Archived: Alder House - Care Home Physical Disabilities

Updated 12 January 2023

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 Health and Social Care Act 2008.

This was a responsive inspection to check whether the provider had met the requirements of the Warning Notices in relation to Regulation 12 Safe care and treatment, Regulation 11 Need for consent and Regulation 17 Good Governance.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by two inspectors

Service and service type

Alder House - Care Home Physical Disabilities is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Alder House - Care Home Physical Disabilities is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 24 November 2022 and ended on 15 December 2022. We visited the service on 24 and 28 November and 5 December 2022.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 6 people who used the service and 7 members of staff, including the interim

manager, the regional manager and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We reviewed a range of records. This included 5 people's care records, staff recruitment records and records relating to the premises and equipment. We also spoke on the telephone with 2 relatives of people who lived at the service and sent emails asking for feedback to 6 more relatives.

Updated 12 January 2023

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities which most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Alder House - Care Home Physical Disabilities is a residential care home providing personal and nursing care to 20 people at the time of the inspection. The service can support up to 22 people.

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

Right Support

The model of care and setting did not always maximise people's choice, control and independence.

Not enough improvement had been made to ensure risks to people were assessed, monitored and managed safely. The provider sent us information following the inspection which provided additional assurance that risks were being managed.

Right Care:

Care was not always person-centred. Some staff practices remained task focused and did not enable people to make informed choices or promote independence. There was limited evidence people had an opportunity to pursue goals and aspirations in support plans.

Staff understood how to protect people from abuse.

Right Culture:

The ethos, values, attitudes and behaviours of staff did not always ensure all people using the service could lead confident, inclusive and empowered lives. Staff had not received the required training needed to support people with a learning disability or autistic people.

Systems to obtain people's views were not effective through keyworker meetings and further work was needed to adopt a more person-centred approach to enable people's individual views to be sought.

There was a lack of oversight from the provider regarding quality assurance within the service.

Risks relating to the home environment had not always been mitigated to keep people safe. There was minimal evidence to demonstrate staffing levels on a day to day basis. The manager was not aware of who received 1 to 1 care or if it was being funded. Following the inspection more assurance was provided in relation to staffing levels.

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 requires improvement (published 25 July 2022) and there were breaches of regulation. At this inspection we found the rating remained the same.

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 the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service in May 2022. Breaches of legal requirements were found. We undertook this focused inspection to check to see if they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

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 remained requires improvement. This is based on the findings at this inspection.

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

Enforcement and Recommendations

We have identified breaches in relation to risk, person centred care and governance. Please see the action we have told the provider to take at the end of this report.

Follow up

We have met with the provider following this inspection 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, 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.