Archived: Alton House Care Home - Hayling Island

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question good. At this assessment the rating has changed to inadequate. This meant people were not treated with compassion and there were breaches of dignity; staff caring attitudes had significant shortfalls.

The service was in breach of a legal regulation in relation to privacy and dignity. People were not supported to have independence, choice and control in their daily living. People provided mixed feedback about the interactions they had with staff. People were not always treated with kindness, dignity or compassion.

This service scored 30 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not treat people with kindness, empathy and compassion, or respect their privacy and dignity. The serious concerns we found about people's safety showed there was a lack of understanding as to how to care for people in a compassionate and dignified way.

Two people told us some staff treated them and other people with kindness, but some staff did not. They said 2 staff ridiculed people and shouted at them. After our inspection more staff members whistle blew about further instances of staff treating people with no kindness, compassion or dignity. We worked with the local authority team to ensure people were protected.

Despite this, we saw occasions where staff displayed kindness to people and supported them in a caring and compassionate way. New senior staff in the service told us how they had been trying to improve how staff communicated with people. Relatives told us they found the staff to be kind and pleasant.

Some people looked unkempt with greasy hair. Care records showed people did not routinely receive personal care in line with their needs and wishes. This included going for long periods without oral care. One person had very dirty bandages on. We asked the manager when they had last been changed but they did not know. This demonstrated a lack of dignity.

People’s belongings were not looked after. One person asked an inspector to help them get some clothes out of their drawer. The inspector found the clothes to be crammed in and damp meaning they could not be worn. We found people’s clothes frequently on the floor of their wardrobes rather than being hung up. People’s beds were often not made, and some people did not have a bottom sheet or duvet. Some people’s belongings were in boxes or bags and had not been arranged in their rooms for them. 1 relative told us, “We have had a problem with clothes being mixed up; we have found clothes that clearly don’t belong to [Person’s name] and I have had to buy him new clothes.” This demonstrated a lack of care and dignity.

Some people experienced a lack of privacy. The communal areas were small and did not have enough chairs for people. 8 people also shared a bedroom. This meant there was nowhere for some people to go if they wanted some time alone. Shared bedrooms were small and there was a lack of consideration about how to protect people’s dignity or privacy.

There was no culture to ensure people received caring and compassionate care to meet their assessed physical, mental and wellbeing needs. People had nothing to do with their time or enough staff to interact with them in a meaningful way.

The service did not treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. The service did not take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

People’s care plans held limited information about their unique characteristics, life history and communication needs. This meant we could not be assured staff could be guided by people’s care records to support people effectively.

We observed there was no social activities and stimulation to meet people’s social needs. People spent a lot of time sleeping, or watching TV passively, appearing withdrawn and low in mood. Care records demonstrated people who spent all their time in their bedrooms only had interaction when staff supported them with their physical needs. This meant people’s social needs were not met and increased the risk of social isolation for those in their rooms. Two people told us they stayed in their rooms as there was nothing to do and no reason to leave them.

Relatives provided us with mixed views about the activities in the home. Comments included, “They [staff] play games with them [people]. I am aware that they are putting on a carol service for the residents”. “I turned up one day and there was a man playing a guitar and singing to them. There was a lot of talk about day trips, but it has all dwindled. One time I wanted to take her out and they couldn’t find her outside shoes.” and “She can hardly see but they put her into the lounge to watch TV. Nobody seemed to try to find out about her hobbies.”

One relative told us about an occasion that celebrated the person and said, “Somebody made a cake for [person’s name] 90th birthday and she was so pleased that they wanted to make it.” However, people and relatives did not tell us about any other examples of how people were treated as an individual.

The service did not promote people’s independence, so people did not know their rights and have choice and control over their own care, treatment and wellbeing.

We observed staff rushed and the care was task and staff focused rather than person led. A staff member and professional external to the service told us staff routinely woke some people up early in the morning as there was an expectation that a certain number of people were “ready” for the day staff. When we arrived at 9:30am, we saw most people were already up and dressed and the majority were sleeping in chairs in the lounge.

The manager told us some people stayed in bed all of the time. When we asked the manager for the reason, they did not know. After our inspection, the care home quality improvement team supported people to determine if they were able to get out of bed to maximise their independence.

Two people had tables placed in front of them while they were sitting in the lounge. We did not see the tables being used for any purpose and it restricted their movement. When we asked staff for the purpose of this, they removed the tables but could not explain the rationale. We were concerned this practice did not promote, choice, control and independence for these people because they could not get up from their chairs.

The manager told us there were no restrictions on people having visitors to the home but advised they should not visit at lunch time. A relative confirmed this. There was not an appropriate reason why this measure was in place. A staff member said visitors were only able to visit people between the hours of 8am and 8pm and this included if a person was at the end of their life. When we spoke to the manager about this, they said this was historical practice and people could now be visited at night. However, this message had not been passed on to all staff members. This meant people may not be able to have visitors when they wanted to or when they were at the end of their life.

Two relatives told us, people had not been given a choice about their bedrooms. One said they were surprised their relative was sharing and the other said their relative was unhappy about the arrangement. This showed people had not been consulted about their living arrangements. A staff member said some people were negatively impacted by sharing a room. For example, “[Person’s name] screams all night long, and in the day as well. [Person’s name] who shares her room can’t say much, she just lays there. She couldn’t say be quiet or ask me to ask her to be quiet.”

Care plans did not always outline what people could do for themselves or how staff could support people in being more independent. There were no records that demonstrated people had been supported to have choice and control over their care.

Leaders were unable to demonstrate how they monitored the quality of care and whether people were supported to have independence, choice and control. This meant there was a culture in the home of institutionalised care.

The service did not listen to or understand people’s needs, views and wishes. Staff did not respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

There were not enough staff to always respond to people’s immediate needs. For example, a staff member told us about a person who rang their call bell but had to frequently wait long periods of time. They said, “[Person’s name] always says she gets left a lot in the morning. She says she’s been buzzing for an hour, not sure that’s right.” The provider did not have a system in place to check call bell response times.

We saw people who were distressed and required staff support, but this was not provided in a timely manner. For example, 1 person was repeatedly asking to go out, a staff member said they would “help in a minute” but never returned to them. Some people were shouting and swearing at each other but there were no staff in the room to deescalate the situation. This placed people at the risk of harm and demonstrated they had unmet needs.

One person’s care records stated they ‘had been sick many times this morning’, ‘complaining about pain’ and ‘looked green’. There was no record of what action had been taken to support them. When we observed the person, they were in bed laying in their urine with no staff present. We also observed another person who was lying in a wet bed. On both occasions we needed to ask the manager to provide appropriate support for them.

The service did not always care about and promote the wellbeing of their staff. They did not always support or enable staff to deliver person-centred care.

Staff told us their wellbeing was affected because they were over stretched and there was not enough staff to provide people with person-centred care. One staff member told us “Things had been bad” at Alton House but the new manager was trying to improve the service and their working life.

Staff told us they were well supported by the manager. For example, a staff member said, “[Manager] is trying her best to get things sorted. She’s supportive and approachable and we can talk to her whenever we need to.”

Staff told us the opportunities to provide meaningful feedback, raise concerns and suggestions to improve the service had improved. They told us they were listened to by the manager who took their suggestions for improvement on board.

The manager told us they had an open-door policy, and staff could call her whenever they needed to. However, we found the manager was not given the support they needed from the provider to fulfil the requirements of their role. They told us how overwhelmed they were with trying to make the necessary improvements and they were struggling to ensure people received safe and good quality care. The director of the service had not put measures in place to support them.