Allambie House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Allambie House provide accommodation and personal care for up to 30 older people. This can be people who have a learning disability, physical disability, live with dementia or sensory impairment. At the time of our inspection visit there were 21 people living in the home. The inspection visit took place on 23 and 26 January 2018, both visits were unannounced.
When we last inspected the home on 19, 21 July 2017 and 21 August 2017 we found improvements were required in all key questions. There were four breaches in the regulations and the provider was rated as ‘Inadequate’ and was placed in Special Measures. We added a condition to the provider’s registration so that they were not able to admit further people to the home until improvements were made.
Following the last inspection, we asked the provider to complete an action plan to show what they would do, and by when, to improve the key questions Safe, Effective, Caring, Responsive and Well Led.” We also met with the provider who confirmed the actions they planned to take to ensure the home improved.
During this inspection, we found sufficient action had been taken to address three of the previous breaches in the regulations and to improve so that the home was no longer rated inadequate. However, there continued to be areas needing improvement, including person centred care, which we identified as a breach in regulation 9. We also found there were some risks associated with people’s care which meant there was a continued breach of regulation 12. Action was ongoing by the provider to areas of improvement we identified.
The registered person (provider) had been in post since June 2016. The manager in post at our previous inspection had since left and a new manager appointed. They had submitted their application to register with us. Following our inspection visit, we were told the application had been approved. 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 provider’s recruitment system required a series of checks to be made before new staff could work with people at the home. People told us they felt safe living at Allambie House and spoke positively of the staff team that supported them. They told us staff were caring and approachable and we saw enough staff to support people’s needs.
We had been notified of reportable accidents and incidents as required. This included incidents related to safeguarding people from potential risks to their health and safety.
Risks associated with people’s care were not always sufficiently detailed in care plans to ensure these were managed safely by staff. Information in care plans was also limited in regards to people’s backgrounds and interests to assist staff in providing person centred care. Some people told us they wanted more opportunities to go out of the home and to participate in activities that were of interest to them. Where people had identified healthcare needs, sometimes records didn’t support staff to help ensure they effectively addressed them.
Staff who administered medicines had completed the necessary training to do this safely. However, we found medicine records were not consistently completed to show that creams and lotions had been applied as prescribed.
People were positive about the food provided and a daily choice was provided. Staff knew about people’s nutritional needs and took advice from health professionals when required. Staff told us they arranged for people to see a doctor when they needed one and people’s healthcare records confirmed visits undertaken.
There continued to be gaps in staff training but staff were working through e-learning (computer based) training to update this. The manager had started to hold supervision meetings with staff to talk about their training and development needs. Staff had some understanding of the Mental Capacity Act and knew to ask for people’s consent before delivering care. However, records were not clear in determining if people had capacity or not when decisions about their care needed to be made. Deprivation of Liberty Safeguard applications had been made to the local authority for consideration.
Staff had completed training in infection control and wore gloves and aprons when supporting people and carrying out their work to help prevent the spread of infection.
The provider had implemented some quality monitoring processes to assess the quality and safety of the service. There had been no recorded complaints since our last inspection visit and people told us they knew who to raise concerns with if they needed to.
Staff told us they felt valued by the manager and provider and were happy working at the home. They spoke positively of the improvements made at the home since the last inspection visit.
The provider had continued to make improvements to the environment and these were ongoing including the refurbishment of all bathrooms. A maintenance person carried out Health and safety checks of the building to ensure this was safe.