Archived: Alderlea - Care Home Also known as Hica

At the last inspection in February and March 2017 the service did not meet all of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. At that inspection the service was rated ‘Requires Improvement’. This was because the provider had not ensured people’s safety with regard to management of medicines and assessment and treatment following accidents. It was also because they had not always reported incidents and events of importance and did not always use the quality auditing system effectively. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the rating of the key questions ‘Is the service safe?’, 'Is the service effective?' and ‘Is the service well-led?’ to at least good.

At this inspection the provider had improved practice so that the management of medicines was safely carried out. All aspect of the management of medicines was found to be safe. Accidents and incidents were appropriately managed, risk assessed and mitigated. They had improved practice and people received assessment of their needs following accidents and incidents. They had also ensured that all significant events had been reported to the Care Quality Commission and that audits were more effective.

Alderlea – Care Home provides personal care and accommodation for up to 40 people, who may be living with dementia. The service has single bedrooms and bathrooms situated at ground floor and first floor levels. All the bedrooms have a sink and some have en-suite toilet facilities. There are communal sitting and dining areas on the ground floor. The service is situated in a residential area and has a small car park or on-street parking. On the day of the inspection, there were 27 people living there.

The provider was required to have a registered manager in post. On the day of the inspection there was a manager that had been in post for eleven months and registered for the last two. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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.

People were protected from the risk of harm because systems were in place to detect, monitor and report potential or actual safeguarding concerns. Staff were appropriately trained in safeguarding adults from abuse and understood their responsibilities in respect of managing potential and actual safeguarding concerns. The premises were safely maintained and there was evidence in the form of maintenance certificates, contracts and records to show this. Equipment was safely used in the service.

Recruitment policies, procedures and practices were carefully followed to ensure staff were assessed as suitable to care for and support vulnerable people. Staffing numbers were sufficient to meet people’s needs. People were protected from the risks of infection and disease because good infection control management systems and practices were in place. The provider had systems in place to acknowledge and record when things went wrong and from which lessons could be learnt by the registered manager and staff. These were documented and discussed to ensure problems or mistakes were not repeated.

Staff encouraged people to make choices and decisions wherever possible in order to exercise control over their lives. People were cared for and supported by qualified and competent staff who were themselves regularly supervised and received annual appraisals of their personal performance. Staff respected the diversity that people presented and met their individual needs. People’s nutrition and hydration needs were met to support their health and wellbeing. The provider worked collaboratively with other health and social care professionals and supported people with their health care needs.

The premises were suitable for providing care to older people and measures had been taken when developing the service to include features which ensured the environment was appropriate for those people living with dementia. People’s mental capacity was appropriately assessed and their rights were protected. 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 supported this practice. Everyone that worked in the service had knowledge and understanding of their roles and responsibilities in respect of the Mental Capacity Act (MCA) 2005 and they understood the importance of people being supported to make decisions for themselves.

People received compassionate care from kind staff that knew about people’s needs and preferences. People were involved in all aspects of their care and their right to express their views was respected. The management team set good examples to the staff team with regard to attitude and approach, which meant staff had good role models to follow. People’s wellbeing, privacy, dignity and independence were monitored and respected.

We saw that people were supported according to their person-centred care plans, which reflected their needs well and which were regularly reviewed. There were opportunities to engage in pastimes and activities if people wished. People maintained family connections and support networks and their communication needs were assessed and met. We found that there was an effective complaint procedure in place and people’s complaints were investigated without bias. The service sensitively managed people’s needs with regard to end of life preferences, wishes and care.

The provider was now meeting regulation in respect of quality assurance systems and these were effective. Audits, satisfaction surveys, meetings, handovers and the provider’s own internal quality monitoring tools ensured there was effective monitoring of service delivery. The culture of the service was person-centred, open, inclusive, empowering and ensured good outcomes for people. The registered manager understood their responsibilities with regard to good governance and practiced a management style that was open, inclusive and approachable. Engagement and involvement of people, public and staff was fostered. The registered manager strove for continuous learning around best practice, updated their learning and practice at every opportunity and searched for innovative ways to deliver the service. The service fostered good partnerships with other agencies and organisations. Data protection underpinned the management of records.

Further information is in the detailed findings below.

Alderlea Care Home provides personal care and accommodation for up to 40 people. The service has single room bedrooms and bathrooms situated at ground floor and first floor level; all the bedrooms have a sink and some have en suite toilet facilities. There are communal sitting and dining areas on the ground floor. The service is situated in a residential area and has a small car park or on-street parking. On the day of the inspection, there were 31 people living there.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At the last comprehensive inspection in November 2014, we rated the service as Good but with a requirement notice for ensuring staff accurately recorded what people ate and drank when they required additional monitoring in this area. We followed up the requirement notice in March 2015 and found improvements had been made with staff completing accurate food and fluid diaries when required.

We found concerns with the way medicines were managed. There had been some stock issues which meant several people had ran out of their medicines and had not received them as prescribed. There were also some recording issues that required improvement. You can see what action we have asked the registered provider to take at the back of the full version of this report.

We found there had been some shortfalls in ensuring people received effective care. There had been two instances when people had not received intervention in a timely way and one person required closer observation regarding their fluid intake and urine output. There had also been a shortfall in checks on airflow mattresses for two people, in place to help prevent skin damage, which meant staff had not noticed they were at an incorrect setting. Whilst there was no pressure damage to people in these instances, incorrect mattress settings had the potential to make them ineffective. You can see what action we have asked the registered provider to take at the back of the full version of this report.

The registered manager usually sent CQC notifications of incidents which affected the wellbeing of people within the service. However, we found several instances when we had not received notifications for minor safeguarding issues between people who used the service. The registered manager had correctly notified the safeguarding team and taken action to intervene and reassure the people involved, but had not informed CQC, which is a regulation requirement. In this instance we have written to the registered provider to remind them of the need to send notifications to CQC.

There was a quality monitoring system in place which consisted of audits, checks, questionnaires and meetings. Senior managers completed additional checks. There was some improvement required to ensure thorough checks were made and recorded when people required closer monitoring.

The culture of the organisation was one of openness and staff told us they felt supported by the registered manager and senior managers. There was a complaints process and people said they felt able to raise issues and that these would be addressed.

There was sufficient staff on duty day and night to meet people’s needs. We saw staff had been recruited safely, with full employment checks and an induction carried out before they started working with people. Staff had access to a range of training, supervision and support to help them become skilled, experienced and confident when supporting people who used the service.

We observed staff had a good approach when interacting with people. They demonstrated a kind, patient and caring attitude, which was confirmed in discussions with people. Staff knew how to protect people’s privacy and dignity and keep confidential information secure.

Staff supported people to make their own decisions and recognised when people lacked capacity to consent to care. Staff followed the principles of capacity legislation, ensuring relevant people were involved in decision-making.

The registered manager ensured people had assessments of their needs completed and had care plans which guided staff in how to support them. We saw people received care and support that was personalised and in accordance with their preferences.

People’s nutritional needs were met and they had access to a range of community health care professionals for advice and treatment.

There was a range of meaningful activities for people to participate in, to help them feel involved and to stimulate their interests.

We found the environment was safe, clean and tidy. There was personal, protective equipment to help staff maintain good infection prevention and control. Moving and handling items such as hoists and the lift were serviced, and checks were carried out on other equipment such as the nurse call, fire alarm, gas and electrical appliances and hot water outlets.

People who used the service had assessments of their needs and care plans to guide staff in how to meet them in ways that people preferred. Health and social care professionals were involved in people's ongoing care and treatment. Comments included, 'Overall the care is good and she sees the district nurse. I'm very pleased with the care.'

We found there were systems in place such as policies and procedures and staff training to ensure that people were protected from the risk of abuse.

We found that improvements had been made in the management of medicines.

We observed staff to be caring and attentive to people who used the service. There had been some staff changes recently but this was being addressed through recruitment processes. Staff told us they felt supported by management.

The quality of the service provided in the home was monitored and improvements were made when shortfalls were identified. There was a complaints policy and procedure, and evidence that learning from complaints had taken place.

One person spoken with said they were treated with respect by staff and could make choices about aspects of their lives. They said, 'You have lots of fun and a laugh and a joke' and 'The staff are very obliging and are all very friendly.' A relative told us, 'The staff are very good and know the residents well' and 'They keep me informed when they are unwell.'

One person said, 'The food is good and nice to eat. You don't go out leaving it.' A relative told us the meals always looked very good. We observed well presented meals and menus that provided people with variety and choice.

We observed that medicines could be managed more effectively to ensure that people received the medicines they were prescribed.

One person told us they liked their home and bedroom. A relative told us they visited several times a week and the home was always clean and tidy.

A relative spoken with told us they felt able to complain and when they had pointed things out to the staff or the manager they were dealt with quickly.