Archived: Alma Lodge

Updated 16 August 2018

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

This inspection took place on 5 June and was unannounced. The inspection was undertaken by two inspectors. Before our inspection we reviewed the information we held about the service including two previous inspection reports. We looked at notifications which had been submitted to inform our inspection. A notification is information about important events which the provider is required to tell us about by law.

Due to technical problems we were not able to ask the provider to complete a Provider Information Return. This is information we require providers to send us at least once annually to give us 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.

We met all six people who lived at Alma Lodge and observed their care within the communal areas, including the lunchtime meal. We looked at the interactions between staff and people who used the service. 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 inspected the environment, including the laundry, kitchen, bathrooms and people’s bedrooms. We spoke with three support workers, the manager and a visiting healthcare professional. We received feedback from one commissioner.

We displayed a poster in the communal area of the service inviting feedback from people and relatives. Following this inspection visit, we spoke with two people’s relatives.

To help us assess how people’s care needs were being met we reviewed three peoples care records and the associated risk assessments and guidance. We looked at the medicines records of two people, three staff recruitment files, staff induction, training and supervision records and a range of records relating to the running of the service including staff rotas and quality audits.

Updated 16 August 2018

We conducted an unannounced comprehensive inspection at Alma Lodge on 5 June 2018.

Alma Lodge is a ‘care home’ for people with learning disabilities. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Alma Lodge accommodates up to 10 people in one building. On the day of our inspection, six people were living at the home.

There was a manager in post at the time of our inspection who made an application to register with CQC in March 2018 and is awaiting the outcome of their application. A registered manager is a person who has registered with CQC 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.

Alma Lodge has been 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.

We carried out a comprehensive inspection of Alma Lodge in August 2016. At that inspection the service was rated as good overall, but as requires improvement in Safe. This was because the provider had not established proper and safe systems for the management of medicines.

We undertook a focused inspection in August 2017 when we checked to see if the service now met legal requirements. Whilst the service remained rated ‘good’ overall, and the provider had acted to improve medicine management, we found that the service still required improvement in the 'Safe' domain. The provider had failed to ensure that the premises and equipment were clean and suitably maintained. We also found fire safety had not been effectively managed. This was a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to act and they sent us an action plan on 18 September 2017 to say what they would do to meet the legal requirements. They told us they would be compliant within six to twelve months, by September 2018. We also reported our concerns to the fire service who acted by issuing the provider with an Enforcement Notice under the Regulatory Reform (Fire Safety) Order 2005. The fire service has since confirmed that the provider complied with their Enforcement Notice.

At this inspection we found improvements had been made, and the previous breach found at our last inspection had been met. However, we found further areas of concern. People, staff and visitors were not always kept safe as regular monitoring checks of the premises had not always taken place.

We found that systems to monitor and improve the quality of services and mitigate risks were not consistently robust. Risks included those associated with people’s health and wellbeing including eating and drinking. Risk assessments and care plans were not always current; posing a risk that people could receive inappropriate care. The manager was aware of this and told us about the plans they had to improve.

The principles of the Mental Capacity Act 2005 (MCA) had not been properly understood or applied in the service. Peoples consent to care was not always sought in line with the MCA. People were not supported effectively to make their own decisions. There was a lack of evidence to show how decisions were made in people’s best interests. We have made a recommendation about ensuring people’s rights are properly considered.

People were protected from the risk of abuse. Staff had received safeguarding training. They could tell us how to recognise and report safeguarding concerns. Staff knew about the whistle blowing policy and were confident they could raise any concerns with the provider or outside agencies if needed.

Accidents and incidents were not always reported to management, and records were not always completed. This meant there was not effective oversight of incidents and accidents by the provider or manager to ensure lessons were learned and improvements made when things went wrong.

Staff followed correct and appropriate procedures in the storage and dispensing of prescribed medicines. People were supported to maintain good health and attended routine appointments with GPs, health and social care specialists, opticians and dentists. Health needs were kept under review and appropriate referrals were made when required.

There were enough staff to keep people safe and meet their needs. Staff had completed induction training when they first started to work at the service. The manager had carried out staff supervisions and implemented competency checks. Staff had received some training but not in supporting people with challenging behaviour. We have made a recommendation about further training for staff in supporting people who may display behaviour which can be challenging.

People’s care plans contained some person-centred information to help staff to support them in an individual way although some required more detail or updating. People were supported and encouraged to eat and drink to maintain a balanced diet and were offered choices around their meals and drinks. Staff understood people's likes and dislikes and dietary requirements.

People were treated with dignity and their privacy was respected. Some adaptations to the premises had been made to make them suitable for those living with learning disabilities and we were told of further plans to implement changes. People were offered the opportunity to participate in a range of activities in line with their preferences.

Staff were kind and caring. There were positive interactions between the staff and people and people were comfortable with the staff. People were encouraged to remain as independent as possible and to feel included in their environment. Staff knew people and their care needs well.

Quality assurance audits were carried out to monitor the quality and safety of the service. However, these were not effective in identifying shortfalls and areas for improvement. The provider did not have a clear oversight of the service. There was minimal evidence that lessons had been learned and improvements made when things went wrong. Feedback was not sought from people and their relatives to drive improvements. We have made a recommendation about improving systems to seek and review feedback.

Relatives and staff felt the manager was approachable and responsive. Staff told us that the service was well led and that they felt supported by the manager to make sure they could care for people safely and effectively. Staff said they could go to the manager at any time and they would be listened to.

During this inspection, we found two breaches of the Health and Social Care Act 2008 regulations. You can see what action we told the provider to take at the back of the full version of the report.

This is the first time the service has been rated as requires improvement.