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Alton Manor Care Home - Portsmouth Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 30 March 2019

The inspection took place on 26 and 27 November 2018 and was unannounced. Alton Manor Care Home is registered to provide accommodation and personal care for up to 34 older people including people who may be living with dementia or other mental health conditions.

Alton Manor Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Alton Manor Care Home is situated in a residential area. The accommodation is arranged over three floors of a large, converted Victorian building with stair and lift access to all floors. At the time of our inspection there were 31 people living at the home.

There was a registered 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.

We previously inspected Alton Manor Care Home on 10,11 and 26 May 2016 and rated the service as Good. At this inspection we found evidence that demonstrated risks or concerns. This was because risks to people were not assessed, monitored and mitigated effectively and medicines were not managed safely. We also had concerns that the principles of the Mental Capacity Act (MCA) 2005 were not followed and the requirements of the duty of candour had not been met. The provider did not have effective quality assurance processes in place to identify these concerns. The overall rating of the service has changed since our last inspection to ‘Requires Improvement’.

Risks to people were not always managed effectively. Clear plans and records were not in place for people at risk of choking, falls and risks associated with specific health conditions. This meant staff did not always know about risks to people and how to manage or mitigate them.

The administration of medicines was not managed safely. This had not been identified by the service because effective checks had not been undertaken.

There was not a robust quality assurance process in place. Systems to assess the quality of service provision were ineffective in identifying some of the improvements needed. The provider had not followed legislation that required them to act in an open and transparent way when people came to harm.

Staff sought verbal consent from people, before providing support, but did not always follow legislation designed to protect people’s rights when making decisions on their behalf. Care plans lacked mental capacity assessments and there was no record that people had consented to their care at Alton Manor Care Home. All people with the exception of one had a Deprivation of Liberty Safeguard (DoLS) applied for when necessary. Staff were not aware of who had a DoLS in place in the home.

Care plans contained information about how to support people but areas of these needed to be more personalised and detailed to ensure people received support in a person centred way. We have made a recommendation about this.

People’s communication needs were recorded in their care plans. However, we have made a recommendation that the service consults guidance to further develop their practice in accordance with the Accessible Information Standard (AIS).

People had access to external healthcare professionals such as GPs and nurses when needed but were not referred to the falls prevention team or speech and language therapists when risks were identified in these areas. This meant appropriate guidance was not always sought to safely support people.

Accidents and incidents were recorded and monitored to determine if any trends were occurring for individuals but accidents and incidents were not analysed at a service level w

Inspection areas

Safe

Requires improvement

Updated 30 March 2019

The service was not always safe.

Improvements were needed to ensure that all risks to people's safety and welfare were assessed, monitored and mitigated appropriately.

Medicines were not always managed safely which put people at risk of not receiving their medicines as prescribed.

People told us they felt safe and staff were aware of the procedures to follow regarding safeguarding adults.

Staff were recruited safely and there were enough staff appropriately deployed to keep people safe.

Effective

Requires improvement

Updated 30 March 2019

The service was not always effective.

Staff did not always follow legislation designed to protect people�s rights.

People did not always have access to external healthcare professionals to support them effectively when needed.

People were provided with a range of nutritious food and people were positive about the meals.

Staff were appropriately supported in their role and arrangements were in place for them to receive training, supervisions and annual appraisals.

Caring

Requires improvement

Updated 30 March 2019

The service was not always caring.

The provider had not always ensured that people received a caring service because of their lack of oversight.

The provider had not considered how to implement the guidelines of the Accessible Information Standard and we have made a recommendation about this.

People were encouraged to be independent. People�s privacy and dignity was mostly respected but information about people was not stored confidentially.

People and relatives told us staff were kind and caring. Observations reflected people were comfortable and relaxed in staff�s company

Responsive

Requires improvement

Updated 30 March 2019

The service was not always responsive.

Improvements were needed to ensure care plans were detailed and personalised. People's specific health conditions were not always included in care plans. This meant that staff did not always have guidance on how to support people's individual needs and preferences. We have made a recommendation about this.

The service was not supporting anyone at the end of their life; improvements were needed to ensure end of life care planning

was person centred.

People knew how to make a complaint and complaints were investigated and resolved for people.

People were supported to take part in a wide range of activities and people told us they enjoyed these.

Well-led

Requires improvement

Updated 30 March 2019

The service was not always well led.

Audit and monitoring systems were not effective in ensuring that

the quality and safety of care was consistently assessed, monitored and improved.

Feedback about the service was sought but there was no system in place to ensure feedback had been acted on.

People had not been supported in line with the requirements of the duty of candour when they had sustained a serious injury.

People, their relatives and staff were positive about the leadership at the service. Staff felt supported by the provider and registered manager.

The provider was responsive to our concerns and put measures in place to improve the quality and safety of the service, however further work was needed to embed this.