Allerton Park Care Centre

Allerton Park Care Centre is a residential care home providing personal and nursing care for up to a maximum of 50 people. The service provides support to people living with dementia and some who have mental health needs. At the time of the inspection there were 46 people living at the service.

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

People were not always safe. People were at risk of harm as the provider had not identified, assessed, or mitigated risks. These included risks related to people’s health and care needs as well as environmental risks. The environment was tired, not well maintained and appeared unclean. Staff did not always follow safe infection and control practices. Medicines were not managed safely. Some people told us they did not feel safe in the home.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

There was a lack of effective leadership and an ineffective governance structure which meant the service was not appropriately monitored at manager or provider level.

Safe recruitment processes were in place and staffing levels were sufficient with effective deployment in the service. Premises and equipment certificates and servicing were in place and in date.

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 good (published 18 November 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Allerton Park Care Centre on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, management of medicines, consent to care, premises, and good governance at this inspection.

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 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.' This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this time frame and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Allerton Park is a residential care home providing personal and nursing care for up to 50 people, including people living with dementia and mental health needs. There were 34 people using the service when we inspected.

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

We received information raising concerns about staffing levels, risk management and the maintenance and safety of the building. The issues raised about the building related to water damage due to a leaking roof, a pest infestation, the fire panel not working, no window restrictors, only one shower for people to use and safety and maintenance checks not in place

We found risks were managed. We looked round the building. The roof had been leaking and had been repaired recently. There was evidence of water damage to plasterwork in some areas however the provider confirmed there was no structural damage. These areas were not occupied or accessible to people who used the service. A refurbishment plan was in place.

An external pest control company was working with the provider to manage a current pest situation and repairs were underway to address the issues identified.

Safety and maintenance checks of the building and equipment were in place and up to date. The fire systems were in working order. Window restrictors were in place.

One shower room was out of use however people had access to five other communal bathrooms.

Specific concerns had been raised in relation to two people’s needs not being met. We met both people and reviewed their care records which were up to date and provided clear guidance. We found some gaps in food and fluid monitoring records. The provider confirmed they would take action to address this. Accident and incident reports were well completed, reviewed, analysed and lessons learned.

There were enough staff to meet people’s needs safely. People told us staff were available when they needed them. Staff were present in communal areas. Call bells were answered quickly.

The service was clean. Staff had access to personal protective equipment (PPE) and were wearing it appropriately. COVID-19 guidance was displayed throughout the service. However, there was no clear process in place to ensure visitors were safe to enter the premises. When we arrived at the service we were not asked about any COVID-19 symptoms or contacts and our temperatures were not taken. The provider said they would take immediate action to put safe systems in place.

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

Rating at last inspection

The last rating for this service was good (published 18 November 2019).

Why we inspected

We undertook this targeted inspection to check on specific concerns we had received about staffing levels, risks management and safety relating to the environment. The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the Safe section of this full report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Allerton Park Care Centre provides care and support for up to 50 people, including people living with dementia and some who have mental health needs. There were 49 people living at the service when we visited on the first day and 48 people on the second day.

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

People and relatives told us the service provided safe care and people's feedback was consistently positive about the support offered by staff.

The provider completed person centred assessments and care plans were updated when required. Some aspects of the recording of risk assessments and care plans required further detail, but this was not found to have impacted on people using the service and the provider immediately addressed the issues found.

Medication was administered safely although further detail was required in relation to some people's 'as and when required' protocols.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported to access relevant healthcare services when they needed them, and they were supported to eat and drink well.

People remained supported by staff that were caring, compassionate and respectful. People and where appropriate relatives were involved in making decisions about the care people received.

People's independence was promoted, and their confidentiality was protected.

People received care that met their needs. People had opportunities to take part in activities and outings of their choice.

People, relatives and staff shared positive feedback about the quality of care and the management of the service. There was an open culture within the service, where people, staff and healthcare professionals could approach the registered manager who acted on concerns or suggestions.

There were systems in place to monitor and improve the quality of the service.

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

Rating at last inspection

The last rating for this service was good (published 29 March 2017).

Why we inspected

This was a planned inspection based on a change in this location’s registration.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Allerton Park Care Centre provides nursing care for up to 50 people including some who are living with dementia and some who have mental health needs. There were 49 people living at the service when we visited. Accommodation is provided in two units over two floors with lift access between the floors. There is a communal lounge and dining room on each unit as well as toilets and bathroom facilities. A central kitchen and laundry are located on the ground floor.

The home 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. The registered manager had tendered their resignation and was due to leave the service. However, a new manager had been appointed who was due to commence employment two weeks after our inspection. On the day of our inspection the registered manager was on leave and the service was supported by the area manager and the provider.

Safeguarding policies and procedures were in place and appropriate referrals made to the local authority and Care Quality Commission. Staff had received safeguarding training, were able to recognise signs of abuse and understood how to report this. Detailed risk assessments and management plans were in place to mitigate risks to people.

Although some areas of the premises looked tired and requiring refreshing and some bedrooms looked more homely than others, a refurbishment plan was in place to address these. Some areas had new flooring and dementia friendly signage with memory boxes in place. However, the service needed to ensure all people had access to personal toiletries in their rooms. Maintenance checks were in place and any maintenance issues addressed.

People's monies were kept safely although transaction management needed to be more robust.

Medicines were managed and administered in a safe manner.

Accidents and incidents were reported effectively and actions taken as a result documented.

Staffing levels were sufficient to support people safely. Staff employed had checks in place to ensure their suitability to care and support vulnerable people and appropriate staff training was up to date. Supervisions and appraisals were in place to ensure staff received support in their roles. Staff told us morale was good and they received good support from the management team.

Evidence of consent and best interest decisions were visible in people's care records and the service was acting within the legal framework of the Mental Capacity Act 2005.

People's health care needs were met and referrals were made to health care professionals appropriately.

People were supported to consume a varied diet and supplements were in place where people were at risk nutritionally. Referrals were made to the dietician where required.

Interactions between staff and people were positive and staff were kind and caring in their manner. We saw staff knew people well and people were happy and relaxed in their presence.

People and/or their relatives were involved in the planning of their care. Advocates were involved where people lacked capacity and did not have any relatives to speak on their behalf.

Plans of care were clear and easy to follow and personalised according to people's needs. However in some cases these required further details of specific needs to increase person centred care planning. Reviews of care records were regular and reflected people's changing needs.

A varied activities programme was in place according to people's choice. The activities co-ordinator respected if people did not want to take part in the activity on offer and alternatives suggested.

People's preferences were respected such as where they wanted to sit, what they wanted to eat and what activities they wanted to take part in.

Complaints were taken seriously and well managed. The complaints procedure was on display at the service.

A range of quality audits were in place to monitor and improve the service and to ensure the provision of high quality care. The provider had oversight and conducted meetings with senior staff to ensure the smooth running of the service.

Staff were unanimous in their praise for the registered manager and provider and said they received good support in their roles. We saw the provider and senior management team had a visible presence in the service. Morale was good and there was a positive atmosphere in the home.

Staff meetings and surveys were conducted as well as meetings for people living at the service and their relatives. Quality surveys and communication with people showed their views were listened to and actions taken as a result of feedback.

At the last inspections in May 2013 and July 2013 the home was found to be meeting the regulations we looked at.

Before this visit we had received information of concern about people's care at the home. We looked at these areas during our visit and found no evidence to support this information.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key questions we always ask;

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. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

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

Is the service safe?

The service was not safe. People were not protected from abuse and avoidable harm. We identified a number of accidents and incidents involving people who lived at the home which had been recorded by staff and not followed up appropriately. Following our visit we made a safeguarding referral to the local authority so that someone independent of the service could consider the issues. We have asked the provider to make improvements.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines correctly and within the law. We have asked the provider to make improvements.

Following our visit we made a referral to the local Controlled Drugs Accountable Officer so that someone independent of the service could consider the issues we had identified.

People were cared for in an environment that was safe, secure and clean. However, we found parts of the building and premises were not well maintained. Plans were in place for redecoration and refurbishment of the building.

Is the service effective?

Care provided at the home was effective. Peoples' care, treatment and support achieved good outcomes. However, we found audits carried out at the home were not effective; issues identified were not always followed up.

Care was planned and delivered in a way that ensured people's safety and welfare. There were sufficient numbers of appropriately trained staff to meet peoples' needs.

People and relatives we spoke with told us they were happy with the care provided at the home and their care needs were being met. From our observations, and from speaking with people, we found staff knew people well and were aware of their needs.

People were protected from the risks of poor nutrition and dehydration and were supported with food and drink. The food served at lunchtime on the day of our visit looked appetising and people were allowed time to eat at their own pace as independently as possible.

Is the service caring?

People who lived at the home were cared for by kind and attentive care workers who treated people with respect. Staff were patient and encouraging when they were supporting people. We heard care workers speaking courteously with people and asking permission before assisting them.

We observed how care staff interacted with people whilst medicines were administered. We observed staff were gentle and patient with people and provided assistance to those who required help. Staff were respectful when they spoke with people and enabled people to take their medicines in an unhurried manner.

We spoke with one relative who visited their family member every day for several hours. This relative did not speak much English, but told us that they came every day because they wanted to spend time with their relative and they were happy with the care provided by staff. The person receiving care could not speak much, but they understood English, so communication with staff was possible. Staff told us they were able to communicate well with this person and their relative.

Most people we spoke with who lived at the home told us they were happy living there. One person said 'It's quite nice here. I like the view from my window.' Another person said 'It's a good place to be. It's got a nice feel to it.' One of the staff said, 'We try to make it homely for them.'

This showed us staff treated people with compassion and kindness. Peoples' privacy, dignity and independence were generally respected.

Is the service responsive?

The service was responsive. Care and support was generally provided in accordance with peoples' wishes. We observed interactions between people care workers and people who lived at the home, including people with dementia, that were cheerful, patient, friendly and affectionate. Care workers seemed to know people's interests, preferences and family histories.

Relatives we spoke with told us they were happy that their family members were living there. One relative said 'It's much better than the last care home X was in. They look after X much better here.'

One person who lived at the home told us the home was 'alright, but I don't want to live here, I want to be more independent. I think this home is more for older people with problems, not for me.'

We found people had limited access to activities and were not always supported to maintain relationships with friends and relatives. We spoke with one person whose wife had been in hospital and was reliant on neighbours to bring her to the home to visit them. They told us they would like to see their wife more and go out more, but they were not allowed out without an escort. They told us, 'It's like being in jail.'

The home did not promote people's wellbeing by taking account of their social and emotional needs and providing meaningful activities. We saw people were able to choose where they spent their day. During our inspection some people were taken out to lunch by the activities co-ordinator. However, we did not see any meaningful activities taking place in the home for the people who did not go out for lunch.

This meant that activities at the home were not organised to meet everyone's needs.

Is the service well-led?

The service was not well-led. People were not protected against the risks of inappropriate or unsafe care because the provider did not have effective systems to assess and monitor the quality of the service people received; the home was also failing to identify, assess and manage risks to the health, safety and welfare of people who lived at the home.

Staff were not receiving appraisal to monitor their performance and development needs and there was a lack of evidence to demonstrate that the home consulted with people who lived there, relatives and staff. We have asked the provider to make improvements.

We found people's complaints were not fully investigated and resolved, and there were no systems in place for responding to complaints that were not made in writing. We have asked the provider to make improvements.

The registered manager was a Registered General Nurse who had been in post since 28 October 2013. They had registered with the Care Quality Commission as the home's registered manager in February 2014.

We found staff were satisfied with the culture of the home and commented how there was an open culture and any concerns they expressed were listened to and acted upon appropriately.

We found the environment of the home was comfortable for people but there were areas requiring attention; the areas highlighted during the inspection formed part of the current refurbishment programme.

We also found the staff were well supported in terms of supervisions and one-to-one support but formal appraisals were out-of-date. The provider had recognised this and was in the process of introducing a new appraisal system.

We spoke with three people who used the service; one person said they were happy and comfortable at the home. They also enjoyed the food and found staff to be helpful. Another person we spoke with said the food was okay and the third person we spoke with stated they felt safe at the home and they liked living there.

We looked at the systems the provider had in place to monitor the quality of service. This included health and safety checks; audit and monitoring of care planning and delivery; staff training and competency; staff and resident questionnaires and their involvement in a local improvement programme. We judged the provider had an effective system to regularly assess and monitor the quality of service that people received.

The care people received had improved. We spoke with two relatives, they told us the 'door was always open' and that staff were always 'ready and willing to listen' to them. They also said their relative was really happy and settled in the home and they 'could not fault' the care they received. They recalled an instance when access to health professionals was required. Staff had noticed a rash and promptly sent their relative to the GP for treatment. The staff had then contacted them to explain the treatment and what it meant for their relative and how staff would support them.

Overall, they felt their relative was safe living at the home and they had never had to complain.

Despite the positive comments people made we found the home lacking monitoring systems for the quality of the care provided.