We carried out a review of the data available to us about Allendale Residential Home Limited 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 Allendale Residential Home Limited, you can give feedback on this service.
There was a comprehensive cleaning schedule in place. Cleaning had increased during the COVID-19 outbreak at the home.
Infection control meetings were held monthly with staff and the frequency increased when required. The management team kept staff up to date of any changes around the use of personal protective equipment (PPE).
Staff had a good knowledge of the PPE requirements and how to support people safely. We observed staff wearing PPE in line with the latest government issued guidance.
Due to the outbreak, visiting to the home was restricted. The manager has a visiting schedule in place to reduce the risk of transmission of coronavirus within the home.
The admission process, for the most recent admission to the home, had not fully followed the latest government guidance. The person had received their vaccine and had a negative test for COVID-19 prior to admission. This person was required to have additional testing within the home. This additional testing did not take place. The registered manager gave assurances that this guidance would be followed for future admissions.
We found the following examples of good practice.
The provider followed the most up to date guidance in relation to infection prevention control. Policies and procedures were reviewed and updated as guidance changed.
The provider had arrangements in place to ensure anyone moving into the home received a negative COVID-19 test.
Regular testing for COVID-19 was in place for staff and people living at the home.
Relatives were supported to visit their relation and guided by the registered manager for testing, hand hygiene and the use of personal protective equipment (PPE).
Staff had received training in the management of infection control and the use of PPE.
The provider had effective plans in place in the event of an outbreak to allow people to be supported safely.
Allendale Residential Home Limited is a care home providing personal care to for up to 24 older and younger people and people living with dementia. At the time of inspection, there were 22 people living at the home. There were 16 single rooms and four shared rooms at the home.
People’s experience of using this service and what we found
People and relatives felt safe at the home. Improvements to the safety of the home had been made and the registered manager and the provider had good oversight of the home’s health and safety. Staff were knowledgeable in describing how to keep people safe and how to report any concerns. The staff were confident, any concerns would be acted up on. Staff were recruited safely. Risks to people were assessed and monitored. Staff were aware of the risk people presented and the strategies to manage them.
People were appropriately assessed to ensure the home could meet their needs. People had access to health and medical support when they needed. Relatives were kept up to date with changes to people’s health. Staff received induction and training appropriate to their job role, staff felt the training gave them the skills they needed to carry out their role. The home worked in line with the Mental Capacity Act 2005. People’s capacity was assessed, and applications were made to deprive people of their liberty to keep them safe.
People and their relatives felt well cared for. The staff team were described as kind, caring and patient. People were supported to make their own decisions and staff could describe people’s personal preferences. The staff team encouraged people to be as independent as possible and relatives praised the staff team for the kind care they gave.
Care plans had improved and involved the person and their family. Relatives told us they were involved in reviewing the care plans and attended an annual review of the care. People had access to a large range of activities both in and away from the home. Activities were person centred and everyone we spoke with told us they enjoyed attending them. The home had received no complaints since the last inspection. The registered manager and provider held good relationships with people and their families and welcomed them to the office to discuss any concerns. People were supported effectively should they be at the end of life while living at the home.
The registered manager and the provider were actively involved in the running of the home. Staff told us they were well supported by both and received regular supervision and appraisal. The manager and provider were aware of their responsibilities of being registered with the Care Quality Commission (CQC). Audits to monitor and improve the service were in place.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 10 July 2018) and there were breaches of regulations. 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 planned inspection based on the previous rating.
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.
Our last inspection of this service was on the 24 May 2017 and we found the service to be good in all domains. At this inspection, we found a number of concerns relating to the quality and safety of people living at the service. Further information can be found in our findings in the body of the report.
Allendale Rest Home Limited is a “care home” providing care for up to 24 people in the Blackley area of Manchester. People in care homes received accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. There were 24 people living at Allendale Rest Home Limited on the day of inspection.
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 a number of concerns relating to the safety of people living at the service. An access route to a fire escape was not safely monitored. People were being moved and handled in the wrong type of sling. Fire drills and personal evacuation plans did not provide sufficient detail. A sluice room was left unlocked which left a potential scalding hazard to people.
Recruitment procedures were not always thorough.
Medicines were administered, recorded and stored safely. There were regular audits in place to monitor medicines. Staff received medication training and had their competency checked regularly.
Deprivation of Liberty Safeguards had been applied for but the service did not routinely assess people’s capacity in relation to why they were being deprived of their liberty.
Staff members received regular training appropriate to their role.
Staff members were aware of people’s preferences and needs in relation to eating and drinking. People were offered a choice of healthy and nutritious meals. The cook was knowledgeable about peoples eating and drinking requirements.
The home’s décor was not always specific to people with dementia. Also, the noise from the nurse alarm was loud and appeared to affect people when it sounded.
We saw caring interactions between staff members and people living at Allendale Rest Home Limited. Staff spoke to people with dignity and respect.
Health professionals said they found the staff team to be kind.
Our observations were that the staff team knew the people living at the service well.
There were a number of activities available for people to take part in. We saw that the service has enabled people to attend local music festivals and singers and exercise groups regularly visited the home.
Care plans were not always reflective of people’s current needs. There was no evidence that people or their families had been involved in care planning.
People did not have their wishes and preferences recorded at the end of life.
People, relatives and staff members felt the registered manager was approachable and supportive.
There were regular meetings held with the staff team and people living at the service.
The registered manager provided opportunity for people, relatives and the staff team to comment on the service in the form of satisfaction questionnaires. However, the questionnaires were not analysed to monitor and improve the service.
The provider was a regular visitor to the service and knew people living there well.
Allendale Residential Home is a privately owned residential care home. Accommodation is for up to 24 people. The home is located in the Blackley area of Manchester. There is parking either in the grounds or on the residential street outside. On the day of the inspection the home was full, with 24 people using the service.
The home had a registered manager in place. 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.
At the previous inspection six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment, fit and proper persons employed, consent, staffing, person-centred care and failure to display ratings. At this inspection we found there had been considerable improvements in all areas.
People told us they felt safe at the home. Staffing levels were sufficient to meet the needs of the people who used the service. The recruitment system was robust and helped ensure staff were suitable to work with vulnerable people.
Safeguarding information was in place and any issues were recorded and reported appropriately. Staff demonstrated a good understanding of the issues.
Accidents and incidents were documented appropriately and general and individual risk assessments were in place and reviewed regularly
The service had an infection prevention and control information and guidance in place. Health and safety records were complete and up to date and medicines were managed safely at the service.
The induction programme at the service was robust and a training programme was on-going to help keep staff skills and knowledge current. Records we looked at showed systems were in place to ensure staff received supervisions and appraisals.
Appropriate health information was held and we saw that nutrition and fluid intake and weights were recorded where appropriate. People were given a choice of nutritious food and drink.
The service were working within the legal requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). Staff had undertaken appropriate training and had an understanding of the issues involved.
People were well presented and staff interactions with people were friendly and respectful. People’s dignity and privacy were respected by staff.
We saw from care plans that people who used the service and their relatives, where appropriate, were involved in care planning and reviews. Information was produced for people who used the service and their relatives.
The service endeavoured to ensure that people’s wishes for when they were nearing the end of their lives were respected.
Care plans were person-centred and included a range of health and personal information. People’s preferences and lifestyle choices were documented.
There was a range of activities on offer at the service. People’s spiritual needs were met with visits from the local church to offer communion.
The service had a complaints policy which was displayed prominently within the home. Complaints were dealt with appropriately.
People told us the management at the home were always approachable. Staff supervisions and appraisals were undertaken on a regular basis.
There were a number of regular audits undertaken at the service to help drive continual improvement in care delivery.
The provider had a business plan in place for 2016 – 2017.
This inspection took place over two days on 25 and 26 January 2016. The first day was unannounced. This means the manager and staff did not know in advance that we were coming.
Allendale Residential Home Limited (‘Allendale’) is a privately owned residential care home which does not have provision for nursing care. It is on a residential road in Blackley, north Manchester. Accommodation is provided for up to 24 people. At the time of our visit there were 21 people living at the home. There is a small dining room and two lounges, one of which has three tables used for dining.
Since our last inspection a new manager had been appointed in August 2015, who became the registered manager in October 2015. 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 previous inspection on 2 June 2015 we found that the service was not complying with regulations relating to ensuring the safety of people using the service, particularly in relation to the management of medicines, and also in relation to not reducing risks associated with the premises. We also found breaches of seven other regulations, relating to the need for consent, treating people with dignity and respect, staff training, meeting nutritional needs, providing person-centred care, reporting requirements and governance.
Following the last inspection we gave the service an overall rating of ‘Inadequate’ and placed the service in special measures. This meant we kept the service under close review. We also imposed a restriction to prevent new people coming to live in Allendale without the prior written agreement of the CQC. This restrictive condition remains in place.
At this inspection we found there had been significant improvements regarding the safe handling of medicines. We also found improvements had been made in all the other areas identified in the last report, but room for improvement still remained in some aspects. The overall rating for the service is now ‘Requires improvement’ which means it has been taken out of special measures.
We found that new processes in handling medicines meant the risk of errors had been reduced, and fewer errors had been made. A communication diary was in use which helped to ensure that the correct medicines were available. A daily balance check ensured that any discrepancies could be identified and corrected if necessary. A new audit system was in use and any findings were used to improve the process.
We found one error which concerned failing to ensure medicine was obtained for a person whose prescription had been changed while they were in hospital. We found this was a breach of the regulation relating to the safe handling of medicines. Despite this, the service had significantly improved in this area since the last inspection.
We looked at whether Allendale had appropriate procedures for recruiting staff. Most of the procedures were in place, but the service allowed new staff to start before obtaining a certificate from the Disclosure and Barring Service (DBS). This was a breach of the regulation relating to suitability of staff.
The registered manager and other staff had received training in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). There were forms in use which allowed family members to give consent where a person lacked capacity. This is not the correct process under the MCA and was therefore a breach of the regulation relating to consent.
Staff told us they received regular training but the record of training showed that it had tailed off in the second half of 2015. Supervision was provided regularly and annual appraisals for all staff were taking place in January and February 2016.
We saw that the rating from the last CQC inspection was displayed in the registered manager’s office but not where it was accessible to the people or any visitors to the home. This was a breach of the regulation relating to the requirement to display the results of performance assessment.
Incidents and accidents were recorded but we did not see evidence that accidents were analysed in order to reduce the likelihood of recurrence.
We saw that risks and defects in the premises reported after our last inspection had been rectified. The premises were well maintained and clean. Actions following a recent infection control report were being implemented.
We found that staffing levels were adequate for the number of people and their current needs. The staff had received training in safeguarding and knew how to report any incidents or suspicions. Allendale had made applications for authorisations under DoLS which had not yet been decided by Manchester City Council. We saw the correct process of a best interests meeting had been followed in reaching one decision.
We observed the lunch and saw that it was better organised and calmer than at our last inspection. People were given a choice of food, and told us they were happy with all the meals at Allendale.
People’s weight was monitored and they were referred to dieticians when needed.
We received extremely positive comments from both residents and their visitors about the quality of care at Allendale. There was one exception, but we learnt that the issue the complainant had raised had been dealt with.
We observed that people were treated with respect and good humour. Staff respected people’s privacy and the confidentiality of their personal information.
Allendale was regarded by a community Macmillan nurse, the practitioner of a programme of end of life care, as being a model of good practice in that area.
We found that there were not enough activities and no activities organiser. There were some themed food nights, but people told us there was not enough going on and they got bored watching television. This was a breach of the regulation relating to person-centred care.
We saw that the care files were being updated, and the updated versions were now more person-centred. We found that all the care plans had improved since our last inspection. Keyworkers were reviewing the care plans each month and the registered manager checked to ensure this had been done.
Residents’ and relatives’ meetings were held and the registered manager had an open door policy. We saw there was a complaints policy and complaints were addressed in line with the policy.
Staff were motivated and enthusiastic. They were aware of the previous CQC rating and its consequences. We sensed there was a real team effort to improve the performance of Allendale.
The registered manager made the required notifications to the CQC. She had implemented a full range of audits and we saw that the results of these audits and of audits by the provider were used to improve the service.
In relation to the breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 we found, you can see what action we told the provider to take at the end of the full version of the report.
This inspection took place on 2 June 2015 and was unannounced. This means the manager and staff did not know we were coming in advance.
The previous inspection had taken place on 20 August 2014. At that inspection we found that the service was not complying with regulations relating to management of medicines, safeguarding people from abuse and assessing and monitoring the quality of service provision. There had been breaches of equivalent regulations relating to management of medicines in five previous inspections since December 2012. Part of the purpose of the inspection in June 2015 was to see whether the service had made improvements in these areas.
Allendale Residential Home (‘Allendale’) is a privately owned residential care home without nursing. Accommodation is provided for up to 24 people.
Following our last inspection a new manager was appointed in November 2014, who was registered in March 2015. 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 inspection on 2 June 2015 we found there were still breaches of regulation in relation to the management of medicines. Medicines were not always obtained in a timely manner. A new medicine recommended for one person by a consultant psychiatrist had not been obtained for nearly a month. This resulted in a risk to that person’s health.
We found there was a breach of the regulation relating to providing care and treatment safely, in regard to ensuring there were sufficient quantities of medicines and the proper and safe management of medicines Some medicines were not being administered at the correct times. The recording of other medicines was poor and medicines were not always stored safely.
We found four examples where the premises were unsafe or being used unsafely. We found this was a breach of the regulation relating to providing care and treatment safely, in regard to ensuring the premises were used safely.
The service used regular staff who knew the people who used the service well. We observed there were enough staff on duty, but at times staff were not present to supervise meals. We found this was a breach relating to the regulation on meeting nutritional needs.
Staff were trained in safeguarding and knew what to do if they witnessed or suspected abuse.
Proper processes were followed for the recruitment of staff.
We found that staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards, but that correct processes were not always followed. In particular we found that the procedures in the MCA in relation to the covert administration of medicine were not being followed. We found that this was a breach of the regulation relating to consent.
There was a good record of training in some areas, but not all. The registered manager was conducting regular supervisions of staff.
The food was good but the mealtimes were chaotic due to the lack of staff presence.
Feedback from professionals, relatives and the residents themselves was that the care was good, and the staff were compassionate. However, we observed that some interactions showed a lack of respect.
The service was involved in the regional Six Steps programme for end of life care. The lead practitioner spoke highly of Allendale’s contribution to improving end of life care.
At this inspection we found there was little improvement in the accuracy and continuity of care records which meant some people were at risk of unsafe care and treatment. Care plans were not person-centred. They lacked individual detail about people’s lives. We found examples where people’s needs were not being met. We found this to be a breach of the regulation relating to person-centred care.
We found that the service had not responded to a request from a hospital to continue monitoring one person’s weight. We found this was a breach of the regulation relating to providing care and treatment safely.
Relatives knew how to complain although most issues were dealt with informally. One complaint in 2015 had been dealt with by the registered manager.
There was a system of audits but it had failed to identify and deal with ongoing failings in regard to the management of medicines. This was a breach of the regulation relating to the requirements to assess monitor and improve the quality of the service, and mitigate risks relating to the health safety and welfare of people using the service.
Not all notifications required under the Health and Social Care Act 2008 had been made. We found this was a breach of the regulation relating to submission of notifications.
Staff told us they felt well supported by the management. The registered manager was still new in post and was told us she was still establishing herself in that role.
We found there were a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the end of the full version of the report.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
We met the registered manager. We talked with four residents and three relatives who were visiting on the day of our inspection. We talked with other staff and a visiting professional, and we observed care being given. We also looked at care records and other files.
We set out amongst other things to answer five key questions: "Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?"
The evidence that supports this summary can be found in our full report.
Is the service safe?
The CQC monitors the operation in care homes of the Deprivation of Liberty Safeguards (DoLS). There were no DoLS authorisations in place on the day of our visit.
Staff were well trained to be aware of signs of abuse and knew how to report any incidents or suspicions. However, we found that in four cases medication had not been given correctly, and these had not yet been reported as safeguarding concerns. We asked the registered manager to make these referrals after the inspection, which she did. This meant that people had not been kept safe. We also found that the management, handling and storage of medicines was not safe. We are taking action in relation to these breaches of regulation.
Is the service effective?
We found that care plans were detailed, enabling both staff and outside professionals to see clearly a person's care needs. We spoke with staff who were knowledgeable about people's care and support needs. We looked at a sample of people's care plans and saw evidence which showed, where possible, people had been involved in developing their care plans. It was the home's policy to involve relatives in care planning and reviews. This meant people received care and treatment in a way they preferred. However, the persistent problems in relation to medication had not been dealt with effectively by the provider.
Is the service caring?
One person told us: "The staff look after me. I have no problems." A visiting relative told us: "[My relative] has been well looked after." We saw that the staff had time to engage with people, although there were some people who received less attention. Some people mentioned that there were not enough activities to keep them occupied. We saw there were some activities provided on the day of our visit.
Is the service responsive?
We had found problems with the safety of medication on a sequence of previous inspections, and required Allendale to make improvements. Although the provider had made some improvements we found they were still in breach of the regulation. We received information from other professionals which suggested the registered manager was not always responsive to advice.
Is the service well-led?
The manager had been registered with the Care Quality Commission since January 2011 and had been in post for a long time prior to that date, and had a loyal staff team. In many ways the manager had created a comfortable and happy environment for the people living in Allendale. The registered manager was also the nominated individual of the provider. This is perfectly acceptable, but it meant that there was no independent oversight or scrutiny. We became aware of a potential unwillingness to accept criticism, and there was no line management structure in place to provide an objective appraisal of service delivery. The service had been non-compliant in relation to medication since December 2012. Despite two Warning Notices and despite submitting action plans to show that they were putting matters right the registered manager had failed to do so. We concluded that the service was not well-led.
We observed that there was good interaction between staff and people who used the service.
We did not talk to people about their medicines during this visit. We observed how they were given their medication and we spoke to the senior care worker who was administering medicines on the day of our visit and the registered manager. We also looked at records about their medication and the medicines in the home for them.
We found that although significant improvement had been made, the service needed to make further improvements in medication management to be fully compliant.
We found that although staff were kind and treated people well, the service needed to ensure that important assessments were completed quickly for people who moved into the service so that the correct care was provided as quickly as possible.
At the previous inspection people who used the service were at risk because there were significant gaps in the way medication was managed. At this inspection on 22 and 23 July 2013 we found that mistakes were made in the administration of medication and furthermore medication was not well managed. This meant people who used the service were at risk because systems did not promote the safe administration of medication.
People who used the service were happy with the support provided. Their comments included:
'The staff are very nice to me. I couldn't wish for better. They have little chats with me.'
And
'The staff speak nicely to her. They're OK.'
We found that Allendale residential home took steps to meet the individual needs of people who used the service.
We found the service needed to improve in following up routine health checks and in providing recreational activities.
At the previous inspection visit on 20 December 2013 we found the service needed to improve the management of medication. At this visit on the 16 April 2013 we only found minor improvements.
People who used the service were happy with the support provided. Their comments included:
'I'm looked after very well. I couldn't be looked after better. They help me to do everything.'
We observed that people who used the service were provided with physical, emotional, and social support to meet their needs.
We saw there were sufficient staff on duty that were skilled at meeting people's needs and liked by the people who used the service. We were told:
'I get up when I'm ready and there's always staff around at the moment I decide.'
We found that Allendale residential home met the individual needs of people and promoted their physical and social wellbeing and development. We saw that people using the service were supported to achieve a lifestyle of their choice and so their sense of self worth was promoted.
We found the provider needed to ensure they followed their medication policy in respect of booking medication into the home and recording information on the medication administration records. We found the provider needs to further develop their quality assurance systems.