Allambie Court

Allambie Court is a nursing home providing nursing care and accommodation to up to 30 people. There are 26 bedrooms across two floors. Four of these bedrooms can be shared. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 20 people living at the home.

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

Allambie Court has not achieved an overall rating of good for the last six inspections undertaken between March 2016 and January 2022. Effective governance has not been robust enough to drive forward the required improvements.

The provider had not ensured clinical staff had the skills to continuously monitor people's complex nursing conditions. Systems and processes had not identified and mitigated the risks related to people’s health. Action had not always been taken to mitigate and monitor risks related to catheter care and wound management.

Some improvements were required to infection control practices such as asking visitors to wash their hands and the completion of COVID-19 screening questions before visitors entered the home. In addition, the provider was not facilitating visits for people in accordance with current government guidance. They had not consulted with people about the impact a lack of visitors would have on their well-being.

Medicines were stored and administered safely, and people received their medicines as prescribed. Staff were recruited safely and were kind and compassionate towards the people living at the home. There were enough staff to keep people safe. Further training was required to ensure some staff had the skills and competencies to provide high quality care.

The registered manager and general manager were committed to making the required improvements and we received positive feedback from staff and relatives about the leadership of the home. They were responsive to feedback from professionals and had made some improvements following external quality checks.

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 26 May 2021). The service remains rated requires improvement. This service has been rated requires improvement or inadequate for the last six consecutive inspections.

Why we inspected

We received concerns in relation to staffing and people’s nursing care needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained requires improvement based on the findings of this inspection. 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. This included checking the provider was meeting COVID-19 vaccination requirements.

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

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

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.

We have identified a breach in relation to regulation 9 person centred care and regulation 17 good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Allambie Court is a nursing home, providing nursing care and accommodation for up to 30 people. It provides care to older people, some of whom are living with dementia. Care is provided across two floors. At the time of our inspection visit 22 people lived at the home.

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

Systems and processes were in place to audit the quality. Most audits identified where improvements were needed and actions were taken. Medication audits had not identified a few issues we found.

Risks related to people’s health and nursing needs were assessed, and actions had been taken to mitigate identified risks. Relatives felt their loved one was well cared for in a safe place by trained staff. Improvements had been made to risks associated with people's health and care needs. People identified at risk of malnutrition and / or dehydration were supported to maintain their food and fluid intake and improvement had been made to people's records so effective monitoring could take place.

Environmental risks had been assessed and, overall, actions taken to reduce risks. However, the provider had not taken all the action reasonable to mitigate risks related to legionella or fire safety. The provider had undertaken risk assessments, but we could not be assured, from the assessments that the provider had assessed night-time staffing levels as being the minimum required to safely carry out an evacuation, to a place of safety, if there was an emergency.

Relatives felt their loved ones were protected from the risks of abuse and staff were trained in safeguarding people from abuse and understood how to report concerns.

People had their prescribed medicines available to them and were supported to take these by nurses.

An 'infection prevention control' audit was carried out by CQC during the inspection. We found the provider was following government guidelines. Personal Protective Equipment (PPE) was available and used by staff. Improvements had been made to the cleanliness of the kitchen. Improvement had been made to ensure people had individually named hoist slings where they needed them, which reduced risks of cross infection.

There were enough staff on shift to meet people's agreed care needs. Staff were recruited in a way that assessed their suitability to work at the home.

Relatives felt managers were approachable and staff were positive about the day to day management of the home and felt managers listened to them.

During our inspection we found the provider was operating outside of their registered service user bands.

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. (Report published 14 May 2019).

Why we inspected

This was a planned inspection based on the rating of the last inspection. We undertook a focused inspection on Safe and Well Led based on our methodology.

Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The rating continues to be Requires Improvement.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Allambie Court on our website at www.cqc.org.uk.

Follow up

We will continue to monitor intelligence about the service.

Allambie Court Nursing Home is a care home, providing personal and nursing care and accommodation for up to 26 people. There were 22 people with frailty due to older age and / or dementia living at the home at the time of the inspection.

What life is like for people using this service:

• People felt well cared for and described staff as kind and compassionate toward them.

• Staff knew people well and how they liked to be cared for.

• There were some risks of potential infection posed to people. Cleanliness was not consistently good and improvements in hygiene were needed in the kitchen and to soft furnishings in communal lounges.

• Food safety guidelines were not always followed and a food handling practice posed potential risks of infection to people.

• People felt care staff were kind towards them and looked after them well. Activities were planned for and took place during the afternoons which met people’s needs.

• People had individual plans of care, so staff had the information they needed to care for them.

• Risks were identified, and actions taken to reduce the risks of harm and injury. However, monitoring records were not always in place to support effective monitoring of identified risks.

• Medicines were managed safely. People’s prescribed medicines were available to them and records had been completed as required.

• Staff had the necessary skills to meet people’s needs.

• Care staff understood the need to gain people’s consent before personal care was provided. The registered manager understood, and worked within, the requirements of the Mental Capacity Act 2005.

• People were supported to eat and drink adequately.

• Staff interacted positively with people, showing a caring approach.

• People and relatives were, overall, complimentary about staff. No written complaints had been received, however, concerns about cleanliness were shared with us.

• The provider had systems and processes in place to assess the quality and safety of the service. Most actions were taken to make improvements where needed. However, we found occasions where actions for improvement identified were not always implemented.

Rating at last inspection: The last report for Allambie Court Nursing Home was published on 28 June 2018 and we gave an overall rating of Requires Improvement.

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection we found some improvements in how effective the service was and how people were cared for. However, improvements continued to be needed in the safety, responsiveness and how well led the service was. The rating continued to be Requires Improvement.

Follow up: We will continue to monitor intelligence we receive about the service.

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

Allambie Court 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.

Allambie Court is registered to provide accommodation with nursing and personal care for up to 30 older people who are living with dementia. At the time of our inspection visit there were 25 people living there.

The home had a registered manager. 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.

When we inspected Allambie Court in October 2017, we gave a rating of ‘inadequate.’ At that inspection, we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.’ We found there were not enough staff to keep people safe, and that risk was not properly managed. Medicines were not administered safely or as prescribed and the systems in place to quality assure and check the care provided were ineffective. Furthermore, people, relatives and staff were not confident the home was well led.

The service was placed in ‘Special Measures’. Services in special measures are kept under review and inspected again within six months.

At this inspection, we found sufficient improvements had been made to remove the service from special measures, and the rating changed to ‘Requires Improvement’. However, we found continued breaches of the regulations related to the safe and effective management of medicines. This was because guidelines for people prescribed medicine to control their diabetes had not been reviewed by a clinician, the application of prescribed creams was not properly recorded, and guidance in place for people in receipt of ‘as required’ medicines was not sufficiently detailed.

Action had been taken to ensure risks were assessed and plans were in place to manage those risks. Risks relating to weight loss were now tracked and recorded, with action taken to protect people where there were concerns. People’s needs for supervision had been reassessed and the registered manager regularly calculated and reviewed the level of need throughout the home to ensure there were enough staff to keep people safe.

Some action had been taken to improve the systems used to check and audit the quality of the care provided at the home. Maintenance was better managed, and the home environment had been improved. However, the provider’s system of checks and audits had not identified some of the issues we found, particularly around medicines management and infection control.

People told us they felt safe with the staff who supported them, and we saw people were comfortable with staff. Staff received training in how to safeguard people and understood what action they should take in order to protect people from abuse. The provider ensured staff followed safeguarding policies and procedures. The provider conducted pre-employment checks prior to staff starting work, to ensure their suitability to support people. Staff told us they had not been able to work until these checks had been completed.

Whilst the provider had taken action to identify gaps in training and had plans in place to address them, there remained significant gaps in some staff training such as dealing with behaviour that challenges, as well as supporting people living with dementia. Not all staff demonstrated confidence in dealing with behaviours effectively. Staff induction still did not included national recommended standards, but plans were in place to introduce these.

Staff were supported to maintain their skills through regular individual ‘supervision’ meetings, and care staff spoke about effective checking of their competence to do their work. However, recorded checks of nursing staff competence were not sufficienty detailed to assure us how this had been assessed.

People were offered a choice of meals and drinks that met their dietary needs, and where they were at risk, their food and fluid intake was recorded. Whilst action was taken as required, fluid monitoring was not effective and the provider was making changes to ensure fluid recording protected people.

People received timely support from appropriate health care professionals. Staff now felt supported by the registered manager, and reported significant improvements had been made since the provider ensured more support was available.

People were asked for their consent before staff supported them. Where people lacked capacity to make particular decisions, this had been assessed to ensure people were protected. Where people lacked capacity and had been deprived of their liberty to keep them safe, the provider ensured they applied to the relevant authority to ensure this was done lawfully.

People and relatives told us staff were respectful and treated people with dignity. We saw this in interactions between people and staff. However, people were not supported through positive interactions consistently, which could impact on their well-being.

People did not always receive care that was responsive to their needs. Records designed to ensure this happened were not always properly completed, and we found staff were not always aware of when people had their needs met. However, we observed several examples of staff responding to people’s needs and requests quickly during our inspection visit.

Improvements had been made to ensure people were able to maintain activities and hobbies that interested them. Further improvement was planned.

People who were supported at the end of their lives had their needs met and their care plans recorded their needs, preferences and wishes at this time.

Complaints were logged and acted on in line with the provider’s policy and procedure, and actions were taken to ensure the service improved following complaints and concerns.

Allambie Court is registered to provide accommodation with nursing and personal care for up to 30 older people who are living with dementia. At the time of our inspection visit there were 23 people living in the home.

The service had a registered manager. 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.

The home was last inspected on 22 February 2017, when we found the provider was compliant with the fundamental standards described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However, the home was awarded an overall rating of 'requires improvement'.

At this inspection, we checked to see if improvements had been made. We found improvements had not been made, and we had increased concerns as to the safety of the care provided and the leadership and oversight of the manager and provider.

People did not always receive their medicines safely and as prescribed. Systems designed to record and check medicines administration were not effective.

Assessed risks were not always managed effectively, and staff knowledge of how risks should be mitigated was not always consistent. This posed a risk to people’s health and safety.

There were not enough staff to support people safely and meet their needs effectively.

Staff did not always receive the training required to ensure their skills and knowledge remained up to date. The risk of malnutrition and dehydration was not always well managed, and records designed to monitor and help address these risks were not always completed consistently.

Care records were not always updated or completed, which meant we could not be sure people were supported consistently. People were not consistently supported to maintain activities, hobbies or interests.

There were quality monitoring systems in place to identify any areas needing improvement, but these were not used consistently or accurately. They had not identified the concerns we found during our inspection, and governance of how the home was run was weak and ineffective which meant it had not improved.

People were comfortable with the staff who supported them. Staff received training in how to safeguard people from abuse and understood what action they should take in order to protect people from harm. The provider conducted pre-employment checks prior to staff starting work, to ensure their suitability to support people who lived in the home. Staff told us they were not able to work until these checks had been completed.

The provider ensured staff had information on the level of support people needed with decision-making so people were protected. The registered manager had a good understanding of the Mental Capacity Act (MCA), and the need to seek informed consent from people before delivering care and support. Staff had a limited understanding of the MCA, but understood the importance of consent. Where restrictions on people’s liberty were in place, legal processes had been followed to ensure applications for legal authorisation had been sent to the relevant authorities.

Staff were respectful and treated people with dignity and respect, but staff did not always take opportunities to engage with people to enhance their well-being. People experienced a lack of interaction and engagement, as support focussed on tasks to be completed.

Complaints were managed effectively.

Staff and relatives did not always feel well supported by the registered manager

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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.

Allambie Court is registered to provide accommodation with nursing and personal care for up to 30 older people who are living with dementia. At the time of our inspection visit there were 23 people living in the home.

The service had a registered manager. 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.

The home was last inspected on 23 March 2016, when we found the provider was compliant with the fundamental standards described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However, the home was awarded an overall rating of 'requires improvement'. This was because procedures and policies were not always followed to ensure people consistently received safe and responsive care. The provider’s quality assurance checks did not identify when improvements needed to be made.

At this inspection, we checked to see if improvements had been made. We found some

actions had been taken and improvements had been made, but there were still areas where improvement was needed.

People were comfortable with the staff who supported them and relatives were confident people were safe living in the home. Staff received training in how to safeguard people from abuse and understood what action they should take in order to protect people from harm. Risks to people’s safety were assessed, and risk assessments were updated in response to incidents or changes in need. Staff knew how to support people safely. However, risk assessments were not always clear or detailed enough to ensure consistency.

Risks associated with fire or other emergencies required review, but the provider had already identified a number of measures required to improve people’s safety in the event of fire.

People were supported with their medicines by staff who were trained and assessed as competent to give medicines safely. Medicines were given in a timely way and as prescribed.

There were enough staff to meet people’s basic care needs. The provider conducted pre-employment checks prior to staff starting work, to ensure their suitability to support people who lived in the home. Staff told us they were not able to work until these checks had been completed.

The provider ensured staff had information on the level of support people needed with decision-making so people were protected. The registered manager had a good understanding of the Mental Capacity Act, and the need to seek informed consent from people before delivering care and support. Where restrictions on people’s liberty were in place, legal processes had been followed to ensure applications for legal authorisation had been sent to the relevant authorities. However, ‘best interests’ decisions were not always clearly documented and we could not be sure this requirement had always been met.

People had access to health professionals when needed and we saw the care and support provided in the home was in line with what had been recommended. Risks around eating and drinking had been assessed and staff ensured people received the support they needed to remain well.

Staff were respectful and treated people with dignity and respect. People were supported to make choices about their day to day lives.

Care planning and reviews took place, but there was not always evidence of how the views of people and their relatives had been taken into account. The service was not always responsive to the needs of people living with dementia, and the care plans in place did not contain sufficient person centred information to enable this to happen. Staff did not always take opportunities to engage with people and the support provided continued to be task focussed.

Relatives told us they felt able to raise any concerns with the registered manager. They felt these would be listened to and responded to effectively and in a timely way. Staff told us the management team were approachable and responsive to their ideas and suggestions. There were systems in place to monitor the quality of the support provided in the home. However, the registered manager had been unable to ensure issues identified through these systems had been acted on and the service improved.

Allambie Court is registered to provide accommodation with nursing and personal care for up to 30 older people who are living with dementia. At the time of our inspection visit there were 26 people living in the home.

The service had a registered manager. 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.

People were comfortable with the staff who supported them and relatives were confident people were safe living in the home. Staff received training in how to safeguard people from abuse and understood what action they should take in order to protect people from harm. Risks to people’s safety were assessed, but risk assessments were not always updated in response to incidents or changes in need. The provider’s checks had not identified this.

People were supported with their medicines by staff who were trained and assessed as competent to give medicines safely. Medicines were given in a timely way but in some cases were not given as prescribed. Checks designed to ensure medicines were administered safely had not identified this.

There were enough staff to meet people’s basic care needs. However, it was difficult for staff to find time to interact with people outside of completing care tasks. People were not routinely engaged in activity which had been identified as being meaningful to them. The provider conducted pre-employment checks prior to staff starting work, to ensure their suitability to support people who lived in the home. Staff told us they were not able to work until these checks had been completed.

The provider ensured staff had information on the level of support people needed with decision-making so people were protected. Staff and the registered manager had a good understanding of the Mental Capacity Act, and the need to seek informed consent from people before delivering care and support. Where restrictions on people’s liberty were in place, legal processes had been followed to ensure they were in people’s ‘best interests’, and applications for legal authorisation had been sent to the relevant authorities.

Staff were respectful and treated people with dignity and respect. People were supported to make choices about their day to day lives.

People had access to health professionals when needed and we saw the care and support provided in the home was in line with what had been recommended.

Relatives told us they felt able to raise any concerns with the registered manager. They felt these would be listened to and responded to effectively and in a timely way. Staff told us the management team were approachable and responsive to their ideas and suggestions. There were systems in place to monitor the quality of the support provided in the home. However, these systems had not always worked as intended as gaps and inconsistencies in the quality of care people received had not always been identified.

Relatives told us, 'It is very nice here. The staff are nice. I see staff singing to people' and 'The manager sorted it out so we could we could spend time privately together.'

We saw that staff were thoughtful and compassionate toward people. Staff checked that people consented to being assisted.

In the four care plans we looked at, we saw people's needs were assessed and risks to their health and well-being were identified. Care staff told us the care plans were detailed and they knew people well.

A nurse told us that the provider's medicines policy was effective. They told us they were given clear guidance and the manager checked that medicines were administered appropriately and safely.

Care staff told us they felt well supported by the manager and nurses. They told us they had training and plenty of opportunities to discuss people's needs and their own practice. One member of staff told us, 'If you need a chat with the manager, you just ask.'

The records we looked at accurately reflected people's needs and staff's skills and abilities. We asked the manager to send us additional records to demonstrate that they have effectively analysed staff's training and support needs.