Alverstoke House Nursing Home

We found the following examples of good practice.

The provider was aware of the correct procedures for professional visitors and the home’s policy reflected this. However, the procedure to check vaccination status was not followed on our arrival. The provider took action to address this.

The provider had adequate supplies of Personal Protective Equipment (PPE) available and this was used appropriately during the inspection.

People were supported to have visitors in line with government guidance.

The correct procedures were in place and followed for COVID-19 testing. When people needed to isolate the service was able to accommodate this and minimise the impact on people’s well-being.

The service was not currently open to admissions. The appropriate measures were in place to facilitate safe admission when these occurred.

Alverstoke House Nursing Home is a care home providing accommodation and nursing care for up to 29 people, including people living with physical and nursing needs. There were 14 people living at the home at the time of the inspection.

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

During the inspection we identified significant improvements in all aspects of the service. People were happy living at Alverstoke House, spoke positively about the care they received and told us they felt safe.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, some improvements were still required in relation to the service working within the principles of The Mental Capacity Act.

People's care plans and risk assessments contained detailed information about them and their care and support needs, to help staff deliver care that was individual to each person. These were reviewed regularly to ensure the care and support provided to people, continued to meet their needs.

New processes in relation to medicine management had been implemented. This had resulted in improvements in all aspects of medicine provision to ensure safe and effective administration.

Recruitment practices were effective, and we observed there were sufficient numbers of staff available to meet people's needs in a safe and unhurried way. Staff had received appropriate training and support to enable them to carry out their role safely. They received regular supervision to help develop their skills and support them in their role. People were protected from avoidable harm and individual, environmental and infection control risks were managed appropriately.

People were supported to access health and social care professionals when needed and received enough to eat and drink, however we received mixed views of the food provided.

People’s needs were met in a personalised way. Staff knew the people they supported well and had a good understanding of their needs. People were supported to partake in both group and one to one activities.

Effective quality assurance systems had been developed and implemented to continually assess, monitor and improve the quality of care people received.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 14 May 2021) and there were multiple breaches of regulations.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since February 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

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.

We undertook a focused inspection to review the key questions of safe, effective, responsive and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key question. We therefore did not inspect it. Ratings from previous comprehensive inspections for this key question were used in calculating the overall rating at this inspection. Please see the safe, effective, responsive and well led sections of this full report.

The overall rating for the service has changed from Inadequate 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 Alverstoke House Nursing 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.

Alverstoke House Nursing Home is a care home providing accommodation and nursing care for up to 29 people, including people living with dementia and nursing needs. There were 16 people living at the home at the time of the inspection.

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

Procedures were in place to support safe visiting by family members. Staff undertook screening of all visitors including temperature checks and a questionnaire to determine risks posed by visitors. Rapid response lateral flow tests (LFT) were undertaken for visitors before they were able to visit people. Visitors were provided with Personal Protective Equipment (PPE) and guided to its safe use.

New admissions to the service were supported in line with best practice guidance. All new admissions were expected to provide recent COVID-19 test results, a further test by the service following admission would be competed and people would be isolated upon arrival for 14 days to minimise the risk of infection to existing people. People and staff were regularly tested for COVID-19. Staff had LFT testing twice a week as well as standard Polymerase Chain Reaction (PCR) tests weekly.

Individual risk assessments regarding COVID-19 were now in place for people, although we noted these would benefit from being more person centred in content.

The service had a good supply of PPE to meet current and future demand. Staff had received training in the correct use and disposal of PPE and we observed this being used appropriately.

The home was kept clean. Records of cleaning schedules were maintained and included a program of frequent cleaning of high touch surfaces, such as light switches, handrails and door handles.

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

Rating at last inspection and update: The last rating for this service was inadequate (published 14 May 2021) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We served a warning notice to the provider requiring them to become compliant with the subsection of Regulation 12 of the HSCA 2008 (Regulated Activities) regulations 2014 that relates to infection prevention and control. This warning notice required the provider to be complaint by 8 February 2021.

This inspection was carried out to check whether the provider had acted and was now compliant with this.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

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.

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.

Alverstoke House Nursing Home is a care home providing accommodation and nursing care for up to 29 people, including people living with physical and nursing needs. There were 17 people living at the home at the time of the inspection.

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

Significant concerns regarding infection prevention and control procedures were found. Practice was not in line with government guidance for care homes during the pandemic and placed people at risk of harm.

We continued to find for the third consecutive inspection that risks associated with people needs were not always assessed and plans implemented to mitigate these; Where people required specific intervention and monitoring to ensure risks associated with the needs were managed, guidance was not always consistent and records did not reflect people were receiving the support they needed to ensure their care was safe.

We continued to find for the third consecutive inspection medicines management was not safe. We could not be assured people were receiving the topical medicines they required and there was a lack of guidance to support staff to understand when this was needed. Protocols for ‘as required’ medicines were not consistently in place. A medicines error that placed a person at risk of harm had not been identified by the service.

Leadership and management of the service had been inconsistent and unstable and staff told us this resulted in a negative culture. Staff described a blame and bullying culture and a lack of confidence in the provider was expressed by some of them. The new manager was working hard to change this.

Despite receiving support from partner agencies since 2019 around monitoring of health conditions, medication management and care planning, the provider had been unable to demonstrate these areas had improved. The governance systems in place were ineffective in monitoring the safety and quality of the service and as such in driving improvements. The provider demonstrated a consistent failure to make and sustain improvements. They demonstrated a consistent failure to meet the requirements of the regulations. The ongoing failure of the provider meant people were placed at risk of receiving a poor quality and unsafe service.

We received mixed views about the staffing levels although we observed peoples request for support for responded to and call bells were not alarming for extended periods of time. We have made a recommendation about this.

Recruitment procedures were in place to help ensure staff were suitable for their role. Appropriate systems were in place to protect people from the risk of abuse and staff and the manager understood they role in safeguarding. The manager had started to take action to make improvements including; ensuring staff had clear job descriptions, reinforcing registered nurses’ accountability and revisiting their code of practice; identifying lead roles and sourcing training to support this. They had also recruited a project manager, who was looking at care plans and risk assessments.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (Published 13 August 2020) and there was an ongoing breach of Regulation 12. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We undertook this focused inspection to follow up on ongoing concerns we had received in relation to the safe care and treatment of people who lived in the 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 coronavirus and other infection outbreaks effectively.

This report only covers our findings in relation to the Safe and Well-led. We reviewed the information we held about the service. 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 inadequate. 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 Alverstoke House Nursing Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the management of risks associated with people’s needs, infection prevention control, medicines management and governance systems.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Alverstoke House is a care home providing accommodation and nursing care for up to 29 people, including people living with physical and nursing needs. There were 17 people living at the home at the time of the inspection.

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

People's care plans and risk assessments contained consistent and detailed information in relation to people’s needs and how these should be managed. However, people’s health needs were not always monitored in line with the information highlighted in their care plans and risk assessments. This placed people at risk of not receiving appropriate care and treatment in a timely way. Following the inspection we were advised that improvements had been made in the monitoring and recording of people’s care needs. Although further improvements were needed.

People received their oral medicine as prescribed. Medicine administration care plans and ‘as required’ (PRN) plans provided staff with clear and detailed information on how people liked to receive their medicines and when these medicines should be given. However, information provided in relation to the administration of topical medicines, such as creams and lotions did not provide assurances these had been administered as prescribed.

Following our inspection we were advised that improvements had been made to the completion of the topical medication administration records. Although further improvements were needed.

We observed sufficient numbers of staff available to meet people's needs. However, we received mixed views from people and relatives about the staffing levels at the home. The manager and provider agreed to investigate this. Safe and effective recruitment practices were in place and followed.

Care staff demonstrated they knew people well and understood their likes, dislikes and preferences. People and relatives told us they felt safe and were happy with their care. They confirmed staff were kind and caring and we observed positive interactions between staff and people.

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.

Since the appointment of the manager there had been a number of improvements made to the service. These improvements included, increased oversight, more robust monitoring of the quality of care provided and the upskilling of staff. The manager had also implemented systems to help ensure themes and trends could be identified when accidents, incidents and near misses had occurred to allow timely interventions to mitigate future risks. However, these actions had yet to be fully implemented and embedded in practice.

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

Rating at last inspection and update

The last rating for this service was requires improvement (report published 18 February 2020). There were three breaches of regulation. We issued warning notices requiring the provider to make improvements regarding the safe care and treatment of people and the governance of the service. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Alverstoke House Nursing Home on our website at www.cqc.org.uk.

At this inspection enough improvement had not been made and the provider was still in breach of the regulations. This service has been rated requires improvement for the last three consecutive inspections.

We will describe what we will do about the repeat requires improvement in the follow up section below.

Why we inspected

We undertook this focused inspection to follow up on concerns we had received in relation to the management of people's nursing care needs, medicines, wound care and nutrition and hydration needs. We also wanted to ensure that the Warning Notices we previously served to the service in relation to, Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

This report only covers our findings in relation to the Safe and Well-led. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained as Requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified the following breach at this inspection.

Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to ensure risks relating to the safety and welfare of people using the service were assessed and managed, unsafe medicines management placed people at risk of harm and the service failed to ensure people were provided with safe care and treatment. This was continued breach of regulation 12.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will request an action and continuous improvement plan from the provider to understand what they will do to improve the standards of quality and safety. 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.

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

Safe medicine practices were not consistently promoted and people did not always receive their medicines as prescribed. Risks to people were not always identfied and some risks assessments lacked robust detail about how risks should be managed.

People were at risk of not receiving appropriate healthcare because care plans did not provide guidance to staff on how people’s healthcare needs should be managed. Nurses had failed to monitor and attend to a person’s health needs effectively resulting in a deterioration to their health. Actions taken by the registered manager to prevent reoccurrence of incidents or accidents had not always been effective.

We saw that some people were under continuous control and supervision due to their cognitive impairments, with restrictions on their liberty. However, we found that for some of these people, no applications had been made to the local authority. This meant these people were being deprived of their liberty unlawfully.

People’s care plans contained inconsistencies in the amount of person-centred information that was recorded and required further development to meet with best practice. However, care staff demonstrated they knew people well and understood their likes, dislikes and preferences.

There was not a culture of continuous improvement or understanding of quality performance evident in the service. We found reoccurring concerns had been noted and the registered manager and provider had taken action in relation to these. However, the actions taken had failed to mitigate the issues found.

Although the registered manager had attempted to implement changes in practice, changes were not imbedded. Systems and processes designed to identify shortfalls and to improve the quality of care were not always effective. Auditing that had taken place had not identified the issues we found.

Recruitment practices were effective and there were sufficient numbers of staff available to meet people’s needs. Staff had received training and support to enable them to carry out their role. They received regular supervision to help develop their skills and support them in their role. People were supported to maintain relationships and avoid social isolation. People were provided with a range of activities and reported enjoying these.

People were happy with the meals and activities provided. People and relatives told us they felt safe and were happy with their care. They confirmed staff were kind and caring and we observed positive engagements with people during the inspection.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 29 January 2019) and there were three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified the following breaches at this inspection.

Regulation 13 (Safeguarding service users from abuse and improper treatment) The provider failed to ensure people were not deprived of their liberty, for the purposes of receiving care or treatment, without lawful authority. This was a repeat breach of regulation 13.

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

Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to ensure risks relating to the safety and welfare of people using the service were assessed and managed, unsafe medicines management placed people at risk of harm and the service failed to ensure people were provided with safe care and treatment.

Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider failed to operate effective systems to assess, monitor and improve the service. This was continued breach of regulation 17.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor the service to gain assurance that appropriate measures are put in place to address concerns. We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. 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.

The home was based over two floors, connected by two stairwells. Bedrooms had en suite facilities and there were toilets and bathrooms available on each floor. There was a choice of communal spaces comprising of two communal lounges, a dining room and a conservatory where people were able to socialise.

The inspection was conducted on the 6 and 12 December 2018 and was unannounced. 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 2008 and associated Regulations about how the service is run.

At this inspection we identified two breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also identified one breach of Care Quality Commission (Registration) Regulations 2009. You can see at the end of this report the action we have asked to provider to take.

Safeguarding issues were not dealt with effectively to ensure that people were protected from abuse. Where reports of abuse had been raised the provider and the registered manager had failed to take responsive action to investigate concerns.

The management team adapted a staff based culture which resulted in the views and feelings of the staff taking priority over the need to safeguard, protect and consider the needs of the people living at the home.

People were not always involved in the development of the service and their views were not always considered or acted on by the management team. The provider had arrangements in place to deal with complaints, however these arrangements were ineffective and complaints were not always acted on appropriately.

Systems and processes used to monitor the quality and safety of the service had not been fully effective in identifying and preventing the shortfalls found at this inspection.

Staff were not consistently supported in their roles. Systems in place to monitor staff training were ineffective in identifying training that had been received or when it was required to be updated.

Staff did not follow the principles of the Mental Capacity Act 2005 (MCA). Capacity assessments had not been robustly completed for all people as required and those completed were not decision specific.

Individual and environmental risks to people were managed effectively. Risk assessments identified risks to people and provided clear guidance to staff on how risks should be managed and mitigated.

There were enough staff to meet people’s needs in a timely way and staff were able to support people in a relaxed and unhurried way. Appropriate recruitment procedures were in place to help ensure only suitable staff were employed.

People received their medicines as prescribed. The home was clean and staff followed best practice guidance to control the risk and spread of infection.

People's nutritional needs were assessed and people were supported to eat and drink. There was a choice of food.

People were supported to maintain good health and had access to appropriate healthcare services when required. Staff were aware of people’s health needs understood how people's medical conditions impacted their abilities. There were clear procedures in place to help ensure that people received consistent support when they moved between services.

People were supported to use technology and specialist equipment to meet their care needs and to support their independence where appropriate.

People received personal care in line with their personal preferences. Care files contained detailed information to enable staff to provide care and support in a personalised way. Care and support was planned in partnership with people, their families and healthcare professionals where appropriate.

People received mental and physical stimulation and had access to a range of activities. Staff supported people to meet their cultural and religious needs.

The home was based over two floors, connected by two stairwells. Bedrooms had en suite facilities and there were toilets and bathrooms available on each floor. There was a choice of communal spaces comprising of two communal lounges, a dining room and a conservatory where people were able to socialise.

The inspection was conducted on 30 November 2017 and was unannounced. There was a registered manager in place, however, they were on holiday on the day of the inspection. 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 of the home we identified that the service had breached a regulation in relation to medicines management. At this inspection we found action had been taken to address all areas of concern and there were no longer any breach of the regulations.

Medicines were administered by staff who had received appropriate training and assessments. People received their medicines at the right time and in a way that met their needs.

People and their families told us they felt the home was safe. Staff and the registered manager had received safeguarding training and were able to demonstrate an understanding of the providers’ safeguarding policy and explain the action they would take if they identified any discrimination or concerns.

Staff knew the people they supported and were able to explain the risks relating to them and the action they would take to help reduce the risks from occurring.

The home was clean and hygienic and staff followed best practice guidance to control the risk and spread of infection.

People were supported by staff who had received an induction into the home and appropriate training, professional development and supervision to enable them to meet people’s individual needs.

There were enough staff to meet people’s needs in a timely way. Appropriate recruitment procedures were in place and pre-employment checks were completed before staff started working with people.

Staff sought consent from people before providing care. Although nobody at the home lacked the capacity to make a decision staff were able to explain the action they would take to ensure they followed legislation designed to protect people’s rights.

Staff developed caring and positive relationships with people and were sensitive to their individual communication styles, choices and treated them with dignity and respect. People were encouraged to remain as independent as possible and maintain relationships that were important to them.

People were supported to have enough to eat and drink. Staff who prepared people’s food were aware of their likes, dislikes and dietary needs. Mealtimes were a social event and staff supported people, when necessary in a patient and friendly manner.

People and when appropriate their families were involved in discussions about their care planning, which reflected their assessed needs. Healthcare professionals, such as chiropodists, opticians, GPs and dentists were involved in people’s care when necessary.

Staff took account of people’s end of life wishes and preferences. They supported people to remain comfortable and pain free.

There was an opportunity for people and their families to become involved in developing the service. They were encouraged to provide feedback on the service provided both informally and through resident and family meetings and a bi-yearly survey. They were also supported to raise complaints should they wish to.

People told us that they felt the home was well-led and were positive about the registered manager and the provider who understood the responsibilities of their role. The provider was fully engaged in running the home and provided regular support to the registered manager.

The provider’s clear vision and values underpinned staff practice and put people at the heart of the service. Staff were aware of the vision and values, how they related to their work and spoke positively about the culture and management of the home.

There were systems in place to monitor quality and safety of the home provided. Accidents and incidents were monitored, analysed and remedial actions identified to reduce the risk of reoccurrence.

Alverstoke Nursing Home is a service that is registered to provide accommodation and nursing care for up to 30 older people, some of whom are living with dementia. Accommodation is provided over two floors and there are lifts to provide access for people who have mobility problems. There were two communal areas on the ground floor that people could choose to spend their time in. At the time of our visit 27 people lived at the home.

A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Following our last inspection on 3 December 2015 requirement notices were issued for breaches in Regulation 9, 12, 17 and 18. The registered person had not ensured personalised care was planned and delivered, risks associated with people’s care were not assessed, staff had not received the training they needed to undertake their roles effectively and the quality systems had not been effective in identified poor records.

At this inspection improvements had been made and these areas were no longer a breach.

Improvements had also been made to the management of risk and the plans of care for people.

Care records contained information to guide staff about the management of risk associated with people’s needs. Staff were knowledgeable of people’s needs and the support they required. They were no longer in breach of this element of Regulation 12. However the management of medicines needed to be improved as this was not always safe, errors had not been identified, and we were not assured medicines were always stored within safe temperature’s because these were not consistently checked.

People felt safe and staff knew their roles and responsibilities in safeguarding people.

Thorough recruitment checks were carried out to check staff were suitable to work with people. Staffing levels were mostly appropriate to meet people’s needs.

Training had improved for staff who described this as beneficial to the role and always available. Staff were supported to develop their skills through training and the provider supported staff to obtain recognised qualifications. Staff were supported through supervisions and appraisals and felt support by the manager. We have made a recommendation about setting staff development objectives.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found the provider had suitable arrangements in place to establish, and act in accordance with people’s best interests if they did not have capacity to consent to their care and support. The manager understood their responsibility with regard to Deprivation of Liberty Safeguards (DoLS) and they had applied for authorisation under DoLS to ensure people were protected against the risk of being unlawfully deprived of their liberty. We have made a recommendation about the recording of best interest decisions.

People’s views on the choice of food were varied. Care plans were in place to guide staff and we saw that staff took action. People’s intake was monitored and additional health professional input was sought. However, we have made a recommendation that the service seek guidance about the management of weight in the elderly as they did not always contact external professionals promptly. Staff supported people to ensure their healthcare needs were met.

People told us the staff were kind and caring. No one had any concerns and said they were happy with the care and support they received. Staff respected people’s privacy and dignity and used their preferred form of address when they spoke to them. Observations showed that staff had a kind and caring attitude.

Care plans were personalised and people and their relatives were involved in decisions about their care.

No one had a complaint and knew who to speak to if they did. Records to show how complaints were managed were held.

Systems were in place to monitor and assess the quality of the service and records had improved. The registered manager operated an open-door policy and staff felt they were supportive and encouraged learning opportunities.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

One inspector carried out this inspection. At the time of our visit 25 people were using this service.

At our last inspection we found concerns in relation to medication, quality assurance and record keeping. The purpose of this inspection was to check the provider had made the required improvements to ensure the safe management and administration of medicines, accuracy of records.

During this inspection we found the provider had taken appropriate action in relation to the management of medicines and quality assurance ensuring people were safe. However, a concern remained with regards to the maintenance of accurate record keeping in relation to the care people were receiving. We found there had been some improvements with record keeping but there were still gaps in recording in relation to the care given to people.

During this inspection we spoke with seven people who lived at the home, five staff members and one visiting professional. All made positive comments about the care people received and the attitude of the staff. One person told us, "This is my home and it is very pleasant. The carers are very good and they always listen to me". A professional from the speech and language team who was visiting told us, "The staff know people well and people receive a good level of care. I can leave instructions and know staff will follow these instructions".

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe within the home. Systems were not in place to make sure that the manager and staff learnt from events such as accidents and incidents, concerns and investigations.

We found the service was not safe because people were not protected against the risks associated with medicines. The provider did not have appropriate arrangements in place to manage people's medicines safely.

There were enough staff on duty that had the skills to care for people. There was a qualified nurse on duty at all times.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place.

Is the service effective?

People's health and care needs were assessed and there were clear care plans in place. We could see that people's specialist dietary needs had been identified in care plans where required. We could see that staff members had access to the care plans and were able to follow the plans of care.

Staff told us they felt they had adequate training to equip them to do their job. The training matrix identified there were some areas where staff needed training.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers and nurses showed patience and gave encouragement when supporting people. People commented, 'Staff are kind and caring'.

People's preferences, had been recorded and care and support was provided in accordance with people's wishes.

Is the service responsive?

People completed a range of activities in and outside the home. People told us they felt they were consulted on how the home was organised. People told us they would feel very comfortable telling the staff and manager if they were unhappy. One person told us they regularly fed back to the cook on whether the meals were good or could be better.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a coordinated way. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home. We found that records were not well maintained and did not always provide evidence of the care each person was receiving.

You can see our judgements on the front page of this report.

People told us they were well looked after. They told us they felt safe living at Alverstoke nursing home. Assessments and care plans had improved and reflected the needs of people and gave information on how staff should meet people's needs. People told us they enjoyed a range of activities within the home and the community. One person told us how staff had escorted them to a local restaurant so they could have a meal with friends.

One person told us a member of staff was, "Attentive and always listened", and another person then told us, "They all do, I can talk to all the staff". We sampled the recruitment records for staff members and found all necessary checks and references had been undertaken, ensuring the safety of people was considered.

The manager and provider had taken steps and had procedures to ensure people were receiving a safe and effective care in a well maintained environment. People and visitors told us the home was always clean and tidy.

Records regarding people's care and staffing recruitment records were adequately maintained.

People told us their care needs were met. One person told us, 'I am getting very well looked after, there is enough staff and they are always polite and respectful'. We found that staff members were not always following details in the care plan, which could put people and them at risk. Care plans did not always reflect the current care needs for each person to follow.

The home had suitable information available to staff on abuse to ensure staff were aware of how to identity and protect people from abuse. People told us they felt safe living at Alverstoke House.

People told us they were happy with the staff and found them to be "polite, helpful and respectful". We found that recruitment records were not adequate to ensure the safety of people.

People told us if there were unhappy with any aspect of their care or environment they would complain to the manager. People told us they had confidence the manager would be able to resolve their complaint.

We found that service user' records and staffing records were inadequate and did not ensure the safety of people living in Alverstoke House.