Archived: Alsager Court Care Home with Nursing

This focused inspection took place on 24 October 2016 and was unannounced.

We previously carried out an unannounced inspection of this service on 7 December 2015 and 11 January 2016. After that inspection we received concerns in relation to the standard of care, specifically about the use of agency staff and their knowledge of people’s needs, the appropriate management of risk and safeguarding the people who lived at the service. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those concerns. You can read the report from our last inspection, by selecting the 'all reports' link for Alsager Court on our website at www.cqc.org.uk.

Alsager Court Care Home with nursing is part of the Blanchworth Care group and is registered with the Care Quality Commission (CQC) to provide accommodation and personal care with nursing for up to 27 older people. During the inspection there were 21 people living at the service, including one person who was in hospital.

There was a registered manager in post at the time of our 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.

Overall we found that people were comfortable and at ease in the home's environment. The people and relatives’ who were able to speak with us provided positive feedback. We found that the registered manager understood her responsibility to identify and report any suspicion of abuse. Where necessary she had taken appropriate action to protect people so that their safety was maintained.

We found that there were sufficient staff to meet the needs of people living at the home. The registered manager was knowledgeable about the people living at the home and used this knowledge to determine staffing levels, although there was no specific tool that was used for this purpose. Therefore we recommend that a suitable staffing tool is sourced and utilised, to ensure a systematic approach to determine the number of staff and range of skills required to meet people’s needs.

The level of agency staff being used by the home had recently increased. The registered manager demonstrated that she was actively recruiting new staff and there were people in the recruitment pipeline awaiting appropriate recruitment checks. Agency staff were given information about people’s needs but we found that this information needed to be more robust and consistent. The registered manager was already in the process of re-instating care folders which would contain a one page profile of people’s needs.

People’s care records contained a number of risk assessments according to their individual circumstances including risks of pressure ulcer, falls, weight loss and bedrails. Risk assessments identified actions were put into place to reduce the risks to the person and were reviewed regularly. We specifically looked at the risks to people around maintaining a safe environment to ensure that staff used the safest procedures when supporting people. Staff were required to carry out frequent monitoring checks for some people. Staff were required to sign charts which indicated when they had carried out these checks. We found that the monitoring records were not entirely accurate all of the time, although people were monitored on a regular basis. We recommend that staff should accurately record the time of any observational checks, so that these correctly reflect the times that the observations were carried out.

Care plans provided detailed and updated information about people’s care needs. However in one case we found that some aspects of the care being provided had not been detailed fully in the care plan.

We could not improve the rating for safe from requires improvement because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection

Alsager Court Care Home with nursing is part of the Blanchworth Care group and is registered with The Care Quality Commission (CQC) to provide accommodation and personal care with nursing for up to 27 older people. During the inspection there were 12 people living at the home on the first day and this had increased to 14 on the second day.

The home provides care in a large single storey bungalow in its own grounds in a residential area of Church Lawton near Alsager. All of the rooms are single and 16 of them have en-suite facilities.

At the time of the inspection the home did not have 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 home had a manager in place, but had not yet registered with CQC, the manager told us that they were in the process of applying to become registered.

At the last inspection in May 2015 we found that a number of improvements were needed and breaches of the Health and Social Care Act 2008 had been identified regarding person centred care, dignity and respect, need for consent, safe care and treatment, safeguarding service users, meeting nutritional needs, premises and equipment, good governance and staffing. The provider was placed into 'Special measures' by CQC in relation to these breaches. The purpose of special measures is to ensure that providers found to be providing inadequate care, improve significantly. They provide a framework within which we use our enforcement powers in response to inadequate care and work with or signpost to other organisations in the system to ensure improvements are made. They provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further actions, for example cancel their registration.

During this inspection we saw that improvements had been made in relation to staffing, person centred care, meeting nutritional needs, need for consent, dignity and respect and safe care and treatment. However, there remained concerns in relation to safeguarding service users, premises and equipment and good governance. You can see what action we told the provider to take at the back of the full version of this report.

People told us that they felt safe and well cared for. We saw there were sufficient staff to meet the needs of the people living at the home. Staff were knowledgeable about people’s needs and the home was no longer dependent upon agency staff. People received their medicines in a way that protected them from harm. However, we found that safeguarding procedures were not always followed and records were not always kept to demonstrate that action had been taken to protect people from harm.

Some improvements had been made to the environment and work had been carried out to ensure that there was an adequate hot water supply and that the fire safety regulations were met. Further work was required to ensure that recommendations made by the infection control team were fully carried out, including improvements to the cleanliness of some parts of the home.

Improvements had been made to the way that people were supported with their food and drinks. People were offered a choice of meal and staff had enough time to support people at meal times.

We found that improvements had been made to how a person’s mental capacity to consent to care and treatment had been assessed and documented. Best interest decisions had also been made and recorded where appropriate. Applications had been made to the supervisory body under the Deprivation of Liberty Safeguards, to ensure that people’s rights were protected. However further improvements were required to ensure that all staff had a full understanding of this process.

People were treated with dignity and respect. Staff were kind and caring in their approach to people living in the home. Improvements in staffing meant that people’s needs were met in a timely manner which promoted their dignity. Records were kept securely.

Improvements had been made because an activities coordinator was now in post and activities were being offered to people throughout the day and stimulation was being offered to people on a one to one basis. Care plans were reflective of people’s needs and were updated on a regular basis.

People knew how to make a complaint and the complaints procedure was available however we found that the system for recording and dealing with complaints needed to be improved.

There was a manager in place, but the manager had not yet registered with CQC.

People and staff told us that improvements had been made at the home over the past few months. The manager had been focused on improving the standards.

The system in place for monitoring the quality and safety of the service was not robust enough. We were unable to see that regular audits were being carried out on a routine basis. Notifications to CQC had improved but further improvements were required to ensure that these were received consistently.

During our inspection we spoke with the service quality manager, acting manager, deputy manager, two staff, five relatives and nine people who used the service.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

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.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Policies and procedures had been developed by the registered provider (Blanchworth Care) to provide guidance for staff on how to safeguard the care and welfare of the people using the service.

The acting manager demonstrated awareness of the Mental Capacity Act and the circumstances when it was necessary to apply for authorisation to deprive a person of their liberty and to ensure the correct safeguards were in place.

We noted that since our last inspection the provider had invested in the home to enhance the environment for the people using the service. For example, we noted that the carpets had been replaced in all communal areas (except for the lounge which was due to also be replaced); caution signage had been placed in areas where there were rises and falls in the floor levels; all communal areas had been redecorated; the heating and lighting had been improved (although it should be noted that we visited on a warm bright summer’s day) and problems associated with dampness, ventilation and hot water supply to bathroom areas had been rectified.

We identified some outstanding work that required attention and raised these issues with the management team so they could take action. We received confirmation following our visit that action was in the process of being taken to address these issues. This will help to further improve the standard of accommodation provided to people using the service and help to safeguard the welfare of people living at Alsager Court.

Is the service effective?

On the day of our inspection the atmosphere in the home was relaxed and sociable. We observed staff carrying out their duties and responsibilities in a relaxed and positive manner. Staff were seen to be sensitive to the needs of the people using the service and were attentive to their individual needs.

At the time of our inspection the home had 21 service users. The acting manager told us that staffing levels varied subject to occupancy levels and the needs of the people using the service.

The service utilised a care staffing tool to assist in monitoring the dependency levels of the people using the service and the staffing hours required to meet their needs. This was based upon staffing guidance issued by the Residential Forum 2002.

Is the service caring?

People who were able to discuss arrangements made for their care told us that they were generally satisfied with the service. A programme of activities was displayed in the reception area for people using the service to access. No activities took place on the day of our inspection. We were told that this was because the activities worker was off work that day.

Comments received from people using the service included: "I’m happy enough and the care is good”; "The activity girl does her best” and “It’s much nicer since they decorated. It’s brighter and cleaner. Most residents reported that “Yes I am treated with respect” however two people reported that “The staff do not knock before entering our room.”

Likewise, feedback received from relatives included: “She gets very confused but they know how to support her”; “We are very happy with the care. There are no problems. They know what she likes” and “Staff are hardworking and try their best but they are under pressure at times as these people can be difficult to support.”

Is the service responsive?

We looked at the personal files of three people who lived at Alsager Court during our site visit and found copies of assessment and care planning information that had been developed and produced by the provider.

A range of supporting documentation including: mental capacity assessments; best interest checklists; body charts; risk assessments; daily records of care; handover sheets and other records were also available to refer to. Care plans had been kept under monthly review and had been subject to a programme of audits by the provider.

Care plans viewed lacked background information and personal details of people using the service. Plans viewed were also clinical and task orientated and did not take into consideration the person’s view or how they wished to be cared for. Examples were discussed with the management team so that they could take action to develop person centred care planning.

Is the service well- led?

The service had an acting manager in place to provider direction and leadership to the staff team. At the time of our inspection the manager had not registered with the Care Quality Commission and they confirmed that they would take action to do this as a matter of priority.

A range of internal auditing systems have been established to enable the provider and acting manager to maintain an overview of the service. Likewise, the provider had systems in place involve and obtain feedback from people using the service and / or their representatives and staff.

Periodic monitoring of the standard of care provided to people funded via the local authority is also undertaken by Cheshire East Council’s Quality Assurance Team. This is an external monitoring process to ensure the service meets its contractual obligations and safeguards the welfare of people using the service.

We were told by the manager that there was no recognised guidance or standards of good practice for dementia used at Alsager Court. The training provided to all staff was provided by ‘Social Care’ that is an e-learning programme. Looking at training records the training was provided every three years.

We observed how people were cared for and supported. We saw that staff interacted positively with people. When staff offered people drinks and snacks, they took the opportunity to chat with them about a topic that the person was clearly interested in.

The layout of the rooms and corridors provided was the same throughout as the rooms were all on the ground floor on one level. The corridors were dark, with uneven flooring and with poor lightening that made it difficult for people to see the signage to warn them about the uneven surfaces. On the day of our visit people took part in a couple of activities. However for the majority of the time people were left sitting in the lounge with little staff interaction.

The three staff we spoke with told us they liked working at the home. They told us they were not trained in dementia care. They said, “We care about the residents but it’s difficult at times” and “I need to have updated dementia training so I can respond more effectively and inform other staff.” The provider sent the CQC a training matrix informing the CQC that staff had received e-learning dementia training.

The provider had a quality monitoring system that included asking people and their relatives, what they thought about the service. We were not able to access the findings of the last quality monitoring audit.

People experienced care, treatment and support that met their needs and protected their rights, through good care planning and risk assessment. One relative said, "I think that the care is generally good. I have every confidence in the manager."

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening through regular staff training and a clear policy.

We found that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. One close friend said, "The staff have been so kind."

We found that the provider had an effective system to regularly assess and monitor the quality of service that people receive and to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.