Archived: Alma Residential Home

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.

Alma Residential Care Home provides accommodation and personal care for up to 22 older people. Some were older people living with dementia and some people had mobility difficulties. Accommodation is arranged over two floors. There were 22 people living at the service when we inspected.

The service had two registered managers. One registered manager was also one of four providers. 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 and associated Regulations about how the service is run.

This was the first inspection undertaken since the service was taken over by Preferred Care Service Ltd.

At this inspection we found that the new providers had already had visits by other authorities, the social services commissioner and the fire officer. The providers had been working towards the recommendations made by social services and had also almost completed the work required by the Fire Officer.

Recruitment procedures were in place and work was underway to check that potential staff were of good character and had the skills and experience needed to carry out their roles. Although we were told that people’s gaps in work history were discussed during interview this had not been documented. We made a recommendation about this.

It was not clear if there were appropriate numbers of staff being deployed to meet people’s needs. For example people were not always being provided with meaningful activities to promote their wellbeing. Some people said they were bored and would like more to keep them occupied. We found that staff were having difficulty fitting in activities as they were needed to provide care.

Not all staff had received training relevant to their roles, we made a recommendation about this.

Staff had not received regular supervision.

Staff knew and understood how to protect people from abuse and harm and keep them safe. Staff were positive about the support they received from the management team. They felt they could raise concerns and they would be listened to.

Relatives told us their family members were well cared for and they felt that the care was delivered in a safe way. They said that staff responded well when there had been deterioration in their relatives’ health and they were always kept well informed.

Medicines were managed safely via an electronic system. However some people had not received their medicines at appropriate times. Controlled medication needed its storage arrangement to be reviewed however other medicines were stored securely. We made a recommendation about this.

People’s care plans had been reviewed and updated to ensure that their care and support needs were clear and their preferences were known. People were supported and helped to maintain their health and to access health services when they needed them.

Risks to people’s safety and wellbeing had been assessed and a management of that risk was available for staff to minimise the risks of harm. However risk assessments had not always been reviewed and updated in a timely way.

Effective systems were not in place to enable the provider to assess, monitor and improve the quality and safety of the service.

There were procedures and guidance in relation to the Mental Capacity Act 2005 (MCA), which included steps that staff should take to comply with legal requirements. Staff gave people choices throughout the day and helped them to make decisions by showing them examples. Capacity assessments followed the principles of the MCA 2005. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Deprivation of Liberty Safeguards (DoLS) applications had been made appropriately to the local authority.

Surveys had been sent out to people, their relatives and staff recently. We were told they intended to use the comments made to improve people’s experience of living in the home.

The provider had made some improvements to the environment to ensure it was fire safe. The living area/dining room had been decorated and the people living there had chosen the colour. Further improvements were required such as decorating chipped and damage paint work around the home, some furniture also needed to be recovered or replaced. We made a recommendation about this.

People had choices of food at each meal time. People were offered more food if they wanted it and people that did not want to eat what had been cooked were offered alternatives.

Staff were cheerful, kind and patient in their approach and had a good rapport with people. The atmosphere in the service was calm and relaxed. Staff treated people with dignity and respect.

People were supported to maintain their relationships with people who mattered to them. Relatives and visitors were welcomed at the service at any reasonable time and were complimentary about the care their family member’s received.

The home had not received any complaints, they did not have their own complaint procedure and therefore this was not displayed appropriately. People and families we spoke to said that they would speak to the manager if they were not happy or they wanted to make a complaint. They were confident that their complaints would be taken seriously. We made a recommendation about this

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