Allington House

We found the following examples of good practice.

Robust infection control policies, procedures and systems were in place.

Visitors were carefully screened for COVID-19. Visitors were required to have their temperature taken and a negative lateral flow test. Where it was appropriate to do so, the service checked visitors’ vaccination status.

Staff wore appropriate PPE and there were ample supplies throughout the home. Staff and people were part of a regular COVID-19 testing programme.

Staff had received infection control training. The provider had a comprehensive infection control policy, and the registered manager was knowledgeable about current guidance and best practice.

People had COVID-19 care plans and risk assessments. Additional measures were implemented to minimise the risk of infection for people who were particularly vulnerable to COVID-19.

The service was clean, tidy and well maintained. There was a cleaning schedule and the registered manager carried out regular infection control audits to ensure a high standard was maintained.

Allington House is a residential care home that provides accommodation and personal care for up to 49 people, some of whom were living with dementia. On the day of our visit there were 46 people using the service.

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

People were happy living at Allington House and felt safe. Appropriate safeguarding procedures were in place to protect people from abuse. Staff were confident any concerns raised would be taken seriously by management. Medicines had improved; however, work was still needed to make sure staff made clear records, so they could be understood.

There were enough staff to meet people’s needs and staff were recruited safely. Staff received appropriate training and support to enable them to carry out their role effectively. 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 home supported this practice. People were happy with the food provided

We have made a recommendation about up to date guidance for kitchen staff and updating the menus to include all preferences.

Staff were caring and treated people with kindness. People were treated with dignity and respect.

People had clear, detailed and person-centred care plans, which guided staff on the most appropriate way to support them. People received kind and compassionate end of life care.

There was a clear management structure and staff were supported by the registered manager and provider. Quality assurance systems were now completed in a robust and consistent manner.

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 22 August 2018) and there were multiple breaches of regulation. 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.

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.

Allington House 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. The service is registered for 49 people and at the time of inspection there were 45 people living at the service.

A registered manager was in post at the time of the inspection visit. They were registered with the Care Quality Commission in January 2018. 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 last inspection was carried out in August 2017 and found that the service was not meeting all the requirements of Health and Social Care Act 2008 and associated Regulations. We found concerns relating to risks to people arising from their health and support needs and risks to the premises and equipment. Falls were not analysed monthly to prevent or minimise reoccurrence. We also found systems and processes were not in place to ensure effective operations of the service, there were limited checks to ensure the safety of people living at the service. Following this inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions to at least good.

At this inspection we found that the provider had made some improvements however we found further improvements were required to become fully compliant with the Fundamental Standards of Quality and Safety. This is the second time the service has been rated requires improvement.

We found concerns with the safe administration of medicines.

Risks associated with people's support needs were not always fully considered or correctly documented in care plans.

Audits were taking place; however, they were not robust enough to highlight the issues we found during our visit.

The registered manager understood their responsibilities in relation to Deprivation of Liberty Safeguards (DoLS). However, decisions to administer medicines covertly (medicines that are given to people disguised in food or drinks) had not been made following best guidance.

We have made a recommendation about this.

Staff training was up to date. Supervisions and a yearly appraisal were taking place.

Feedback on the quality of the service had been sought and was positive.

People enjoyed the food provided. Specific cultural diets were provided if needed.

People who lived at the service were safeguarded from abuse. People told us that they felt safe at the service and that they trusted staff. Staff had received training in the safeguarding of vulnerable adults and said they would not hesitate to report concerns.

A number of recruitment checks were carried out before staff were employed to ensure they were suitable to work with vulnerable adults.

We found there was sufficient staff employed to support people with their assessed needs.

Staff demonstrated a person-centred approach to care and they knew people well. Person-centred is when care is developed with people and their preferences, wants, needs and wishes are valued and included.

Care plans had information of people's wishes, preferences and life histories.

We saw evidence of activities taking place and people we spoke with enjoyed them.

The service had a complaints policy that was applied if and when issues arose. People and their relatives knew how to raise any issues they had. The service had received one complaints since the last inspection.

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

The service was last inspected in June 2015 and received a rating of good.

Allington House is a purpose built 46 bed care home. The home provides personal care for older people and also for older people who have dementia. Accommodation is provided over two floors and includes communal lounge and dining areas. All rooms have en-suite facilities. There are garden areas surrounding the building. At the time of inspection 44 people were using the service.

The service did not have a registered manager. The previous registered manager had left in June 2017 after only being registered four months. 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 time of the inspection they were interviewing for a new manager. Two regional managers and two regional support managers were overseeing the running of the service. A previous regional manager who had been supporting the registered manager had also left.

Most risks to people arising from their health and support needs or the premises were assessed, and basic plans were in place to minimise them. A number of checks were carried out around the service to ensure that the premises and equipment were safe to use. However some risks were not fully documented to provide staff with sufficient information on how to mitigate the risks. The calibration of the weighing scales was due June 2016 and the electrical safety certificate could not be found.

Medicines were securely stored in people’s rooms. However medicines that required refrigeration did not always have the temperatures recorded to evidence they were maintained at safe levels. The service used an electronic medication administration record system (eMAR) and further work was needed with this system to support when required and topical medicines.

There were enough staff to meet people's needs. However, the service’s dependency tool had not been updated for two months. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. Staff were not given effective supervision and the yearly appraisal was just a small number of tick box questions, with no input from the staff member or support for their personal development.

Staff understood safeguarding issues, and felt confident to raise any concerns they had in order to keep people safe.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. We found the provider had taken appropriate action to comply with the requirements of the MCA and therefore people's rights were protected. At the time of inspection 17 people had a DoLS authorisation in place.

Staff received training to ensure that they could appropriately support people, and the service used the Care Certificate as the framework for its training. Staff had received Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) training and understood the requirements of the Act. This meant they were working within the law to support people who may have lacked capacity to make their own decisions.

People were supported to maintain a healthy diet, and people’s dietary needs and preferences were catered for. People told us they had a choice of food at the service, and that they enjoyed it. However where people required weekly weights to be monitored these were not occurring regularly. Food and fluid charts were not always fully completed.

The service worked with external professionals to support and maintain people’s health. Staff knew how to make referrals to external professionals where additional support was needed. Care plans contained evidence of the involvement of GPs, district nurses and other professionals.

We found the interactions between people and staff were cheerful and supportive. Staff were kind and respectful; we saw that they were aware of how to respect people’s privacy and dignity. People and their relatives spoke highly of the care they received.

People had access to a range of activities, which they enjoyed. However the activity coordinator required additional support, so people were not socially isolated. A plan was in place to provide activities on a weekend.

Procedures were in place to support people to access advocacy services should the need arise. The service had a clear complaints policy that was applied when issues arose. People and their relatives knew how to raise any issues they had. However outcomes were not recorded.

Care was planned and delivered in a way that responded to people’s assessed needs. Care plans contained detailed information on people’s life history. Care plans were quite difficult to follow and had information that was not relevant to the person such as altered state of consciousness. The regional support manager had recognised the care plans needed work and provided one that they had worked on.

Limited feedback was sought from people, relatives, external professionals and staff to assist with the quality of the service. The service had quality assurance systems in place that had recognised a number of the concerns we identified. We found the quality audits did not have robust action plans in place. For example, there was no named person responsible or a date when an action needed to be done by. Due to a lack of a registered manager and changes in regional managers there was a lack of managerial oversight.

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

We found some improvement in record keeping such as care plans were starting to be reviewed monthly, body maps and the Malnutrition Universal Screening Tool (MUST) scores were now completed and behaviour that challenges care plans were now in place. Although records were kept in a filing cabinet, this was not locked and daily care records (room records) were not always completed.

The inspection was conducted by one inspector. During the inspection, we spoke with nine people out of 46 people living at Allington House, three relatives, the manager and five staff. We looked at five sets of care records. We also observed care practices within the home.

The manager at the home was new to post and was creating a positive environment for people and staff. Staff spoke highly of their manager and the support which they received.

We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Everyone we spoke with told us they felt safe and secure living at the home. Staff we spoke with understood the procedures which they needed to follow to ensure that people were safe. Allington House was clean, hygienic and well maintained. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

The registered manager sets the staff rotas, they took people's care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people's needs are always met.

Recruitment practice was safe and thorough. There has been a high turnover of staff recently and two qualified members of staff had been suspended. The manager used agency staff but was trying to keep to the same agency and staff for consistency. They were recruiting new staff and where staff had been sourced, they were awaiting the appropriate Disclosure and Barring Service (DBS) checks. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Whilst no applications had been submitted to the local authorising authority, the home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards and there was evidence to show that this had been followed appropriately.

Care plans and risk assessments were in place and updated on a regular basis. We found that not all care plans were person centred and did not detail what the person could do independently or the assistance that was needed from staff.

Staff we spoke with during the inspection were very knowledgeable about the people they cared for. Staff we spoke with were aware of risk management plans that had been written for people with particular needs.

Systems were in place to record events such as accidents and incidents, concerns, whistleblowing and investigations. The provider may wish note that there was no system in place to learn from such events.

Is the service effective?

Everyone had their needs assessed and had individual care records which set out their care needs.

It was clear from our observations and from speaking with staff that they had a good understanding of the care and support needs of people living at the home and that they knew them well. Assessments included physical and social assessments, nutritional assessment, moving and handling assessment and continence assessments. These assessments were reviewed monthly.

People spoke highly of the staff and said that they were happy with the care that had been delivered and their needs had been met.

People had access to a range of health care professionals some of which visited the home and all was documented in the care files.

Is the service caring?

People were supported by kind and attentive staff who showed patience and gave encouragement when supporting people, whilst helping them to remain independent.

People told us that they were happy with the care and support provided to them.

People who used the service and their relatives, had not completed an annual satisfaction survey since February 2013. Therefore they did not have up to date information on any shortfalls or concerns. The manager stated she was going to arrange for a survey to be sent out within the next few weeks.

Is the service responsive?

There was evidence contained within people's care plans to show how they worked with other health and social care professionals.

People told us that they knew how to make a complaint if they needed to.

Discussion with the manager during the inspection confirmed that any concerns or complaints were taken seriously. We did see a complaints policy and there was a file for complaints, but no complaints were filed. The manager stated that there had been complaints but they must have been misfiled. We did not see evidence of complaints on the day of our visit.

Is the service well-led?

There were systems in place to assure the quality of the service they provided. Actions were put in place when needed but these needed to be more robust to include dates and names of who was to be responsible for completing them.

Regular audits were carried out which were used to identify changes and improvements to minimise any risks to people and staff. The regional quality assurance manager also completed a monthly audit. Due to the new manager being in post for only about seven weeks and a high use of agency staff some audits such as the medication audits and daily audits had not taken place.

Staff were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and were knowledgeable about people's needs. This helped to ensure that people received a good quality service at all times.

What people said:

People who were able to express their views told us they were satisfied with the care and support they received. One person told us, "I have been here one year eight month and I have settled in lovely," another said, "Staff are very nice, lovely carers.' And another said 'The staff are very friendly, I call them my friends, they do their best for you.' One person we spoke with said 'Some staff are okay, some are not, they are just bits of kids.'

Staff told us they enjoyed working at Allington House. Staff spoke highly of their team and of their manager. One staff member told us, "I have recently seen a lot of changes for the better.' Another told us, "My manager is the 19th manager I have had since starting, I can go to her about anything, I feel I get all the support I need.' And 'It is the best home I have ever worked in.' Also 'The manager listens to me, I feel supported.'

Relatives and friends of people who used the service said 'When X came into the home she could not walk or feed herself, now she is fully mobile and has no problem feeding herself.' And 'We could not have picked a better place.'

People who used the service expressed satisfaction with the care and service they received. One person told us, "Staff help me when I ask, they are good." Another person told us, 'I've been very happy in here.' A relative we spoke with said, 'They treat her well, The staff are wonderful.' We used a number of different methods to help us understand the experiences of people who used the service because some people had complex needs which meant they were not able to tell us their experiences.

We found that people had their needs assessed and care plans were in place. We found that some assessments and care plans had not been developed when needed and were not always kept up to date.

We saw that staff worked in collaboration with other health and social care professionals.

Staff had a clear understanding of the protection of vulnerable adults

We found that the environment was homely and clean. Equipment was available to meet people's needs and it was maintained regularly to ensure it was safe to use.

Processes for the administration and management of medicines were not being followed.

Effective systems were in place for people to raise concerns and for them to be appropriately responded to.

The people we spoke with told us that they were pleased with the service and felt the staff worked hard to meet their needs. People told us that they felt confident that the staff knew how to best support them and treated them with respect. People told us; 'I'm happy here and do like it', 'We have plenty to do and the other week we had the Zoo people in. I held a snake' and 'Its fine here'.

The relatives told us that they found that the manager and staff were friendly, helpful and supportive. Relatives told us; 'The staff are wonderful', 'Staff are really pleasant', and 'This is a lovely place'.

From our observations and discussions with the people we found that care staff maintained people's dignity and treated individuals with respect as well as empathy.