Archived: Alness Lodge Limited

Alness Lodge is a residential care home for up to 10 people living with mental health needs. Single occupancy accommodation is provided over two floors; the service does not have a passenger lift. Bathing, showering and toilet facilities are shared.

At the time of this inspection there were nine people living at service and one person was away staying with relatives.

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

The service did not have effective systems in place which sought to protect people from abuse or improper treatment. This exposed people who used the service, and others, to a risk of harm.

The provider considered the majority of people who used the service to be either independent or semi-independent. This meant there was a distinct lack of person-centred care and support. The service did not always provide support to people that was appropriate, met their needs, and reflected personal preferences.

Some people were able to access the community independently and instigate their own social activities, many people were not. There was no evidence of activities organised by the service and people simply spent the majority of their time watching TV in the communal lounge or remaining in their private room, only coming out at meal times.

Potential new admissions into the service were offered an opportunity to participate in trial visits. However, the provider did not complete a specific pre-admission assessment and there was an overreliance on the information provided by other external professionals, some of which was historical.

There was no regular schedule of audit and quality assurance which meant the provider lacked oversight and was reactive, rather than proactive.

Since our last inspection, 14 incidents had been recorded in the accident book, one of which resulted in a serious injury. However, no overarching analysis had been completed to identify themes or trends and action needed to reduce the likelihood of such incidents occurring again in future.

Staff prioritised completing tasks rather than assisting people to be as independent as they could. Staff we spoke with told us they would like to spend more time with individuals, but the daily routine of the home meant this was not always possible.

During this inspection we observed staff speak openly about people's care needs in front of other people. This did not respect their privacy and confidentiality.

People who used the service were from diverse backgrounds and the workforce was reflective of this. However, the provider had no clear philosophy or approach round equality and diversity, and how the needs of people from different backgrounds would be met.

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 requires improvement (published 23 July 2018) and there were 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 insufficient improvements had been made.

Why we inspected:

This was a planned inspection based on the previous rating.

Enforcement:

At this inspection we have identified new and continued breaches in relation to providing person-centred care, safeguarding people from abuse, good governance, and staffing. Please see the action we have told the provider to take at the end of this report.

Follow up:

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 six 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 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.

Alness Lodge Limited is a ‘care home’ for up to 10 people with mental health needs. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. People living at Alness Lodge Limited did not require nursing care.Throughout this report Alness Lodge Limited is referred to as Alness Lodge.

At the time of this inspection there were 10 people living at Alness Lodge, within the age ranges of 33 to 64 years. Alness Lodge is a large, detached house spread over two floors with parking to the front and a large garden area to the rear of the home. The home is situated in the Whalley Range area of Manchester, close to local amenities and public transport routes.

At the time of our inspection 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 2008 and associated Regulations about how the service is run. The registered manager was absent from the service on the days of inspection however we spoke with them over the telephone and dealt with the deputy manager and the owner, who was at the home carrying out maintenance work and checks.

The cleanliness of the home was a cause for concern. Areas of the home were untidy or cluttered and there were recording gaps in all the cleaning schedules we checked. We saw no use of personal protective equipment by staff, such as aprons or gloves. We were not assured that the home was taking adequate measures to prevent and control the spread of infection.

We saw positive practice around how people were supported to manage their risks and move safely around the home. Examples of identified risks were around mobility, medicines, smoking and finances.

People received their prescribed medication when they needed it and appropriate arrangements were in place for the storage and disposal of medicines. However there was no evidence of any checks in place to ensure medicines were stored at a suitable temperature and there were no protocols for ‘as required’ medicines (PRN), as is good practice.

People’s health was monitored as required so appropriate referrals to health professionals could be made. People received regular reviews to check their prescribed medicines were suitable and this promoted good health.

There were enough staff to meet people’s needs. Recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. Staff told us they received training to be able to carry out their role.

People were supported to make their own choices and decisions. Staff sought people’s consent before assisting them with support and people had signed to consent to their care. No one living at Alness Lodge had a Deprivation of Liberty Safeguard (DoLS) authorisation in place. People were able to go out independently and we saw people chose to come and go as they wanted to. Staff had received training on the Mental Capacity Act and described how they helped to promote people’s choices. Staff demonstrated a good understanding of how to protect vulnerable adults.

People living at Alness Lodge were able to develop and maintain social relationships that were important to them. People living at the home spent time together and appeared relaxed in one another’s company. People were treated with care and respect and staff respected the privacy and dignity of individuals.

People engaged in a range of activities, although these were mainly in the community, with no activities being arranged within the home. We observed interactions between staff and people were friendly and staff knew people well. Staff had good relationships with the people living at the home and the atmosphere was happy and relaxed. People were appropriately supported with their nutritional requirements and were encouraged to carry out tasks independently when safe to do so.

People expressed positive views and experiences of the support they received which reflected that their needs had been met. Care plans contained current information about how best to support people and were reviewed every three months, or more frequently if a response to changes in need was required.

There were some checks in place, though these were not always effective when monitoring the quality of service delivery. Policies and procedures were generic and part of a quality management system, therefore not specific to Alness Lodge and practice did not always mirror the policy. We saw the provider had procedures on how complaints should be managed if any were to be received.

People had been consulted about the quality of the service however it was not clear what actions, if any, the service had taken in response to these comments, or if the results of the survey had been communicated back to people living in the home.

Staff spoke highly of the management team and felt well supported by them. Partnership working was evident as the home had established good working relationships with health professionals and local authority representatives. Community links had also been built up and we saw some community ventures advertised around the home.

Alness Lodge is a residential care home providing 24 hour personal care and accommodation for 10 people with mental health needs. The home is situated in the Whalley Range area of Manchester, close to local amenities and public transport routes.

At the time of our inspection 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 2008 and associated Regulations about how the service is run.

We found people’s care plans and risk assessments had not been reviewed in a timely way and we could not establish if the information was still relevant and up to date.

There were enough staff to meet people’s needs. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. Staff told us they received training to be able to carry out their role. However, we noted some staff training had expired. Staff did have the opportunity to attend supervision, but this was not in line with the provider’s procedure. We recommend the provider determines what timescale are appropriate for staff training requirements and how often the management team should carry out staff supervision meetings.

Staff spoke highly of the management team and felt well supported by them. There were checks in place, though these were not always effective when monitoring the quality of service delivery. We saw the provider had procedures on how complaints should be managed if any were to be received.

Staff we spoke with could tell us how they supported people to make decisions but not all staff had received Mental Capacity Act (2005) (MCA) or Deprivation of Liberty Safeguards (DoLS) training. Staff demonstrated a good understanding of how to protect vulnerable adults.

People received their prescribed medication when they needed it and appropriate arrangements were in place for the storage and disposal of medicines. People’s health was monitored as required so appropriate referrals to health professionals could be made.

People’s privacy and dignity were respected. People engaged in a range of activities, both in-house and in the community. We observed interactions between staff and people were friendly and staff knew people well. Staff had good relationships with the people living at the home and the atmosphere was happy and relaxed. People were appropriately supported with their nutritional requirements.

We found a breach 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.

At the inspection carried out in June 2014 we saw some information was difficult to find in the care records we viewed and some information was not included within care plans. We also saw there was no evidence to demonstrate staff had received training in fire safety.

We also found improvements were required in the quality assurance systems at Alness Lodge. We found medication audits and care records audits were not documented, and incidents and accidents were not recorded to enable effective analysis to be carried out.

Following the inspection the provider sent us an action plan which showed us the manager would check medication administration records monthly, audit individual daily notes monthly and records of the audits would be kept to identify any trends. The action plan also showed us the manager intended to create an accident and incident file to monitor trends. In addition the action plan showed us care records would be updated to accurately reflect the needs of people who used the service.

During this inspection we found improvements had been made. We looked at three care files and found two files contained up to date and accurate information regarding people's needs. A third care file required further information to ensure staff were able to access written information regarding a person's needs. The manager assured us they would address this.

We saw a medication audit had been introduced and individual daily care notes were checked to ensure entries contained an accurate reflection of people's day to day activities and the care and support they received.

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

During the inspection we spoke with four people who used the service, three relatives, three care staff, the registered manager and the deputy manager of the home. Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

Is the service caring?

We spoke with four people who used the service who all told us they liked living at the home and they were treated well and supported to do the things they liked to do. We also spoke with three relatives who told us they were happy with the care and support the staff provided to their family. Some comments included; "It's good care here. (My family member) is really well now", "I'm being really honest, it's a lovely home." and "I'm absolutely delighted with the care." We saw staff were patient and kind. Our observations and the comments from people we spoke with showed us people were treated with empathy and dignity by the staff.

Is the service safe?

The people we spoke with us told us they felt safe.

On the day of our inspection we found staff were knowledgeable of the procedures to take if there was an emergency such as a fire or health emergency. However we noted there was no documentary evidence to show us when staff had last received fire training, and some information was sometimes difficult, or not present in care records. We discussed this with the manager who acknowledged this was the case and informed us this would be amended. We considered improvements were required in this area.

We also checked whether improvements which were required from our last inspection had been carried made. On the day of our inspection we saw there were sufficient staff on duty to support people in the way they had agreed and the staff we spoke with were knowledgeable of the action to take if they were concerned a person was at risk of harm and abuse. People told us they felt safe and there needs were met in a timely manner. Comments we received included; 'I sleep well here because I am safe' and 'If I need any help, they are there straight away.'

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. At the time of our inspection there were no applications in place as these were not required.

Is the service effective?

We saw people who lived at Alness Lodge had received support from other health professionals as required and this was recorded within the care records. The people we spoke with were positive about their experiences at Alness Lodge. Comments we received included; 'When I came here I was really ill, but they've made me better.' and 'I've improved no end since I came here.' We spoke with three staff members who were knowledgeable of the care and support each person needed and could also describe people's individual likes and dislikes. Our observations and the comments from people we spoke with showed us the service was effective when meeting people's needs.

Is the service responsive?

The service had systems in place to ensure people were regularly consulted about their views and ideas on how the service should be run. This was done by means of regular discussions with people, meetings and satisfaction surveys. The people we spoke with told us they were consulted and the management of the home listened to their views.

We saw records that showed us regular environmental audits were carried out and we saw refurbishment had taken place in some areas of the home to ensure people had facilities that met their needs.

Is the service well led?

We discussed other audits with the manager. The manager told us audits such as records, medication and incidents and accidents were carried out but these were not recorded. We considered the audit systems in place required improvement to enable the manager to review the information the audit contained and identify and respond to any shortfalls noted.

People told us that 'Things are good here, I like living here because the staff listen to me', 'Staff speak nicely to me' and the staff were 'very good'.

Staff spoken with were aware of people's individual needs and provided care according to their care plans. We saw involvement of other professionals, such as doctors, district nurses or a chiropodist.

Although people told us they enjoyed their meals they sometimes experienced lack of support during meal times.

We found that improvements are needed to the way in which incidents and safeguarding matters are managed.

We found that improvements are needed to the way staffing levels are planned and implemented for the service.

People living in Alness Lodge were provided with information about how to raise a concern or complaint. Details of how to contact the local authority were also made available.