Archived: Alderton House

This unannounced inspection took place on 01 and 05 November 2018.

At the time of the inspection there was a registered manager in place. 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 our last inspection we rated the service Good, with a rating of Outstanding in the area of Responsive. At this inspection we found the evidence continued to support the rating of Good overall. However due to the lack of staff and how this sometimes resulted in people not being able to attend their planned activities responsive has now been rated as Good. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. We have written this inspection report in a shorter format because our overall rating of the service has not changed since our last inspection.

The care service has been developed 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.

However, the service was in a large home which was larger than most domestic style properties and was registered for the support of up to 10 people. This is larger than current best practice guidance. The size of

the service having a negative impact on people had been mitigated in the following ways. The design of the building was such that it fit into its environment as it is in a residential road with other large domestic homes

of a similar size. There were nothing outside the building that may indicate it was a care home. Staff wore their own clothes and removed badges when in the community. People had a high level of autonomy over how they spent their time. People's support was built around them and this enabled people to live individualised lifestyles. There were numerous rooms that people could use in addition to their private space. The building did not feel overly busy or institutionalised.

People continued to receive a safe service. Staff protected people as far as possible from discrimination, abuse and harm. Risk assessments were in place and had been regularly reviewed so staff were aware of what action to take to reduce risks to people. There were enough staff to ensure that people’s needs were met. Recruitment checks were completed to ensure staff were suitable to work at Alderton House. People received their medication as prescribed. Accidents and incidents were monitored so that action could be taken to prevent a reoccurrence.

People continued to receive an effective service. Staff received training and support which gave them the skills and knowledge they required to do their job well. There was a detailed assessments and lengthy transition period when people moved into Alderton House to ensure it was the right place for them. Staff supported people to eat and drink the right food to maintain their health. People were supported 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 practice.

People continued to receive care and support from staff who cared about them. Staff were kind, compassionate and gave emotional support when needed. Staff respected people’s privacy and dignity. They knew people well and supported people to be as independent as possible including learning new skills. Staff welcomed people’s relatives and visitors.

People continued to receive a service that was very responsive to their needs. People and their families were fully involved in planning their care and support. Support plans were personalised and included information about what goals they wanted to achieve. People choose what activities they wanted to do and where they would like to go. People and their families were confident if they needed to complain it would be dealt with appropriately.

The service continued to be well-led, by a registered manager who provided good, hands-on leadership. People were put at the heart of the service and staff were motivated to provide them with a good quality service. They monitored all aspects of the service for quality and put actions in place to address any shortfalls. There was an open, person-centred culture. The provider sought the views of people, their relatives and staff and these views were taken into account to ensure continuous improvement. The service worked in partnership with organisations such as the local learning disability partnership to provide people with joined-up care.

Further information is in the detailed findings below.

This unannounced inspection took place on 18 February 2016.

At the time of the inspection there was a registered manager in place. 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 Care Quality Commission (CQC) is required by law to monitor the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The provider was acting in accordance with the requirements of the MCA including the DoLS. The provider was able to demonstrate how they supported people to make decisions about their care. Where people were unable to do so, there were records showing that decisions were being taken in their best interests. DoLS applications had been submitted to the appropriate authority. This meant that people did not have restrictions placed on them without the correct procedures being followed.

People felt safe and relatives said that they had no concerns about the arrangements that were in place to keep people safe. Staff built good relationships with people that enabled them to report any concerns to their own safety. People were involved in compiling their own risk assessments; the service supported people to maintain their independence and take managed risks. Staff had an understanding of how to protect people from harm and knew what action they should take if they had any concerns.

Staffing levels ensured that people received the support they required at the times they needed it. The service responded flexibly and robustly to ensure a suitable number of staff with the right skills and knowledge were available at all times. The recruitment practices were thorough and protected people from being cared for by staff that were unsuitable to work at the service. People using the service were thoroughly involved in the recruitment procedures, with only the most appropriate staff being selected for a job.

Staff were kind and compassionate when working with people. They knew people well and were aware of their history, preferences, likes and dislikes. People’s privacy and dignity were upheld.

People were supported to take their medicines as prescribed. Records showed that medicines were obtained, stored, administered and disposed of safely. People were supported to maintain good health as staff had the knowledge and skills to support them and there was prompt and reliable access to healthcare services when needed.

Comprehensive support plans, health plans and objectives for the future were in place detailing how people wished to be supported and had been produced in conjunction with people using the service. People had agreed what care and support they needed and were fully involved in making decisions about their support. People participated in a range of activities within the home or in the community and received the support they needed to help them to do this. People were able to choose how they spent their time and what activities they participated with. Some people had been supported to find employment.

People were provided with a choice of food and drink that they enjoyed.

There was a complaints procedure in place and people felt confident to raise any concerns either with the staff or the registered manager if they needed to. The complaints procedure was available in different formats so that it was accessible by everyone.

People had confidence in the registered manager and the way the service was run. The provider ensured the service was well supported and there were opportunities for people and staff to provide feedback about any improvements that could be made, and these were listened to and acted on.

We reviewed information about staff recruitment and training. We also confirmed how the provider monitored the quality of the service provided together with cleanliness and infection control. Below is a summary of what we found.

If you wish to see the evidence that supports our summary please read the full report.

Is the service safe?

People told us they felt safe and we saw that procedures were in place that protected people from abuse. One person said, 'Yes, I feel safe here'. A relative commented, '(Person) is completely safe here. I have never had any concerns about safeguarding.'

Care records contained detailed risk assessments that promoted people's independence and kept them safe. Staff we spoke with demonstrated an awareness of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards which protect people who are unable to make decisions for themselves.

Is the service effective?

We observed good relationships between staff and people who used the service. Staff we spoke with demonstrated that they understood how to meet people's individual needs. One relative commented, '(Person) has got better and better since they have been here. I cannot praise Alderton House highly enough."

Care records we checked were regularly reviewed and up to date. One relative commented, 'Staff tell me what has gone on during the week. I read the daily notes and support plan.'

Is the service caring?

People were supported by staff who were kind and respectful. One person told us, 'All the staff look after me. They are nice and friendly.' A relative commented, 'I am extremely happy with the service provided by Alderton House.'

Care records contained information about people's preferences and it was clear that people had been involved in planning their care. One relative told us, 'The care is beyond our expectations.'

Staff were up to date with their annual mandatory training which meant that people were supported by staff with the right skills and experience to ensure their needs were met.

Is the service responsive?

People and their relatives expressed high levels of satisfaction with the service and told us they could approach the team with any concerns. One relative told us, "I can approach staff with problems or concerns. They understand.'

We found that there had been no recent complaints and that many compliments about the service had been received.

Is the service well led?

The provider had systems in place that ensured there was regular contact with people who used the service, staff and health care professionals. Feedback from the most recent questionnaire showed that levels of satisfaction with the service were high.

Records relevant to the operation of the service were available on request and demonstrated that the provider has systems in place to ensure the environment was safe. We also saw that Alderton House was visibly clean and tidy and staff demonstrated that they understood their responsibilities with regard to infection control.

We saw that people responded in a positive manner when staff members entered the room and the relationships seemed warm and caring. Staff members knew what individual people responded well to and this was evidenced when one person was becoming agitated and a staff member offered them a foot massage. The person seemed to enjoy this and became calm.

People received the care and support they required to improve their health and well-being. Care records were written in detail and provided clear guidance to staff members.

Medicines were stored appropriately and records were maintained to show all storage areas were kept at the correct temperature. Administration records were kept and people received their medicines in a safe way.

Staff members received supervision and training from the provider or from external sources to ensure they had the skills and support to properly carry out their roles and support people. One person told us, "The staff make me feel safe".