Alan Morkill House

We found the following examples of good practice:

The home was clean throughout. Cleaning schedules had been increased to ensure that specific areas identified as high risk of transmission of the virus, such as light switches and other touch points, were cleaned several times per day. The provider had disabled the staff time clocks throughout their homes as these used a fingerprint to identify the staff member, which had been identified as a point of high risk.

The registered manager had changed shift patterns for care workers within the home, to ensure that staff were allocated to work exclusively in one unit. Staff shift times had been staggered to ensure staff could take adequate and appropriate breaks without having to distance from their colleagues.

Staff and people who lived at the home participated in a weekly testing programme for coronavirus. Staff were also required to undertake a lateral flow test at the beginning of each shift, and were not able to work if they returned a positive result. The home made use of exclusive agency staff covering staff shortages due to the need to isolate, who also undertook a lateral flow test prior to the start of their shift and were not able to work with a positive result.

People who use the service who were required to isolate were supported by a consistent staff team. Staff working with people required to isolate also took into account their social needs and need for stimulating activities, and ensured they spent quality one-to-one time with each person. People were supported to see their loved ones by video calls, as during the outbreak of coronavirus the service was only accepting visitors in exceptional circumstances to minimise risks.

There was enough Personal Protective Equipment (PPE) available at the home and we observed staff using it according to government guidance. Medicine cabinets outside each person’s room had been repurposed to use as PPE stations, which ensured that PPE was available for each person. We observed that some people who lived at the home had been supported by staff to wear PPE when moving around the premises, to reduce risks.

There was appropriate and clear signage throughout the home to remind staff and visitors to wear PPE and maintain distance, and to ensure that all staff, visitors and people who use the service were aware of people who were required to isolate. The home was well ventilated when we visited.

The registered manager told us they received good support from the provider organisation, the local authority and the Clinical Commissioning Group. The registered manager and provider organisation ensured that staff and people who lived at the home were provided with emotional and practical support to assist them through the ramifications of the coronavirus outbreak.

We found the following examples of good practice:

• The service had made good use of the spacious layout of the building, enabling people to continue to be sociable during meals and activities while maintaining social distancing.

• The service had used different methods, such as video calling and more individual time with staff, to ensure people did not feel lonely or isolated.

• Staff meticulously followed the home's PPE and infection control procedures, which were also clearly on display for visitors.

People’s experience of using this service:

Feedback from people using the service and their relatives reflected the significant improvements the home has made since the last inspection.

People were cared for by staff who knew how to keep them safe and protect them from avoidable harm.

Staff were kind and compassionate, and we saw evidence of good caring relationships between people and staff. There was a good atmosphere at the home. A relative told us, “The staff here are fantastic, very keen, very enthusiastic, very caring.”

People’s needs and wishes were assessed and documented, and care plans were reviewed regularly. Staff knew the people they cared for and understood their communication needs.

People were provided with a nutritious diet. Support with eating was provided in a caring and dignified way.

People were supported to have choice and control in their lives and were supported in the least restrictive way possible. The principles of the Mental Capacity Act 2005 were followed.

The home was clean, recently decorated, and well maintained.

People were supported by staff who were safely recruited and trained.

People and their relatives spoke very highly of the registered manager who had successfully led the improvements to the home. Staff spoke highly of the home as a workplace.

More information is in the full version of the report.

Rating at last inspection: At the last inspection the home was rated Requires Improvement. At this inspection the rating has improved to Good.

Why we inspected: This was a planned inspection based on previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

The service had a registered manager. A registered manager is a person who has registered with CQC 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 registered manager joined the service in June 2017 following the previous inspection and was present on the three days we visited.

At our previous comprehensive inspection on 29 and 31 March, and 3 April 2017, the service was given an overall rating of Requires Improvement. Caring and Responsive were rated as Good, Effective and Well-led were rated as Requires Improvement and Safe was rated as Inadequate. We had found five breaches of regulations in regards to how the provider ensured the safety of people who used the service, staff training and supervision, ensuring appropriate arrangements for people using the service to consent to their care, meeting people’s nutritional and hydration needs and ensuring that effective auditing practices and accurate record keeping were in place to improve the quality of the service provided to people.

Following this inspection we had issued a warning notice due to the issues of concern we had found in relation to people’s safety. The concerns were in regards to the safe management of medicines, the inaccurate completion of positioning charts for people who were at risk of developing pressure ulcers and the failure of the provider to ensure that people were consistently protected from the risk of accessing areas used for the storage of cleaning chemicals. We received an action plan from the provider to explain how they would address the warning notice and breaches of regulation within a specified timescale.

At this inspection we found that the provider had met the warning notice and the breaches of regulation.

We saw that improvements had been made and people received their medicines safely. Risks to people’s safety and wellbeing had been identified; however, some of the risk assessments we looked at required additional information to demonstrate how the provider guided staff to address these risks. We observed that actions had been taken to provide people with a warm environment although the provider’s risk assessments for the use of portable heaters in people’s bedrooms needed further details to meet people’s individual needs. This was addressed by the provider during the inspection.

Staffing levels were satisfactory although we received comments from two people who used the service and the relatives of two other people that they did not think there were always enough staff. People were protected from the risk of harm and abuse as staff understood the provider’s safeguarding procedures and employees were subject to appropriate pre-employment checks before they were offered positions at the service.

Improvements had been achieved in relation to staff training and supervision. Records showed that the provider ensured staff undertook their required training and had regular support through one to one supervision sessions and team meetings. Records maintained about people’s daily care demonstrated that the management team and senior staff now applied better scrutiny to ensure that people received the care and support they needed. For example, people were weighed in accordance with professional guidelines and any concerns about their weight were reported to the GP and other healthcare professionals including dietitians and district nurses, if applicable.

People had developed good relationships with staff and we observed that staff supported people in a respectful way. People’s needs were assessed before they moved into the service and the quality of these assessments was good. However, more information was needed in the care plans we looked at to guide staff to meet people’s individual needs. For example there was insufficient information about how people wished to be supported to meet their social needs, although there were several positive remarks from people who use the service and their relatives about how the new activities organiser was making changes to create a more bespoke activities programme.

There were systems in place to seek people’s views about the quality of the service and complaints were dealt with in a professional manner. We received positive comments about the approach of the registered manager and the actions he was taking to improve the service. At the previous inspection we found that confidential information about people was not always securely maintained. At this inspection we observed that this practice had not ceased, which meant that private details about people’s health care needs and other circumstances could be read by parties that did not have a valid reason to know this information. Although audits were being carried out more regularly, there were still some shortfalls with the auditing system that the provider needed to address.

We have made a recommendation in regards to the safe storage of food items. We found one breach of the Health and Social Care Act 2008 regulations in this report. This was in relation to the provider’s failure to protect people by ensuring that all confidential information about their needs is safely stored and accurately recorded. You can see what action we told the provider to take at the back of the full version of the report.

At our last comprehensive inspection on 5 April 2016 we rated this service “Requires Improvement” and found breaches of regulations relating to safe care and staff training. We carried out a follow up inspection in December 2016 and found that the provider had made some improvements but was still not meeting these requirements. We received concerns about the quality of care provided by the service and brought forward this scheduled inspection in order to look into these. At this inspection we rated the service “Requires Improvement”.

Alan Morkill House is a care home for up to 49 older people and people with dementia. There is a large kitchen and communal lounge on the ground floor and a shared courtyard and garden, and each floor includes a communal lounge, kitchen and dining room. The service is divided into seven units, three of these units provide care for people with dementia. At the time of our inspection there were 39 people using the service.

The service had a registered manager. 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.

We found that the building was not always safe and potentially unsafe issues with premises were not always addressed in a timely manner, for example kitchens and cupboards storing cleaning materials were left unlocked. Although staff carried out checks of water temperatures and fridge temperatures, there were not always clear guidelines in place, and in some cases people were bathed in water which was too hot, which was not checked by managers. Where people were at risk of pressure sores, turning charts were not correctly completed or checked. Medicines were not managed safely, and we found that in many cases people did not receive their medicines as prescribed. Managers did not carry out sufficient checks to detect these issues.

Call bells were checked to ensure that they were operational, and these were responded to promptly, although staff could not always hear these in some areas of the building. Units for people living with dementia did not use dementia friendly design to aid people’s orientation around the building. We have made a recommendation about this.

The provider had assessed people’s capacity to make decisions, but did not always review these regularly, and when people were deprived of their liberty in their best interests the provider had acted lawfully. However, the provider did not ensure that people had appropriately consented to their care.

Staff training had improved, but some staff had not received training in mandatory areas, and the provider did not have a clear assessment of the training needs of the service. Many staff did not receive regular supervision and team meetings were not well attended enough to ensure good communication.

People received good support at mealtimes and food was nutritious and varied, however recommendations from dietitians were not always followed, and people’s weights were not audited in a way which would detect and address weight loss. Where people required food and fluid charts these were not always correctly completed or checked by managers.

People’s needs were assessed and reviewed regularly, and people’s wishes and preferences were identified by staff, including their wishes for the end of their lives. We found that people benefitted from caring and attentive staff and from a varied and interesting activity programme.

People told us they were treated with respect by staff and we observed friendly and caring interactions. Staff worked to maintain a suitable and friendly environment for people. Staffing levels were not unsafe, but staff told us they felt stretched at times. Managers addressed complaints effectively, and took appropriate action against staff where poor practice had taken place. The provider carried out appropriate pre-employment checks to ensure staff were suitable for their roles.

We found breaches of regulations regarding safe care, medicines, staff support, consent, nutrition and good governance. We issued a warning notice in relation to safe care and the management of medicines. You can see what action we told the provider to take at the back of the full version of this report.

We undertook this focused inspection to check that they had followed their action plan, to confirm that they now met legal requirements and to look into these concerns. This report only covers our findings in relation to these areas. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Alan Morkill House on our website at www.cqc.org.uk.

There was a registered manager at the service. 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.

We received information that the building was not safe due to mice infestation and that the heating was not always working correctly. We saw that the provider had taken measures to address these issues.

At our previous inspection we found that the provider was not carrying out satisfactory measures to ensure water safety and the safe functioning of the call system. We found that the provider was still not fully meeting these requirements. Although the provider was carrying out satisfactory measures to protect people from legionella, there was not sufficient checking of water temperatures to protect people from the risk of scalding. The provider was not always carrying out checks to ensure that the call bell system was working correctly.

At our previous inspection we found that staff were not receiving sufficient training. We found that the provider was still not fully meeting these requirements. Although many staff had received training in key areas there were still some staff who had not received this training, and some staff did not undertake refresher training in line with the provider’s requirements. Some staff who had recently joined the service did not receive training in important areas such as safeguarding.

We found that the provider was still breaching regulations with regards to safe care and treatment and staff training. You can see what action we have told the provider to take at the back of the full version of this report.

Alan Morkill house is a residential service providing accommodation for up to 49 older people and people living with dementia. At the time of our inspection there were 36 people living in the service. The provider had recently closed the dementia unit on the ground floor, meaning that there were now six units across the three upper floors of the building. Each of these units had a dining room and shared kitchen. On the ground floor there was an activities room, lounge and kitchen.

The service had a registered manager, who had registered in February 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.

There had been significant improvements in staffing since our last inspection. Staff and people who used the service told us that this had made them feel safer and better supported. The provider had measures in place to manage the risks of people falling or leaving the building in a way which may be unsafe and these were reviewed regularly and in response to accidents.

We saw that the provider used a monitoring system to notify staff when people may have fallen and to allow people who used the service to call for help. Staff responded quickly to calls from this system, however the service did not have measures in place to ensure the system was working effectively, which meant there were times when people were not safe. There was also a large number of vacant rooms in the service, where the provider had not carried out appropriate measures to reduce the risk of legionella from unused taps and showers. The provider has since put measures in place to manage these risks.

The new registered manager had an improvement plan in place for the service. As part of this, staff training was being reviewed and training was arranged when necessary, and a new timetable was in place for staff supervision. However, at the time of our inspection staff training and supervision was still not adequate to ensure that staff were able to carry out their roles effectively.

We saw that people were treated with respect and appeared clean and well-cared for. People had the opportunity to attend activities which were appropriate for people living with dementia and carried out in an inclusive and sensitive manner. Care plans provided detailed information about people’s support needs and wishes, these were routinely reviewed every month. People’s nutritional needs were assessed monthly and measures were in place where people were at risk of dehydration or malnutrition to manage these risks. We saw that people were able to choose their own meals, and the kitchen had systems in place to ensure that people received food of their choice which met their nutritional and health needs.

Where people may be deprived of their liberty due to restrictions such as door locks, the provider had carried out its responsibilities to apply to the local authority and demonstrate that these restrictions were proportionate and in the person’s best interests. However, staff were not working in line with the Mental Capacity Act 2005 to demonstrate that a person’s care plan was in the person’s best interests where they did not have capacity to consent to their own care.

We saw a number of compliments about the service, and relatives and people who used the service were positive about the care staff and management. Where people had complained about the service these concerns were addressed quickly and effectively. The registered manager had brought about significant improvements to the service, however it was too early for all of these improvements to be effective or sustained.

We found breaches of regulations concerning the safety of people who use the service and the training of staff. We have made a recommendation regarding the consent of people to their care. You can see what actions we have told the provider to take at the back of the main report.

The service had implemented a new care planning system and had consulted people who use the service about how their needs should be met. The new care planning system enabled staff to identify risks to people health and welfare and address them promptly. There were suitable arrangements for dealing with foreseeable emergencies.

The provider had reviewed and increased staffing levels following our inspection in June 2013 so there were sufficient people on duty to meet people's needs. Staff were supported by a new senior team who had provided supervision, support and training.

At local and provider level there were robust monitoring processes in place and evidence that the service sought feedback for people who use it.

There were not always enough staff to meet people's needs. People we spoke in the home were complimentary about the staff. One person said when talking about staff ''they do their best for us.'' However on the day of the inspection we observed that on one floor of the home people had been left unsupported with personal care for over four hours.

We were not assured that people's needs were being met by competent staff as there were no appropriate arrangements in place to identify where staff needed support and what their training needs were.

We found that there were arrangements in place to give people their medication. However we found some discrepancies in how some information was being recorded. On each box of people's medication there was a dispensing date however there was no record of the date for when the medication was started.

We identified concerns in the quality monitoring within the home and found that the provider's own management audit systems were insufficient to pick out the inconsistencies we found across a number of areas. For example we found gaps in information in how accidents / incidents were being recorded.