Archived: Alvaston House Care Home

Updated 23 August 2019

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection was prompted in part by the information shared with CQC about the incident indicated potential concerns about the management of risk of by the provider, who was unable to access the home. The management of the home had been taken over by the building landlord who leased the building to the provider. We had concerns over people’s safety.

Inspection team

On the first day of the inspection the team consisted of two inspectors. On the second day the team consisted of one inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert’s area of experience was using mental health services.

Service and service type

Alvaston House Care Home 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 had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. The registered manager was not at the home at the time of our inspection and we were provided with limited information by the acting manager.

Notice of inspection

The inspection was unannounced. Inspection site visit activity started on 4 June 2019 and ended on 5 June 2019. We visited the service on 4 and 5 June 2019 to see the people living there, the acting manager and office staff; and to review care records and policies and procedures.

What we did before the inspection

Before the inspection we spoke with local authority safeguarding, contracts and

commissioning teams. We reviewed notifications of incidents received since the provider was registered in May 2018. We used all of this information to plan our inspection.

Due to technical problems, the provider was not able to complete a Provider Information Return. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We spent time observing the care and support being provided throughout the home. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with six people who lived in the home. This home is owned by a limited company, the nominated individual is appointed by the directors of the company to act on their behalf. We also spoke with the acting manager, the senior carer and two support staff.

We looked at the care records for three of the people who lived in the service. We also looked at records that related to how the service was managed including staffing rotas, recruitment, training and quality assurance.

After the inspection

We asked the acting manager to send us further documentation following the inspection which included copies of the training records, the staff rota and minutes of meetings for the people who used the home and staff meetings. These were not supplied following the inspection.

Updated 23 August 2019

About the service

Alvaston House Care Home is a 17 bed residential home providing personal and nursing care to 11 people at the time of the inspection. The care home supports people in an adapted building.

The service rarely applied (didn’t apply the full range of) the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons; lack of choice and control and limited independence. People did not have choice in the food they ate or at what times meals were served. Menus were developed by staff with limited input from people who lived at the service.

The care service should be developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Health and safety checks were not regularly completed or evidenced to ensure risks to people’s safety were minimised. We brought some health and safety issues to the attention of the acting manager on the first day of our inspection visit where we had immediate concerns to people’s safety. Staff recruitment procedures were adequate which ensured people were cared for by staff who had been assessed as safe to work with them. People’s health and welfare was placed at risk from an environment that was not risk assessed in line with people’s life history and the risks associated with that. There were no adequate infection control checks in place which resulted in a heightened potential for cross infection and cross contamination of infection in the home. The environment was in need of cleaning and some areas disinfected, there were areas of malodour that required attention.

The provider did not have effective systems in place to assess the needs of people prior to entering the home. People were (not) supported to have maximum choice and control of their lives and staff (did not support) supported them in the least restrictive way possible; the policies and systems in the service (did not support) supported this practice. Staff did not understand the Mental Capacity Act 2005 (MCA). Staff confirmed they had not been trained to care for people with enduring mental health needs, and no training records existed to confirm what training staff had completed. There was no system in place that allowed the acting manager to consistently supervise the staff to ensure people were safe in the home. People could cater for themselves and others were provided with a varied menu which met people’s cultural needs, but choice was limited.

Staff observed people’s privacy and dignity, but did not recognise they were employed to respect people’s environment and not intrude on their personal space. Staffing levels were adequate to provide basic levels of care.

The provider did not have effective systems in place to assess, monitor and improve the quality of care. Care plans provided limited information for staff that identified some people’s support needs, however there was little information about people’s associated risks. There was enough staff on duty to respond to people’s health and care needs, however, social care and pastimes were not seen as a priority and people were not supported with these. There was no complaints process or records in place. Staff had not considered people’s end of life choices or made reference to this in care plans.

There was no evidence that any quality monitoring had been undertaken. The audit systems had not been put in place by the registered manager to ensure people received a quality service. Incidents were recorded but information was not always sent to CQC. Improvements are required in assessing risk to people. There was no access to policies and procedures which would give staff the information to operate systems effectively and protect people in the home.

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

This service was registered with us on 25/05/2018 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about allegations of financial irregularities. A decision was made for us to inspect the home but not look at the allegations and incidents that were subject to a Local Authority investigation.

Enforcement

We have identified breaches in relation to the safety of people in the service, safety and monitoring of the environment they live in. There are further breaches around assessing people’s needs and the composition of care plans and the risks associated with caring for people.

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

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 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.

Special measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. We have assessed the inspection outcome is so serious that people are placed at risk. We propose to cancel the provider’s registration, and are in contact with the local authority to identify alternative accommodation.