Archived: Alma Residential Home

Updated 29 January 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the registered persons continued to meet the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service and to provide a rating for the service under the Care Act 2014.

Before the inspection we looked at previous inspection reports and notifications about important events that had taken place at the service. A notification is information about important events, which the provider is required to tell us about by law. Due to technical problems, we did not ask the provider for to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also looked at the provider’s action plan which detailed progress towards meeting the breaches of Regulations.

We visited the service on 19 and 20 November 2018 and the inspection was unannounced. The inspection team consisted of one inspector and an expert by experience. An expert by experience is someone who has personal experience of using this type of service. We received feedback from a commissioner of the service, the local authority safeguarding team and a health care professional. They had all voiced their concerns about the way the service supported people with their care and treatment.

During the inspection visit we spoke with six people who lived in the service and two relatives. We spent time with people and the lounge and joined some of them for lunch.

We spoke with the registered manager, deputy manager, care coordinator, senior carer, carer, chef and two housekeepers. We looked at the care records for six people. We also looked at records that related to how the service were managed. This included four records of staff who had been recently employed by the service, staff training matrix, health and safety, the management of medicines and quality assurance.

Updated 29 January 2019

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

Alma residential home is registered to provide accommodation and personal care for up to 22 older people. There were 17 people living in the service at the time of our inspection visit, some of whom were living with dementia.

We inspected the service on 19 and 20 November 2018. The inspection was unannounced.

There was a registered manager in post who was also one of the registered providers. They were present on both days of the inspection. 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 on 17 and 18 October 2017, the overall rating of the service was ‘Requires Improvement. We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The quality of the service was not checked to make sure risks to people were minimised and that staff knew what to do in the event of an emergency. Checks on new staff were not thorough, staff were not supervised and there were not enough staff employed to meet people’s needs. Records were not accurate.

We required the provider to take action to make improvements. The provider sent us an action plan detailing how they planned to address the breaches of Regulations and said that this would be completed by 28 March 2018.

We also made five recommendations. These were: to make sure staff had access to local safeguarding procedures; about the management of medicines; that staff had all the training they needed; that people could take part in meaningful activities; and that there was a complaints procedure.

At this inspection we found that shortfalls remained in checking the quality of the service; managing risks; staff recruitment, training and supervision; record keeping and activities. We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This is the second time the service has been rated as Requires Improvement.

Quality assurance processes continued to be ineffective in assessing, identifying and addressing shortfalls in the service. The registered manager had delegated responsibility for the day to day running of the service to a manager. However, there had been several changes to the manager to whom the registered manager had appointed, which had had a direct impact on people and staff.

The provider had not done all that it could to minimise assessed risks. Not all staff had received training in fire safety, visual checks had not taken place on fire-fighting equipment to make sure it was operational and night staff had not completed fire drills. The fire officer identified concerns about fire safety and people being safely evacuated in the event of the fire on the second day of the inspection.

The provider was not proactive in making sure lessons were learned. Accidents and incidents were reported to the management team, but they had not reviewed them to make sure appropriate action had been taken to minimise any reoccurrence.

Recruitment checks of new staff continued to be incomplete so it could not be assured that only suitable people were employed to support people.

Staff had not all received the training or supervision that they required for their role. After the inspection the provider confirmed that training in safeguarding and mental capacity had been arranged for the staff team.

Consideration had not fully been given to adapting the environment to meet the needs of people living with dementia or those who needed support with their mobility and we have made a recommendation.

The range of frequency of activities did not provide people with opportunities to pursue their interests and for everyone to engage in social activities. We have made a recommendation regards this.

Staff who gave people their medicines had not received regular training or had their competence assessed. Medicines were not audited to check people received their medicines as prescribed by their doctor.

People's health needs were assessed but support was not always provided in a timely manner.

Staff gained consent from people before providing care and knew how to support them in the least restrictive way possible. The provider was reviewing DoLs authorisations to make sure they were reapplied for in a timely manner.

Assessments of potential risks to people’s individual safety had been undertaken and strategies put in place to minimise their reoccurrence.

The provider had assessed each person’s needs and made sure that there were enough staff available to meet them.

Staff knew how to identify and report potential abuse and the registered manager accessed local safeguarding guidance during the inspection.

The service was clean on the days of the inspection and staff followed protocols to minimise the spread of any infection.

People were positive about the meals provided and were helped to eat and drink enough to maintain a balanced diet.

Staff knew people well and treated them with dignity, respect and kindness. People were supported to be as independent as possible.

People’s care plans set out their assessed needs and the support and assistance they required from staff. Steps had been taken to present information to people in an accessible way.

Provision was in place to support people at the end of their life to have a comfortable, dignified and pain-free death.

Resident meetings were held and people felt that their views were listened and responded to. People knew how to make a concern or complaint.

Full information about CQC's regulatory response to the breaches of regulations noted above will be added to our report after any representations and appeals have been concluded.