The Care Quality Commission
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  • Care home

Alpha Community Care

Overall: Requires improvement read more about inspection ratings

Green Tiles, 5 Green Lane, Stokenchurch, High Wycombe, Buckinghamshire, HP14 3TU (01494) 482229

Provided and run by:
Alpha Medical Care Limited

All Inspections

4 July 2019

During a routine inspection

About the service:

Alpha Community Care (Green Tiles) home was providing personal care for four adults with learning disabilities at the time of the inspection. The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service:

Risks to people's safety and well-being were not always managed through a risk management process. One person’s risk assessment plan was not followed, putting the person at risk of harm.

Systems to ensure people were protected from the risk of infection were not always effective. Areas of the home were damaged, making it difficult to clean effectively. Dirt had accumulated, and some areas were mouldy. This presented a risk of infection.

The provider had quality assurance systems in place to monitor the quality and safety of the service. However, these systems were not always effective. The systems had failed to identify our concerns relating to risks and, although most of the infection control concerns had been identified, little or no action had been taken.

People living at the home received safe care from skilled and knowledgeable staff. Relatives told us they felt people were safe. Staff understood their responsibilities to identify and report any concerns. The provider had safe recruitment and selection processes in place. There were sufficient staff deployed to meet people's needs. Medicines were managed safely, and people received their medicines as prescribed.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the procedures in the service supported this practice. People were supported to maintain good health and to meet their nutritional needs.

Relatives told us staff were caring. Consistent staffing enabled people to receive good care from staff who knew them well. People had access to a variety of activities to prevent social isolation. However, activities could be improved and be more linked to people’s interests and hobbies. The registered manager was taking action to address this.

The service had a clear management and staffing structure in place. Staff worked well as a team and had a sense of pride working at the service.

Rating at last inspection:

At our last inspection we rated the service Good. Our last report was published in November 2016.

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Enforcement:

We have identified three breaches in relation to risks to people, infection control and quality assurance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up:

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

3 November 2016

During a routine inspection

This inspection took place on 3 November 2016. It was an announced visit to the service. This meant the service was given 24 hour notice of our inspection. This was to ensure staff were available to facilitate the inspection.

Alpha Community Care is a care home which provides accommodation and personal care for up to four people with learning disabilities and complex needs such as autism.

At the time of our inspection there were four people living in the home. There was a registered manager in post. 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 was previously inspected in October 2015 and given a “Requires improvement” rating. A focused inspection was carried out in May 2016 to check if requirements made at the inspection in October 2015 had been met. We found improvements had been made, sustained and further improvements were planned.

At this inspection we found the improvements to the service were sustained and the home provided safe, effective, caring, responsive and well led care for people. Relatives were happy with the care provided. They described staff as kind, caring and responsive to people.

Systems were in place to safeguard people. Risks to people were identified and managed which promoted people’s safety. Systems were in place to promote safe medicines practices.

People had care plans in place which outlined the care and support they required. They were updated in response to people’s changing needs. Relatives contributed to the development and review of people’s care plans to promote safe and consistent care.

Staffing levels had increased and people had better access to regular activities.

Staff were suitably recruited, inducted, trained, supervised and supported. This enabled them to have the right skills and training to support people effectively.

Relatives were aware of the complaints procedure and knew how to raise concerns. Relative meetings took place which provided them with the opportunity to be involved in the development of the service. The registered manager and the provider audited the service to satisfy themselves the service was running effectively. Actions were taken to address issues found.

The registered manager was accessible, approachable and supportive. Relatives were positive about the registered manager and the changes that had taken place. They described the registered manager as, “Very skilled in what they do, they lead the team and staff respect and listen to them”.

Staff felt the home was well managed. They described the registered manager as knowledgeable, professional, organised, brilliant leader, friendly, polite, listens, helpful, understanding, supportive and committed to providing the best care for people.

The registered manager was a positive role model to staff. They were instrumental in bringing about many improvements to the service to provide a homely person centred service to people. They had trained and supported staff and is skilled, knowledgeable, motivated and committed to providing good quality care to people.

11 May 2016

During an inspection looking at part of the service

The inspection took place on the 11 May 2016 and was announced. This meant the provider was given notice that we were coming. The inspection was a focused inspection to follow up on the requirements made at the previous inspection on the 14 and 15 October 2015 where we found the provider was in breach of two regulations of the Health and Social Care Act 2008.

This report only covers our findings in relation to this inspection and does not change the overall rating of “requires Improvement” which was determined at the October 2015 inspection. You can read the report from that inspection, by selecting the 'all reports' link for ‘Alpha Community Care’ on our website at www.cqc.org.uk’.

Alpha Community Care is a care home which provides accommodation and personal care for up to four people with learning disabilities and complex needs such as autism. At the time of our inspection there were four people living in the home.

There was a registered manager in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At this inspection we found those requirements had been met. Staff involved people in their care and were enabling and encouraging. Risks to people, including infection control risks were identified and managed. Systems were in place to ensure the home was suitably maintained and plans were in place to continue to improve the environment.

The registered manager and provider were clear of their responsibilities to make notifications to the Commission and had completed the required notifications. The registered manager was committed and motivated. Improvements had been maintained and further improvements were planned.

14 and 15 October 2015

During a routine inspection

Alpha Community Care is a care home which provides accommodation and personal care for up to four people with learning disabilities and complex needs such as autism.

At the time of our inspection there were four people living in the home. There was a registered manager in post. 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 had appointed a new manager who was in the process of applying to the Commission to be registered. They facilitated this inspection. The new manager was enthusiastic, motivated and committed to improving the service. They had the skills and knowledge to enable them to do that. They were aware what needed to improve and had prioritised the areas for improvements.   

People living at the home had deprivation of liberty safeguards approved. The registered manager failed to notify the Commission when these had been approved.

Areas of the home had been decorated and a refurbishment plan was in place. However the fire doors did not close fully and the water temperatures in the sink and bathroom were above safe levels which posed risks to people.

Policies and procedures were in place in relation to infection control. However good hand hygiene was not encouraged and promoted by people involved in food preparation.

Staff were aware of risks to people. Risk assessments were in place. However the risk assessment documents was not specific and did not include management plans to manage those risks.

Medicines were safely managed. The provider needs to review the storage of medicines to ensure it was safe and secure.

Relatives felt their family member was safe and staff supervision was maintained to promote people’s safety. Training and policies were in place to safeguard people from abuse. However some staff’s practice had the potential to put people at risk of abuse.

People were provided with three meals a day. People were being supported and enabled to make meal choices. The meals provided were not always nutritious and balanced. These were being further developed.

The new manager was a positive role model to staff. We saw they worked alongside staff in promoting good practice. They had developed communication with people who used the service and we saw prompts, aids, signs and symbols were used to communicate with people. We saw people were responsive to the input and there was more engagement between people and staff.

Person centred care plans were in place and more person centred care was being provided. People were being encouraged to make choices and decisions and their independence was being promoted. The range of activities on offer to people had increased and continued to be developed to provide a more person centred activity programme.

Staff were suitably recruited, inducted, trained and supported. New staff were enrolled on the care certificate training and existing staff were enrolled on a top up of this training to ensure they had the required skills. Staff were clear of their roles and they received supervision to support them in their roles. Staff’s practice was observed and poor practice addressed.

Policies and procedures were being updated to provide guidance for staff. Systems were in place to audit the service. These were being developed to ensure all aspects of the service were audited effectively.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The service was in special measures as a result of the previous inspections. This inspection showed improvements had been made. Therefore the service is now out of special measures.

22 April 2015

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 14 and 15 January 2015. We found breaches of a number of regulations of the Health and Social Care Act 2008. This resulted in the Commission serving three warning notices on the registered manager and provider. These warning notices were in relation to staffing, quality monitoring and dignity and respect. The timescale for meeting the warning notices was the 14 April 2015.

The registered manager sent us an action plan which indicated action had been taken to address the breaches of regulations outlined in the warning notices. We undertook a focused inspection on the 22 April 2015 to check that they were meeting the legal requirements which the warning notices related to. This report only covers our findings in relation to these breaches of regulations. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Alpha Community Care’ on our website at www.cqc.org.uk’. We will follow up the other breaches referred to in that report at a later stage.

Alpha Community Care is a care home which provides accommodation and personal care for up to four people with learning disabilities and complex needs such as autism. At the time of our inspection there were four people living in the home.

There was a registered manager in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At this focused inspection on the 22 April 2015, we found the required improvements had not been made. Staff were not providing person centred care. This was because people were not encouraged or supported to make choices and decisions in relation to their care such as meals and activities. People were not enabled to communicate using their preferred ways of communication and as a result people were not stimulated. We saw some people wandered around the home without a purpose whilst others displayed challenging behaviours. People’s dignity and independence was not promoted and people had no involvement in the running of the home.

We found the provider had made some improvements in relation to the quality monitoring of the service. A quality monitoring policy had been developed but the systems referred to within the policy were not implemented. Night checks of staff had been introduced to ensure staff were carrying out their responsibilities on night shifts. The home had been decorated, carpets replaced and task lists put in place to ensure staff carried out the required cleaning tasks to an acceptable level. Some policies had been developed and a schedule for staff supervisions had been introduced. A training matrix was in place to audit what training staff had and what was required.

Relative meetings were planned to enable relatives to be consulted on the service provided. However we saw risks to people were not identified and managed. This was because people’s care plans did not include up to date risk assessments. General risk assessment to identify and manage risks to people who used the service, staff and visitors was out of date and overdue for review. Health and safety and infection control audits had not been carried out. This meant people’s health, safety and well-being was not promoted.

We found the provider had made improvements to the staffing levels. Two new staff had been appointed and they were advertising for a staff member to take responsibility for organising activities for people. The registered manager had assessed two staff were required for day time shifts but these staffing levels did not allow for person centred or individual activities to take place. It also did not allow people the choice to stay at home if they wanted to.

We found continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We took enforcement action against the provider. As a result the provider put measures in place to make the necessary improvements to the service. 

14 and 15 January 2015

During a routine inspection

Alpha Community Care is a care home which provides accommodation and personal care for up to four people with learning disabilities and complex needs such as autism.

At the time of our inspection there were four people living in the home. There was a registered manager in post. 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.

We previously inspected the service on the 10 February 2014. At that time the service was meeting the regulations inspected.

The inspection took place on the 14 and 15 January 2015 and was carried out in response to concerns raised with us by the Local Authority’s contracts monitoring team.

Relatives were generally happy with the care provided. However we found people’s safety was being compromised in a number of ways.

The provider did not have a system in place to assess the number of staff needed and there was not enough staff to support people and meet their needs. As a result staff worked excessive hours including day and night shifts in succession.

Risks to people and others were not always identified or managed to promote their safety. Care plans lacked detail and did not address people’s identified needs. The home worked in isolation and had no community links established. People did not have activities provided for them which met their individual needs.

Staff were not suitably inducted and trained to meet people’s specialist needs. They did not receive supervision in line with the provider’s policy on supervision and an annual appraisal of their performance was not taking place. The required recruitment checks were not always carried out on staff before they commenced work at the home.

We were told people did not have capacity to make decisions around their care and support. Decisions on their care were not made in a best interest meeting as is required by law. People were prevented from leaving the house unescorted and the doors were kept locked. Deprivation of Liberty Safeguard applications (DoLS) had been submitted to the Local Authority for approval. DoLS aim to make sure that people in care homes are looked after in a way that does not inappropriately restrict their freedom. In the absence of the DoLS assessments being carried out staff continued to keep the door locked without recognising it was restraint and there were no care plans or risk assessments to support the decision.

Staff were trained in how to safeguard people from abuse and were aware of the process to follow in the event of any such allegation. Staff practices indicated staff were not safeguarding people as they did not provide person centred care and failed to involve people in decisions and choices and promote their independence in relation to their daily care. There was no system in place to question staff practices to ensure people were safeguarded from potential abuse.

There were no quality monitoring systems in place to ensure the service was being effectively monitored and managed. Accurate records were not maintained and up to date polices were not available to support staff in their practice. The registered manager was not up to date with current legislation and best practice and therefore was not able to develop their staff team to promote safe person centred care.

People were provided with three meals a day but the menus indicated the meals were not varied and balanced. Staff supported people with their meals. Aids were provided to enable people to eat independently and mobilise around the home.

Relatives told us they thought staff were kind and caring. One relative commented “It feels like the staff are an extension to our family”. We observed staff were kind but they had minimal engagement and communication with the people they supported. They did not use any communication aids to engage with people as was outlined in people’s communication passports included in their care plans.

Infection control was not being managed which put people at risk of cross infection and contamination. The home was clean but was not adequately maintained to provide a safe and homely environment for people. Health and safety checks of the property were not taking place to ensure it was safe and fit for purpose.

Prescribed medicines were safely administered but there was a lack of guidance for staff in relation to the administration of over the counter medicines and as required medicines. People’s health needs were met and people had access to health professionals such as GP’s, Dentists and Opticians. They had no input from other health professionals such as dieticians, occupational therapist or psychologist. Staff supported people to attend appointments and records were maintained of the visit and outcome.

People’s records were kept secure and their confidentiality was upheld as discussions about them took place in private. Systems were in place to deal with complaints and relatives told us issues raised were always addressed.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which from the 1 April 2015 is the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

10 February 2014

During a routine inspection

There were four people living in the home and they all had complex needs and very little verbal communication. Three of the people were present in the home when we visited. They showed us their individual bedrooms and they all seemed happy and relaxed in the home whilst we were there. One relative we spoke with said 'they have created a brilliant family atmosphere, the staff are caring and I have no concerns'. Another relative said 'it is a small home, which is what we wanted for him, and the staff have got to know him very well and understand his needs. It is excellent.'

The provider was away when we visited but we spoke with three members of staff who were on duty. One said 'I think we are doing what they need and the parents seem happy. It is so much easier when you have the time to get to know them and I can now anticipate what they will want.' We saw that the people living in the home had personalised their bedrooms with their own photographs, books and collections of music and films. The staff confirmed that the people living in the home were encouraged to support their own personal care and to choose activities and food from the menus. The home made good use of pictures and images to help people express their preferences.

One member of staff said that the provider was 'thorough' about the paperwork and policies, and ensured that everything was up-to-date and complete. We found that the care plans contained helpful information including risk assessments and the daily notes were detailed and well maintained. The staff confirmed that they received regular training and updates and they felt well supported. One member of staff said 'it is lovely working here, I am so pleased I came to work here'.

24, 28 August 2012

During a routine inspection

The people using this service had complex needs and were unable to communicate their views directly to us during our visit. We spoke with families of people who use the service. They were very positive about the level of care they saw and the degree of co-operation they received from the service. They told us that 'they couldn't fault it' and 'they always tell us what is going on'. The family members we talked to all had weekly contact with the service. They said they could talk to either the manager or staff about any concerns they had.

Two members of staff were able to use 'sign' language to help them communicate with those people using the service who were familiar with it. We saw care plans included risk assessments and details of contacts with health professionals. Daily notes were recorded for each person including details of the activities they had taken part in, in the community. The staff we spoke with had a good awareness of the subject of safeguarding adults and were aware what to do if they had any concerns about the safety and welfare of people using the service. When we spoke to the provider and staff they gave details of training they had received that meant staff had the necessary skills and qualifications for the work they undertook.