Alpha House - Huddersfield

Alpha House is a residential care home providing personal and nursing care to three people with autism and/or a learning disability. The service can support up to four people.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

Medicine management had not always followed best practice and audits had not identified areas which required improving. Day staff had been trained to administer medicines and had their competency assessed. Night staff had not been trained and although this had not presented an issue, it had been highlighted as a requirement but not yet actioned.

Some improvements were required in how the service assessed and managed risk, as some risks were managed well, but others had not been identified to ensure the necessary risk reduction measures were in place.

Improvements were needed in how the service recorded behaviours that challenged others. More detailed records would help ensure the effectiveness of the resources available to reduce these behaviours.

Staff were recruited safely. Staff training, supervision and appraisal were not all up to date.

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; the policies and systems in the service supported this practice. However, formal decision specific capacity assessments and best interest decisions had not always been undertaken which meant the service was not acting within the legislative framework.

People were supported to prepare meals of their choice and weights were recorded regularly to ensure their wellbeing. Staff supported people with hospital appointments, and professional visits. Professional advice was sought when required.

People using the service and relatives spoke highly of the caring support provided by the staff and told us people were treated as if they were a member of the family. They were happy with the service provided.

Audits and checks were carried out; however, these were not always effective in identifying areas which needed to be improved. The provider had not notified CQC of significant events as required which showed an issue with the overview of the service.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. Some people's support focused on them having as many opportunities as possible for them to gain new skills and become more independent. However, for other people the service had identified they needed to look again at their outcomes to ensure goals were continuously reviewed.

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

Rating at last inspection

The last rating for this service was Good (published 5 December 2019)

Why we inspected

The inspection was prompted in part due to concerns received about the safety of people at the service. A decision was made for us to inspect and examine those risks.

The inspection identified areas where the provider needs to make improvements. These included how they assessed and managed risk, ensuring lawful consent, records and how they assess and monitor the quality of the service they provide. The provider had failed to notify CQC of all occurrences that affected the people who use services

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

Enforcement

We have identified breaches in relation to safe care and treatment, good governance, staffing and failure to notify. The provider has taken immediate action to mitigate the risks.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service is in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At the last rating inspection in February 2016, the service was rated Good. At this inspection we found the service remained Good. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

A registered manager was in post. 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.

Staff understood their responsibility to report any concerns and were aware of the action to take if they suspected abuse had occurred. People were supported to manage their risks by staff who were aware of the need to protect people from avoidable harm. There were sufficient numbers of staff available to meet people's care and support needs. The provider recruited staff safely.

People received their medicines as prescribed. Medicine stocks tallied with those determined by the medication administration record. The environment was maintained and generally clean but some areas were in need of attention. Systems were in place to monitor infection control.

Staff had the skills and knowledge to carry out their roles and were supported by a system of induction, relevant training, one-to-one supervision and appraisals.

Staff understood their responsibilities under the Mental Capacity Act 2005. People's capacity had been assessed and when required best interest's meetings had been held and recorded.

People had a choice of meals and were supported to maintain a balanced diet in line with their choices, preferences and any healthcare needs. People's health was assessed and monitored. Staff took prompt action when they noticed any changes or decline in health. Staff worked closely with health professionals and followed guidance given to them to ensure people received safe and effective care.

Staff maintained people's dignity and encouraged choice and independence. Staff supported people to maintain friendships and relationships. People's friends and family could visit when they wanted and without restriction.

People were encouraged to follow their interests and develop daily living skills. There were a range of activities which took place within and outside the home.

Information about how to complain was displayed in the service. People and their relatives were asked their opinions of the service and responses were collated to form action plans. Staff meetings were held regularly and their feedback valued. Staff told us that they felt supported by the registered manager and that the service was a good place to work.

Audits were in place to monitor the quality of the service people received. The registered manager reviewed any recorded accident and incidents. These were analysed to identify any patterns or trends and plans were put in place to reduce the risk of them happening again in the future.

Services that provide health and social care to people are required to inform the CQC of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had submitted notifications to CQC in an appropriate and timely manner in line with CQC guidelines.

Further information is in the detailed findings below.

Alpha House provides accommodation, care and support for three adults with learning disabilities and complex needs/ behaviour that challenges.

The service is required to have a registered manager. 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. The service had a registered manager.

Staff had a good understanding about safeguarding adults from abuse and who to contact if they suspected any abuse. Risks assessments were individual to people’s needs and minimised risk whilst promoting people’s independence.

Effective recruitment and selection processes were in place and medicines were managed in a safe way for people.

There were enough staff to provide a good level of interaction. Staff had received an induction, supervision, appraisal and role specific training. This ensured they had the knowledge and skills to support the people who lived there.

People’s capacity was considered when decisions needed to be made and advocacy support provided when necessary to support and enable people to express their views. This helped ensure people’s rights were protected when decisions needed to be made.

People were supported to eat a balanced diet and meals were planned on an individual basis.

Staff were caring and supported people in a way that maintained their dignity and privacy. People were supported to be as independent as possible throughout their daily lives.

Individual needs were assessed and met through the development of detailed personalised care plans and risk assessments. People and their representatives were involved in care planning and reviews. People’s needs were reviewed as soon as their situation changed.

People engaged in social activities which were person centred. Care plans illustrated consideration of people’s social life which included measures to protect them from social isolation.

Systems were in place to ensure complaints were encouraged, explored and responded to in good time and people told us staff were always approachable.

The culture of the organisation was open and transparent. The registered manager was visible in the service and knew the needs of the people who used the service.

The registered provider had an overview of the service. They audited and monitored the service to ensure the needs of the people were met and that the service provided was to a high standard.

We saw that care planning and delivery was of a high standard. We observed a relaxed atmosphere with warm, supportive and friendly interactions between staff and the people who lived at the home.

Staff told us they enjoyed working at the home and there were enough staff to support each individual. From talking with staff it was clear they had very detailed knowledge of people's needs, likes and preferences.

Medicines were managed safely and quality audits were in place to make sure that the home was safe and people received good quality support and care.