Aldercar Residential Care Home

People were supported with their nutritional needs however, we made a recommendation about improving people's meal time experience.

People told us they enjoyed their food. Their comments included, “meals are very good,” “I like some [meals] but don’t like others,” “the meals are quite nice but I could do with more to eat” and “the food is lovely.”

People continued to receive safe care. Staff had a good understanding of safeguarding procedures that should be followed to report incidents of harm or concern. Risk assessments were in place to manage potential risks within people’s lives, whilst also promoting their independence.

The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service.

Safe staffing levels were in place to meet people's needs. A staff member told us, “There are always cover arrangements in place and staffing is not an issue here.”

There were procedures in place for evacuating people with limited mobility who were in the event of an emergency, such as a fire.

Infection control procedures were in place that were based on a Code of Practice on the prevention and control of infections. The premises, including communal areas and people rooms, were clean and fresh.

Staff members had training that provided them with knowledge they needed to perform their roles. The management team supported staff to put their training into practice. A staff member told us, “The training has really helped me to understand each person's needs and to treat everybody differently. I know about their history and their needs and then use the knowledge [from training] to provide better care.”

Staff obtained people's consent before they provided care and support. People gave consent for the use of bed rails to prevent them falling from their beds. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People participated in a wide range of meaningful and stimulating activities.

Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. People told us that staff were polite and that they had a good relationship with them. Care plans reflected people’s likes and dislikes, and staff spoke with people in a friendly manner, addressing them by their preferred name. We saw positive and friendly interactions between staff and people, though at times when staff were at their most busy in one dining room they were more task orientated.

Staff supported people’s independence. A person told us, “Since I have got here I have a lot more independence.” For most people this meant that they were encouraged to do more for themselves, though support was available if it was needed. A person told us, “I know help is nearby if I need it.”

People, or if needed their relatives, were involved in the planning of care and could contribute to the way in which they were supported. People and their relatives were involved in reviewing their care and making any necessary changes if they wanted.

Care plans were detailed and included information about the support people required.

People knew how to raise any complaints or concerns. These were acted upon promptly.

The service continued to be well managed. The provider had systems in place to monitor the quality of the service. Actions were taken and improvements were made when required.

Rating at last inspection: Good (report published 24 May 2016).

About the service: Aldercar Residential Care Home is a care home that was providing personal care to 21 older people at the time of the inspection.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained rated Good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme.

Aldecar Residential Care Home provides personal care and accommodation for up to twenty eight older adults. At the time of our visit, twenty two people were using the service. Aldecar Residential Care Home has mainly ground floor facilities, with two bedrooms on the first floor. The service has some double rooms but these are all currently single occupancy with the exception of one room which was a double room.

Aldecar Residential Care Home had a registered manager in post at the time of our visit. 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 protected by staff who had been trained to identify the signs and types of abuse and knew what actions to take.

Care plans contained detailed risk assessments and care plans which showed how potential risks to people were managed.

There were sufficient staff to ensure people were kept safe and their needs could be met. Although staff were recruited in a safe way, we saw an example of where the provider had not undertaken all relevant risk assessments in relation to recruitment.

People’s medicines were stored safely and given by staff who were trained to administer them. However the stock levels of some medicines had been recorded incorrectly and staff were not following their own policy on covert medication.

People received care from staff who had the training and skills to carry out their roles and meet people’s needs. Staff felt supported by the management

The registered manager had the processes in place to apply the principles of the Mental Capacity Act (2005) when people do not have the mental capacity to make decisions. Where required, Deprivation of Liberty Safeguards had been applied for. Staff understood the principles of consent.

People were provided with a balanced diet and staff were aware of people’s dietary needs. Staff responded to any unexpected weight changes appropriately. People were referred for their healthcare needs promptly and as needed.

The layout and design of the service was suitable for people’s needs, including people living with dementia.

Staff developed positive and caring relationships with people, and clearly demonstrated this in their interactions. People and their families were supported by staff to give their views and opinions about how their care was given.

People’s privacy and dignity was supported by staff. Staff treated people with respect.

People received care and support from staff who knew them well and who understood their needs and preferences. There were sufficient staff to ensure people’s needs were met quickly and in the way they preferred. Staff responded well to people who were distressed or who had behaviour that may challenge.

People, their relatives and staff spoke highly of the registered manager and there was a positive atmosphere at the service. The registered manager had an ‘open door’ policy and welcomed people’s and staff’s views on how to improve the service. The registered manager understood their responsibilities and ensured staff knew of what was required of them in their role. There were a number of quality assurance processes in place that regularly assessed the quality and effectiveness of the support provided.

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Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service and staff told us.

If you want to see the evidence that supports our summary please read the full report.

During our visit we spoke with five people who used the service, one relative, five members of staff including the manager and the provider.

Is the service safe?

People were assessed how they wanted to receive their medicines. One person said, "My medicines are given to me by the staff." Another person told us they were responsible for taking their own medication and they were happy with this arrangement.

We did not find any Deprivation of Liberty Safeguards referrals had been made, but the manager and staff were aware of the new guidelines that had been put in place in March 2014. The manager told us they had contacted the deprivation of liberty safeguarding team for advice to ensure they followed the correct procedure if they had to make any referral in the future.

Each person had received a Mental Capacity and Best Interest Assessment to ensure decisions were made in their best interest where appropriate.

Staff followed appropriate guidance for infection control to ensure any risks were kept to the minimum.

Is the service effective?

Staff told us they had received training in mental capacity and Deprivation of Liberty Safeguards. They told us they were aware of what this meant for people who used the service.

People who used the service received professional visits such as GP's, district nurses, dentist and chiropodist when required.

We found mattresses audits were in place to ensure people slept on clean mattresses and any that required inflation were kept at the correct setting to ensure people with or at risk of pressure ulcers were protected.

Is the service caring?

People we spoke with told us they felt their needs were being met. One person said, 'I am well looked after, you couldn't want for better.'

We used the Short Observational Framework for Inspection (SOFI), which is an observational tool used to help us collect evidence about the experiences of people who use services, where they were not able to share their experiences with us. We saw staff offer people a choice of food and drink and where required they supported people with eating and drinking.

Staff assisted people with everyday tasks, such as toileting and moving around the home if they required support.

Is the service responsive?

People had access to relevant information to help to support them make informed choices.

Staff responded well when people needed assistance. We saw they sat with people if they wanted a general chat. One person was tapping their head and we saw staff sat with the person and distracted them from doing this.

We found a broken bath panel in one of the bathrooms upstairs. The manager assured us this bath was not in use. They told us they would have their maintenance person source suitable material and replace the broken panel immediately.

Is the service well-led?

The manager ensured staff attended relevant training to make sure the people who used the service were well looked after.

Systems were in place to ensure the quality of the service was satisfactory and met people's needs. The provider attended the home on a daily basis and conducted visual audits around the home.

People's views were sought and acted upon. The manager had an open door policy where people who used the service and their family could discuss any issues or concerns at any time.

People using the service who we spoke with told us staff provided care that met their needs. One person said, 'They're always willing to help ' more than willing'. We also spoke with two relatives. They told us they felt their family members received good care. One relative said, 'From what I've seen from all the staff without exception they treat them all really well.' However, we found gaps in some care records, which meant there was a risk appropriate assessments of the needs of people were not always carried out.

We found that people were not fully protected from the risk of acquiring infections because appropriate guidance had not been followed. We found that people were not always cared for in a clean, hygienic environment.

We found that medication was not always administered safely.

We found that there were enough qualified, skilled and experienced staff to meet people's needs. We also found staff received inductions, supervision and training.

During our inspection we saw that staff were kind, polite and respectful.

However, we saw that some Mental Capacity Act 2005 capacity assessments were not clear about the specific decision they were about. We also saw that assessments stated that a person did not have capacity to make some decisions but we did not see any completed best interests checklists that recorded what options had been discussed, who had been involved and what best interests decisions had been made.

People using the service who we spoke with told us they had no concerns about the building. They told us they felt the building was well maintained. One person said, 'It's pretty safe actually, comfortable.'

We looked at the supervision records for two staff and the staff supervision matrix and saw evidence that regular supervision was taking place. However, we found some gaps in training. For example, we saw that 11 care staff had not received medication training. This included all of the night staff.

People using the service who we spoke with told us they had never made a complaint, but would talk to the care manager or senior carer if they wanted to.