Archived: Alton House

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.”

Alton House is a care home, providing accommodation and support for 23 adults including people who may have a diagnosis of dementia. At the time we inspected there were 22 people living at the service.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. This service provides personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had 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.

At our last inspection on 5 and 6 January 2017 the service was rated ‘Requires Improvement’ overall. We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service did not manage and administer all medicines, safely. The lack of detailed and specific information about people's needs placed them at risk of not consistently receiving the care that they required. The service did not have adequate governance systems in place to ensure people were receiving a service that safe, effective or responsive to their needs.

At this inspection, we rated the service as now being ‘Inadequate’. We found that these previous breaches had not been addressed and we found further breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and of the Registrations Regulations Act 2009. 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.

The service did not oversee people's medicines in a safe way. Covert medicines and PRN medicines were not managed in a way that was safe and in line with best practice. Individual risk assessments were not detailed and not kept up to date. People's changing support needs were not reviewed and staff were not provided with enough information about how to keep people safe from potential harm. The service had not been adapted in a way that kept people safe from hazards and the home was not always cleaned sufficiently which meant people were at risk of cross-infection. In particular, the service did not manage the moving and handling of people in a safe way and people were being moved incorrectly which put them at risk of harm or injury. Staffing levels were not sufficient and therefore impacted on the safety of people who had high level care and support needs. The service did not have safeguarding systems in place which meant that people were not protected from potential abuse.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. At the time of the inspection, applications for DoLS had been made to the local authority in relation to all people who lived at the service. The service had not followed the principles of the MCA correctly and some DoLS applications had been incorrectly applied for. This meant people's legal rights were not protected.

Staff did not receive an induction into the service. We found that training was not always well managed and systems were not in place to ensure all staff received regular support through supervisions and appraisals from their managers. This meant staff were not equipped with the necessary skills and tools to practice in a safe and caring way. People did not always have a varied choice of food they could eat and were not supported to eat in a way that was responsive to their needs and preferences. The service did not engage well with other health and social care professionals, which meant holistic care and support was not being provided and people were at risk of becoming more unwell.

People did not always experience meaningful and caring interactions from staff. This meant people were at risk of social isolation which in turn impacted on their wellbeing. People were not made to feel involved in their care. We found the service did not support people in a way that respected their privacy and dignity, and people were not encouraged to live independently.

Individual care plans were not detailed and not kept up to date, and as a result people did not receive personalised care and support. People were not being supported to engage in activities and their individual social needs were not being met. People did not feel happy living at the service. The service did respond to complaints received. However, the complaints procedure was not made available for people living with dementia or other sensory communication needs and therefore people may not have always felt able to make a complaint. The service was unclear about their approach to supporting people at the end of their life and not all staff knew who needed end of life care.

The service was not well managed: the leadership of the home was not strong and the management team evidenced inconsistencies in their approach. We found that previous breaches had not been addressed and the quality assurance systems in place did not identify the concerns we found during our inspection. People, relatives, staff and the wider community were not asked to provide feedback about the service and there was no evidence of lessons learnt or plans to make improvements. Statutory notifications, required by law, were not always sent to the CQC.

Alton House is a 23 bed care home providing accommodation and care for older people, including people living with dementia. The service is accessible throughout for people with mobility difficulties and has specialist equipment to support those who need it. When we visited, 21 people were 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 and associated Regulations about how the service is run.

At the last inspection in November 2015, we found three breaches of regulations. The arrangements for managing medicines were not robust. Peoples care plans were not detailed and the quality of service was not robustly monitored. Initial action had been taken to address the breaches but this had not been structured or completed. At this inspection, we found that although people were very happy with the service provided, the breaches had not been rectified.

Medicines were monitored and audited and were safely stored but staff competency to administer medicines, had either not been assessed or was not current. Limited information was available to enable staff to make decisions about when and how to give certain medicines. People who received their medicines without their knowledge (covertly) did not have their rights protected.

The process to improve care plans had continued and additional information had been gathered about people but care plans were still not person centred. They did not contain sufficient detail to enable staff to provide an individualised service that safely met their needs and preferences. However, there was a consistent staff team who knew people well and were aware of their needs and likes.

Management systems had not supported the necessary improvements to address the shortfalls identified at the last inspection.

Staff had received training and additional training was scheduled. They told us they received the right training to carry out their duties and that it was kept up to date.

Systems were in place to ensure that people were not unlawfully deprived of their liberty and the necessary applications had been made to the supervisory body when this was required.

We saw that staff supported people patiently and with care and encouraged them to do things for themselves. Staff knew people’s likes, dislikes and needs and provided care in a respectful way.

People were happy to talk to the registered manager and felt they would listen and address any concerns that arose.

We have recommended that staff, relatives and ‘residents’ meetings be held to ensure that everyone has the opportunity to discuss the service and to give feedback on future plans and changes.

The provider’s recruitment process ensured that staff were suitable to work with people who need support.

People were happy with the food and said they had a choice of food and drink and their nutritional needs were met. If there were concerns about their eating, drinking or weight, they were discussed with the GP. We have recommended lunchtime arrangements be reviewed, changed and monitored to ensure that everyone is fully supported in a timely manner.

People’s healthcare needs were monitored and they were supported to receive the healthcare they needed.

People said they were satisfied with the activities staff provided.

People told us they felt safe at Alton House and that there were always staff available to help them.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People told us they were happy with the food at the service. One person said "the food is quite good. Plenty enough to eat, good variety" and "it's all right (the food), I've not turned anything down yet."

We found that medications were stored securely. However, there were concerns with the recording and administration of medications. We also had concerns in relation to staff training and induction.