This inspection took place over two days on 25 and 26 January 2016. The first day was unannounced. This means the manager and staff did not know in advance that we were coming.
Allendale Residential Home Limited (‘Allendale’) is a privately owned residential care home which does not have provision for nursing care. It is on a residential road in Blackley, north Manchester. Accommodation is provided for up to 24 people. At the time of our visit there were 21 people living at the home. There is a small dining room and two lounges, one of which has three tables used for dining.
Since our last inspection a new manager had been appointed in August 2015, who became the registered manager in October 2015. A registered manager is a person who has registered with the Care Quality Commission (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.
At the previous inspection on 2 June 2015 we found that the service was not complying with regulations relating to ensuring the safety of people using the service, particularly in relation to the management of medicines, and also in relation to not reducing risks associated with the premises. We also found breaches of seven other regulations, relating to the need for consent, treating people with dignity and respect, staff training, meeting nutritional needs, providing person-centred care, reporting requirements and governance.
Following the last inspection we gave the service an overall rating of ‘Inadequate’ and placed the service in special measures. This meant we kept the service under close review. We also imposed a restriction to prevent new people coming to live in Allendale without the prior written agreement of the CQC. This restrictive condition remains in place.
At this inspection we found there had been significant improvements regarding the safe handling of medicines. We also found improvements had been made in all the other areas identified in the last report, but room for improvement still remained in some aspects. The overall rating for the service is now ‘Requires improvement’ which means it has been taken out of special measures.
We found that new processes in handling medicines meant the risk of errors had been reduced, and fewer errors had been made. A communication diary was in use which helped to ensure that the correct medicines were available. A daily balance check ensured that any discrepancies could be identified and corrected if necessary. A new audit system was in use and any findings were used to improve the process.
We found one error which concerned failing to ensure medicine was obtained for a person whose prescription had been changed while they were in hospital. We found this was a breach of the regulation relating to the safe handling of medicines. Despite this, the service had significantly improved in this area since the last inspection.
We looked at whether Allendale had appropriate procedures for recruiting staff. Most of the procedures were in place, but the service allowed new staff to start before obtaining a certificate from the Disclosure and Barring Service (DBS). This was a breach of the regulation relating to suitability of staff.
The registered manager and other staff had received training in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). There were forms in use which allowed family members to give consent where a person lacked capacity. This is not the correct process under the MCA and was therefore a breach of the regulation relating to consent.
Staff told us they received regular training but the record of training showed that it had tailed off in the second half of 2015. Supervision was provided regularly and annual appraisals for all staff were taking place in January and February 2016.
We saw that the rating from the last CQC inspection was displayed in the registered manager’s office but not where it was accessible to the people or any visitors to the home. This was a breach of the regulation relating to the requirement to display the results of performance assessment.
Incidents and accidents were recorded but we did not see evidence that accidents were analysed in order to reduce the likelihood of recurrence.
We saw that risks and defects in the premises reported after our last inspection had been rectified. The premises were well maintained and clean. Actions following a recent infection control report were being implemented.
We found that staffing levels were adequate for the number of people and their current needs. The staff had received training in safeguarding and knew how to report any incidents or suspicions. Allendale had made applications for authorisations under DoLS which had not yet been decided by Manchester City Council. We saw the correct process of a best interests meeting had been followed in reaching one decision.
We observed the lunch and saw that it was better organised and calmer than at our last inspection. People were given a choice of food, and told us they were happy with all the meals at Allendale.
People’s weight was monitored and they were referred to dieticians when needed.
We received extremely positive comments from both residents and their visitors about the quality of care at Allendale. There was one exception, but we learnt that the issue the complainant had raised had been dealt with.
We observed that people were treated with respect and good humour. Staff respected people’s privacy and the confidentiality of their personal information.
Allendale was regarded by a community Macmillan nurse, the practitioner of a programme of end of life care, as being a model of good practice in that area.
We found that there were not enough activities and no activities organiser. There were some themed food nights, but people told us there was not enough going on and they got bored watching television. This was a breach of the regulation relating to person-centred care.
We saw that the care files were being updated, and the updated versions were now more person-centred. We found that all the care plans had improved since our last inspection. Keyworkers were reviewing the care plans each month and the registered manager checked to ensure this had been done.
Residents’ and relatives’ meetings were held and the registered manager had an open door policy. We saw there was a complaints policy and complaints were addressed in line with the policy.
Staff were motivated and enthusiastic. They were aware of the previous CQC rating and its consequences. We sensed there was a real team effort to improve the performance of Allendale.
The registered manager made the required notifications to the CQC. She had implemented a full range of audits and we saw that the results of these audits and of audits by the provider were used to improve the service.
In relation to the breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 we found, you can see what action we told the provider to take at the end of the full version of the report.