Archived: Alder House - Care Home Physical Disabilities

About the service

Alder House - Care Home Physical Disabilities is a residential care home providing personal and nursing care to 20 people at the time of the inspection. The service can support up to 22 people.

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

Right Support

The model of care and setting did not always maximise people's choice, control and independence.

Not enough improvement had been made to ensure risks to people were assessed, monitored and managed safely. The provider sent us information following the inspection which provided additional assurance that risks were being managed.

Right Care:

Care was not always person-centred. Some staff practices remained task focused and did not enable people to make informed choices or promote independence. There was limited evidence people had an opportunity to pursue goals and aspirations in support plans.

Staff understood how to protect people from abuse.

Right Culture:

The ethos, values, attitudes and behaviours of staff did not always ensure all people using the service could lead confident, inclusive and empowered lives. Staff had not received the required training needed to support people with a learning disability or autistic people.

Systems to obtain people's views were not effective through keyworker meetings and further work was needed to adopt a more person-centred approach to enable people's individual views to be sought.

There was a lack of oversight from the provider regarding quality assurance within the service.

Risks relating to the home environment had not always been mitigated to keep people safe. There was minimal evidence to demonstrate staffing levels on a day to day basis. The manager was not aware of who received 1 to 1 care or if it was being funded. Following the inspection more assurance was provided in relation to staffing levels.

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 25 July 2022) and there were breaches of regulation. At this inspection we found the rating remained the same.

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 the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service in May 2022. Breaches of legal requirements were found. We undertook this focused inspection to check to see if they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. 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 Alder House - Care Home Physical Disabilities on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to risk, person centred care and governance. Please see the action we have told the provider to take at the end of this report.

Follow up

We have met with the provider following this inspection 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, 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.

About the service

Alder House - Care Home Physical Disabilities is a residential care home providing personal and nursing care to 21 people at the time of the inspection. The service can support up to 22 people.

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

We were not assured the service understood or met the principles of right support, right care, right culture. When we arrived the registered manager told us there were five people with a learning disability, following a review of records the registered manager asked people’s GP for this information and we were told there were 12 people with a learning disability at Alder House - Care Home Physical Disabilities.

Based on our findings at this inspection. The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right Support

¿ Care records did not always evidence if less restrictive options had been explored prior to restrictions being in place or who was consulted in people’s best interests.

¿ The registered manager was not aware how many people with a learning disability were being supported.

¿ Risks to people’s health and wellbeing were not always assessed, monitored and managed effectively.

¿ Improvements were needed to ensure the service was well maintained and easy to clean.

¿ Limited evidence was recorded to demonstrate how staff supported people to achieve their aspirations and goals.

¿ Whilst activities were available for people there was limited evidence of individual plans for people to pursue people’s individual interests or identify opportunities for these to be pursued.

¿ Improvements were needed to medicines management.

Right Care

¿ Care and support did not always reflect current evidence-based guidance, standards and best practice to meet the needs of people with a learning disability. The provider had recognised this and had plans in place to deliver training on right support, right care, right culture.

¿ We were not assured that all staff were appropriately skilled to meet people’s needs and keep them safe.

¿ Staff had training on how to recognise and report abuse, however more work was needed to ensure staff knew how to apply this training. Systems to safeguard people were not robust.

¿ Improvements were needed to ensure people had access to information in a format that was suitable for them. We did see some people had access to communication aids.

¿ We have made a recommendation about records related to end of life care.

Right culture

¿ Significant concerns had been identified which had impacted on the service provided. The provider had recognised these failings and additional support had been put into place.

¿ We were not assured that people were being supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have.

¿ Staff turnover had been high, which meant people were not always receiving consistent care from staff who knew them well.

¿ There was limited evaluation of the quality of support provided to people which involved the person, their families and other professionals as appropriate.

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

Why we inspected

This inspection was prompted by concerns that had been identified by the local authority in relation to infection control, medicines management, risk and the culture in the service. We initially did not inspect this service to assess that the service was applying the principles of Right support, right care, right culture as we were not aware that people with a learning disability were supported at the service. When it was identified that people had needs associated with their learning disability, we did inspect this area.

As part of CQC's response to the COVID-19 pandemic we are looking at how services manage infection control and visiting arrangements. Initially we undertook a focused inspection to look at safe and well led. We inspected and found concerns, so we widened the scope of the inspection to become a comprehensive inspection which included all the key questions.

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.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to mitigating risks, safeguarding people, consent and overall governance and culture of the service at 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 request an action 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.

Alder House is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection. Alder House accommodates up to 22 people with physical or sensory disabilities. At the time of our inspection, there were 20 people living at Alder House.

At our last inspection, we rated the service Good. At this inspection we found the evidence continued to support the rating of Good, and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a registered manager at the service. 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.

Why the service is rated Good.

People received care and treatment which was planned and delivered in a way that ensured their safety and welfare. There were enough staff to ensure people’s care and support needs were met. Staff had been recruited and employed after appropriate checks had been completed. People's medicines were managed safely and medicines were administered by staff who had received training to do so. There were systems in place to minimise the risk of infection.

People were safeguarded from the potential of harm and their freedoms protected. Staff were provided with training in safeguarding adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People received a service which was responsive and centred around their needs. People's care plans provided clear guidance to staff on how people wished to be supported, and were regularly reviewed. The environment at Alder House was appropriately designed and adapted to meet people's needs.

Staff received training and structured supervision to enable them to acquire the skills and knowledge to meet people’s care needs. Staff were kind and caring in their approach with people. Staff treated people with dignity and respect and promoted people's independence.

People were supported to eat and drink enough, ensuring their dietary and nutritional needs were met. Staff worked effectively with other health care professionals to ensure people's health needs were met.

People were provided with the opportunity to participate in activities and pursue their hobbies and interests. There was an effective complaints procedure in place, and complaints had been dealt with in line with the registered provider's policy.

There were systems in place to continually monitor the quality of the service, and to drive improvements. This included people being encouraged to feedback about the quality of the service, and make suggestions for improvements.

Further information is in the detailed findings below.

Alder House is registered to provide accommodation with personal care for up to 20 people who have physical or sensory disabilities. There were 18 people living at the service on the day of our inspection.

A registered manager was in post. 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.

Staff were knowledgeable about how to protect people from the risk of abuse and other areas where they may have been assessed as being at risk. Risk management plans were in place to support people to have as much independence as possible while keeping them safe. There were also processes in place to manage any risks in relation to the running of the service.

People received their medicines safely and had regular access to health care professionals. People were supported by staff who knew them well and were available in adequate numbers to meet people's needs. There was a good choice of food and drink and people who were at risk of not eating or drinking enough were monitored.

Staff used their training effectively to support people. The manager understood and complied with the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Staff were aware of their role in relation to MCA and DoLS and how to support people so not to place them at risk of being deprived of their liberty.

People received care that met their individually assessed needs and preferences. People’s dignity and privacy was respected and they found the staff to be friendly and caring. People were supported to participate in social activities including community based outings.

People received personalised care and staff knew them well. Relationships between people, relatives and staff were positive. Staff were caring and responsive. Care plans were clear, provided staff with guidance and were reviewed regularly. People were involved in the planning and reviewing of their care.

The service was well led; people knew the manager and found them to be approachable and available in the home. People living and working in the service had the opportunity to say how they felt about the home and the service it provided. Their views were listened to and actions were taken in response. The provider and manager had systems in place to check on the quality and safety of the service provided.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information we had gathered to answer questions we always ask; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff had been trained to understand when an application should be made, and in how to submit one.

The provider had safe and effective recruitment and selection procedures in place. No staff had been subject to disciplinary action. Policies and procedures were in place to make sure that unsafe working practice was identified and people protected.

Is the service effective?

People's health and care needs were assessed with them. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People told us that they had been involved in writing them and that they reflected their current needs.

People's needs were taken into account with signage and the layout of the service. This enabled people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with physical impairments.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People we spoke with told us; 'The staff are kind here and do as much as they can for us. Most importantly for me they really respect my independence and help me to retain this."

People who used the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were identified we saw that these were addressed. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly. The home has its own adapted minibus, which helped to keep people involved with their local community.

People knew how to make a complaint if they were unhappy. One person said that they had made a complaint and were satisfied with the outcome. We looked at how complaints had been responded to. We noted that the responses had been open, thorough, and timely. People can therefore be assured that complaints are investigated and action is taken as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system. Records seen by us showed that identified shortfalls were addressed promptly. We were therefore assured that the provider had taken steps to continually improve the service.

People could spend time how they wished. Some chose to stay in their own rooms, others used the communal lounges, took part in activities or went out.

All staff members had been trained in the Mental Capacity Act. With the knowledge they had of the people they were caring for, this meant they knew what assistance a person would require to make a decision or give consent.

People told us they enjoyed the food at Alder House. One person said, "We get to choose the menus. I like the cakes best.'

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

We found that the required improvements had been made. The provider had an effective system in place to identify, assess and manage the risks to the health, safety and welfare of people using the service and others. We also saw that the views of people using the service were considered and acted on.

We spoke with one person who used the service. They confirmed that people using the service had the opportunity to express their views on the service and be involved in shaping the way it was provided. This was through involvement in meetings for people using the service, completing questionnaires and taking part in interview panels to appoint new staff.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

People we spoke with told us they felt well cared for and that they were happy living at the home. One person said, 'The care is quite good here.' We found that people made choices about their daily lifestyles where they were able to and they were involved in making everyday decisions about their care. People's diversity and individual preferences were respected and supported.

People told us they felt safe at the home. They spoke in a complimentary way about the staff working there. One person said, 'Staff are very nice here, I do feel safe with them.' People also told us that they would feel able to tell someone if they had any worries or concerns and that they knew how to make a complaint.

We looked at records that would tell us about people's care or show us that the service was well run in a way that kept people safe. Some of the records did not have all the information they needed to. They were not always clear or easy to follow.

People who used the service were able to attend meetings so that they could express their views about the home. They were also asked to give feedback in written surveys. We found that the provider did not always show clearly that people's views were listened to and acted upon.