Altham Court Care Home

Altham Court Care Home is a residential care home providing regulated activities personal and nursing care, to up to 48 people in one adapted building. The service provides support to older and younger people and those with a physical disability. At the time of our inspection there were 38 people using the service.

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

People were protected from abuse and staff understood their responsibilities and ways to report any concerns of abuse to the registered manager. However, Care Quality Commission (CQC) were not notified about one case of abuse between people.

People’s risks around environment, care and treatment, medicines and other factors were understood and addressed by staff.

Staff told us and rotas identified a shortfall in staffing at times, however people told us they did not feel impacted by this.

Medicines were managed safely.

Infection prevention and control was generally effective and where an issue was identified with staff not wearing face masks correctly, this was promptly addressed by the registered manager.

Incidents and complaints were handled correctly by the registered manager.

Where documentation had not been completed fully by staff, the management team addressed this in clinical staff meetings.

The provider and management team were committed to improvement at the service. Audits were completed and feedback was sought from people, relatives and staff to identify what improvements could be made.

The registered manager and provider understood their responsibilities to be open, honest and apologise if things went wrong.

There was a positive culture at the home. Staff told us they felt supported by the management team.

People were supported in a person-centred way.

The management team worked in partnership with others well.

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.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 11 January 2022) and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations and warning notices had been lifted.

Why we inspected

We undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulation 12 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met and also concerns we received about staffing. The overall rating for the service has not changed following this focused inspection and remains requires improvement.

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.

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 as requires improvement. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Altham Court Care Home is a care home providing personal and nursing care to 36 people at the time of the inspection. The service can support up to 48 people in one adapted building.

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

People were at risk of unsafe care as care plans and risk assessments had not been kept up to date. This meant staff may be unable to provide care that was relevant to their current need as their records contained information that was not relevant.

We were told choking risks had been identified before the inspection. However, lessons had not always been learnt, as at inspection we found some people’s needs had not been recognised around their choking risk.

Staff were trained and understood the process of escalating safeguarding concerns. However, we found evidence of one safeguarding concern that was not escalated as appropriate.

People were supported by staff that had been safely recruited. However, we were not fully assured that enough numbers of staff were available, to ensure people's individual care needs were consistently met.

Whilst there were attempts to get feedback from relatives and people by the provider, this could be improved. Generally, we heard people were happy with their care and they thought the registered manager was nice and approachable. External health and social care professionals felt the registered manager was keen to engage with them and was proactive in their action.

Infection prevention and control measures were identified and actioned by the provider.

There was a lack of oversight of the service. Processes and quality assurance systems did not identify that records did not always show people’s current support needs. The registered manager was not known to all people and relatives but where people knew who the registered manager was, feedback about them was generally positive.

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 20 November 2019).

Why we inspected

The inspection was prompted in part due to concerns received about choking risks. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of Safe and Well-Led only.

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.

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.

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe and Well-Led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Altham Court Care Home 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.

We have identified breaches in relation to safe care and treatment, and governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

• Sufficient stocks of personal protective equipment (PPE) including masks, gloves, aprons and hand sanitiser, were available. PPE stations were located in appropriate areas of the home.

• Staff received training about IPC which included how to put on, take off and dispose of PPE. Staff were observed to be using PPE in line with government guidance.

• Enhanced cleaning schedules were in place. The home was clean and hygienic. Regular checks were carried out to ensure IPC guidance was followed.

• The provider’s Infection prevention and control (IPC) policy was up to date and reflected current national guidance.

• People and staff underwent regular COVID-19 testing in line with government guidance.

• A recent outbreak was well-managed and staff worked with local health and social care agencies to keep people safe. People were supported to keep in contact with relatives and friends through video and telephone calls and emails during the outbreak.

• The provider kept their visiting policy under review and had arrangements in place to minimise the risk of spreading infection.

• Arrangements were in place to ensure people’s mental health and well-being were supported during the pandemic.

Altham Court Care Home is a care home providing personal and nursing care to 48 people for people aged 65 and over. Altham Court Care Home is located in Lincoln.

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

Although people and relatives felt the service was safe, we found concerns with the reporting of low level safeguarding issues. However, accidents and incidents were monitored and recorded appropriately. Where staff were administering medicines, they were administered and stored safely. However, where people administered their own medicines, these were not always stored safely. Risks to people’s safety had been assessed and we saw examples of people being supported to take positive risks. The processes in place ensured people were protected from infection. Agency staff were used to cover shortfalls on the rota, however, occasionally safe staffing levels were not met. People were supported by staff, the provider carried out pre-employment checks for staff. Where there were volunteers providing an activity for people, in the service appropriate checks had not been carried out.

We recommend that where volunteers are used to provide activities in the service, appropriate checks are carried out by the provider.

Peoples capacity had been assessed where it was thought people lacked capacity to make a specific decision. People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible and in their best interests; the policies and systems in the service promoted this. People’s nutrition needs were supported. People’s needs were assessed, and people were involved in their care planning. The premises were fit for purpose and had an accessible garden. Staff received on going training to support them in their role. People had access to health care services, however this was not always managed in a timely way.

Staff did not always speak about people with dignity and people’s choices were not always respected. However, some staff interacted positively with people. People told us staff worked to maintain their privacy.

People’s care and support had been planned in a person centred way, however there was a lack of personalised activities in the service. Records showed formal complaints had been recorded and action taken, however, re-occurring concerns and actions taken had not been recorded. People communicated using a variety of different methods and they were supported to follow their chosen faith. People received meaningful end of life care from staff who were passionate about providing this care to the people they supported.

The registered manager had quality monitoring systems in place to monitor the standards of care. However, actions identified had not always been signed off as complete. People who used the service had limited access in to the community. There was not always a positive culture from people in relation to leadership in the service. The organisational values had not been fully embedded in to the service. There was a lack of clarity, at times, for staff roles however, staff felt supported by the registered manager. The service had positive relationships in the community. Staff felt empowered by to develop with the organisation.

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

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

There was a registered manager in post. 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. There was also an Acting Manager in post who was in the process of applying to CQC to register as the new registered manager for the home.

On the day of our inspection staff interacted well with people. People and their relatives told us that they felt safe and well cared for. Staff knew how to keep people safe. The provider had systems and processes in place to keep people safe from abuse including financial abuse.

Protocols were in place for as required (PRN) medicines. Medicine administration sheets were not completed according to the provider’s medicines policy. Arrangements were in place to keep medicines stored safely.

We saw that staff obtained people’s consent before providing care to them. The provider did not consistently act in accordance with the Mental Capacity Act 2005 (MCA). Best interests assessments were not clearly documented. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. If the location is a care home the Care Quality Commission is required by law to monitor the operation of the Deprivation of liberty Safeguards (DoLS) and to report on what we find. We found that the provider acted in accordance with DoLS.

We found that people’s health care needs were assessed and care planned and delivered to meet those needs. People had access to healthcare professionals such as the district nurse and GP and also specialist professionals. People had their nutritional needs assessed and were supported with their meals to keep them healthy. People had access to drinks and snacks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

We found there were sufficient staff to meet people’s needs and staff responded in a timely and appropriate manner to people. Staff were kind and sensitive to people when they were providing support.

Staff had the knowledge and skills they needed to care for people in the right way and they had received most of the training and guidance they needed. Staff were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place and staff had received supervision. People were encouraged to enjoy a range of social activities. They were supported to maintain relationships that were important to them.

Staff felt able to raise concerns and issues with management. Relatives were aware of the process for raising concerns and were confident that they would be listened to. Regular audits were carried out and action plans put in place to address any issues which were identified. Accidents and incidents were recorded and investigated. The provider had sent us of notifications. Notifications are events which have happened in the service that the provider is required to tell us about.