Archived: Alma Lodge

Alma Lodge is a ‘care home’ for people with learning disabilities. People in care homes receive 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. Alma Lodge accommodates up to 10 people in one building. On the day of our inspection, six people were living at the home.

There was a manager in post at the time of our inspection who made an application to register with CQC in March 2018 and is awaiting the outcome of their application. A registered manager is a person who has registered with 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.

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

We carried out a comprehensive inspection of Alma Lodge in August 2016. At that inspection the service was rated as good overall, but as requires improvement in Safe. This was because the provider had not established proper and safe systems for the management of medicines.

We undertook a focused inspection in August 2017 when we checked to see if the service now met legal requirements. Whilst the service remained rated ‘good’ overall, and the provider had acted to improve medicine management, we found that the service still required improvement in the 'Safe' domain. The provider had failed to ensure that the premises and equipment were clean and suitably maintained. We also found fire safety had not been effectively managed. This was a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to act and they sent us an action plan on 18 September 2017 to say what they would do to meet the legal requirements. They told us they would be compliant within six to twelve months, by September 2018. We also reported our concerns to the fire service who acted by issuing the provider with an Enforcement Notice under the Regulatory Reform (Fire Safety) Order 2005. The fire service has since confirmed that the provider complied with their Enforcement Notice.

At this inspection we found improvements had been made, and the previous breach found at our last inspection had been met. However, we found further areas of concern. People, staff and visitors were not always kept safe as regular monitoring checks of the premises had not always taken place.

We found that systems to monitor and improve the quality of services and mitigate risks were not consistently robust. Risks included those associated with people’s health and wellbeing including eating and drinking. Risk assessments and care plans were not always current; posing a risk that people could receive inappropriate care. The manager was aware of this and told us about the plans they had to improve.

The principles of the Mental Capacity Act 2005 (MCA) had not been properly understood or applied in the service. Peoples consent to care was not always sought in line with the MCA. People were not supported effectively to make their own decisions. There was a lack of evidence to show how decisions were made in people’s best interests. We have made a recommendation about ensuring people’s rights are properly considered.

People were protected from the risk of abuse. Staff had received safeguarding training. They could tell us how to recognise and report safeguarding concerns. Staff knew about the whistle blowing policy and were confident they could raise any concerns with the provider or outside agencies if needed.

Accidents and incidents were not always reported to management, and records were not always completed. This meant there was not effective oversight of incidents and accidents by the provider or manager to ensure lessons were learned and improvements made when things went wrong.

Staff followed correct and appropriate procedures in the storage and dispensing of prescribed medicines. People were supported to maintain good health and attended routine appointments with GPs, health and social care specialists, opticians and dentists. Health needs were kept under review and appropriate referrals were made when required.

There were enough staff to keep people safe and meet their needs. Staff had completed induction training when they first started to work at the service. The manager had carried out staff supervisions and implemented competency checks. Staff had received some training but not in supporting people with challenging behaviour. We have made a recommendation about further training for staff in supporting people who may display behaviour which can be challenging.

People’s care plans contained some person-centred information to help staff to support them in an individual way although some required more detail or updating. People were supported and encouraged to eat and drink to maintain a balanced diet and were offered choices around their meals and drinks. Staff understood people's likes and dislikes and dietary requirements.

People were treated with dignity and their privacy was respected. Some adaptations to the premises had been made to make them suitable for those living with learning disabilities and we were told of further plans to implement changes. People were offered the opportunity to participate in a range of activities in line with their preferences.

Staff were kind and caring. There were positive interactions between the staff and people and people were comfortable with the staff. People were encouraged to remain as independent as possible and to feel included in their environment. Staff knew people and their care needs well.

Quality assurance audits were carried out to monitor the quality and safety of the service. However, these were not effective in identifying shortfalls and areas for improvement. The provider did not have a clear oversight of the service. There was minimal evidence that lessons had been learned and improvements made when things went wrong. Feedback was not sought from people and their relatives to drive improvements. We have made a recommendation about improving systems to seek and review feedback.

Relatives and staff felt the manager was approachable and responsive. Staff told us that the service was well led and that they felt supported by the manager to make sure they could care for people safely and effectively. Staff said they could go to the manager at any time and they would be listened to.

During this inspection, we found two breaches of the Health and Social Care Act 2008 regulations. You can see what action we told the provider to take at the back of the full version of the report.

This is the first time the service has been rated as requires improvement.

Alma Lodge offers accommodation, care and support for up to 10 people with learning disabilities. People’s needs varied; some people required support to mobilise around the home, some were not able to verbally communicate their needs and one person was more independent, so required less support. At the time of the inspection there were six people living at the service.

There was a registered manager employed at the service. 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 last comprehensive inspection, the service was rated Good overall and Requires Improvement in the 'Safe' domain.

We carried out an announced comprehensive inspection of this service on 09 August 2016. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches of Regulation 12 of the Health and Social Care Act Regulated Activities Regulations 2014, Safe care and treatment. The provider told us they had met the regulation by 28 August 2016. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Alma Lodge on our website at www.cqc.org.uk.

At this inspection we found that the service still required improvement in the ‘Safe’ domain.

Fire safety had not been effectively managed, which meant people were at risk if a fire broke out. Some areas of the home required additional cleaning and maintenance. The kitchen units were damaged and worn; because of this they could not be effectively cleaned to promote good hygiene practice. Flooring outside a bathroom was damaged which was a trip hazard at the top of the stairs.

Medicines practice had improved. Medicines were well managed; they had been stored and administered appropriately.

Effective recruitment procedures were in place to ensure that potential staff employed were of good character and had the skills and experience needed to carry out their roles. There were suitable numbers of staff on shift to meet people’s needs.

Staff knew and understood how to protect people from abuse and harm and keep them safe.

Risks to people’s safety and wellbeing were managed effectively to make sure they were protected from harm.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Alma Lodge offers accommodation, care and support for up to 11 people with learning disabilities from those that have some degree of independence to those needing more support. At the time of the inspection, seven people lived at the service, all of whom were receiving care and support.

There was a registered manager employed at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

People’s medicines had not always been administered as it had been prescribed by their GP to protect people’s health and well-being. Staff were not following the provider’s medicines policy and published good practice guidance for administration of medicines.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Management understood when an application should be made. They were aware of the Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. The service was meeting the requirements of the Deprivation of Liberty Safeguards.

The registered manager and staff had received training about the Mental Capacity Act 2005 and understood when and how to support peoples best interest if they lacked capacity to make certain decisions about their care.

People were protected against the risk of abuse. Staff had had training and recognised the signs of abuse or neglect and what to look out for. Management and staff understood their role and responsibilities to report any concerns and were confident in doing so. Staff told us they knew what to do if they needed to whistle blow, and there was a whistleblowing policy available.

People had varied needs, and the people living in the service had a limited ability to verbally communicate with us or engage directly in the inspection process. People demonstrated that they were happy by facial expressions for example, a smile to the registered manage, deputy manager and staff who were supporting them. Staff were attentive and interacted with people in a warm and friendly manner. Staff were available throughout the day, and responded quickly to people’s requests for help.

There were enough staff with the skills required to meet people’s needs. Staff were recruited using procedures designed to protect people from the employment of unsuitable staff. Staff were trained to meet people’s needs and were supported through regular supervision and an annual appraisal so they were supported to carry out their roles.

There were risk assessments in place for the environment, and for each person who received care. Assessments had been updated and were individual for each person. Assessments identified people’s specific needs, and showed how risks could be minimised. There were systems in place to review accidents and incidents and make any relevant improvements as a result.

People and their relatives were involved in planning their own care, and staff supported them in making arrangements to meet their health needs. Staff contacted other health and social care professionals for support and advice, such as doctors, speech and language therapist (SALT) and dieticians.

People had access to GPs and other health care professionals. Prompt referrals were made for access to specialist health care professionals.

People could easily access food and drink and snacks during the day. People were involved in shopping. Staff knew people that lived in the service well and were engaged in meaningful and fun conversations with people. Staff encouraged people to be as independent as possible.

Interactions between people and staff were positive and caring. People responded well to staff and engaged with them in activities. People were encouraged to take part in activities that they enjoyed. People were supported to be as independent as possible.

People were aware that they could complain and they knew who to talk to if they were worried or concerned about anything. The registered manager said there had been no complaints made in the last twelve months.

The registered manager had sought the views of people living in the service as well as relatives. The results of these surveys were positive.

The provider and registered manager regularly assessed and monitored the quality of care to ensure standards were met and maintained. The providers and registered manager understood the requirements of their registration with the CQC.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.