Archived: Alwoodleigh

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

People did not always receive safe care. Risks were not always identified and responded to appropriately following accidents and incidents. Care records did not always take account of risks and include guidance for staff to support people safely. We found concerns relating to the safety of the environment. Remedial action to ensure compliance with fire safety of the premises had not all been completed within set timescales.

Quality assurance systems were not always effective and did not drive improvement within the service. We found concerns relating to the management of risk and the safety of the premises. Learning was not always shared when things went wrong.

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.

Recruitment procedures were in place, but we made a recommendation to strengthen these.

Medicines were managed safely, and staff were knowledgeable about recognising and reporting abuse.

There were sufficient staff who were appropriately trained to support people safely. People were supported to access healthcare and maintain a nutritious diet.

Staff told us the registered manager was approachable, they felt supported and communication amongst the team was good.

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

Rating at last inspection

The last rating for this service was Good (published 24 April 2018).

Why we inspected

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 coronavirus and other infection outbreaks effectively.

The inspection was prompted in part by notification of some specific incidents. Following one of these a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of accidents and incidents including falls and missing persons. This inspection examined those risks.

Some of these incidents are subject to or have the potential to be subject to a criminal investigation. As a result, this inspection did not examine the circumstances of these incidents.

The information CQC received about the incident along with other concerns we received indicated concerns about the management of risks, staff skills, communication within the service and recording. This inspection examined those risks.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well-led sections of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to people’s safety and governance at this inspection.

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

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

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Alwoodleigh 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.

Alwoodleigh accommodates 40 people in one adapted building. There were 34 people living at the home during our inspection.

There was a manager in post who was in the process of registering with the Care Quality Commission. 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.

Staff had received training in how to keep people safe. All the staff we spoke with demonstrated they understood how to ensure people were safeguarded against abuse and they knew the procedure to follow to report any incidents.

At our previous inspection we found improvements were required in the assessment for some risks such as the use of assistive equipment and there was not always detailed guidance for staff to follow. At this inspection although some improvements had been made, further improvements were still required and the manager had implemented an action plan to address these issues.

Staff received an induction and training to ensure they had the skills to meet the needs of the people who lived there. Staff were supported to continually develop by on-going supervision and appraisal.

People were supported to eat their meals by care staff appropriately and sensitively and people told us how much they enjoyed their meals. People’s nutritional needs were met and they were encouraged to drink throughout the day. The dining experience in the main dining room was a pleasant experience although we have recommended the manager reviews the dining experience in the first floor unit.

Records showed people had regular access to healthcare professionals to help meet their wider health needs.

We found the home was well maintained, clean and tidy and people's bedrooms had been personalised. The décor was dementia friendly with pictures and signage which helped support people living with dementia to navigate their way around the home.

The home was compliant with the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and had applied for authorisations to the local authority. Decision specific capacity assessments were in place and the home kept a record of Lasting Power of Attorney.

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.

We found all the staff to be caring in their approach to the people who lived there and treated people with dignity and respect. We observed staff to be kind and compassionate throughout our inspection.

Care provision was personalised and support plans were reviewed regularly to ensure they were relevant to the people who lived there. Families were invited to input into the reviews of their relative to ensure known preferences and views were incorporated into people’s care plans.

People enjoyed the different activities available and we observed activities taking place on the residential unit. Our observations during our inspection found there were limited activities taking place on the nursing unit.

Complaints were handled appropriately and people were happy that any concerns raised had been acted upon.

The home was well led and the management team encouraged an open and transparent culture where people using the service and staff were able to make suggestions for change and improve the quality of the service.

The registered provider had undertaken a detailed audit of the service and the home had an improvement plan in place to ensure the service continued to improve.

Alwoodleigh is registered to provide nursing and personal care for up to 40 people. There were 34 people staying there at the time of our inspection. The home provides support for older people some of whom are living with dementia. Accommodation is arranged over two floors and there is a passenger lift to assist people to get to the upper floor. The nursing unit is based on the upper floor and the residential unit on the ground floor.

There was a manager in post on the day of our inspection who was in the process of registering with the Care Quality Commission. 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 our previous inspection we found there had not been enough staff to meet the needs of the people at the home. There was now a system in place for determining staffing levels and there were sufficient numbers of staff at the service on the days of inspection to meet the needs of the people at the home in a timely way.

All the staff we spoke with demonstrated they understood how to ensure people were safeguarded against abuse and they knew the procedure to follow to report any incidents. They were confident their concerns would be acted upon.

The ordering, storing and administration of medicines was safe. Staff had had an annual medication management competency check and regular audits were undertaken. There was an issue with a person receiving their medicines without their knowledge hidden in a drink but this had been resolved by the second day of inspection.

We found personal emergency evacuation plans in place, although equipment people required was not included on this information. Standardised risk assessments were in place around pressure sores and nutrition and these were regularly reviewed. We found a lack of recorded information regarding assessments for assistive equipment and moving and handling care plans lacked the method and a description of the equipment to be used. This meant a safe system of work had not always been clearly recorded.

We found the environment to be clean and we observed good infection control practices in place. There was a programme in place for replacing carpets where malodours were present and could not be removed by carpet cleaning.

The registered provider supported staff to develop by offering mandatory training courses and enabling staff to undertake e-learning whilst on shift. Staff received supervision to help them develop into their roles and all new staff received an induction into the service and shadowing opportunities.

Staff had received training in assessing mental capacity or the Deprivation of Liberty Safeguards. However, we found decision specific capacity assessments had not always been undertaken and capacity assessments had not led to recorded best interest decisions, when a person had been assessed as lacking capacity. Staff were able to advise us how they would act in the person’s best interests whilst providing care. We found consent for care and treatment was recorded in some care plans but not in all the care plans we reviewed and decisions made on behalf of people who lacked capcity were not in line with the requirements of the Mental Capacity Act 2005.

People told us how much they enjoyed the food. We saw people being supported with their food and drink. However, the recording of what some people had eaten and drank was not always detailed and although staff could tell us exactly what people had eaten this was not always reflected in the records.

Staff protected people’s privacy during personal care delivery and were kind and polite to people during our inspection.

There had been an improvement in the activities on offer to people at the home and an enthusiastic activities coordinator had been employed who was developing the programme to ensure they were offering activities which met the choice and preference of the people at the home.

We found the quality of care plans was mixed with some very personalised information. Other care plans had been difficult to navigate due to the quantity of information which was not always current. The registered provider was in the process of transferring these over to their new paperwork.

The manager and regional manager were working together to improve the quality of the service provided. They were actively trying to recruit staff with the knowledge and skills to support a high quality service.

Not all audits were identifying issues which needed to be addressed such as care plan audits to ensure care records were to a high standard.

Regular meetings were held to keep people at the service, their relatives and staff informed about what was going on at the home.

You can see what action we told the provider to take at the back of the full version of the report.

Alwoodleigh is registered to provide nursing and personal care for up to 40 people. There were 33 people staying there at the time of our inspection. The home mainly provides support for older people some of whom are living with dementia. Accommodation is arranged over two floors and there is a passenger lift to assist people to get to the upper floor. The nursing unit is based on the upper floor and the residential unit on the ground floor.

There was a registered manager in post on the day of our inspection who had been registered since 2015. 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 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.

All the staff we spoke with demonstrated they understood how to ensure people were safeguarded against abuse and they knew the procedure to follow to report any incidents.

We found that the assessment of risk was inadequate. There were no personal emergency evacuation plans and missing risk assessments for identified risk. We found no moving and handling care plans in five out of the nine care plans we reviewed. This meant staff were moving and handling people without clear guidance and although we did not evidence any poor practice during our inspection, the service was not able to evidence it had complied with the legal requirements to ensure the safe moving and handling of people.

There was no robust system in place for determining staffing levels. The service had recently taken on a high number of people with end of life care needs, requiring intense support from staff. This meant staff were only able to focus on care tasks, and they neglected to complete care plans and engage with people in a meaningful social way.

The ordering, storing and administration of medicines was safe , Staff had had an annual medication management competency check and regular audits were undertaken.

We found the environment to be clean and with minor exceptions, we observed good infection control practices in place.

We found not all staff had received training in assessing mental capacity or the Deprivation of Liberty Safeguards. Decision specific capacity assessments had not been undertaken and capacity assessments had not led to recorded best interest decisions, when a person had been assessed as lacking capacity. Staff were able to advise us how they would act in the person’s best interests whilst providing care.

We found consent for care and treatment had not always been recorded in people’s care plans.

People told us how much they enjoyed the food. We saw people being supported with their food and drink. However, the recording of what some people had eaten and drank was intermittent which meant the service could not confidently evidence people’s nutritional intake.

Staff told us they “loved the home” or they were a “caring person” and continued to enjoy their work. They told us they could tell they were providing good care from the positive feedback from relatives but also from the people using the service either verbally or through their body language.

We saw evidence that staff protected people’s privacy during person care delivery.

We found that people who had been admitted recently had either partial or no care plans in place and inadequate assessments in relation to their care and support needs. Consequently people were providing task centred care based on mainly personal hygiene care. Those people who had been living at the home longer, had care plans in place but they also lacked the detail to provide all the care they required. They did have some evaluations that reflected a response to changes in their conditions. But the level of detail was not consistent in all the files we reviewed. The home is to transition to new care plans following the takeover of management services.

We found there had been a lack of leadership at the service. The registered manager did not have a clear vision for the home in terms of improving the service for the people living there and supporting staff. Although we found issues at our previous inspections, actions to improve the quality of the service had not been sustained. Auditing of the areas of concerns had not happened and there were insufficient checks and balances in place to quickly identify where systems were failing.

The registered provider had employed a new operating company to take over the management of the service in January 2016. They had undertaken a whole service audit and although this had not been shared with the home found similar issues to those found at inspection. The registered manager left the week following the inspection. A temporary support structure had been put in place following the departure of the registered manager by the operating company, with management oversight from the regional manager to ensure immediate improvements in the service provided at Alwoodleigh.

However, during our inspection we observed that some interactions between staff and people who lived at the home were not respectful. We saw one staff member telling two people they were 'toileting' them before they had their dinner. We saw one person being brought into the dining room in their wheelchair backwards with their feet on the floor asking 'Where am I going?'. During lunch being served we heard a staff member asking one person if they wanted the staff member to 'feed' them. We also saw a staff member telling a person they were putting a 'bib' on them whilst they ate their lunch. We saw another staff member who was handing out people's meals picking up the person's knife and fork and cut the person's food up without asking the person. This showed little regard for people's dignity and was not respectful.