Archived: Alde House

Alde House is a residential care home providing personal care up to 17 older adults. At the time of the inspection 16 people lived at the home. The care home is located within the Chiltern area of outstanding natural beauty. People had access to a lounge, dining area, sun lounge and could freely access a garden area.

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

The service did not routinely ensure all the required pre-employment checks were completed for new staff. People were supported by enough staff who were deployed to meet their needs. Staff were skilled in recognising potential abuse and knew what to do to protect people from harm.

People were not routinely supported to have maximum choice and control of their lives and staff did not routinely support them in the least restrictive way possible and in their best interests. This was because the service did not fully adopt best practice for assessing people’s mental capacity to make informed decisions.

People, relatives and staff told us the service was well-led. We found the provider and registered manager failed to notify us of all reportable events. Record management within the service required improvement.

We observed people were supported by staff who demonstrated kindness and a caring approach. People were treated with dignity and respect by staff. People and their relatives described the care home as ‘Homely’ and felt part of a ‘Family’.

People told us they received a personalised service from staff and were supported to engage in meaningful activities. People were supported to practise their chosen faith.

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 15 August 2018).

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 some improvement had been made. However, we found the provider was still in breach of regulations.

This is the second consecutive time the service has been rated requires improvement.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led section of this full report.

Enforcement

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We identified one breach of the Care Quality Commission (Regulation) Regulations 2009.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

Alde House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. We regulate both the premises and the care provided, and both were looked at during this inspection.

Alde House can accommodate 17 people across two floors, each of which has separate adapted facilities. The service cares for older adults, including people living with early stages of dementia. The premises are a converted building, set on acreage. People live in their own bedrooms and have access to communal facilities such as a dining room, lounges and bathrooms. At the time of our inspection, there were 15 people living at the service.

The provider is required to have a registered manager as part of their conditions of registration. 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 our inspection, there was a registered manager in post.

People safety was not always adequately protected. There were risks from fire and Legionella which were not satisfactorily assessed and mitigated. However, people were protected from the risks of abuse, neglect, discrimination, injuries and accidents. People’s risk assessments and the support they received from staff ensured their safety. There were sufficient staff deployed to meet people’s needs. People were protected from the risk of infections. The service was clean and well-maintained. The management of people’s medicines was robust. We made a recommendation about incident and accident reviews.

The service was compliant with the requirements of the Mental Capacity Act 2005 (MCA) and associated codes of practice. People were assisted to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practise.

Staff training, supervision and performance appraisals ensured workers had the necessary knowledge and skills to effectively support people. We made a recommendation about staff induction. People’s care preferences, likes and dislikes were assessed, recorded and respected. We found there was appropriate access to other community healthcare professionals. People were supported to maintain a healthy lifestyle. People had adequate nutrition and hydration to ensure their wellbeing.

There was complimentary feedback from most people who used the service and their families. They said staff were kind, friendly and committed. People told us they were able to participate in care planning and reviews and there was evidence that the service promoted people’s independence. People’s privacy and dignity was respected when care was provided to them. People’s care records and confidential operational information was appropriately secured away.

The service provided person-centred care. Care plans were suitable and contained information of how to support people in the best possible way. We saw there was an appropriate complaints system in place. The complaints policy and signage required updates. People and their families had a say in the everyday decision-making and operation of the service.

The provider had failed to notify us, without delay, of certain events that were related to people’s care. This meant between our inspections, we could not effectively monitor the governance of the service. The service and provider had a clear and credible strategy that included person-centred aims and objectives for the operation of Alde House. There was positive feedback about the registered manager from people who used the service, staff, relatives and community agencies. A small number of audits were used at the service to monitor the effectiveness of the care. Investment was made in the premises to ensure refurbishment and redecoration over time. There was good oversight from the provider’s board of trustees. Communication methods for people with cognitive and sensory impairments required improvement.

We found three breaches of the Regulations.

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

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

People were very positive and complimentary about the quality of the staff and the care and support they experienced. We spoke with staff as part of our visit. They knew the individual needs of people and how their safety could be assured. We saw staffing rotas were maintained which ensured people's care needs were met throughout the day and at night.

CQC monitors the operation of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. The manager told us they had not needed to submit any applications to deprive people of their liberty. However, the provider may find it useful to note there were no recorded mental capacity assessments in the care plan records we saw, to support this judgement. When we spoke with staff, they told us they had been trained to understand when an application should be made, and how to submit one. This ensured there were proper safeguards in place.

We looked at three paper care plans and also at computer based care notes. Basic information about people was available on one or other format. For example, pre-admission assessments which established people's basic needs and how they were to be met together with assessments of risks and how these were to be eliminated or managed. Risks assessed included falls, nutrition and moving and handling. This confirmed care and support was planned and delivered in a way that was intended to ensure people's safety and welfare.

When we looked at the storage, administration and recording of medication we found people were not protected against the risks associated with medicines because the provider had not put in place or maintained appropriate arrangements to manage medicines. We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to medication.

Is the service effective?

Care plans had been put in place for each person. These were either as hard copies or on a computer based system. These outlined the care and support people needed to meet their needs. Staff had reviewed information, to make sure it was up to date, relevant and continued to meet people's needs. However, there was very little detailed or useful personal history and some key records, for example a full history of weight gain or loss, appeared to be split between the two systems. This meant staff found it hard to access all the information they needed in one place. The provider may find it useful to note this made the process of, for example reviews of people's care, harder to maintain effectively as some information was in one system and some in another.

People had access to external healthcare professionals and specialist advice, such as GPs, community nurses, tissue viability nurses and stoma care nurses. Records were kept of any visits or appointments. This helped maintain people's health and welfare.

Is the service caring?

We observed the routines of the home and staff interaction with people who lived there. We saw staff gave people choices. For example about what they ate and where they wanted to sit. People told us "Staff are very willing and helpful." The interaction we observed between staff and the people they provided support to was respectful and relaxed. People appeared to be at ease with staff and staff provided support without obviously 'rushing'.

Is the service responsive?

People were aware of the complaints system. We saw a copy was displayed along with other information about the service. The We found detailed records were kept where anyone had raised issues about standards of care. In each case, action taken in response had been recorded.

Is the service well-led?

The provider had an semi-structured, informal system in place to regularly assess and monitor the quality of service that people received. This had been through meetings and informal feedback together with more detailed provider visits and reports. We were told whilst there were no structured surveys currently carried out, these were planned to take place in June or July 2014 and at least annually thereafter. These would include health and social care professionals involved with Alde House as well as people who lived in the home and those who were responsible for them.

The provider showed us a recent contract monitoring report carried out by Buckinghamshire County Council in April 2014. They detailed the actions they had already taken or were taking to meet any identified shortfalls. This showed both that Alde House was subject to external scrutiny by the local authority and also that they responded in a timely manner where any minor concerns were raised. The report did not identify any significant problems with the standard of care provided by Alde House.

We found there were systems in place to gain consent to care from people. We saw care plans and risk assessments were signed by the person receiving care and or a family member. People told us that care staff asked them how they liked to be supported. We found risks relating to the person had been identified and assessed. Risk assessments had been written for risks such as, falling, moving and handling, showering and challenging behaviour.

People told us that they felt safe living at Alde House. Comments included "I feel very safe here", "I have no reason not to feel safe" and "Oh yes I feel safe both in the home and when I go out in the community."

We found appropriate checks were undertaken before staff began work. Each file had evidence of enhanced Criminal Records Bureau disclosures, written evidence of references obtained and proof of identification.

People we spoke with did not have any complaints about their care. There was a system in place to listen to any complaints people had.

The provider informed us that monthly meetings were now being held with people. Since April five meetings had taken place. The provider said that as a result of such meetings a new staff call system had been installed and the service had changed its supplier of some materials.

The provider informed us that care plans were now routinely audited. Since April three audits had been completed. The results of the audits were discussed with staff. The audits, combined with monthly care plan reviews and quarterly reviews of risk assessments, supported action to achieve consistent standards of staff practice in meeting people's needs.