Alston View is registered to provide accommodation, nursing and personal care for up to 49 people and is owned by MPS (Investments) Limited. At the time of our inspection on 30 September 2015 there were 37people living at the home: 21 people requiring nursing care and 16 requiring residential care. The home is located in the village of Longridge where access to local facilities are within walking distance. Alston View is a modern home with accommodation on three floors. All of the bedrooms are en-suite with the exception of two single rooms. A small car park is available for visitors. Accommodation is provided over three floors (including the ground floor) with lift access between the floors. There are communal lounges and a dining room as well as toilets and bathroom facilities. A kitchen and laundry are located on the ground floor.
We previously inspected the home in May 2015, and found the home required improvement in the following areas. People who used the service did not have their medicines well managed and that the infection control measures were not consistently adequate to protect people from the spread on infection. Staff training and supervision was not always carried out in a timely manner to ensure staff were properly supported to undertake their work. Staff were not confident in their knowledge and use of the Mental Capacity Act 2005. In some instances, care records and assessment were very narrowly based on clinical issues, and not focused on the whole person. People were not always supported to take part in a range of activities whilst staying at the home. Quality assurance and governance systems were in place; however they were not always followed and implemented. The staff communication systems were sometimes ineffectual. Staff were found to be caring, but some were not given support to reflect on practice through appropriate supervision.
We carried out a series of unannounced inspection visits in July 2015. On 15 July 2015, our inspection was undertaken as part of a joint visit with representatives from Lancashire County Council Social Services Department and the Police Public Protection Unit. Our visits were made after Social Services were alerted to the death of a service user, who had been found to be gravely ill when attended to by a visiting healthcare professional. We undertook subsequent inspection visits on 17, 21 and 22 July 2015 in order to collect further evidence of how the service was operating.
In July 2015 we found that that people were not kept safe from harm as staff had not received up to date training in safeguarding and allegations of abuse were not always recognised or reported. There was a lack of meaningful activities for people, although people told us they enjoyed the outside entertainers who visited. People’s care was not always planned or delivered in a way that met their individual needs and preferences: care records were not robust and people’s needs had not been comprehensively assessed. Medicines were not managed safely and properly: stock balances did not reconcile.
Staff had not received training in, and lacked understanding of, the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Feedback from staff and information held within the records showed that the registered provider had not provided appropriate and sufficient support, training, professional development, supervision and appraisal to enable all staff members to carry out the duties. Care and treatment was not provided by suitably qualified, competent, skilled and experienced staff: the home relied on nursing care from registered mental nurses (RMNs), when clinical input from registered general nurses (RGNs) would have been more appropriate.
The data relating to the number of deaths at the home in the past 12 months differed across a number of agencies: CQC, the Local Authority and the Clinical Commissioning Group were all found to hold a different number. It was clear that the service provider had not correctly notified external agencies as required to do so. There was a lack of quality assurance systems and those that were in place were ineffective and had been used to effectively identify service deficits such as concerns around staff training, staff qualifications, care assessment and planning activities and notifications.
We revisited the home on 30 September 2015, and found that some improvements had been made. The care records were found to be well organised, making information easy to find. We were pleased to note that RGNs had now been appointed, rather than relying purely on the clinical input from RMNs. The RGNs had more suitable qualifications, experience, skills and knowledge to provide the care and treatment for those who required a higher level of nursing intervention. Staff spoken with were able to discuss the needs of those who lived at the home well.
The area manager advised that some progress had been made in recruiting new staff and that this was on-going. This meant the service were able to reduce their use of agency staff, which had previously been an issue, which was noted on the staff rotas.
Alston View is required to have a registered manager. At the time of our inspection there was an acting 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. The service provider has given the Commission assurances that the acting manager will applied to be registered.
We found errors in the way medicines were administered and managed. These issues were similar to those found in May 2015 and July 2015, and this put the care and welfare of people living at the risk. Medicine audits were not effective. Not all the staff had received appropriate fire safety training. Incidents and accidents were not properly monitored, and when these needed to reported to external agencies, we found that this had not always taken place.
Some areas of the home were found to be in need of a deep clean, and the home did not have a staff member who took overall responsibility of infection control measures. We have made a recommendation about this.
We did not have assurances that staff members had adequate knowledge to undertake their work, as many had not received sufficient training and supervision in order to perform their work effectively, although we noted that the home had an action plan to tackle this issue, and were working through the plan. Some areas of the home were in need of repair, and needed to be properly maintained.
Although people’s needs were being met, and these were reflected in their improved care records, staff were sometimes slow to respond to people’s requests for support, and the home did not always provide appropriate social activities.
Management record keeping was poor, and the governance systems operated within the home were not robust or effective, although we noted that some improvements to the systems had taken place. Systems and processes to record, assess, analyse and mitigate risks and promote people’s well-being were not being followed.
We found five breaches of the HSCA 2008 (Regulated Activities) Regulations 2014 in relation to Person Centred Care, Safe Medicines Management, Safe Care and Treatment, Staff Training and Supervision’, Safeguarding, Safe Premises and Good Governance.
We found two breaches of the (Registration) Regulations 2009 in relation to notifications of deaths and notifications of other incidents.
We recommend that the service provider consults and implements best practice guidance on injection control measures.
We identified a number of breaches in regulations and the Care Quality Commission is considering the most appropriate regulatory response to resolve the problems we identified. The overall rating for this service is ‘Inadequate’ and the service is therefore in 'Special Measures'. The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
You can see what action we took at the end of this report