Alma Lodge Care Home

Alma Lodge Care Home is a residential care home providing personal care up to a maximum of 14 people. The service provides support to older people with physical health needs. Some people were living with dementia. At the time of the inspection there were 10 people living at the home, one of whom was in hospital.

People’s experience of using this service and what we found

The providers’ governance and quality monitoring systems had not been effective in identifying areas of shortfall found at this inspection. This included the completion of full and accurate records. Audits had not identified the management of medicines was not safe in all areas. Environmental risk assessments had not identified some risks posed by windows and flammable items.

Systems followed had not ensured all medicines were handled safely and did not ensure people received their prescribed medicines safely and appropriately. Some medicines were not recorded within a required register. Medicines given ‘as required’ did not always have guidelines in place to support staff to give these in a consistent safe way. A loose tablet was found in the medicine’s trolley with no explanation.

The service was clean, and the managers had taken measures to minimise the risk from COVID-19. Staff had a good understanding of how to identify and respond to any suspicion or allegation of abuse or discrimination.

The staffing arrangements provided enough staff to meet people’s needs in a timely manner. The registered and deputy manager cover many of the shifts. Recruitment was ongoing and records confirmed practice ensured staff were recruited safely. People’s individual risks were assessed, and actions were taken to reduce any risks.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The registered manager had established an open and honest culture where staff and people felt able to share their views. Feedback from staff, relatives and visiting professionals was positive about the leadership of the service.

The registered and deputy manager were committed to continuously improve and had plans to develop the service further. They acknowledged it had been a difficult time recently with the pandemic and were looking forward to a more settled time.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 2 July 2019) and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

This inspection was prompted by our data insight that assesses potential risks at services, concerns raised and based on the previous rating. This enabled us to review the previous ratings. We also used this opportunity to look at the previous breaches of Regulation 12, 11 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and previous breaches of regulation 16 and 18 of the Care Quality Commission (Registration) Regulations 2009. As a result, we undertook a focused inspection to include the safe and well-led key questions. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified continued breaches in relation to the handling of medicines and good governance at this inspection.

The provider took immediate action to mitigate some risks which have been effective.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Alma Lodge Care Home on our website at www.cqc.org.uk.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

• Alma Lodge care home is a residential care home in the Meads area of Eastbourne. The home provides accommodation for up to 14 older people who may have some physical health needs but do not require nursing care. Some people are living with dementia. At the time of the inspection there were seven people living at the home.

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

People’s experience of using this service:

• Medicines were not always given at the prescribed time. Some medicines were time specific and these were not always given at the correct time although staff were seen to record the time as if they had been. One person in receipt of time specific medicines had experienced several falls and any potential link between these falls and medicines had not been investigated by the registered manager. There were no protocols in place for medicines required now and again like pain relief. Staff were not consistently recruited safely.

• Mental capacity assessments had been completed for everyone despite only a few people lacking capacity . People were not supported to have maximum choice and control of their lives and staff did not support supported them in the least restrictive way possible; the policies and systems in the service did not support supported this practice.

• The assessments were not decision specific. The registered managed was not aware that people with capacity did not require an assessment or that assessments had to be decision specific.

• The provider had not notified CQC of some deaths and incidents as required.

• Care plans were disorganised, and it was not always easy to find important information and sometimes used language that was disrespectful. Some care plans lacked specific detail about important health or care needs that people had.

• Audits that were carried out contained some inconsistencies for example in relation to sensor mat use.

• No minutes had been recorded from meetings with people, staff or relatives so there was nothing to share with those who could not attend and no record of any actions. No questionnaires had been sent out to people and relatives to enable them to give their views and opinions.

• People told us they felt safe. Staff had knowledge of individual people and they were aware of what to do should a safeguarding situation arise. Staffing levels were sufficient to provide a good level of care and support for all people.

• There were regular health and safety checks of the environment and people had person centred evacuation plans. Staff had the skills and knowledge to meet people’s needs in most areas. Staff received appropriate training and support to enable them to look after people. They received supervision to support them in their roles.

• People and their relatives thought that staff were caring, and that people were well cared for. Staff interactions were observed throughout the inspection and it was clear that all were very attentive and understanding of people’s needs. People’s dignity and privacy was promoted. People were asked discreetly if they needed help with personal care. Staff would knock before entering people’s rooms.

• Staff responded well to people’s needs. Person centred care was evident and people were provided with choices throughout each day. There was an activity programme and the feedback from people was positive. Staff responded to people in a way that suited their needs. People’s communication needs were met by talking to them in a way they understood and by taking time with people.

• The registered manager was very well thought of by staff, people and relatives. It was clear that they knew all the people well and that they spent time helping with day to day care and support when needed. Links with the local community had been established.

Rating at last inspection:

• At the last inspection the service was rated Requires Improvement (March 2018). This inspection rates the key questions for Safe and Effective as Requires Improvement for the second time and Well led as Requires Improvement for the fourth time. The service remains as Requires Improvement overall.

Why we inspected:

• We inspected the service as part of our inspection methodology for ‘Requires Improvement’ rated services.

Enforcement:

• We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and two breaches of the Registration Regulations 2009 Notifications. You can see what action we told the provider to take at the back of the full version of this report.

Follow up:

• The registered manager addressed some of the issues raised during the inspection straight away. We will ask the provider to send us an action plan to address the remaining issues. On 10 June 2019 we met with the provider and registered manager and they showed us their action plan and reassured us that steps had already been taken to improve. We will continue to monitor the service until the next inspection. This will be within a year of the publication date of this report.

Alma Lodge Care Home provides facilities and services for up to 14 older people who may have some physical health care needs but do not require nursing care provided by the staff working in the service.

At the time of this inspection seven people were living in the service. This inspection took place on 18 and 19 January 2018 and was unannounced.

There is a registered manager at the home who is also one of the partners and registered providers that own the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

At the last inspection in January 2016 the provider was found to be meeting all of the regulations and was rated ‘good’. However at the previous inspection completed in October 2014 the service was rated Requires Improvement. This is now the second time that the service has been rated Requires Improvement since our new methodology was introduced in October 2014.

At this inspection we found the provider had not ensured all equipment had the correct safety checks completed. Fire risk assessments and emergency evacuation procedures had not taken account of the people’s limited mobility and their wish to have doors open. This meant people could be put at risk from unsafe equipment and unsuitable fire arrangements including the lack of effective evacuation procedures. The registered manager confirmed they were having equipment checked for safety and would seek specialist fire advice to ensure appropriate procedures and safety measures were established. We found not all medicines were handled safely. Procedures for the safe administration of medicines were not followed in all cases and there was no evidence to clarify how and when topical creams were applied. The provider could not be assured all medicines were given appropriately. .

New staff were not trained to support people in a safe and effective way. There was no evidence to demonstrate that new staff completed any induction training. This meant not all staff were trained appropriately to care for people living in the service.

The quality monitoring and management systems did not ensure safe and best practice was followed in all areas or identify areas for improvement. This included the lack of safety checks, full effective emergency procedures and safe medicine handling at all times. The monitoring of accidents did not identify appropriate responses and actions taken following falls. Quality monitoring systems had not identified when records were not accurate or completed consistently, and when policies and procedures were out of date and not adhered to.

People were happy with the care they received and they appreciated the contact and friendly relationship they had with staff. Staff were kind and attentive and demonstrated a caring approach to people.

Recruitment records showed there were systems which ensured as far as possible staff were suitable and safe to work with people living in the service. Staff understood the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The managers had an understanding of DoLS and what may constitute a deprivation of liberty and followed procedures to protect people’s rights.

There was enough staff to ensure that people’s needs were responded to in a timely manner. People were supported to maintain good health with the support of local community resources.

Staff assessed people's nutritional needs and responded to them. Preferences and specific diets were catered for. People told us they were not bored and a varied activity and entertainment programme was provided based on people’s preferences. People were supported to maintain their own friendships and relationships with whoever they wanted to.

Feedback was regularly sought from people, relatives and staff. People were encouraged to share their views on a daily basis and satisfaction surveys were used to improve the service. People were given information on how to make a complaint and said they were comfortable to raise a concern or complaint if need be.

The service was run as a small family business with an emphasis on providing a friendly homely environment for people to live in.

We found 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 this report.

Alma Lodge is a care home that provides accommodation for up to 14 older people who require a range of personal and care support. Some people lived reasonably independent lives but required support for example with mobilising safely due to their age and general frailty. At the time of the inspection six people lived there.

There is a registered manager at the home who is also the provider and owner. 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.

People were looked after by staff who were patient and kind. They understood people’s individual care and support needs and knew people really well as individuals. People were supported to make choices and staff respected their right to make decisions. They were cared for by staff who treated them with dignity and demonstrated a genuine interest in their needs and views.

There was an audit system in place however this was not yet fully embedded into practice. It did not identify where some information was missing from people’s care plans.

Staff supported people to see their GP when they were unwell or when they wished to. People were asked for their consent before they were provided any care or support. Staff understood their responsibilities in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

There were risk assessments in place and staff had a good understanding of risks and what steps they should take to reduce risks to people. People were supported to maintain a healthy diet, they were involved choosing what they would like to eat. Nutritional assessments identified people who may be at risk of malnutrition. People received their medicines safely when they needed them.

There was a robust recruitment procedure in place which helped to ensure staff with the appropriate experience, skills and character were employed to work at the home. There were enough staff, with the appropriate training, on each shift to meet people’s needs.

There was an open and relaxed atmosphere within the home. People and relatives told us if they had a problem or were worried they were happy to talk with any of the staff. Whenever concerns or issues were raised action had been taken to address them.

We examined the systems and processes in place for the safe management and administration of medicines and found they were effective and took account of people's preferences. There were appropriate recruitment and training systems in place for staff.

The premises were homely, safe and met the needs of people who used the service. None of the people at the home were subject to deprivation of liberty safeguards.

People were enabled to express their views and were involved in making decisions about their care and treatment. We found that care and treatment was planned and delivered in a way that ensured people's safety and welfare. We saw documentation showing that the provider responded appropriately to any allegation of abuse. We saw that complaints were taken seriously and there was an effective complaints system available.

We observed staff dealing with people in a respectful but friendly manner and ensuring their dignity was maintained by always knocking before entering rooms and seeking people's permission before doing anything for them.

Records we examined showed that the service had training and audits in place which ensured that staff were able to deliver care and treatment safely. We saw quality assurance systems in place to assess the service's performance and ensure improving standards.