During this visit we checked what progress the service had made to the compliance action's we made in November 2013 about care practices. This was because at the last inspection we found medicines were not being managed in the right way and records were not completed and reviewed in a timely manner. The provider wrote to us outlining what actions would be taken to put this right. Since the last inspection the provider had put systems in place to try to address the problems with medication, but there were still issues with recording and quantities. We found some improvement in record keeping such as care plans were starting to be reviewed monthly, body maps and the Malnutrition Universal Screening Tool (MUST) scores were now completed and behaviour that challenges care plans were now in place. Although records were kept in a filing cabinet, this was not locked and daily care records (room records) were not always completed.
The inspection was conducted by one inspector. During the inspection, we spoke with nine people out of 46 people living at Allington House, three relatives, the manager and five staff. We looked at five sets of care records. We also observed care practices within the home.
The manager at the home was new to post and was creating a positive environment for people and staff. Staff spoke highly of their manager and the support which they received.
We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?
Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.
Is the service safe?
Everyone we spoke with told us they felt safe and secure living at the home. Staff we spoke with understood the procedures which they needed to follow to ensure that people were safe. Allington House was clean, hygienic and well maintained. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.
The registered manager sets the staff rotas, they took people's care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people's needs are always met.
Recruitment practice was safe and thorough. There has been a high turnover of staff recently and two qualified members of staff had been suspended. The manager used agency staff but was trying to keep to the same agency and staff for consistency. They were recruiting new staff and where staff had been sourced, they were awaiting the appropriate Disclosure and Barring Service (DBS) checks. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Whilst no applications had been submitted to the local authorising authority, the home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards and there was evidence to show that this had been followed appropriately.
Care plans and risk assessments were in place and updated on a regular basis. We found that not all care plans were person centred and did not detail what the person could do independently or the assistance that was needed from staff.
Staff we spoke with during the inspection were very knowledgeable about the people they cared for. Staff we spoke with were aware of risk management plans that had been written for people with particular needs.
Systems were in place to record events such as accidents and incidents, concerns, whistleblowing and investigations. The provider may wish note that there was no system in place to learn from such events.
Is the service effective?
Everyone had their needs assessed and had individual care records which set out their care needs.
It was clear from our observations and from speaking with staff that they had a good understanding of the care and support needs of people living at the home and that they knew them well. Assessments included physical and social assessments, nutritional assessment, moving and handling assessment and continence assessments. These assessments were reviewed monthly.
People spoke highly of the staff and said that they were happy with the care that had been delivered and their needs had been met.
People had access to a range of health care professionals some of which visited the home and all was documented in the care files.
Is the service caring?
People were supported by kind and attentive staff who showed patience and gave encouragement when supporting people, whilst helping them to remain independent.
People told us that they were happy with the care and support provided to them.
People who used the service and their relatives, had not completed an annual satisfaction survey since February 2013. Therefore they did not have up to date information on any shortfalls or concerns. The manager stated she was going to arrange for a survey to be sent out within the next few weeks.
Is the service responsive?
There was evidence contained within people's care plans to show how they worked with other health and social care professionals.
People told us that they knew how to make a complaint if they needed to.
Discussion with the manager during the inspection confirmed that any concerns or complaints were taken seriously. We did see a complaints policy and there was a file for complaints, but no complaints were filed. The manager stated that there had been complaints but they must have been misfiled. We did not see evidence of complaints on the day of our visit.
Is the service well-led?
There were systems in place to assure the quality of the service they provided. Actions were put in place when needed but these needed to be more robust to include dates and names of who was to be responsible for completing them.
Regular audits were carried out which were used to identify changes and improvements to minimise any risks to people and staff. The regional quality assurance manager also completed a monthly audit. Due to the new manager being in post for only about seven weeks and a high use of agency staff some audits such as the medication audits and daily audits had not taken place.
Staff were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and were knowledgeable about people's needs. This helped to ensure that people received a good quality service at all times.
What people said:
People who were able to express their views told us they were satisfied with the care and support they received. One person told us, "I have been here one year eight month and I have settled in lovely," another said, "Staff are very nice, lovely carers.' And another said 'The staff are very friendly, I call them my friends, they do their best for you.' One person we spoke with said 'Some staff are okay, some are not, they are just bits of kids.'
Staff told us they enjoyed working at Allington House. Staff spoke highly of their team and of their manager. One staff member told us, "I have recently seen a lot of changes for the better.' Another told us, "My manager is the 19th manager I have had since starting, I can go to her about anything, I feel I get all the support I need.' And 'It is the best home I have ever worked in.' Also 'The manager listens to me, I feel supported.'
Relatives and friends of people who used the service said 'When X came into the home she could not walk or feed herself, now she is fully mobile and has no problem feeding herself.' And 'We could not have picked a better place.'