Alphington Lodge Residential Home

Alphington Lodge is a residential care home. The home is registered to provide

accommodation and personal care for up to 28 older people. The home does not provide nursing care. At the time of this inspection there were 25 people living there.

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

The provider and management team were working to improve the management and culture at the service. Relatives, staff and external health and social care professionals spoke positively about the progress made since the current manager had come into post.

People were supported by sufficient numbers of suitably trained and competent staff. A virtually new staff team had been recruited with the values and commitment required to support people effectively. A review of job roles and responsibilities had improved monitoring and accountability. Staff received a comprehensive induction, training and supervision, with support to develop and progress if they wished. One member of staff told us, “They care about the staff and want to make sure you’re well. They are really supportive.”

There was an open and transparent culture at the service. The provider and management team were open about the previous failings, the work they were doing to address them and where improvements were still required.

There was a comprehensive quality assurance programme in place, which incorporated the views of people, relatives and staff. The management team spent time working alongside care staff observing practice and identifying where further improvements might be needed.

Relatives told us staff were kind and their family members were safe. Staff were recruited safely, and safeguarding processes were in place to help protect people from abuse. Risks associated with people's care had been assessed and guidance was in place for staff to follow.

People were supported to engage in a wide range of activities and maintain contact with their family members. This maximised their quality of life and was particularly important due to visiting restrictions and the need for people to isolate in their rooms during the pandemic.

People received their medicines safely, and in the way prescribed for them. The provider had good systems to manage safeguarding concerns, accidents, infection control and environmental safety.

Staff worked effectively with external health and social care professionals to meet people’s healthcare and nutritional needs.

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 Good (published 14 March 2019).

Why we inspected

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We undertook this targeted inspection to check on specific concerns that had been raised about the safety and management of the service. The overall rating for the service has not changed following this targeted inspection and remains Good.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the Safe and Well Led sections of this full report.

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.

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

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.

Rating at last inspection: Requires Improvement. Report published 27 April 2018.

Why we inspected: All services rated "Requires Improvement" are re-inspected within one year of our prior inspection. This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

People’s experience of using this service:

The provider had made good improvements to the service since our last inspection on 26 January 2018.

The governance of the service had improved. There was a comprehensive programme of checks and audits to determine the quality of the care. The provider had acted decisively to make improvements where failings had been identified.

There were safe systems in place for the storage and administration of medicines.

The provider had taken steps to ensure confidentiality was maintained.

The area manager had encouraged a change in the culture of the service so it was now more person centred.

People were supported by staff who treated them with patience, kindness and understanding. One person said, “They love me, and they come in and say, ‘are you alright?’ and look after me.”

Support plans provided information for staff on all aspects of people’s health and personal care needs. Staff knew people well and understood how they needed to be supported.

Staff received better training and induction so they could effectively perform their roles. They were well supported and spoke positively about the improvements at the service.

The service met the characteristics for a rating of "good" in all the key questions we inspected. Therefore, our overall rating for the service after this inspection was "good". More information is in the full report.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

At the time of the registration of this new provider, an action plan was requested to demonstrate the new provider had taken account of the areas of improvement, including enforcement action that had been taken against the previous provider. This gave us information on what the new provider intended to do to make improvements.

Alphington Lodge 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 home is registered to provide accommodation and personal care for up to 28 older people. The home does not provide nursing care. At the time of this inspection there were 20 people living there, although two people were in hospital. The accommodation is situated over three floors. There is a shaft lift providing access to each floor.

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 about how the service is run.

Some aspects of medicine storage were not entirely safe. We found medicines received into the home had been placed in a vacant bedroom which was not locked. The medicines were left on the floor, bed and cupboard. We discussed this with the registered manager who took prompt action to ensure the medicines were safely stored. All other aspects of medicine administration and recording were found to be satisfactory. Staff who administered medicines were well trained and their competency was assessed and monitored.

Some records relating to people’s care needs, including medicines, were not always stored securely. This meant records relating to people’s personal and health needs were not maintained confidentially. We saw some care plans were left unattended on a desk in the lounge, and a cupboard holding care plans and personal records was not always kept locked. Medicine administration records were left unattended on top of medicine trolleys.

People’s needs were met by sufficient staff on duty, although staff told us they were sometimes rushed. People living in the home and their relatives gave a mixed response when we asked if they felt there were sufficient staff to meet their needs. Comments included, “Yes, as far as I am concerned”; “Sometimes, and sometimes not. Sometimes they are frazzled and pushed”; “If someone is ill, someone on leave” [staff are not as readily available]”. The provider told us they were aware of staff feeling rushed and had asked the staff to complete an anonymous survey to gather their views. They carried out a review of staff routines shortly before our inspection and took actions to support staff, improve staff morale, and improve the delivery of care and services to people living in the home. Safe recruitment procedures were followed before new staff were confirmed in post. Staff were well trained.

People and their relatives were involved and consulted in assessing the person’s needs and drawing up a plan to show how their needs should be met. Care plan documents were detailed, accurate and easy to follow. People received care and support from staff who understood their personal needs and abilities. Risk assessments were in place and regularly reviewed and staff knew how to support people to reduce the risks.

People's legal rights were respected and protected. People's capacity to make decisions was assessed and staff understood the procedures they must follow if people did not have the capacity to make important decisions about their lives.

People told us they received a caring service. Comments included, “The girls have been very good to me. I can’t grumble”. A visiting professional told us they brought in cakes for the staff when they visited the home, saying “I know how much they care for people here. The girls here are really caring.” Staff knew how to communicate with each person. People could be confident they would receive compassionate care at the end of their lives from staff who had the knowledge and skills needed to meet their needs fully. Staff understood and respected people's preferred daily routines, likes and dislikes. Privacy and dignity was respected.

Overall people told us they were happy with the level of social stimulation and activities provided. Comments included “I go out with Age Concern, once a week. I go to Exeter for lunch and a little walk,” “I sit in the summerhouse and watch the birds. I like the garden area. Art work, I like painting”, “I sit. I sometimes get involved in art work. I have made friends with [name]. Sometimes they have classes. They do their best. There’s an activities girl and she does activities such as I-Spy and we have someone who plays an accordion, reads poetry and plays a guitar.” People’s social needs were assessed when they first moved into the home and we saw staff sitting with people during the inspection playing board games, and supporting people to go out for a walk. The provider and registered manager had identified, and were in the process of introducing, new ways of supporting people to meet their social needs and involvement in daily routines in the home.

People were confident they could raise any concerns or complaints and these would be listened to, investigated and actions taken to address the issues. A person told us “I would speak to the staff or the manager. We have had no complaints.” The registered manager told us that the complaints procedure was explained to every new person when they moved in. The registered manager personally visited each person every month and asked them if they have any concerns.

People lived in a home that was clean. Most areas were free from odours although we noted an odour in one corridor. Equipment was regularly serviced and maintained. Risks to the environment had been assessed and systems were in place to ensure risks such as fire were minimised.

People told us they felt safe. For example, one person said “I look after myself, so I have to feel safe. Yes, I am safe.” Training records showed that all staff had received training on safeguarding. Staff confirmed they had received training and knew how to raise concerns if they felt anyone was at risk of harm or abuse.

There was a range of comprehensive audits and monitoring checks carried out on aspects of the service. The provider had a drawn up a programme to improve the care and support people received. We found improvements had been made since the last inspection, although the provider’s monitoring systems needed further improvements to ensure issues relating to security of medicines, and security of confidential records we found at this inspection could been identified and addressed promptly by the provider’s own quality assurance systems.

We found two breaches of regulations. You can see what action we told the provider to take at the back of the full version of the report.