. We saw lunch being served on the first day of our inspection visit. The food appeared wholesome and well-presented. If people needed assistance or prompting with their meals staff provided this. The deputy manager carried out a monthly meals audit and made change to the menus in line with people’s wishes.

People told us staff supported them with their healthcare needs and accompanied them to appointments where necessary. People’s medical history and healthcare needs were documented in their care records so staff had the information they needed to help keep people healthy. Records showed people had access to a range of health care professionals including GPs, district nurses, chiropodists, and opticians.

People told us there were concerned about the lack of activities and outings at the service. They said this had left some of them feeling bored and unstimulated. Records showed activities were infrequent and mainly consisted of watchin

Inspection carried out on 19 August 2016

During a routine inspection

Alston House provides personal care and accommodation for up to 19 people. On the day of the inspection the registered manager informed us that 16 people were living at the home.

This inspection took place on 19 and 23 August 2016. The inspection was unannounced and was carried out by one inspector and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. Our expert for this inspection had experience of the care of older people and older people living with dementia.

A registered manager was in place. 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 and associated Regulations about how the service is run. The registered manager had delegated day-to-day management of the services to the deputy manager at the time of the inspection.

We carried out an unannounced inspection of this service on 10 August 2015. Three breaches of legal requirements were found. The provider had not ensured that people were protected against the risks of unsafe care being provided, people's consent and not always been sought in providing personal care to them and systems had not been effective in providing a quality service to meet people's needs. After this inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We checked that the provider had followed their plan, and to confirm whether they had now met legal requirements. We found improvements in these issues and these breaches had been rectified.

People using the service and the relatives we spoke with said they thought the home was safe. Staff had been trained in safeguarding (protecting people from abuse) and generally understood their responsibilities in this area.

People's risk assessments provided staff with information of how to support people safely.

Staffing levels were sufficient to ensure people were protected from risks to their safety.

People using the service and their relatives told us they thought medicines were given safely and on time and we found this to be the case.

The premises appeared safe with no tripping or slipping hazards observed, except for access to a storage area, which was then made safe on the day of the inspection visit, and a lack of side tables to place hot drinks on.

Staff were subject to checks to ensure they were appropriate to work with the people who used the service.

Most staff had been trained to ensure they had the skills and knowledge to meet people's needs, and we saw that more training was to be provided to staff so that they had the skills and knowledge to meet all of people's needs.

Staff generally understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have an effective choice about how they lived their lives. The service had obtained legal approval for limiting people's choices when necessary for their best interests.

People had plenty to eat and drink and people told us the food was satisfactory. People were assisted to eat when they needed help.

People's health care needs had been protected by referral to health care professionals when necessary.

People and relatives we spoke with told us they liked the staff and got on well with them, and we saw many examples of staff working with people in a friendly and caring way.

There was some evidence that people and their representatives were involved in making decisions about their care, though this needed to show that people and their representatives were involved in drawing up individual care plans.

Care plans were individual to the people using the service and covered their health and so

Inspection carried out on 25 October 2013

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

We spoke with seven people using the service and two relatives visiting their family member. We also spoke with three members of staff.

We found people's privacy, dignity and independence were respected. One person told us “the staff look after me well.” Another person told us “everything is okay, I’m very happy here.” We found the provider had introduced an activities programme, and saw people using the service taking part in, and enjoying, activities during our inspection.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. We found the provider had robust systems in place relating to the management of medicines.

We found there was a clear and up to date recruitment procedure in place that was followed by the service. This meant that people were cared for, or supported by, suitably qualified, skilled and experienced staff.

Inspection carried out on 21 August 2013

During a routine inspection

We spoke with eight people using the service, two relatives and a visitor. We also spoke with five members of staff and a visiting social care professional.

Although we found people's privacy and dignity were respected, we found that most people using the service had no opportunity to take part in any social or leisure activities.

We found people experienced care and support that met their needs and protected their rights. One person told us “I like it here, the food is lovely and the staff look after me well." Care and support was delivered in a way that met people’s needs and ensured their safety and welfare.

We found that the provider did not have appropriate arrangements in place to manage medicines which meant that people may not be protected against the risks associated with medicines. People’s medication was not always stored safely and securely. The number of controlled drugs in the controlled drugs cupboard did not match with the number recorded in the controlled drugs register.

Although there was a recruitment and selection process in place, we found that gaps in a person’s employment history were not fully explained.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained. We found the provider had clear and effective systems in place relating to record keeping.

Inspection carried out on 20 September 2012

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

We spoke with five out of 16 people using the service on the day of our inspection. They all told us they were happy with the service. One visitor commented, “I’ll have to get in here myself.” We saw that care workers were supporting people discreetly and responded when people asked for attention. We saw that people were supported to be involved in meaningful activities of their choice. The people we spoke with said they were happy with their bedrooms and communal areas. The environment was clean and well maintained.

Inspection carried out on 26 April 2012

During a routine inspection

We spoke with five of the 17 people using the service on the day of our visit, including one person using day care at the service. We also spoke with three relatives and two care professionals who were visiting the people we spoke with.

Comments included, “It’s alright.” , “I think it’s quite reasonable.” Relatives told us, “It’s clean, it’s warm. It’s homely. Her bedroom is like the lounge at home.” We asked a relative what they thought of the environment at the home. They said, “Excellent. They’ve just painted.” We saw that the home had been recently refurbished but there were some risks to people because checks of the environemnt were not identifying hazards. Everyone we spoke with was satisfied with the cleanliness of the home. They all said they felt safe using the service. The people we spoke with were confident they would know what to do if they were abused or suspected abuse.

We asked people what they thought of staff and whether they were competent to do their jobs. Comments included, “The ones we see are lovely.” “They’re alright." and “They’re all very good at their jobs.”

Everyone we spoke with about fees had been given information prior to deciding to use the service. They all knew what was included in their fee and which services they would pay extra for. One relative was not happy with charges for an escort to a hospital appointment. The provider was discussing this with the funding authority and the relative at the time of our visit.

Inspection carried out on 6 December 2010

During a routine inspection

People told us that they have privacy. One had a key to their bedroom door, and told us that "everyone has". She also said that people would want to get into her bedroom ‘but we can lock the door’.

People also told us they have choice within their daily lives. One told us that "they have a strict routine, some go to bed early," but "if there’s something on television they are watching they can stay". Another said they went to bed when they wanted "usually sometime after 9".

One person said they liked living in the home described the home as "brilliant". Another told us that "care is OK". One visitor who advocated for their relative said they thought people were well cared for and had no complaints about the care. They said "she is looked after very well".

People told us that the food was good, one told a care worker "lunch was very good", another said "food is beautiful – I have no complaints about that". One relative said the food was "very good".

One person showed us a letter they had been given from their Consultant Psychiatrist outlining some of their care needs. Another told us that the District Nurse had been in that day to care for some leg wounds they had.

One person said that staff came in every day to clean their room. Another said "staff are always cleaning".

People told us that staff made sure they got their medicines. One said that they got their tablets given to them and staff made sure they took them. Another told us "staff make sure I get my tablets".

People told us they liked living in the home and that their bedrooms were comfortable. One said "I like it now I am up here" (referring to the fact that they now have a first floor bedroom where they can see out of the window). Another told us "it’s fine here".

People told us that there were enough staff employed and that they got on well with them.

People knew the names of the staff who looked after them. They told us: "Staff are Ok"; "The staff are good" and "they take me shopping, there is a big shop locally we go to". One said they got on well with staff and always saw the same people. One regular visitor said "the staff are very good" and that they thought their relative was well cared for. They had no complaints about the care, saying "she is looked after very well". They also knew the names of staff.

One frequent visitor to the home told us that "if there were any problems there are two managers here, and they are very responsive, they would sort it out", they had no complaints about the care. One person told us that if they were not happy they would see the senior person "or the one above them" and said that things got sorted out.

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