Alma Barn Lodge

Alma Barn Lodge is a residential care home providing accommodation for people who require nursing and personal care. The care home accommodates 85 people across 3 separate floors, each of which has separate adapted facilities. One of the wings specialises in providing nursing care to people. At the time of our inspection there were 33 people living at the home across 2 floors.

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

People were not always protected from harm. Risk assessments did not always identify all known risks or contain sufficient mitigation strategies. Concerns with risk management included, risk of skin pressure damage, health concerns, and food and fluids.

There was not always sufficient staffing to meet people’s needs in a timely manner. People, relatives and staff consistently told us staffing was an issue. People at times had to wait for staff support due to the deployment of staff.

Staff had not always received training in all the areas required to meet people’s holistic needs. Staff did not always feel supported.

Records to evidence staff supported people in line with their assessed needs were not always in place. We found records were not kept updated for support with repositioning, support with oral care, food and fluid recording and support with personal hygiene tasks.

Systems and processes to ensure good oversight of service were not always effective or in place. Management oversight was a concern due to the number of managers the service had employed who left soon after. Action plans submitted were not reflective of the actions that were still outstanding from the previous inspection.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Cleaning schedules were in place to identify the areas of the home that required regular cleaning. The main communal rooms all appeared clean. However, people told us, and we observed people’s bedrooms and furnishings were not always kept clean and tidy.

People were supported by staff who had been recruited safely. The provider had made the relevant checks prior to staff working to ensure they were of good character. People told us staff were kind.

People were supported to access healthcare. Referrals had been made as required to district nurses, GPs, speech and language therapists and occupational therapists. People received their medicines in a timely manner. Staff had the necessary training and competencies to safely administer medicines.

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 9 December 2022) and there were breaches of regulation found.

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.

At our last inspection we recommended that the provider seek advice and guidance from a reputable source, about creating a physical environment that supports the needs of people living with dementia. At this inspection we found the provider had acted on the recommendation and had made improvements.

Why we inspected

We received concerns in relation to staffing, record keeping and oversight. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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 not changed from requires improvement, based on the findings of this inspection.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Alma Barn Lodge on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to staffing, management oversight, risk mitigation, and consent from people 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Alma Barn Lodge is a residential care home providing accommodation for persons who require nursing and personal care. The care home accommodates 85 people across three separate floors, each of which has separate adapted facilities. One of the wings specialises in providing nursing care to people. At the time of our inspection there were 35 people living at the home across two floors.

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

People were not always protected from the risk of harm. Staff we spoke to understood their responsibilities to report concerns.

Information in people's care records was not complete and needed more detail. The records did not contain descriptions of how people would like to be cared for and their preferences.

There were systems in place to monitor the safety and quality of the service. However, there were shortfalls in ensuring all documentation was accurate and up to date across people’s records. Some people's records contained conflicting information leading to uncertainty about what people's up to date care and support needs were. These risks were mitigated as staff had good knowledge of the people they were supporting.

People using the service told us that staff were kind and compassionate and we observed this during our visit. However, we also saw staff were not always supported and not all staff were trained to meet people's needs.

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 were not always assured that appropriate measures were taken to ensure the homes cleanliness.

People told us they enjoyed the food and specific dietary needs were met. People's dignity and privacy were respect and the provider ensured people's needs were met in line with current practice and guidance. People were supported to have access to a range of health and social care professionals.

Medicines were managed safely, and people received their medicines as prescribed. The provider had an electronic self-auditing system which allowed safe management of all aspects of medicines. Where there had been errors, we saw that action had been taken in order to mitigate the occurrence of them happening again.

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. However, we have made a recommendation for the provider to work to best practice in their application of the Mental Capacity Act 2005 and ensure mental capacity assessments and best interest decisions are referred to in relation to the delivery of care. We have made a recommendation about ensuring that the environment supported people living with dementia.

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

This service was registered with us on 13 May 2022 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received such as, poor infection control, and low staffing numbers impacting on care. A decision was made for us to inspect and examine those risks.

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

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 person centred care (Regulation 9), safe care and treatment (Regulation 12), good governance (Regulation 17) and staffing (Regulation 18).

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

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 continue to monitor information we receive about the service, which will help inform when we next inspect.