Alston View Nursing and Residential Home

Alston View Nursing and Residential Home (Alston View) is a care home providing personal and nursing care and accommodation to older people. At the time of the inspection, 44 people were receiving regulated activities at the home. The service can support up to 50 people. The home is a purpose-built building with two lounge areas and a dining room on the ground floor. Bedrooms are based over two floors.

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

People were exposed to the risk of harm. Risks were not appropriately identified, assessed or managed in a timely way. During the inspection, we identified failings in respect of fire safety arrangements, use of bed-rails, medicines and in the leadership and governance of the service. Poor communication often meant essential safety issues and risks were not appropriately elevated and dealt with effectively.

Some aspects of staff recruitment were not completely effective at ensuring staff members were always suitable to work with vulnerable people. Some essential safety checks had not been made. We have made a recommendation about this that can be seen in the 'safe' section of this report.

Infection, Prevention and Control (IPC) processes were appropriate and we were assured about the service's ability to mitigate the transmission of infections.

Staff were competent with safeguarding processes and knew how to protect people from abuse. Relatives said their loved ones felt safe in the home and were trusting of staff and management. We observed good practices and interactions between staff and people during the inspection. The service's safeguarding processes were robust.

Staff supported people to have access to healthcare professionals and specialist support and the service worked with external specialists. Professional's views on the service were mixed but those who we spoke with at inspection said that the service was improving.

People were confident in the management team at the home and praised how approachable they were. Relatives said their loved ones were safe and praised the friendly and caring attitudes of staff and managers. We noted good interactions between people, management and staff. The service made appropriate notifications to CQC and other authorities of safety incidents to ensure these incidents received appropriate oversight.

The registered provider was responsive to concerns noted during the inspection and has started to take action to make improvements and promote safety within the home.

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.

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

Rating at last inspection

The last rating for this service was requires improvement (published 13 July 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

At our last inspection in 2021 we recommended that the provider's programme of improvements should be expanded to cover all areas of care and support to people. At this inspection, we found the provider had not acted on this and the service was now in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service and information provided to us by partner agencies. As a result, we carried out a focused inspection to review the key questions of safe and well-led only.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 'Alston View Nursing and Residential Home' on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches of the regulations in relation to management of risk, administration of medicines and governance at this inspection. We have also made a recommendation around the provider's recruitment processes.

You can see what action we have asked the provider to take at the end of this full report.

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 and fire service to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Alston View Nursing and Residential Home is a residential care home and at the time of inspection was providing nursing and personal care to 42 people aged 60 and over and some people living with dementia. The service can support up to 50 people.

The home is a purpose built property that has been extended and adapted to provide accommodation in mainly single rooms. There are two floors with a lift and an area specifically adapted for people living with dementia.

We found the following examples of good practice.

The provider had established systems to prevent visitors from spreading and catching infections. They had followed guidance on supporting safe visiting. Visitors were also screened for symptoms and their contact details were recorded to support the NHS Test and Trace service.

In the event of an outbreak of COVID-19, people living in the home could shield from people who may be infected and there were appropriate isolation processes in place to mitigate the risk of transmission of disease.

Social media platforms were used to facilitate contact between people and their relatives where physical visiting was not possible. People were supported by staff to use this technology and this included the use of handheld devices. Relatives and friends were able to visit people living at the home in line with current guidance.

The provider had established safe admission procedures for staff to follow. This included requiring new people to have a negative COVID-19 test before moving into the home, a further test during residency and to self-isolate in their bedrooms. The service was in the process of developing a new admissions process. We were told this would reflect current guidance and best practice.

During our visit we observed staff using Personal Protective Equipment, (PPE) safely. The provider had ensured sufficient stocks of appropriate PPE were available to protect people.

People living in the home and the staff were tested regularly for COVID-19. The provider had also supported staff and people to receive COVID-19 vaccines and boosters.

The home was clean and hygienic. Comprehensive cleaning schedules were in place and there were designated staff members who performed these duties.

The provider had safe infection prevention and control policies and procedures.

The provider could adapt the layout of the building to support safe cohorting in the event of an outbreak.

Alston View Nursing and Residential Home is a care home providing personal and nursing care for a maximum of 50 people in one purpose built building. One of the floors of the home specialises in providing care to people living with dementia. There were 35 people receiving care and support at the time of the inspection.

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

People told us they did receive a prompt response when requesting support from staff with their call bells. People and their relatives told us staff were attentive and had time for them. They were particularly complimentary about the level and quality of staff.

Most people told us the management team were not familiar to them but it was noted the interim manager had only been in place a short time before the inspection. The home did not have a registered manager in place and had recently recruited a new manager who was to seek registration with CQC. This instability had led to some staff members feeling there was no clear position with leadership.

Some staff members raised concerns around the quantity and variety of meals in some circumstances. However, people who could engage with us were complimentary about the meals. We have made a recommendation about this together with other oversight issues that can be seen in the well-led section of this report.

The recruitment of staff was robust and staff received appropriate training. People had their needs assessed and risk assessments were in place. The service had recently started to completed regular checks of records to identify any changes in people’s support requirements or any actions required.

Medicines were administered safely by well trained staff. Their competency to do this was checked. Staff had also received relevant medicines training. Safeguarding procedures, policies and staff training were in place to protect people from abuse. Staff were aware of the signs of abuse and what action to take if this was suspected.

People said their privacy and dignity was respected. We observed respectful and friendly interactions between people who used the service and staff.

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

Visiting arrangements were appropriate and safe processes were observed to mitigate the risk of infection. Infection control processes were robust and everyone was following the rules around the response to COVID-19.

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

Rating at last inspection

The last rating for this service was requires improvement (published 13 January 2020) and there were multiple breaches of regulation. 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 improvements had been made and the provider was no longer in breach of the regulations in the areas we inspected.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Alston View Nursing and Residential Home on our website at www.cqc.org.uk.

Why we inspected

The inspection was prompted, in part, due to concerns received about infection prevention measures, nutrition and management oversight. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led.

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

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Alston View Nursing and Residential Home is a care home that accommodates up to 49 older adults, some who may be living with dementia or mental health needs and require nursing care. At the time of the visit there were 45 people who lived there.

People’s experiences of using this service

People told us that they received safe care and treatment. People and their relatives spoke positively about the care and support provided. However, our findings showed improvements were required to ensure the care delivered was consistently safe, reliable and person-centred.

In the majority of cases people’s needs had been assessed and planned for and people’s outcomes had been identified. However, we found shortfalls in the care records and risk assessment for people who had been admitted for a short term stay or as part of a hospital discharge plan. Risk assessments had not been adequately completed and reviewed. The registered manager took immediate action to address this.

The registered manager and the registered provider had ensured the premises were maintained and any faults rectified. They had also completed audits to monitor the safety and quality of care provided.

Staff showed a good understanding of their roles and responsibilities for keeping people safe from harm. However, individual risks to people and the environment had not been adequately monitored to ensure measures were put in place to manage them and minimise the risk of avoidable harm occurring. Risks associated with falls and malnutrition had been managed. However, post falls observations had not been carried out. The infection prevention and control practices in the home needed to be improved.

Governance arrangements were in place to check, monitor and improve the care delivered. However, we found the audits and quality checks had not been adequately implemented to support the registered manager and the provider in identifying shortfalls.

While people’s medicines were safely managed, improvements were required to the safe storage and management of topical medicines such as creams.

Staff had received a range of training and support to enable them to carry out their role safely. However, staff training had not been consistently monitored. There were shortfalls in the provision supervision, appraisals and competence checks to staff.

Consent records were completed, and people told us they were always offered choice and control over the care they received. However, authorisations for restrictions on people’s liberties had not been considered or applied for where required. The registered manager took action after our inspection.

While staff showed a motivation to deliver care in a person-centred way, we found some practices in the home did which did not consistently support a dignified and person-centred approach. This was because people’s preferences for getting up and washing and dressing in the morning were not always followed.

People received support to maintain good nutrition and hydration and their healthcare needs were understood and met.

People and family members knew how to make a complaint and they were confident about complaining should they need to. They were confident that their complaint would be listened to and acted upon quickly.

The leadership of the service promoted a positive culture within the staff team. People, family members and staff all described the registered manager as supportive and approachable. The registered manager showed they were committed to improving the service and displayed knowledge and understanding around the importance of working closely with other agencies and healthcare professionals where needed.

Rating at last inspection: At the last inspection the service was rated good (published 22 July 2016).

Why we inspected: This was a routine planned comprehensive inspection.

Enforcement: We identified four breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around the management or risk to receiving care and risks of the spread of infections, staff training and supervision, seeking consent and good governance. Please see the 'action we have told the provide to take' section towards the end of the report.

Follow up: The service is required to provide an action plan to us because there were four breaches of the regulations. We will continue to monitor the service to ensure that people received safe, high-quality care. Further inspections will be planned for future dates. We will follow up on the breaches of regulation we have made at our next inspection and we may inspect sooner if we receive any concerning information.

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

Alston View is required to have a registered manager. At the time of our inspection there was an acting manager in place. 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. Our records showed that the acting manager's application to be registered with the Commission had been received, and was being processed.

During our last inspection on 30 September 2015 the service was rated as inadequate and was placed in 'Special Measures'. We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of Safe Administration of Medicines for which we issued the provider with a warning notice in respect of this breach.

During this inspection we found improvements had taken place in the way medicines were administered and managed. Medicine audits were now effective. Incidents and accidents were now properly monitored, and when these needed to reported to external agencies, we found that this had taken place. The home now had a staff member who took overall responsibility of infection control measures. Staff now received sufficient training and supervision in order to perform their work effectively. People’s needs were being met, and these needs were reflected in their improved care records. Management record keeping was improved, and the governance systems operated within the home were now a lot more robust. The systems and processes to record, assess, analyse and mitigate risks and promote people’s well-being were now being followed.

The service had made improvements in many areas including the way they reported on, responded and dealt with safeguarding incidents and risk.

Employees were asked to undertake checks prior to employment to ensure that they were not a risk to vulnerable people; records relating to these checks were complete. Risks associated with, infection control and cleanliness, and environment factors were assessed.

The service had policies in place in relation to the Mental Capacity Act 2005 (MCA) and depriving people’s liberty which were put into practice. The building was found to be in a good state of repair, and the environment was found to be fit for purpose. The service had procedures in place for dealing with allegations of abuse. Staff were able to describe to us what constituted abuse and the action they would take to escalate concerns.

People were able to express their choice in relation to meals and how they spent their time. The menu offered people a choice of meals and their nutritional requirements were met. People knew how to access the complaints process, and knew who to talk to if they wanted to raise a concern.

There was a wide range of policies and procedures in place which provided staff with clear information to guide them on good practice in relation to people’s care. We found written evidence to show that the acting manager had an appropriate system in place used to assess and monitor the quality of the service. Surveys were sent out to all the people who received a service, and other stakeholders on an annual basis. The feedback contained within the surveys showed that the service was consistently meeting its objectives. Any issues raised via the surveys had been addressed via an action plan.

As the overall rating for this service is no longer inadequate, in line with our guidance it will no longer be in special measures.

Is the service safe? People who use the service were not always protected from the risks associated with unintentional poor practice, because the provider had not taken reasonable steps to identify the possibility of unintentional poor practice taking place. The registered person did not have an effective system in place to identify, assess and manage the risks relating to the deployment of the staff team, and how this deployment impacted on the health, welfare and safety of service users.

Is the service caring? Although it was clear that the staff approach to their work was positive, and they had positive relationships with the service users, they believed they were at risk of providing an inconsistent service to people.

Is the service responsive? Care and treatment was not consistently planned and delivered in a way that was intended to ensure people's safety and welfare. Although there were enough qualified, skilled and experienced staff employed by the service, there deployment at different times of the day was sometime ineffective to meet people's needs.

Is the service effective? We found that service users did not always benefit from safe, quality, care and support that was based on effective decision making and the management of risks to people's health, welfare and safety.

Is the service well-led? The provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service. Although the majority of people living at the home received a quality service, some did not, and the management systems at the home were not robust enough in identifying potential shortfalls in care practices.

Is the service safe? People are treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures were in place and staff understood how to safeguard the people they supported. Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. The service was safe, clean and hygienic. Equipment was maintained and serviced regularly therefore not putting people at unnecessary risk. Recruitment practice is safe. Policies and procedures are in place to make sure that unsafe practice is identified and people are protected.

Is the service effective? There was an advocacy service available if people needed it, this meant that when required people could access additional support. People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they had been involved in writing them and they reflected their current needs. People's needs were taken into account with signage and the layout of the service enabling people to move around freely and safely.

Is the service caring? People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People at the home said that they felt their needs were very well met by the staff. One relative said that the staff were very helpful, and knew their relative very well. They added that the staff were quick to respond to requests for help. We observed the staff work with people in positive ways, giving them time to think, treating them with care and respect, and responding to their requests for help and support. People living at the home said that they felt safe and secure. One person said that they knew they could always turn to a staff member for help and reassurance. A relative said that they believed their loved on lived in a very safe and caring environment.

Is the service responsive? People completed various activities in and outside the service. People knew how to make a complaint if they were unhappy.

Is the service well-led? The service worked well with other agencies and services to make sure people received their care in a joined up way. The service had a quality assurance system, records showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and wanted to ensure it was implemented.

We found that input from health professionals such as Speech and Language Therapists was clearly documented and staff were aware of relevant changes. We found that nursing staff had received guidance to ensure care planning documents were kept up to date and time had been allocated to staff to allow this to happen.

However, during our inspection we found that on occasions, the care provided did not ensure the welfare of the people who used the service. One person told us, 'I don't want to go downstairs because you get left there for hours. I'd like to have my lunch there but no-one brings you back because they are too busy, so I just stay in my room.' We also saw and were told that during busy periods some people have to wait for call bell's to be answered.

Relatives and visitors said; "I never have to complain, the nurses are great."

and; "The staff are friendly and helpful."

and; "It's absolutely wonderful. Really well run. The staff are kindness itself."

and; "Previously, (my wife) was on medication that made her sleep. When she came here they took her off it. Best thing they have ever done."

We observed staff giving care and support in a sensitive and friendly manner. They took steps to preserve people's dignity and support their choices. There were effective systems in place to reduce the risk and spread of infection.

People were able to describe what they would do if they had a comment or a complaint. One person said; "I would go to matron, she is lovely. She is very approachable".

The care records of eight people were reviewed. Seven of the care plans for nutrition and hydration did not fully reflect the outcome of an assessment and report by the speech and language therapist. One record contained contradictory information about whether a person could be given food and fluids orally or not. This means that people may be at risk of unsafe or inappropriate care or treatment because accurate and appropriate records were not maintained.

Everyone that we spoke with gave very positive feedback about the home and spoke highly of the manager and staff. Comments included;

'They are a fantastic bunch ' nothing is too much trouble!'

'Matron is wonderful! She knows every single resident and she asks me every day if I am happy with things.'

'The staff here go above and beyond!'

'I love Matron. She is super and so very kind!'

We observed staff going about their duties and providing support in a kind and pleasant manner. We noted that staff, although busy, responded to residents requests and took time to check that people were comfortable. We heard one resident chatting with staff, mention that he fancied a drink of beer. We saw that a carer arranged this for him straight away.

We looked at a number of areas during the inspection, which included how the home promoted the care and welfare of people using the service and how they safeguarded people from abuse. We found that the service was compliant in all the areas we assessed.