Archived: Alfriston Court Care Home

Alfriston Court Care Home is a nursing home providing personal and nursing care to 27 people aged 65 and over. At the time of the inspection there were 23 people living in one adapted building. People living at the home had a range of needs. Some people were living with dementia whilst some had clinical needs and those associated with old age.

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

We found that improvements had been made following the last inspection.

Quality and governance systems had improved however they had not been fully established and embedded into everyday practice. This meant areas needing improvement were not always identified and responded to effectively. We found some care plans were not complete. This included the absence of suitable care plans to support people with dementia, their mental health and emotional needs. Management and medicine audits had not identified missing and poorly completed records. These areas were identified as needing improvement.

People were protected from the risks of harm, abuse or discrimination because staff knew what actions to take if they identified concerns. There were enough staff working to provide the support people needed and recruitment practice ensured only suitable staff worked at the service.

There were suitable arrangements in place to assess and respond to any risk to people and to provide people with their prescribed medicines safely. Infection prevention control measures meant the service was clean and people were protected, as far as possible, from the risk of COVID-19.

People received personalised care that was delivered by staff who had a good understanding of their needs and how they should be met.

People had access to health professionals to promote their health. People had regular contact with the activity staff to promote social interaction and minimise any risk of isolation. Visiting was taking place in line with government guidelines. Complaints were listened to and resolved in a timely way.

The new manager had established a positive culture at the service and was supportive to people and staff. They understood their responsibilities and was making positive changes in the service to improve outcomes for people. There was a clear management structure with the manager supported by a clinical lead and a team of registered nurses.

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 Requires Improvement (published 26 July 2019).

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted by our internal intelligence systems that assesses potential risks at services, taking account of concerns in relation to aspects of care provision and previous ratings and any enforcement. As a result, we undertook a focused inspection to review the key questions of Safe, Responsive and Well-led only. This enabled us to review any potential risks and review the previous inspection ratings.

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.

During the inspection no areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Requires Improvement to Good. 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 Alfriston Court Care Home on our website at www.cqc.org.uk.

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.

Alfriston Court Care Home is a nursing home providing personal and nursing care to 21 people aged 65 and over at the time of the inspection in one adapted building. People living at the home had a range of needs. Some people were living with dementia whilst some people's needs were associated with old age and frailties associated with old age. The service can support up to 27 people.

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

The management of medicine was inconsistent. People received their medicines on time and in a dignified manner. However, stock levels of medicines were not always accurate and protocols for the use of ‘as required’ medicine lacked detail. We have made a recommendation about the effectiveness and oversight of medicine administration.

Fire safety was assessed and people had personal evacuation plans in place. These lacked detailed on how a person would be safely evacuated and fire doors were not consistently connected to the main alarm. Therefore, in the event of a fire door being opened, staff would not be alerted.

A dedicated activity coordinator was in post who was in the process of reviewing the provision of activities and the activity programme. The provider and activity staff had recognised that the activity programme needed to be more varied to ensure it suited a wide range of people.

Quality assurance systems were in place, but these were not always effective in driving improvement and identifying shortfalls. For example, internal audits failed to identify that hospital transfer forms lacked information on whether people had a DNACPR (Do Not Attempt Cardio-pulmonary Resuscitation) in situ or not. We have made a recommendation about the oversight of audits.

There were enough staff working to provide the support people needed, at times of their choice. Recruitment procedures ensured only suitable staff worked at the service.

Staff could recognise and report suspected abuse or poor practice. The registered manager was aware of the process to follow should an allegation be made. Learning was derived from safeguarding concerns and shared with staff to promote safe practice.

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.

People's health care needs were monitored and responded to promptly, with cooperation and support from health and social care professionals. Staff worked creatively with healthcare professionals to ensure people received positive outcomes.

The provider was dedicated to ensuring links with the local community were established and developed. The service was integral to the local community and many events were held at the service which members of the public were invited too.

Staff treated people with dignity, respect, care and kindness. They spoke with people in a friendly and patient manner. Staff knew people well. They knew about their backgrounds and about their routines and preferences. Ongoing training was available and the provider actively sourced training initiatives to upskill staff.

People told us they knew what to do if they had any concerns or complaints about the home and the management team had resolved them. The home used learning from complaints to improve future practice.

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 6 December 2016)

Why we inspected:

This was a planned inspection based on the previous rating. We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) 2014.

Enforcement: Please see other 'actions we have told the provider to take' section towards the end of the report.

Follow up:

We will request an action plan for the provider to understand what they will do to improve the standards of quality. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This inspection took place on 13 and 19 October 2016 and was unannounced.

The service had a registered manager 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 2008 and associated regulations about how the service is run.

At the last inspection, undertaken on the 28 and 29 July 2015, we asked the provider to make improvements to ensure all medicines were administered in a consistent and safe way. Improvements were also needed to ensure when people lacked capacity, appropriate processes were followed to ensure staff took account of their individual rights and care was provided in their best interests' The provider sent us an action plan stating they had addressed all areas identified for improvement. At this inspection we found the provider had ensured staff had guidelines to follow when administering medicines. Staff had a good understanding of gaining consent from people and ensuring if people lacked capacity suitable people were involved in ensuring people’s rights were protected.

Management systems that included quality monitoring did not always ensure safe and best practice was followed in all areas. Some care records were not complete and some care plans did not include all relevant information. The management systems did not ensure all required notifications were sent to the CQC and verbal complaints and concerns had been recorded. All safety checks including those on hot water had not been fully completed.

Although staff took account of people’s rights when providing care and treatment, some records did not evidence appropriate processes to protect people had been followed in all cases. Agency staff had not undertaken an induction and there was no evidence that the provider had checked they had the appropriate skills, before they worked in the service.

Feedback received from people, their relatives and visiting health professionals were positive about the care, the approach of staff and atmosphere in the Alfriston Court Luxury Care Home. People told us they were happy living in the service and liked the staff. People were looked after by staff who knew them well and took an interest in them as people. People were treated with kindness and with a caring approach. Staff understood how to support people, taking into account their individuality and dignity.

Staff had a good understanding of safeguarding procedures and knew what actions to take if they believed people were at risk of abuse. Staff were trained on the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Senior staff had an understanding of DoLS and what may constitute a deprivation of liberty and knew the correct procedures to follow in order to protect people’s rights.

Recruitment records showed there were systems which ensured as far as possible staff were suitable and safe to work with people living in a care home. People were supported to receive the medicines they were prescribed.

Staff were provided with an induction and training programme to support them to meet the needs of people. Staffing arrangements were flexible and ensured staff worked in such numbers, with the appropriate skills that people’s needs could be met in a timely and safe fashion. People’s care needs were identified and responded to with external health care professionals involved with care and treatment appropriately.

There was a variety of activities and opportunity’s for interaction both in and outside of the service. This took account of people’s preferences and choice and gave people meaningful interaction and activity. Visitors told us they were warmly welcomed and people were supported in maintaining their own friendships and relationships. The environment was clean and attractive. Where improvements were required this had been identified and was being responded to. People’s rooms were individual, staff respected each room as people’s own space.

People were complementary about the food and the choices available. Staff monitored people’s nutritional needs and responded to them. Mealtimes were relaxed and pleasant, with people’s preferences and specific diets being responded to.

People were given information on how to make a complaint and said they were comfortable to raise a concern or give feedback. A complaints procedure and comment cards were readily available for people to use. People were encouraged to share their views on a daily basis and satisfaction surveys had been completed. The management style fostered an open culture that listened to people and staff views. The registered manager was visible, approachable and friendly. Staff enjoyed working at the service and felt supported by the management and their colleagues.

The people we spoke with told us they were happy with the care they had received and with the staff team. One person who used the service told us, "The staff are very careful, very kind and treat me with dignity and respect.' Another person who used the service told us, "The staff are very nice, very thoughtful and very kind.' Staff we spoke with had a good understanding of the support needs of the people who used the service. One member of staff we spoke with told us, "The staff here love the residents. People are treated as we would want to be treated ourselves.'

The people who use the service were supported to have adequate nutrition and hydration. People were given choices of food and drink to meet their diverse needs.

We saw that people who used the service, people who worked in or visited the premises were in safe and accessible surroundings.

We saw evidence that the provider had an effective recruitment and selection procedure in place to ensure that staff were qualified to do their job.

The service had a system in place to effectively deal with comments and complaints.

We saw that people were able to personalise their own accommodation. They told us how comforting it was to be able to have their personal items and belongings around them when they came into the home. One resident told us 'staff are so patient in explaining things to me all the time which is good because I cannot always remember'.

We spoke with residents and relatives and they all made it very clear that people's needs were being met. They told us that independence and individuality were promoted within the home. People told us that they would speak to their families or the manager if they felt unsafe or scared. We took the opportunity of talking to relatives who were visiting at the time of our inspection. They told us that staff were ''very relaxed, caring and professional''. They said that in their opinion the staffing compliment was about right. One relative told us 'my mother is safe, well looked after, happy and most importantly adored by all the wonderful staff here - what more could I ask for'.