We carried out a review of the data available to us about Alma Green Residential Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Alma Green Residential Care Home, you can give feedback on this service.
We found the following examples of good practice.
¿ The registered manager had ensured staff could access comprehensive and informative training in various aspects of infection control. Staff confirmed they felt confident in the training and this helped them deliver
care based on best practice.
¿ The environment and equipment had been arranged to minimise the risk of infection and was clean and clutter free.
¿ Information was gathered from visitors to help minimise the risk and spread of infection.
¿ Risk assessments were carried out to minimise the risk and spread of infection.
¿ Processes to minimise the risk of infection were carried out by staff. For example, temperature checks, safe waste disposal and increased cleaning of the home took place.
¿ COVID-19 policies and risk assessments were available and known by staff.
¿ Checks and audits were carried out on the cleanliness of the home and action taken if this was needed.
¿ Adequate handwashing facilities, infection control gel and personal protective equipment (PPE) was available to support best practice.
¿ Staff supported people to use electronic tablets and telephones to maintain contact with loved ones. A visitors room was being introduced to support face to face visits.
¿ People were supported to access health professional advice and maintain their well-being.
¿ Staff and people were tested regularly for COVID-19 and were taking part in the vaccination programme. People at the home were supported to decide if they wanted to participate. If people were unable to make this decision for themselves, best interest discussions were held with relatives and documented.
¿ Appropriate signage was displayed throughout the home to promote best practice.
Alma Green Residential Care Home (Alma Green) is a residential care home registered to provide accommodation and personal care for up to 29 people. At the time of the inspection 25 people were living in the service.
People's experience of using this service and what we found
People were safe living at Alma Green. The practices adopted by the home protected people from harm. We identified some minor shortfalls with the management of medicines, but these were rectified immediately. Enough staff were on duty to meet the needs of people and acceptable recruitment practices were in place. People looked relaxed in the company of staff and relatives confirmed they felt people were safe living at Alma Green.
A wide range of training had been provided for the staff team, which helped to ensure people received the care and support they needed. Community health and social care professionals had been involved in the care and support of those who lived at the home and people's dietary needs were being met.
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.
People received good care. Their preferences and wishes were respected by the staff team. People were treated with dignity and respect and were involved in the decision-making process. Care files were person-centred. Clear guidance was available about how to communicate with people effectively and independence was promoted. A range of activities were provided.
The staff team were open and transparent during the inspection process. There was evidence of community engagement taking place. A range of audits and monitoring was seen. We received positive feedback about the staff team.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection: The service was rated requires improvement at the last inspection (Published on 03 July 2018) and there were multiple breaches of regulation. 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 improvements had been made and the provider was no longer in breach of regulations.
Why we inspected: This was a scheduled inspection based on the previous ratings.
Follow up: The service will be re-inspected as per our inspection programme. We will continue to monitor any information we receive about the service. The inspection may be brought forward if any risks are identified.
Following our last inspection we asked the provider to complete an action plan to show us what they would do and by when to improve the key questions safe, effective, caring, responsive and well led to at least good. At this inspection we found the provider had made the improvements required in accordance with their action plan, so the key questions of caring and responsive were found to be rated good. However, during this inspection we found two breaches of the HSCA 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment and good governance. Therefore, the key questions of ‘safe’ and ‘well-led’ remained as, ‘Requires improvement.’ There were several recommendations made in the area of ‘effective’ and therefore this key question also remained as ‘Requires improvement.’
Alma Green Residential Care Home (Alma Green) is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.
Alma Green is located in the village of Upholland. It provides accommodation for up to 29 people, who require help with their personal care needs. At the time of our inspection there were 23 people who lived at Alma Green. All bedrooms are of single occupancy with en-suite facilities, consisting of a wash hand basin and toilet. A wet room is available and there are a variety of bathrooms located throughout the home, which provide assisted bathing facilities.
There are a variety of amenities within the village itself, such as public houses, shops, a library, a church and a post office. The surrounding areas of Southport, Ormskirk, Liverpool, Wigan and Skelmersdale are all within easy reach by public transport. Some parking spaces are available at the front of the premises.
There was a registered manager in place. The registered manager assisted throughout the inspection. 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 toured the premises and found several areas of risk, which needed to be addressed. Infection control practices were poor. The kitchen and kitchen equipment were dirty and needed to be thoroughly cleaned. We noted the kitchen was being used as a thoroughfare for staff, who were not wearing Protective Personal Equipment (PPE). The storage of food in the fridge did not meet food hygiene standards. This could have put people at potential risk of consuming contaminated food.
The cleanliness of the premises throughout was poor and the environment was in need of updating and modernising. We noted some mattresses were longer than the bed bases and could pose a risk to people if they sat on the end. We noted some concerns around fire safety in relation to seating areas beneath stairwells and the lack of relevant information provided on the Personal Emergency Evacuation Plans (PEEPS).
During the inspection we observed staff transferring people on two occasions. One manoeuvre was by the use of a hoist. This was conducted in a competent and safe manner. The second transfer was with the use of a lifting belt for a person who was unable to weight bare. This manoeuvre was not safe and could have potentially placed the individual at risk of harm. Risk assessments were in place for the premises and these were audited on a regular basis. However, the risk assessments for one person who lived at the home were overdue for reviewing. We made a recommendation about this.
Medicines were being managed safely, although there were some minor areas where improvements could have been made. We made a recommendation about this.
We looked at how accidents and incidents were being managed. We found that actions taken had not always been documented; lessons learned had not been recorded and associated records, such as care plans and risk assessments were not consistently updated. We made a recommendation about this. The registered manager subsequently introduced a more robust system to ensure appropriate recording and monitoring of accidents and incidents was in place.
Records showed that supervision sessions had been started, but these were sporadic and annual appraisals had not been introduced at the time of our inspection. We made a recommendation about this.
People had access to external health care professionals including dieticians, occupational therapists and the speech and language team. We noted meals to be presented well and these were well balanced and nutritious. Fluid and diet charts we found could have been more structured, so that people’s intake could be more closely monitored. We made a recommendation about this.
On the day of our inspection people were not offered recreational activities. We were told an activity coordinator had recently been appointed. A notice board had information about a singing group and their schedule for visits. We made a recommendation about this.
Systems and equipment within the home had been serviced in accordance with the manufacturer’s recommendations and clinical waste was being disposed of in the correct manner. The environment need to be upgraded and modernised. We made a recommendation about this.
We looked at how the service protected people against discrimination, bullying, harassment, avoidable harm and abuse. We found that staff had received training in safeguarding adults and demonstrated a good understanding about the meaning of abuse. We found the service had made safeguarding referrals in line with the home’s policies and procedures.
We looked at the personnel records of four members of staff and found recruitment practices adopted by the home to be robust. This helped to ensure that only suitable people were appointed to work with this vulnerable client group. The turnover of staff at Alma Green was extremely low. This helped to promote good continuity of care. We found there were sufficient numbers of suitably qualified staff employed to meet people’s needs and to promote people’s safety.
Staff told us they felt supported in their roles and had received training to help them understand their role and responsibilities. We looked at the training records and found that staff were provided with a wide range of training courses.
At this inspection, we found that 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. We found areas covering the mental capacity act and consent to be satisfactory. People’s decisions had been made in their best interests and good information was provided around Lasting Power of Attorney. This helped to ensure people received care and support in a way which was best for them.
We observed staff interact with people in communal areas, although this was limited and missed opportunities to engage in conversation were evident. We made a recommendation about this.
People told us they felt involved in their care and making decisions. The plans of care we saw supported this information. We found that people’s care plans were written in a person centred way. The provider had implemented a new electronic care planning system in order to move the service forward.
Audits and quality monitoring systems were in place and completed on a monthly basis. The audits undertaken had not always highlighted concerns found at this inspection. This meant that quality assurance systems were not robust.
Actions we have asked the provider to take can be found at the end of this report.
During this inspection we reviewed the action taken by the provider to meet the requirements of the regulations, these included; medicines management, environment safety and infection control. Person-centred care, Need for consent, Meeting nutritional and hydration needs and good governance.
At this inspection we found the provider was still in breach of Regulation 12 safe care and treatment, in relation to medicines management and Regulation 11 Need for consent. The provider was no longer in breech of the other regulatory requirements highlighted at the last inspection. However, we found the provider to be in breach of other regulations at this inspection, these included; Person centred care and Safeguarding service users from abuse and improper treatment. .
Alma Green is located in the village of Upholland. It provides accommodation for up to 29 people, who require help with their personal care needs. All bedrooms are of single occupancy with en-suite facilities, consisting of a wash hand basin and toilet. A wet room is available and there are a variety of bathrooms located throughout the home, which provide assisted bathing facilities.
There are a variety of amenities within the village itself, such as public houses, shops, a library, a church and post office. The surrounding areas of Southport, Ormskirk, Liverpool, Wigan and Skelmersdale are all within easy reach by public transport. The bus stops very close to Alma Green and there is a railway station nearby. Some parking spaces are available at the front of the premises.
At the time of the inspection there were 26 people who lived at the service. There was a registered manager in place. The registered manager assisted throughout the inspection.
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 looked at how the service protected people against bullying, harassment, avoidable harm and abuse. We found that staff had received training in safeguarding adults and demonstrated a good understanding about the meaning of abuse. However, we found that the service had not always made safeguarding referrals in line with their policy and procedure. For example, one person’s care records showed that they had been physically assaulted by another person who lived at the service. A safeguarding referral had not been made, risk assessments had not been reviewed in relation to the incident and the registered manager told us that they had not been informed about the incident.
We looked at people’s care records in relation to the prevention of accidents and injuries. We found examples of when people who lived at the service had fallen. However, their care plans and risk assessments for falling had not been updated to show how the service had assessed and mitigated the risk for further accidents to prevent injury.
During the inspection we observed staff using a hoist for a person who had fallen in their bedroom. We asked staff if the person had been assessed for the use of a hoist and staff could not confirm if an assessment had taken place. Staff assisting the person were unable to clarify what size hoist sling the person needed. This placed the person at risk of injury. We informed the registered manager who took immediate action.
Risk assessments were in place for the premises and these were audited on a regular basis.
We found variances in stocks of medicines. This suggested that medicines had not always been administered as prescribed. The service did not have a robust monitoring system in place to highlight when medicines had not been administered. We found that the service did not have protocols in place for the administration of medicines prescribed on an as needed basis. This meant that person centred medicine administration was not always provided for people who lived at the service. We observed medicines being administered at lunch time. Medicines were left with service users and the staff member responsible for administering medicines did not ensure that the person had taken their medicines as prescribed.
When employing fit and proper persons the recruitment procedures of the provider were robust in ensuring suitable people had been employed.
We found there were sufficient numbers of suitable staff during the day time to meet people’s needs and promote people’s safety. However, staff told us that night duty was not staffed according to people’s individual needs. We made a recommendation about this.
Improvements had been made around environmental cleanliness and infection control. We found the environment to be warm, comfortable and pleasant smelling. The premises were generally clean and some areas had been painted, decorated and flooring had been replaced. However, some improvements were still needed, particularly in the bathrooms and communal toilets.
We noted that the bed of one person was unsafe for use. The mattress was longer than the bed. Therefore, if the person sat on the end of the bed it was possible they could have fallen on the floor. We informed the registered manager that a new bed was needed straight away. We were told that this had been arranged.
The turnover of staff at Alma Green was extremely low. The last person to be employed started to work at the service in May 2011. This helped to promote good continuity of care.
Staff told us that they felt supported in their roles and had received training to help them understand their role and responsibilities. We looked at the training records and found that staff were provided with a wide range of training courses.
We found that the service had implemented consent care plans and mental capacity assessments since our last inspection. However, these had not always been completed in line with the principles of the Mental Capacity Act 2005. People who lived at the service and their representatives were asked to sign consent and agreement documents. The service had not always effectively recorded consideration of the person's mental capacity or evidenced sight of a Lasting Power of Attorney document, to show that the person’s representative had legal status to make decisions about the person’s welfare on their behalf.
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 of the service supported this practice.
We looked at three staff supervision records, these showed that two staff were last supervised in 2015. The third staff member did not have any supervision records on file. Staff told us they felt supervised by the registered manager.
Annual appraisals were available on one of the staff records we looked at. The most recent one being dated March 2016. Two further staff records did not evidence that appraisals had been undertaken.
People were assessed against the risk of malnutrition, however nutritional care planning was not person centred to show people’s preferences and individual needs. We looked at diet and fluid intake records and found gaps in recording. This meant that the service did not always monitor how much people had eaten and drank when they were at risk of malnutrition or dehydration.
People had access to external health care professionals including dieticians, occupational therapists and the speech and language team. During the inspection a visiting GP provided positive feedback about the standard of care and support provided for people who lived at the service.
During the inspection we did not see people being offered recreational activities, we asked to see the activity time table and we were told that this was not available. A notice board had information about a singing group and their schedule for visits. We made a recommendation about this.
We observed staff interact with people in communal areas. Some staff approached people in a caring way. However, we also observed two instances when staff disregarded people’s questions. For example, one person asked what medicines they had been handed, but the staff member walked away. When the staff member said what the medicine was, the person was unable to hear them. Another staff member mocked a person when they expressed that they were thirsty, the staff member replied, “No it is Friday”.
People told us they felt involved in their care and making decisions. However, when we looked at people’s care records we did not see that people had been involved in the care planning process. We asked the registered manager if resident and relative meetings had been undertaken; the manager confirmed that meetings had not been held.
We found that people’s care plans were not written in a person centred way. The provider had recently implemented a new electronic care planning system; staff told us they had received little training about the system. Care plans had been generated from the system and were generic in content. This meant that care plans did not describe the person as an individual.
Audits and quality monitoring systems were in place and completed on a monthly basis. The audits undertaken had not highlighted concerns found at this inspection. For example care plan audits showed ‘all care plans up to date’. This meant that quality assurance systems were not robust.
During this inspection we found several breaches of the HSCA 2008(Regulated Activities) Regulations 2014 otherwise known as the fundamental standards of care. Two of these were continued breaches from our previous inspection in September 2015.
We will ensure action is taken and report on this in due course.
Further information is in the
Alma Green is located in the village of Upholland. It provides accommodation for up to 29 people, who require help with their personal care needs. All bedrooms are of single occupancy with en-suite facilities, consisting of a wash hand basin and toilet. A wet room is available and there are a variety of bathrooms located throughout the home, which provide assisted bathing facilities. There are a variety of amenities within the village itself, such as public houses, shops, a library, a church and post office. The surrounding areas of Southport, Ormskirk, Liverpool, Wigan and Skelmersdale are all within easy reach by public transport. The bus stops very close to Alma Green and there is a railway station nearby. Some parking spaces are available at the front of the premises.
We last inspected this location on 10 February 2014, when we found the service to be compliant with all five outcome areas we assessed at that time.
This unannounced inspection was conducted on 10 September 2015. The registered manager was on annual leave when we visited Alma Green. She had managed the day-to-day operation of the service for several years. 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 of the Health and Social Care Act and associated regulations about how the service is run.
Some areas of the premises had been recently decorated. However, other areas of the home were in need of upgrading and redecorating. Infection control practices could have been better.
Medications were not being well managed. This did not promote people’s safety and could have potentially put people at risk of harm.
People were helped to maintain their independence. Staff were kind and caring towards those they supported. Assistance was provided for those who needed it in a dignified manner and people were enabled to complete activities of daily living in their own time, without being rushed. However, the provision of leisure activities could have been better, so that people who lived at Alma Green were supported to maintain an interest in a variety of hobbies or pastimes.
The planning of people’s care was based on a thorough assessment of their needs, with information being gathered from a variety of sources. The care plans we saw were well written, person centred documents. A range of health and personal care assessments had been conducted. However, the hydration needs of one person were not being appropriately monitored and another person was not enabled to make their own decisions about their care and treatment, despite being assessed as having the capacity to do so.
There were sufficient numbers of staff on duty to meet people’s needs. Staff members were well trained and had good support from the management team. They were confident in reporting any concerns about a person’s safety and were competent to deliver the care and support needed by those who lived at the home. The recruitment practices adopted by the home were robust. This helped to ensure only suitable people were appointed to work with this vulnerable client group.
Equipment and systems had been serviced in accordance with the manufacturers’ recommendations, to ensure they were safe for use. This helped to promote people’s safety.
Staff we spoke with told us they received a broad range of training programmes and provided us with some good examples of modules they had completed. They confirmed that regular supervision sessions were conducted, as well as annual appraisals.
Staff spoken with told us they felt well supported by the registered manager of the home. They spoke in a complimentary way about her management style and described her as being, ‘approachable’ and ‘caring’.
We found the service to be in breach of several regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in respect of safe care and treatment, good governance, need for consent and meeting nutritional and hydration needs.
You can see what action we have asked the provider to take at the end of this report.
Comments received included:
"They (the staff) are more than helpful. I cannot grumble about any of them."
"They are excellent. They always put themselves out for us."
"I don't get bored. They bring singers in sometimes to entertain us. We are playing bingo this afternoon."
A relative commented, "It is fab here. This is not like a care home. It is like a family home. The staff are very kind, caring and helpful."
At the time of this inspection we looked at how people's needs were being met and how they agreed to the care and support provided. We also assessed the management of medications, recruitment practices and methods used for monitoring the quality of service provided. We did not have any concerns about any areas we assessed on this occasion.
The inspection team was led by a CQC inspector joined joined by a practising professional and an Expert by Experience who has personal experience of using, or caring for someone who uses this type of service.
We also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.
People using the service told us they were satisfied with the care and support they received at Alma Green. We found they were treated with dignity, their independence was promoted and privacy respected. They told us, 'It's lovely and clean. They clean everyday", 'Our visitors can come anytime and we go to my room for some privacy' and 'If you tell the staff anything it gets done straight away'. However, some people said they were bored and would like more activities and entertainment.
Some people told us they liked the meals provided at the Alma Green. However a few were dissatisfied with menu and the choices offered. People's food preferences were known and consideration was being given to people's individual nutritional needs. Although there was no evidence of risk from a lack of nutrition, we found the catering arrangements did not fully respond to people's needs and preferences.
We found there was mostly enough staff to provide care and support. People were content living at Alma Green; they knew what to do if they had any concerns and were confident they would be dealt with.
People living at the home who we spoke with told us that they were aware of their person care plan and that staff did discuss with them how their needs could be best met. We were also told by one person that staff, 'Always help you when you need it, you need to feel safe and I do, I am quite happy with everything'.
During the course of the visit we spoke with five residents and one relative. We also spoke briefly with a number of other people living in the home in a communal area of the home. Without exception people using the service and the relative all spoke very highly of the care and support provided at Alma Green. We were told that, 'I like living here, I am well looked after, we are looked after very well' and 'The care here is very good, I am quite happy with everything'. Another person said, 'Staff are very good, excellent with us. Joanne (Registered Manager) sets a high standard that staff have to follow; staff go beyond their bounds of duty'.
People living at Alma Green stated that they enjoyed the meals served and the variety of the foods provided. One person said, 'It's good food, I don't think I leave anything'. Another person said 'I enjoy the food. You only need to say that do not like or want the menu choice of the day and they ask you what you would like instead. Nothing is too much trouble'.
One person living at Alma Green told us, 'They are definitely good at getting the doctor out if you don't feel well, they do something straight away'.
People living at Alma Green that were spoken with, all stated that they felt safe living at the home and had no concerns. We were told that people were confident that if they did have any concerns this would be swiftly acted on. There was however a lot of praise for the staff team and the level of care and support offered at the home. One person told us 'There is no place like home, but the nearest is here'.
People living at the home told us that the internal environment was always kept clean and tidy. One user of the service told us that 'The cleaners are very good, they keep our rooms clean. This is one of the best homes, always clean and sweet smelling'.
One person said that she was quite happy for staff to administer her prescribed medication.
People spoken with that live at the home described Alma Green as 'homely and comfortable'. Another person told us that she really enjoyed the walk in shower and confirmed that her privacy and dignity was always respected. This same person went on to say, 'I don't mind any of them they are all respectful' (the staff group).
One person told us that following her admission, a specialist bed had been purchased by the home to assist with her breathing. This had been much appreciated and had helped to ease the condition for this person.
A person living at the home stated, 'I am very happy here, the staff are wonderful'. A member of staff spoken with confirmed that a thorough recruitment process had taken place prior to her taking up employment at the home and that 'A very good service is provided, I think it is excellent. Joanne (registered manager) does her up most to make people's lives easier and happier, staff and residents'.
Two members of staff spoken with stated that in their experience, there was always a sufficient number of staff on duty to meet the assessed needs of people living at the home. This was also confirmed by residents with one person telling us 'There is always enough staff we never have to wait long'. Staff spoke positively about the training provided.
Without exception people spoken with, including the relative, were very pleased with the care and support provided and stated they had no need to make a complaint about anything. One person living at the home said, 'My son made a good choice with this home, is 5* in more ways than one'. Another person said, 'I know how to make a complaint and there is a post box if I want to write anything down but I have never made a complaint or needed too. If I did need to I would just speak with a member of staff or Joanne (Registered manager). Staff would always respect and respond to what I said'.