Archived: Alphington Lodge Residential Home

Updated 25 May 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 21 February 2017 and was unannounced. It was carried out by two adult social care inspectors.

Before the inspection we reviewed the information we held about the service. This included previous inspection reports, statutory notifications (issues providers are legally required to notify us about), other enquiries received from or about the service and the Provider’s Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and the improvements they plan to make. The provider also sent us a range of documents and information relating to their recording and monitoring processes and how they monitored the quality of the service.

During the inspection we spoke with the provider, registered manager, deputy manager and six members of staff including the cook and activities organiser. We also spoke with six people using the service and observed lunch in both dining rooms. After the inspection we spoke with one relative and also a number of health and social care professionals and local authority commissioners.

We looked at records relating to the care of people living in the home including four care plans, medicine administration records, staff recruitment and staff training records. We also looked at records relating to the safety and maintenance of the home including fire safety records.

Updated 25 May 2017

This inspection was unannounced and took place on 21 February 2017. The inspection was carried out by two inspectors. The service provides accommodation and personal care for up to 28 older people. At the time of this inspection there were 22 people living there.

There is a registered manager in post. At the time of this inspection the registered manager also managed another home another home owned by the providers and split their working week between the two homes. A trainee manager was employed on a full time basis to support the 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 last inspection of the home took place on 12 and 15 January 2016 when the service was rated as ‘requires improvement’. There was one breach of Regulation 12 of the Health and Social Care Act: Safe care and treatment. We found that risks to people's health and safety were not managed effectively, some aspects of medicine administration and recording were potentially unsafe, and daily reports did not always show that care had been carried out in accordance with each person's agreed plan. We also found that safe recruitment procedures had not always been followed. We recommended the provider looked at guidance and best practice in respect of quality monitoring and audits to ensure these were used effectively to improve the quality of care and support. At this inspection we found these issues had not been fully addressed. We also found further breaches of regulations.

Before this inspection we received concerns from a number of sources relating to various issues including low staffing numbers and allegations that incidents of abuse had been reported to a member of the management team but had not been investigated or acted upon. We passed these allegations of abuse to the local authority safeguarding team for investigation and we heard shortly afterwards that a member of staff had been dismissed for poor conduct during handover sessions. However, during this inspection we found that the provider had not carried out any further investigations into the alleged abuse to find out why the matters had not been taken seriously as soon as they had been reported. This meant the provider had failed identify failings in their safeguarding systems or take actions to improve them. The local authority safeguarding team also shared with us further concerns they had received and investigated, including concerns about end of life care, prevention of pressure sores, and the prevention and management of falls.

Before this inspection we had passed concerns relating to low staffing levels to the provider. We asked them to investigate the concerns and to provide evidence to show how they determined safe staffing levels, which they did promptly. They told us they had increased the staffing levels as a result of their findings. At the time of this inspection they were in the process of recruiting new staff. However, we found staff rotas had at times been poorly managed. Staff rotas for the week of our inspection showed unfilled shifts leaving short notice to obtain cover from agency staff or from the existing staff team. We heard of recent occasions when staff had arrived on duty to find shifts had not been covered, leaving them short staffed. When this had occurred staff told us they had managed to complete all essential tasks, but it had been difficult.

Before the inspection some staff told us they did not always feel well supported. Staff meetings had been held in recent weeks to enable staff to raise concerns and issues and some staff told us they felt things were improving. However, professionals who visited the home regularly told us that communication systems were sometimes poor resulting in messages not always being passed on or acted upon.

While most medicines were stored, administered and recorded safely we found records of creams and lotions contained unexplained gaps. This meant there was insufficient evidence to show that staff had followed instructions issued by medical professionals for the prevention or treatment of skin problems such as pressure sores. At the time of this inspection one person was suffering from a pressure sore. After the inspection we received information to show they had taken prompt action to address this concern.

The provider had failed to fully address issues found at the last inspection relating to safe recruitment procedures. Their recruitment procedures had improved by ensuring Disclosure and Barring Service checks had been carried out before new staff began working in the service. This ensured the applicant did not have serious criminal convictions and had not been barred from working with vulnerable adults. However, they had failed to ensure they had received references that provided evidence of satisfactory previous employment conduct, or evidence of the applicant’s trustworthiness, honesty or suitability for the post. We looked at three recruitment files and found that no references had been obtained for two members of staff, and in one instance the references had not been received until many weeks after they had begun working in the service. The provider amended their recruitment procedures during the inspection and gave us assurances that references will be obtained before new staff are employed in the future.

People’s legal rights were not fully respected and protected. Staff had received training on the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) but did not fully understand how this should be applied. Care records contained some evidence that people’s capacity to make decisions had been considered. However, the records did not show that the service had assessed people’s capacity to make specific decisions in line with the mental capacity act or that a best interest process had been followed

Before this inspection we received concerns relating to poor end of life care. During the inspection we found that staff had not received training on end of life care. There had been poor communication with the local community nursing team which meant that guidance provided by the community nursing team had not always been followed or acted upon promptly.

The provider and registered manager carried out checks and audits to make sure the service was running smoothly. Where they had identified problems they had taken measures to improve the service However, these measures had not been fully effective and had failed to ensure that issues found at the last inspection had been fully addressed.

During our inspection we saw that people were relaxed with staff and enjoyed some laughter and banter. Comments included, “I’m quite happy. The staff are excellent. They always help if they can and are kind, but they’ve got a lot to see to.” “They [staff] always ask if there’s anything they can do to help”. “A lot of them are really caring, I think they do treat me with respect”. A relative told us “We are very happy with (the service)”.

We found three breaches of the regulations. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.