Alderwood Care Home

Alderwood is a care home located in Salford, Greater Manchester and can accommodate up to 39 older people. The home is operated by Hill Care 1 Limited. At the time of this inspection there were 27 people living at the home.

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

Accurate and contemporaneous records were not always maintained regarding people’s care. This included medication records for topical creams, food/drink, re-positioning charts, pressure relieving mattresses and thickened fluids. This meant we couldn’t always determine if people were receiving the care they required. We have also made two recommendations regarding staffing levels and governance systems within the home.

People who used the service and relatives said they felt the service was safe. Staff were recruited safely and carried out routine COVID-19 testing. There was enough personal protective equipment (PPE) available which people confirmed was always worn.

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.

There were systems in place for people who used the service and staff to provide feedback about their care through audits, surveys and meetings. Staff spoken with during the inspection told us they felt the service was well-led and enjoyed their roles. The registered manager was aware record keeping needed to be improved and had identified this through audits.

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

Rating at last inspection

This last rating for the service was good (published 28 January 2020).

Why we inspected

The inspection was prompted in part by notification of a specific incident where a person using the service died. This incident is being reviewed by CQC outside of this inspection process. As a result, this inspection did not examine the specific circumstances of the incident. The information CQC received about the incident indicated concerns about people’s skin integrity. This inspection examined those risks which could effect other people living at the home.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements with regards to record keeping. Please see the safe and well-led sections of this full report.

The overall rating for the service is requires improvement. This is based on the findings at this inspection.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice:

Information was displayed to inform visitors about any infection control procedures relating to Covid-19. Checks were carried out to establish if people had displayed any symptoms of coronavirus. Where people may have been feeling unwell, they would be refused entry to the home.

Social distancing was adhered to within the home and changes had been made to the layout of communal areas to support this. Risk assessments had been completed where it was not always possible to social distance, such as if people were living with dementia and may not understand what was required.

Where people had tested positive for Covid-19, we saw they were appropriately isolated in bedrooms. Testing arrangements were in place in line with current guidance, whilst residents were tested each month.

At the time of our inspection the home was closed to new admissions due to the recent outbreak. Prior to this, if people were newly admitted to the home or had come from hospital, then isolation measures would be followed. We were told sourcing adequate supplies of PPE (personal protective equipment) had never been an issue and we saw staff wore it at all times. People living at the home wore and were encouraged to wear face masks if this was their preference.

We observed the home to be clean and tidy, with domestic staff carrying out their duties throughout the day. Windows were opened at various times during the day to assist with ventilation and outdoor facilities were used when better weather allowed.

There were enough staff to care for people safely, with staff receiving additional infection control training during the pandemic. Agency staff were used to fill any gaps in rotas where regular staff needed to shield, or self-isolate.

Risk assessments were completed where certain groups may be at higher risk of contracting the virus. An appropriate infection control procedure was in place, with specific reference to Covid-19 and regular infection control audits were undertaken to ensure standards were maintained.

Boosting staff morale and keeping people’s spirits high throughout the pandemic was particularly important at the home. This included providing additional activities, video calling, meetings and themed events, such as Italian food tasting, to give people something to look forward to each week.

Alderwood Care Home provides accommodation and personal care for up to 36 older people. The home has two floors with lift access. People had access to a variety of communal areas on the ground floor. At the time of inspection there were 32 people living in the home.

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

People told us they felt safe living in the home and said staff looked after them well. People had been supported to manage the risks in their daily lives by staff who understood their needs. Staff understood the provider's safeguarding policy which helped protect people from the risk of abuse. The home was clean and well maintained, robust infection control policies were followed by staff which protected people from potential harm.

The registered manager assessed people's needs and their care plans had been regularly reviewed and updated. People felt staff understood their needs and were skilled in supporting them. Staff had received appropriate training and support which helped them fulfil their roles. People praised the quality of the food and were supported to eat and drink as required.

People told us the staff were kind and caring. Staff told us they were committed to the people living in the home and wanted the best for them. There was a friendly and respectful atmosphere in the home and we observed positive interactions. People's communication needs had been carefully considered to ensure people had the opportunity to express their views. Some staff had learned some sign language to support people who used this.

People received person-centred care which reflected their needs and preferences. Referrals to other services had been made to ensure people received optimum care. People were able to engage in a variety of activities organised by the activities co-ordinator. The registered manager followed the provider's complaints procedure, people felt able to raise their concerns easily.

People who lived in the home and staff praised the approachability and responsiveness of the registered manager and management team. The registered manager had clear oversight of the service and completed regular checks and audits of care practice and records. We saw any issues identified had been followed up fully.

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

Rating at the last inspection and update.

At the last inspection this service was rated as requires improvement. (published22 January 2019). We identified breaches in relation to person centred care and good governance. 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 the regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Alderwood is a purpose built care home providing accommodation for up to 39 people over two floors. There are 31 single rooms,19 of which are ensuite and three are double rooms. There are three communal lounges and a dining room. The residents have access to well maintained, garden and patio areas. The home is situated in a quiet residential area of Boothstown, near to a range of local shops and transport links.

At the time of the inspection there were 34 people living at the home.

Alderwood 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.

We last inspected Alderwood care home in April 2018 and rated the home as ‘Requires Improvement’. This was because we identified regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to person centred care, safe care and treatment, safeguarding and staffing. Requirement notices were issued due to these breaches of the regulations. We also issued a warning notice regarding to good governance. Following the inspection the home sent us an action plan, detailing how the improvements they planned to make. We also met with the provider and registered manager in October 2018 to discuss the progress being made.

At our most recent inspection in December 2018, although we found improvements had been made in some areas, we identified three continuing breaches of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, for two of the regulations regarding person centred care and good governance (two parts of this regulation). You can see what action we have asked the provider to take at the back of the full version of this report.

There was a registered manager 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.

We found people did not always receive care that met their needs and reflected their preferences.

We found accurate and contemporaneous records were not always maintained. Records were not always stored securely and confidentially.

Further improvements were still required to overall governance systems to ensure the concerns from the inspection were identified and acted upon in a timely way.

We have also made three recommendations relating to the conditions within peoples DoLS authorisations, the accessible information standard and the quality assurance policy and procedure.

Medication was recorded, administered and disposed of safely.

The premises were being well maintained, with regular servicing checks of equipment and the building carried out. The home was clean and tidy throughout, with infection control procedures followed as required.

People who used the service and their relatives told us they felt the service was safe. There were appropriate risk assessments in place for people, with guidance on how to minimise risk. Staff recruitment was robust with appropriate checks undertaken before staff started working at the home.

We found staff received sufficient training, supervision and induction to support them in their role. The staff we spoke with told us they were happy with the training they received and felt supported to undertake their work.

We found the home worked closely with other health professionals and made appropriate referrals if there were concerns. Details of any visits from other professionals were recorded within people’s care plans.

People told us they enjoyed the food and we saw people being supported to eat and drink, throughout the day.

We received positive feedback from people we spoke with about the care provided at the home. Visiting relatives said they had no concerns with the care being delivered at the home. People said they felt treated with dignity and we observed staff treating people with respect during the inspection.

There were a range of different activities available to participate in and people told us there was enough to keep them occupied during the day.

We found complaints were responded to appropriately, with compliments also collated where people had expressed their satisfaction about the care provided.

Staff meetings took place, giving staff the opportunity to discuss their work and raise any concerns about practices within the home. We observed a staff handover taking place, where an update was provided about people’s care needs from that shift.

Staff spoke positively about management at the home and said the manager was supportive and approachable.

Alderwood is a purpose built care home providing accommodation for up to 37 people over two floors. There are 31 single rooms,19 of which are en suite and three are double rooms. There are three communal lounges and a dining room. The residents have access to well maintained, garden and patio areas. The home is situated in Worsley, Salford and is near to a range of local shops and transport links. At the time of the inspection there were 34 people living at the home.

Alderwood 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.

At our last inspection of Alderwood in January 2017, the home was rated as ‘Requires Improvement’ overall and for the key questions effective, responsive and well-led. Regulatory breaches were identified in relation to person centred care and meeting people’s nutrition and hydration needs. We issued requirement notices for these regulatory breaches . This inspection was scheduled to look at the improvements made since our last inspection and to determine whether the provider was now meeting the regulatory requirements.

At this inspection, we identified breaches of the regulations relating to person centred care, safe care and treatment, safeguarding people from abuse and improper treatment, good governance and staff. You can see what action we have taken at the back of this report.

There was a registered manager 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.

We looked at the systems in place to safeguard people from abuse. We found potential instances of abuse were not always being referred to the local authority for further investigation such as unexplained bruising found during personal care.

One person living at the home had been assessed as being at risk of choking and needed their drinks to be thickened so they could swallow safely. However during the inspection, we observed staff providing this person with a drink that was not made to the correct consistency. Fluid charts for this person indicated this was not an isolated occurrence as previous drinks had been documented as being made to different consistencies which could place this person at risk of choking.

Referals to other healthcare professionals were not always made in a timely way when there were concerns about people’s health and welfare. This included referalls to the falls team, dietetics and the podiatry service.

We found creams that needed to be applied to people’s skin were not stored securely and were accessible in both bedrooms and bathrooms. This presented the risk of them being wrongfully ingested by people who did not know what they were. We also found a person’s medication on the floor in their bedroom, yet this had been signed for on the MAR as having been administered. Staff said this person was able to take their medication themselves without observation but we found a risk assessment had not been implemented to determine this.

Two people also raised concerns that their creams were not always applied as prescribed and we found appropriate records were not in place to demonstate this was done consistently by staff.

Control measures were not consistently implemented to protect people at high risk of falls and observed people were not always supported when mobilising as identified in their care plan.

Actions recommended in the latest fire risk assessment were not always being followed and we observed the office door was propped open with a hook meaning it would not be able to close in the event of a fire.

We found there were not always sufficient numbers of staff available to support people at times such as early in the morning when people were waiting for their breakfast. Both staff and people living at the home told us they felt more staff were required at this time.

During the first day of our inspection, we raised some concerns about cleanliness and infection control. This included dirty window frames and slings being hung together on the back of doors, presenting the risk of contamination. These issues had been addressed by the second day of our visit.

Appropriate systems were in place regarding staff recruitment and the safety/suitability of the premises.

We looked at the systems in place regarding deprivation of liberty safeguards (DoLS) and the mental capacity act (MCA). We found two people’s DoLS authorisations had expired in January 2018 and had not been re-applied for. We saw the conditions in another person’s DoLS were not being followed consistently. This meant people were at risk of being deprived of their liberty without lawful authority.

Staff were not receiving appropriate supervision and appraisal in-line with the providerspolicy and procedure. This was confirmed by the staff we spoke with and the records we looked at.

Staff told us they received enough training to support them in their role which was documented on the homes training matrix.

People said they received enough to eat and drink and we saw appropriate action was taken if people were deemed to be at risk of losing weight such as providing people with food and drink with additional calories to help them either maintain or gain weight.

People living at the home, visiting relatives and healthcare professionals told us they were happy with the care provided at the home. We observed caring and pleasant interactions between staff and people living at the home during the inspection.

People living at the home did not always have appropriate care plans in place to inform staff about the care they needed to provide. Accurate records were not always being maintained regarding the care people had received.

There were a range of activities available for people to participate in and we observed some of these during the inspection. Complaints were responded to appropriately and we saw compliments had also been received about the care provided.

People did not always receive care in line with their assessed needs and personal preferences.

Appropriate governance and quality assurance systems were not in place to ensure the concerns found during this inspection were identified and acted upon in a timely manner.

The home was last inspected on 05 March 2015 when the service was rated as good overall in four of the key lines of enquiry (safe, caring, responsive and well-led). The service was rated as requires improvement in effective and a recommendation was made in regards to the environment.

Alderwood is a care home in the Worsley area of Salford, Greater Manchester and is owned by Hill Care 1 Limited . The home is registered with the Care Quality Commission (CQC) to provide residential care for up to 39 people. There were 31 people living at the home at the time of the inspection.

At the time of our inspection, there was no registered manager in post. The home had a manager that had commenced in post 03 January 2017. The home manager had applied to the Care Quality Commission (CQC) to register. 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.

During the inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to person centred care and meeting people’s nutrition and hydration needs. We also made two recommendations regarding staffing and equipment. You can see what action we told the provider to take at the back of the full version of the report.

People told us they felt safe living at the home.

We found medicines were managed safely. Prior to conducting the inspection, we had received information of concern regarding the management of medicines. We found the issues had been as a result of external factors that had been resolved at the time of the inspection.

We received negative feedback from people living at the home and their visitors regarding staffing levels at the home. A formal dependency tool was used to determine staffing numbers but we observed people were left for periods of time and we have made a recommendation with regards to staffing levels in the detailed findings of this report.

The provider had suitable safeguarding procedures in place and staff were able to demonstrate they knew how to safeguard people and were aware of their roles, responsibilities and the alert process. Appropriate employment checks had been conducted before new staff commenced employment in the home, to make sure as far as possible that they were of suitable character to work with vulnerable people.

The service had a training matrix to monitor the training requirements of staff. Staff received appropriate training, supervision and appraisal to support them in their role.

People were supported in line with the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

We received poor reviews from people regarding the food choices offered and we saw instances were people’s preferences were not met. People’s hydration and nutrition needs were appropriately assessed but the provider could not consistently demonstrate that people’s needs were being met as the records didn’t demonstrate this and the person had not gained weight.

We observed people living at the home were living with sensory impairment, memory issues or living with dementia. In consultation with people, dementia friendly resources and minor adaptations had been made to support people’s orientation around the home.

Throughout the inspection we observed positive and appropriate interactions between the staff and people who lived at the home. Staff treated people with kindness and respect. People’s privacy and dignity was maintained and we observed people’s independence was promoted.

We looked at five care files which contained detailed information about people living at the home and how they wished to be cared for. Each file contained detailed care plans and risk assessments but people told us they did not feel involved in planning their care, people expressed not knowing what a care plan was and we found the care plans we looked at had not been consistently reviewed in line with requirements.

There was an activities coordinator in post but they were observed to be working in isolation which meant momentum was lost during activities and we saw people become disinterested as a result of frequent interruptions.

People and their visitors knew how to make a complaint. They told us they were confident in the manager and we saw complaints had been resolved in the required timeframes. The staff had also received compliments regarding the care and support provided to people and their relatives.

The provider had effective procedures in place to measure the quality of the care received. It was evident that areas identified had been addressed and there was a clear audit trail of actions implemented.

The management were honest and transparent throughout the inspection and acknowledged that further progress was required. The management demonstrated a commitment to address the issues identified in a planned and structured way.

Weekly activities were available to people who used the service.

We found staff were courteous and respectful towards people who used the service.

We spoke to people who used the service, some of whom with the onset of dementia, comments included 'Staff alright', 'No complaints at all', 'All girls are very nice, will do anything for you' and 'Staff brilliant'.

When reviewing care files we saw nutritional assessments and care plans had been completed and provided detailed instructions to staff where people were at risk of weight loss.

We did not observe anyone who used the service who gave any cause for concern in relation to nutrition and hydration.

We found medicines were safely administered and people who used the service received their medicines in the way they had been prescribed.

We looked at seven staff personnel files and saw evidence in each file of robust checks being undertaken prior to the commencement of employment by staff.

We found that the provider had effective systems in place to monitor the quality of the service provided.

We spoke with four people who used the service and they all expressed satisfaction with the care they were given. One person said that the staff were 'always polite, one and all' and went on to say 'I don't have to go out of my room if I don't want to, I can just press the buzzer if I need anything.' Another person said 'I'd rather be here than at home, I feel safe'. A visitor at the home said 'they are looked after well and visitors are always made welcome.'

We looked at a sample of five care plans and found them to contain up to date and relevant information including; medical and health,care needs and personal preferences.

We saw that relevant policies and procedures were in place within the home and that staff spoken with were aware of them. We saw evidence of a comprehensive training programme for staff members and we saw evidence that staff members were encouraged to continually develop their knowledge and skills.

We saw that there was a complaints procedure in place and noted that complaints were taken seriously and followed up appropriately.