Allingham House Care Centre

Allingham House Care Centre provides accommodation, nursing and personal care for up to 86 adults living with age-related health problems or dementia. At the time of our inspection, Allingham House Care Centre accommodated 67 people in three units over three floors, each of which had separate adapted facilities. The ground floor unit provided nursing and dementia care. The first-floor unit provided nursing care, and had a segregated wing allocated as a designated setting for people recovering from Covid-19. This unit had no people staying on it at the time of our inspection. The second-floor unit provided residential care.

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

People received the care and support they needed to keep them safe and well. Staff used risk assessments and care plans to support people with their individual care needs. People received their medicines safely. The home had a full staff team who knew people well. The care home had very high standards of cleanliness and hygiene.

People looked well cared for. The home offered them a good choice of healthy food and drink. They received the healthcare they needed from other professionals such as GPs and district nurses. Staff received the appropriate training and supervision to help them support people effectively. People received support that gave them maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The service promoted high quality, person-centred care. People and their visitors gave positive feedback about their experiences. They spoke highly of the staff describing them as dedicated, caring and attentive. Staff showed a strong commitment to keeping people safe and well. Managers used a range of governance systems, tools and processes to assess the quality of the service and identify areas that needed attention.

Rating at last inspection

The last rating for this service was Requires Improvement (published 17 March 2020).

Why we inspected

This was a planned inspection based on the previous rating. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-Led.

We also reviewed the information we held about the service to check that no areas of concern were identified in the other key questions previously rated Good (Caring and Responsive). Ratings from the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection.

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.

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.

We found the following examples of good practice.

The provider had allocated a wing of the home’s nursing unit as a designated care unit for up to seven people with Covid-19. The unit was located on the first floor and had direct access from the outside with a separate entrance, lift and staircase.

People admitted to the unit remained there until they were symptom free or well. People who then needed to move to another unit in the care home had to self-isolate again for 14 days.

Staff had access to a changing facility and staff room on the designated unit. Staff changed into their uniforms on arrival and changed out of these when they left. The provider had given staff laundry bags to carry their uniforms in, which could be placed straight into a washing machine.

The provider included agency staff in their weekly testing programme for staff.

The designated care unit had its own store of supplies such as personal protective equipment (PPE), cleaning materials, linen, medicines and clinical items to prevent the need for staff to enter other areas of the care home.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

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

People told us they now felt safe and risks to people’s health and safety were managed better. People’s needs were met safely with appropriate staffing levels and less use of agency staff. People were supported by staff who understood how to identify and report potential abuse. The failings we identified at the last inspection in relation to medicines had been fully addressed. The implementation of electronic medication systems had been well-managed and people received their medicines as prescribed. When accidents or incidents occurred, learning was identified to reduce the risk of them happening again. Checks were carried out on new staff to ensure they were suitable to work in the home. Infection control was managed well and the home was clean and free from hazards.

Care records indicated that people would receive effective care. There was evidence of monitoring although not all fluid intake and output records had been totalled or were correct. We made the manager aware of this. Staff had opportunities for regular meetings, although staff had not always received supervision in line with company policy. The manager saw this as a priority. The home worked in tandem with other health professionals to make sure people received the right care and support to maintain good health. People did not always have access to routine oral health care. We have made a recommendation in relation to this. Meal time experiences were unhurried and pleasant on both days of our inspection. Hospitality staff employed at Allingham House meant care staff were free to provide support at meal times for those that needed help with this.

Positive, caring relationships with people who lived at the service were promoted by staff. Staff respected people’s privacy and dignity and promoted independence, equality and diversity. There was no discrimination in the service. The service involved people and their relatives in the planning and delivery of care.

Care plans were more person-centred and reflected people’s care needs. There was a good range of activities and events going on in the home. People and their relatives were confident to raise issues and concerns. Complaints procedures were now effective. The service sought feedback to help maintain and improve standards of care. The service had received compliments from relatives and professionals in relation to individual members of staff and the standard of care now being provided.

People living at Allingham House, their relatives and staff all considered management of the service had improved. The registered manager was mentoring the manager, who was waiting for registration at the time of this inspection. The registered manager de-registered shortly after this inspection. The service operated in a way that demonstrated there was an open and transparent culture at the service. Staff told us they received better leadership and direction; they felt part of a team. The service had effective systems of quality assurance in place which assessed and monitored the quality of the service. The provider had implemented a number of keys changes to the service to improve the quality of care. We were assured the service was now safe. However, the provider needs to sustain these improvements and ensure they are fully embedded into practice.

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.

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 inadequate (published 12 August 2019) and there were multiple breaches of regulation. 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 improvements had been made and the provider was no longer in breach of regulations.

Special Measures

This service has been in Special Measures since 12 August 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

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.

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

Allingham House Care Centre is a residential care home providing personal and nursing care for up to 86 people. The home is registered to care for both older and younger adults, some with a diagnosis of dementia. One of the units specialises in providing nursing care to people with complex clinical needs and two others cater for people with nursing and residential needs living with varying degrees of dementia. The service supported 76 people on three floors at the time of this inspection, each floor being a separate unit with adapted facilities.

People’s experience of using this service and what we found The systems and governance procedures to report, monitor and respond internally were not in place and deadlines for information from the home were repeatedly relaxed month after month. The new regional manager had no access to historical information relating to the service as none had been recorded on the system. The provider had failed to respond in a timely manner to early warning signs that this service was failing.

People did not receive safe care. People's medicines were not safely managed. We found multiple failings in relation to medicines.

Care plans and risk assessments were not always updated to reflect changes in people’s care needs. We found recording gaps in relation to pressure care, weights, observation and food and fluid charts. Risks to people were not always identified and risk management plans were not in place to manage risks safely.

There was a high use of agency staff in the home, including agency nurses. Staff were not effectively deployed and were not always aware of their responsibilities or peoples current clinical support needs. Elements of staff training were out of date and staff were not always supported through supervisions to ensure they carried out their roles effectively.

People living at Allingham House Care Centre had complex needs. The service could not always assure themselves that agency staff were competent or had the appropriate skills to meet those needs, as employment profiles supplied to the home were very basic.

Pre-admission assessments were not always thorough. Prior to this inspection six people had been admitted to the service during May and June. We saw one pre-admission assessment which had not fully explored the person’s complex needs. Meeting these needs and how this might detrimentally impact on the care of others living at Allingham Care Centre, had not been taken into consideration.

The provider’s quality monitoring systems were ineffective. The provider was not operating an effective system for handling and responding to complaints and proportionate action in response to concerns raised was not taken.

The registered manager was no longer at the service when we inspected. They had submitted an application to CQC to deregister the week prior to the inspection. The previous registered manager had satisfied their regulatory responsibilities as they had reported incidents to the local authority safeguarding team or CQC where required. However, we saw on inspection, these had not always been communicated via the providers internal reporting mechanisms that were in place. Relatives and staff considered that the previous registered manager had not been visible and had not provided adequate leadership and support.

Whilst there were policies and systems in the service these were not reflected in staff practice. People were protected from the risk of infection because staff followed appropriate infection control

protocols.

People had access to healthcare professionals when required to maintain good health.

Following this inspection, the provider worked in partnership with the local authority and the clinical commission group to ensure people were kept safe.

The extensive nature of the breaches of the Regulations we have identified and the impact of these on people living at Allingham House Care Centre demonstrated a failure of leadership and governance at the home at provider level.

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 in December 2016.

This inspection was prompted in part due to concerns received about the safety of people living at Allingham House Care Centre. The concerns reported to us focused on the inappropriate use of restraint when undertaking personal care, unexplained bruising, poor moving and handling and numerous medicine errors due to insufficient numbers of staff and a high usage of agency staff. A decision was made to bring the inspection forward and for us to inspect and examine those risks.

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

Enforcement

We have identified breaches of Regulations in relation to safe care and treatment, person centred care, complaints, staffing, fit and proper persons employed and good governance at this inspection. We placed immediate conditions on the provider’s registration in relation to the management of medicines. In response to urgent enforcement action the provider appointed a person to have oversight and management of all medicines. Additional clinical and care support has been supplied by the provider from other areas of the business. The peripatetic manager is receiving support in order to mitigate the risks we identified on this inspection.

For requirement actions of enforcement which we are able to publish at the time of the report being published 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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

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 timeframe 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 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.

We last carried out an inspection at Allingham House on 19 November 2014. We rated the service as good overall and the service was meeting legal requirements.

Allingham House provides nursing and personal care and accommodation for up to 86 older people, some of whom are living with a diagnosis of dementia. The home accommodates people over three floors with 82 single and two double rooms. There were 85 people living at the home on the day of our inspection.

There was a registered manager in post at the time of this inspection. 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 kept us informed of safeguarding incidents and other notifiable events which had occurred in the home in line with their statutory obligations. Staff were confident in describing the different kinds of abuse and the signs and symptoms that would suggest a person they supported might be at risk of abuse. They knew what action to take to safeguard people from harm. All of the staff received regular training that provided them with the knowledge and skills to meet people’s individual needs in an effective manner.

People’s safety risks were identified, managed and reviewed and the staff understood how to keep people safe. There were sufficient numbers of suitable staff to meet people’s needs and promote people’s safety. Systems were in place to ensure the correct administration of medicines.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the registered manager understood when an application should be made and was aware of the principles of the Mental Capacity Act 2005. Staff sought people’s consent before they provided care and support. However, some people who used the service were unable to make certain decisions about their care. In these circumstances the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were being followed. Where people had restrictions placed upon them to keep them safe, the staff ensured people’s rights to receive care that met their needs and preferences were protected.

The service supported a high number of Jewish people and ensured all meals were Kosher in order to follow their beliefs. The layout of the kitchens supported the preparation and production of Kosher food in conjunction with the Jewish faith. All crockery, tableware and table linen reflected the type of meal being served and this ensured people’s cultural and religious needs were met with regards to the preparation of food.

The environment was designed to enable people to move freely around the floor of the home where they lived. There were lounges and dining areas on each floor of the home and a large activity room on the ground floor, with access to a large secure garden space. These areas were also used to enable people to participate in social events.

People were treated with kindness, compassion and respect and staff promoted people’s independence and right to privacy. Mealtimes were pleasant experiences for people, and those who needed assistance were helped by staff in a discreet and calm manner.

People, relatives and other healthcare professionals involved with the service said that the support staff were caring. On the day of our visits we saw people looked well cared for. There was a relaxed atmosphere in the home. We saw staff engaging with people, speaking calmly and respectfully to people who used the service.

People’s care plans contained mainly clinical information and focused on meeting care needs and dealing with risks. Information about their likes, dislikes and life histories was basic. However staff demonstrated they knew people’s individual preferences and what they needed to do to meet people’s care needs. The people we spoke with who were using the service, and visiting relatives, told us they were happy with the care provided.

Laminated care plan summaries were in all bedrooms. These documents provided care workers with a summary of people’s care preferences including personal care routines, ways of communicating, favourite foods and activities they liked to do.

During our visit we saw examples of staff treating people with respect and dignity. Staff promoted people’s independence by giving them choices. People using the service and their relatives were consulted and involved in assessments, care planning and the development of the service.

There were enough care staff on duty to meet people’s support needs with bespoke staff employed for domestic, housekeeping and activity duties. People’s access to activities was good; we saw some new ideas in the home with regards to activities. The service actively involved and welcomed family members to events held at the home, including a popular bistro evening.

Staff told us that they felt supported by the registered manager. Formal supervisions with staff had not occurred as frequently as stipulated in the company policy, however staff we spoke with felt valued and listened to. Regular team meetings were also held with incentives offered for staff to attend and staff were able to raise any issues or concerns at these meetings. Staff spoke highly of the management at the home.

There were systems in place to monitor accidents, incidents or safeguarding concerns within the home. The registered manager maintained a monthly record about the incidents which had occurred and what had been done in response. Appropriate action had been taken to address issues identified during these audits.

Feedback was sought in resident and relative meetings and used to improve the care. People knew how to make a complaint and complaints were managed in accordance with the provider’s complaints policy. There was an on-going complaint at the time of our inspection and we saw what the registered manager had done to try to resolve this. The service was pro-active in addressing issues raised with them during this inspection.