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Alston Lodge Residential Home Limited Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 17 May 2019

About the service

Alston Lodge Residential Home Limited is a care home that was providing personal care and accommodation to 13 people aged 55 and over at the time of the inspection. The service can support up to 16 people some who may be living with dementia, physical or mental health needs.

People’s experience of using this service

People and their relatives told us that they received safe care and treatment. They spoke positively about the care and support provided. The registered manager had reported safeguarding concerns to the local authority. However, the reporting procedures were not robust to ensure all safeguarding concerns were reported to allow independent investigations. Our findings showed improvements were required in a number of areas to ensure the care delivered was consistently safe, reliable and person-centred.

The registered manager had assessed people’s needs and, in some cases, provided staff guidance on how these needs were to be met. However, this was not consistent as we found three people had no care plans and people who had experienced falls and people who received medicines covertly did not have care plans for this. This meant staff did not have adequate guidance on meeting people’s needs effectively. Care records were generic and not person-centred. We made recommendation about care planning.

People did not always receive their medicines in a safe and effective manner. Practices for the management of covert medicines and ‘as required’ medicines were not robust. In addition, medicines storage practices and medicine records had not been managed in line with best practice and national guidance.

Staff showed a good understanding of their roles and responsibilities for keeping people safe from harm. Staff showed a motivation to deliver care in a person-centred way. However, individual risks to people and the environment had not been adequately monitored to minimise the risk of avoidable harm re-occurring. People were not adequately observed for injuries that may appear after a fall and the provider did not show how they had learned from incidents, events or near misses in the home. The registered manager and the provider had maintained the premises and any faults were timely rectified.

Staff supported people to have maximum choice and control of their lives however staff’s understanding of mental capacity principles needed improvements. Consent records were signed by family members without mental capacity assessments to show why people could not consent on their own. Some authorisations for restrictions on people’s liberties had been considered or applied for where required. However, we found up to four people who required applications for authorisation did not have this in place. The registered manager took action after our inspection.

Staff had received a range of training and support to enable them to carry out their role safely. This included the care certificate. However, staff training arrangements at the home needed to be reviewed to ensure staff were provided training by a recognised and competent training provider and to ensure training arrangements were consistent with best practice. We made a recommendation about staff training.

Governance arrangements were in place to monitor and improve the care delivered. However, we found the audits and quality checks had not been adequately implemented to support the registered manager and the provider in identifying shortfalls.

The provider had made improvements to the staffing levels since our last inspection. They had also made improvements to ensure people were supported with meaningful day time activities.

People received support to maintain good nutrition and hydration and their healthcare needs were understood and met.

People were not adequately supported with to discuss their end of life preferences. We made a recommendation about end of life care planning.

People and family members knew how to make a complaint and they were confid

Inspection areas

Safe

Requires improvement

Updated 17 May 2019

The service was not always safe.

Details are in our Safe findings below.

Effective

Requires improvement

Updated 17 May 2019

The service was not always effective.

Details are in our Effective findings below.

Caring

Good

Updated 17 May 2019

The service was caring.

Details are in our Caring findings below.

Responsive

Requires improvement

Updated 17 May 2019

The service was not always responsive.

Details are in our Responsive findings below.

Well-led

Requires improvement

Updated 17 May 2019

The service was not always well-led.

Details are in our Well-Led findings below.