Altham Care Home

Altham Care Home is a residential care home providing personal care for up to 36 adults. The home is also registered to accommodate people who are living with dementia. At the time of our inspection there were 27 people living at the home.

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

The provision of activities could have been more structured and in line with people’s wishes and preferences. We made a recommendation about this.

People were kept safe and protected from the risk of infections, including the transmission of Covid-19 because good infection control practices had been adopted by the home. One relative told us, “We all had to get an NHS Covid pass for the home. It seems to be very well managed.”

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.

People needs were assessed and they were supported by staff who were trained and supervised, which helped to ensure effective care was delivered. People’s health and social care needs were being met by the home working closely with a range of community professionals.

People received good care. Their preferences and wishes were respected by the staff team and independence was promoted. People were treated with dignity and respect and were involved in the decision-making process. We observed some lovely interactions by staff members, who were clearly committed to the people who lived at Altham Care Home. One relative commented, “I feel that we can ask the staff anything. It seems like we [the family] are also supported by the staff and it's like being part of an extended family.”

People were involved in planning their own care, which was informative and person-centred. This helped to ensure care and support was provided in accordance with people’s wishes and preferences. People had access to all the relevant information, to enable them to make informed decisions and choices.

People were provided with a good quality service, which was regularly assessed and closely monitored. Any shortfalls identified were addressed without delay. People provided us with positive feedback about the staff team and the registered manager of the home, who were described as kind, caring and approachable. People looked relaxed in the company of staff and the manager was visible around the home. One relative told us, “The manager is very approachable. She seems hands-on. The office manager is also excellent.”

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 12 August 2020) 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 planned inspection based on the previous rating and to follow up on action we told the provider to take at the last inspection.

On this occasion we did not look at all the elements of the safe domain as this area was last rated as good. However, we did look 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.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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

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.

Altham Care Home is a residential care home providing personal care and support to 22 people aged over 65, at the time of the inspection. The service can support up to 36 people. The service can also provide support to people who were living with dementia.

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

There were sufficient numbers of staff to meet people’s needs. People looked settled and we observed good interactions between staff and people living in the home. Any calls for assistance were promptly responded to.

We noted there had been recent changes to the management structure and a deputy manager had been employed. The registered manager was known to people and worked flexibly around the service; this enabled her to monitor staff practice in all areas of care and support.

All areas of the home that we looked at, were clean, well maintained and odour free. There was a refurbishment plan in place, and we observed improvements had been made to the home since the last inspection. We observed management and staff using personal protective equipment (PPE) safely. Designated domestic staff were available and cleaning schedules were being followed. The provider was accessing regular COVID-19 testing and the majority of staff and all people living in the home had been vaccinated. Safe visiting processes were in place in accordance with the current guidance.

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

Rating at last inspection

The last rating for this service was requires improvement (published 12 August 2020).

At the last focused inspection of 28 July 2020, we looked at the breaches of regulation found at the comprehensive inspection of January 2020; we looked only at the requirements made in the key questions of safe and well led. At that time, the provider demonstrated that improvements had been made. However, the breaches of regulation in the key questions effective, caring and responsive were not looked at.

Why we inspected

This targeted inspection was prompted in part due to specific concerns received about staffing numbers, cleanliness and staff responsiveness. A decision was made for us to inspect and examine those risks. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

The Care Quality Commission (CQC) have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We also 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 found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe sections of this full report.

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

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.

Altham Care Home is a residential care home that was providing accommodation, care and support to 32 people at the time of the inspection, some of who were living with dementia. The service can support up to 36 people.

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

Systems and processes safeguarded people from the risk of abuse. People told us they felt safe in the service and staff were confident the management team would act quickly to keep people safe.

The management team understood their responsibility to be open and honest when something went wrong. Systems were in place to ensure lessons were learnt from any incidents. We discussed how the recording of more detail would further support learning.

Risks to people's health, safety and wellbeing were managed well. Accidents and incidents were being recorded, reviewed and acted on. Equipment was safe to use and regularly serviced and maintained. Environmental risks and shortfalls, found at the last inspection, were being addressed with an ongoing improvement plan in place.

Staffing levels had improved and additional staff recruited to ensure people received prompt care and support. Staff, people and their relatives told us there were sufficient staff available. Staff received appropriate training and support. The recruitment systems ensured staff had the right skills and character to work with vulnerable people.

The home was clean and fresh smelling and staff followed safe infection control practices. People told us the cleanliness of the home had improved. Medicines were managed safely.

The management team had worked hard to address the shortfalls found at the last inspection. People, their relatives and staff told us they were happy with the service and with the recent improvements made. Systems to check the quality of the service and to monitor staff practice were effective with clear evidence improvements had taken place. People’s views were sought about the service with good evidence they were listened to.

People were involved in decisions about their care and support. Care was planned in a person-centred way. The records reflected people’s choices and preferences which helped ensure good outcomes for people. Records were accurate and organised. Management and staff worked in partnership with other agencies to ensure effective, coordinated care and support for people.

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 Inadequate (published 6 April 2020). There were multiple breaches of regulation and the service was placed in special measures. This meant the service was kept under review and an inspection would be undertaken within six months to ensure significant improvements have been made. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

During this inspection, the provider demonstrated that improvements have been made in Safe and Well-Led. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in special measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 27, 28 and 29 January 2020. Breaches of legal requirements were found in safe, effective, caring, responsive and well-led. Warning notices were served in relation to Regulation 17 - Good Governance, Regulation 18 - Staffing and Regulation 12 - Safe Care and Treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was placed in special measures. We also made a recommendation about the management of some medicines.

We undertook this focused inspection to follow up on whether the warning notices we previously served, had been met. We also checked they had followed their action plan and to confirm they now met legal requirements in Safe and Well-Led. This report only covers our findings in relation to the Key Questions Safe and Well-Led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

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

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.

Altham Care Home is a residential care home that was providing personal care to 32 people at the time of the inspection. This included people with a diagnosis of dementia. The service can support up to 36 people. Bedrooms comprised of 32 single and two double rooms.

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

Effective systems and processes were not always in place to safeguard people from the risk of abuse. People were not always safe and protected from risks within the environment. People were at risk as the service was dirty and unhygienic. Adequate staffing levels were not always in place, particularly at night time. Recruitment systems and processes were not always robust. There was limited evidence of how lessons were learned.

We have made a recommendation about managing medicines.

Staff had not always received training and support for their roles. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

We have made a recommendation about mealtimes and the recording of food and fluid.

We have made a recommendation about environments for people living with dementia.

People’s privacy and dignity was not always protected. We observed poor practice on two occasions and found CCTV in operation; without the consideration of relevant guidance and legislation. People were not always supported to make decisions about their care and support.

Care was not always planned in a person-centred way. There was no evidence to show people had been involved in planning their care. People told us they had not seen their care plans. People were not always supported to engage in meaningful activities to stimulate them and prevent boredom. People did not access the community regularly. Complaints were not always managed in line with policies and procedures.

We have made a recommendation about end of life care and support.

We have made a recommendation about communication needs.

The registered managers and provider did not always promote a person-centred culture that achieved good outcomes for people. The registered managers failed to ensure robust auditing systems were in place to identify issues and drive improvements. Both registered managers lacked knowledge about certain people using the service and did not ensure adequate risk assessments were in place. The service did not always engage and involve people.

People told us they felt safe in the service. We received positive comments about the food and people received a healthy and balanced diet. People’s needs were assessed prior to them using the service. People had access to external healthcare professionals. People told us they were supported to be independent by kind and caring staff. We received positive comments about the kindness of staff. Staff described the culture within the service as open. The service engaged with external professionals.

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

Rating at last inspection

The last rating for this service was good (published 01 April 2019).

Why we inspected

The inspection was prompted in part due to concerns received about infection control, bathing, risk assessments, staffing, care plans and the use of equipment. A decision was made for us to inspect and examine those risks.

Enforcement

We have identified breaches in relation to person-centred care, dignity and respect, consent, safe care and treatment, safeguarding, complaints, good governance, staffing and recruitment.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the 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.

People’s experience of using this service:

The service met the characteristics of good in all five key questions. Therefore, our overall rating for this service is good.

Assessments and care plans were in place. Although we found some had not always been updated in accordance with policy, staff felt the needs identified were current and they knew the people they cared for well. Following on from inspection the provider ensured specific risk assessments and strategies were in place.

Medicines were being managed safely but creams needed to be signed when opened and topical charts needed to be in place for all people.

People liked living in the service and the home had a warm, friendly atmosphere. People told us they felt safe. They were protected from abuse and discrimination. People told us that staffing levels were appropriate and staff responded in a timely way to people’s needs. We saw that accidents and incidents were managed appropriately.

Staff told us they received a comprehensive induction and had the right skills and experience. People were complimentary about the meals at the service and the dining room experience was pleasant.

Staff had appropriate knowledge of the Mental Capacity Act (MCA)and appropriate Deprivation of Liberty Safeguards (DoLs) applications had been made. People felt the staff were lovely. We observed staff to be kind, caring and empathetic. We saw that they treated people with dignity and respect.

People were consulted about their care and families were involved in reviews.

The management had a visible presence within the home and positive feedback was given about them, in particular the new registered manager. Staff told us they felt well supported by the management.

Rating at last inspection: The service was inspected 8 June 2018 when we undertook a focused inspection and looked at two keys areas, safe and well led. The service was rated good. The report was published 12 September 2018.

Why we inspected: This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care.

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

We carried out an unannounced comprehensive inspection of this service on 24 and 25 February 2016. After that inspection we received concerns in relation to a specific incident which led to the death of someone living in the home. As a result, we undertook this focused inspection to consider those concerns and ensure the home had acted accordingly and people were safe. This report only covers our findings in relation to the key questions associated with this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (Altham Care Home) on our website at www.cqc.org.uk

No risks, concerns or significant improvements were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

Altham Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates 36 people in one adapted building. At the time of the inspection there were 32 people living in the home.

The home is over two floors and has a large dining room and lounge area to its centre. There is also a large quieter lounge. Kitchen and laundry facilities are on the ground floor.

The home had two registered managers in post at the time of the inspection. One of them was a company director. 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 inspection there were no identified breaches to the regulations of the Health and Social Care Act. At this inspection we found there were no breaches to the regulations but have made two recommendations. We recommend the provider undertakes an assessment of people’s dependency levels and ensures there are enough available staff to always meet people’s needs. We have recommended that when the provider undertakes audits to ensure they have a more focused review of the accuracy of the information audited and not just the completeness of the documentation. This is specifically around care plans and the use of body maps after accidents.

We looked at how the provider had managed the specific incident and found they took immediate steps to reduce associated risks. We also found that once the details of the incident were investigated further, more permanent steps were taken to ensure the circumstances of the incident could not be replicated.

We found staff were recruited fairly and equitably ensuring they were suitable to be employed supporting vulnerable people.

Medicines were managed safely including safe storage, administration and recording of people’s prescribed medicines and when they were given.

The home had safeguarding procedures in place and staff at the home understood what constituted abuse and when they should raise concerns, both internally and externally, with the Local Authority.

On the days of the inspection there were enough suitably trained staff to meet the needs of people living in the home.

We saw the provider took steps to ensure equipment was tested and the building was both secure and safe for the people living there.

The provider had improved the home’s management of clinical waste by the second day of the inspection and more focused audit of infection prevention and control was being undertaken.

The registered managers had taken appropriate steps to ensure lessons were learned from both the specific incident under investigation and in general where it was found improvements could be made.

Staff knew the governance structure in the home and each felt supported by their peers, immediate superiors and the directors of the home.

People living in the home and their relative’s views were sought on the service delivered and these had been predominantly positive.

There is a developed suite of quality monitoring and audit which simply undertakes the quality assurance for the service delivered to people and the environment within which it is delivered.

The provider was meeting the requirements of the Health and Social Act (Regulated Activity) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009

Altham Care Home is registered to provide accommodation and personal care for up to 36 older people including people living with dementia. At the time of our visit there were 35 people living in the home.

The home is purpose built and located in Clayton-Le-Moors. It is close to local amenities and public transport. Accommodation is provided on two levels in thirty two single and two shared bedrooms. There is an enclosed garden area that is easily accessible for people. Communal rooms include three lounges, two of these have a dining area. There is a small car park for visitors and staff.

The service was managed by two registered managers. 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 this inspection we found the service was meeting the current regulations.

People living in the home told us they felt safe and well cared for. They considered there was enough staff to support them when they needed any help. The registered managers followed a good recruitment procedure to ensure new staff were suitable to work with vulnerable people. We found there were enough staff deployed to support people effectively.

The staff we spoke with were knowledgeable about the individual needs of the people. They knew how to recognise signs of abuse and had undertaken safeguarding training. Staff were clear about their responsibilities for reporting incidents in line with local guidance and they knew how to report any poor practice.

Risks to people’s health, welfare and safety were managed very well. Risk assessments were in place in relation to pressure ulcers, behaviours, nutrition, falls and moving and handling. Where risk assessments identified potential hazards, plans were in place to promote people's safety.

Medicines were managed safely and people had their medicines as prescribed and when they needed them. Staff administering medicines had been trained to do this safely.

We found the premises to be clean and hygienic and appropriately maintained. Regular health and safety checks were carried out and equipment used was appropriately maintained. The service held a maximum five star rating award for food hygiene from Environmental Health.

Staff followed the principles of the Mental Capacity Act 2005 to ensure that people’s rights were protected where they were unable to make decisions for themselves. Staff understood the importance of gaining consent from people and the principles of best interest decisions. Routine choices such as preferred daily routines and level of support from staff for personal care was acknowledged and respected.

People were provided with a nutritionally balanced diet. All of the people we spoke with said that the food served in the home was very good. They were offered a varied diet and were provided with sufficient drinks and snacks. Menu sampling days were held for people to help them choose favourite foods, and their relatives/visitors were also invited to join in the sampling.

There was an open and friendly atmosphere in the home, which showed good relationships existed with the staff and people they cared for. Staff were respectful to people, attentive to their needs and treated people with kindness and respect in their day to day care. People told us they had their privacy respected by all staff. Staff had been trained in End of Life care. This meant staff could? //approach people’s end of life care with confidence and ensure their dignity, comfort and respect was considered.

Each person had an individual care plan that was sufficiently detailed to ensure people were at the centre of their care. Care files contained a profile of people’s needs that set out what was important to each person, for example how they were dressed, personal care and how they could best be supported.

People’s care and support was kept under review, and people were given additional support when they required this. Referrals had been made to the relevant health and social care professionals for advice and support when people’s needs had changed. This meant people received prompt, co-ordinated and effective care.

People were supported to live full and active lives and activities organised were meaningful and varied. Visiting arrangements were good and visitors could use the tea and coffee making facilities provided.

People told us they were confident to raise any issue of concern with the provider and staff and that it would be taken seriously. They were regularly encouraged to express their views and opinions and also had opportunities to give feedback about the service, the staff and their environment in quality assurance surveys.

All people, their relatives and staff spoken with said the management of the service was very good and they had confidence in the registered managers. There were systems in place to monitor the quality of the service and evidence to show improvements were made as a result of this.