Background to this inspection
Updated
29 February 2020
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by one Inspector and one Expert by Experience (ExE). An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. Their area of expertise was 'older people'. There was also an on-call pharmacist to support with medicines.
Service and service type
Alton House is a ‘care home’. 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.
The service had two managers registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced and took place on 07 January 2020.
What we did before the inspection
Before the inspection we reviewed the information we held about the service and the service provider. We looked at the notifications we had received for this service. Notifications are information about important events the service is required to send us by law.
We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give 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 used all this information to plan our inspection.
During the inspection
We spoke with seven people using the service, and four relatives. We also spoke with 10 members of staff including the two registered managers.
It was not always possible to speak to everyone and ask direct questions about the service they received because of people's cognitive impairments. However, people could express how they felt about where they were, the care they received and the staff who supported them through non-verbal communication. We observed interactions between staff and all the people using the service as we wanted to see if the service communicated and supported people in a way that had a positive effect on their wellbeing.
We reviewed six people's personal care records, one staff record, staff rotas, medicine administration records and other records relating to the management of the service such as health and safety records and training records.
Updated
29 February 2020
About the service
Alton House is a care home, providing accommodation and support for up to 23 older adults including people who may have a diagnosis of dementia. At the time we inspected, there were 15 people living at the service.
People’s experience of using this service and what we found
Risk assessments and the management of medicines were inadequate and did not support staff to ensure people received safe care. People told us they felt safe; however, the systems in place did not always protect people from abuse and harm.
Staff did not receive an adequate induction or relevant, up to date training to ensure they could provide effective care. 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; the policies and systems did not support this practice. We found the service did not always act in accordance with the requirements of the MCA. The service did not always work well with other health and social care professionals and people’s mealtime experience was not entirely positive.
A recommendation was made to ensure the service worked more closely with other health and social care professionals. We also recommended the service review people’s experience at mealtimes.
People were not always treated in a kind and dignified manner. The service lacked a consistent approach to people being involved in the care and support they received.
We recommended the service provide care and support that ensures people are treated with dignity and respect. We have made a recommendation about involving people in decisions about their care
Care plans remained inconsistent and did not always guide staff to provide person-centred care. People were at risk of social isolation and did not engage in community activities. The service did not produce care related documents in a format that people receiving care could understand.
The quality assurance systems were inadequate as they had not identified the shortfalls we found during our
inspection and did not ensure people were always kept safe. We found the service failed to demonstrate they were providing care and support that was safe, caring, effective or responsive. This put people at continued risk of harm.
There were enough staff to meet people’s needs, and staff had been recruited in a safe manner. The service was clean, well maintained and managed infection control well. Lessons were learnt from accidents and incidents to keep people safe in the future.
The home had been designed and adapted with people’s needs in mind. People were assessed prior to moving into the home and supported to settle and feel welcome. Staff told us they felt supported by their managers and received regular supervision. People’s independence was encouraged, and the service promoted a culture and equality and diversity. The systems in place to manage complaints and end-of life care were sufficient.
Rating at last inspection
At the last inspection the service was rated Requires Improvement (Published 25 September 2019) and there were five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was rated ‘Inadequate’ in ‘Safe’ and remained in Special Measures.
This service has been in Special Measures since 15 October 2018.
During this inspection the provider did not demonstrate that improvements have been made. The service is rated as inadequate overall and in the Safe and Well-Led key questions. Therefore, this service remains in Special Measures.
The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of some regulations.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
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.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Alton House on our website at www.cqc.org.uk.
Enforcement
We have identified breaches in relation to safe care and treatment, safeguarding service users from abuse and improper treatment, staffing, need for consent, person-centred care 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 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.
The overall rating for this service is ‘Inadequate’ and the service remains 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.
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.