Archived: Alne Hall - Care Home with Nursing Physical Disabilities

Since our last inspection a new registered manager and deputy manager had been employed at the service. They had worked as a strong team to mentor and empower the staff to make improvements to the support people received. The provider had allocated specialist support to aid those improvements.

Lots of checks had been completed to help the provider understand if improvements were being made. The checks did not always highlight areas for improvement, or where they did we saw action plans were not recorded effectively. The provider had a system to ensure accidents and incidents were well managed and that lessons were learned and changes made to prevent a reoccurrence. We saw this system was not always followed and this meant people were at risk. These systems needed to work better to ensure safety and quality for people.

People, their relatives and the staff all told us they felt more confident in the leadership and management of the service. Good staffing levels afforded people responsive and dignified support.

Staff morale was good and everyone was committed to ensuring people received care and support based on their preferences and choices. People told us they enjoyed their food, the range of activities and felt well cared for. People said they were always treated with respect. Care workers were eager to be involved in the social aspects of people’s lives, which demonstrated their commitment to people’s overall wellbeing. The registered manager was looking for ways to develop this, particularly to ensure activities are provided at weekends in future.

Positive changes were seen at this inspection and the motivation for continuous improvement was demonstrated by the staff team within the service. More robust systems would support the provider to make further change to sustain improvements made.

More information is in Detailed Findings below

Rating at last inspection: Requires improvement (report published 20 April 2018)

About the service: Alne Hall - Care Home with Nursing Physical Disabilities is a residential care home that provides personal and nursing care for up to 30 people with physical disabilities. At the time of the inspection 25 people used the service.

Why we inspected: This was a planned inspection based on the rating at the last inspection. We saw improvements had been made since our last inspection but the impact of poor governance has meant the rating remains requires improvement. This is the fifth consecutive time this service has been rated requires improvement.

Follow up: We will work with the provider following this report being published to understand and monitor how they will make changes to ensure the service improves their rating to at least Good.

At the last inspection in July 2017 we found the provider had breached four regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the safe delivery of care and treatment, person centred care, staffing and overall oversight of the governance of the service. A warning notice was issued in relation to the governance of the service. The service was rated Requires Improvement.

At this inspection we found insufficient improvements had been made to ensure the provider was compliant with all regulations. The service remained rated as Requires Improvement and this is the fourth consecutive time it has been rated as such. We will meet with the provider outside of the inspection process to determine the action they will take to drive improvements. Breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were found during this inspection in areas of good governance, staffing, person centred care and safe care and treatment. You can see the action we have taken at the end of this report.

Alne Hall - Care Home with Nursing Physical Disabilities is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service accommodates up to 30 people in one adapted building. At the time we inspected 28 people lived at the service. The service provides support to adults of all ages who have a physical disability.

The provider is required as a condition of their registration to have a registered manager in post. At the time of this inspection they did not have a registered manager. A manager from one of the provider’s other services had been assigned to carry out the day to day management until a new manager was recruited. 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 not implemented effective quality assurance systems since the last inspection. Although we saw improvements they were not robust enough to prevent continued breaches of regulations. The provider had not ensured their full quality assurance process was carried out alongside changes being made from an on-going action plan. This meant they had not recognised the quality of some changes was poor and that some areas such as medicines support had deteriorated. We have discussed this with the nominated individual and they demonstrated a commitment to making improvements over the coming months.

Appropriate systems were not in place for the management of medicines. People were at risk of not receiving their medicines safely. Overall the recruitment of staff was safe, however records relating to staff’s full work history’s and risk assessments where staff commenced employment before a full DBS check was received had not always been completed.

Improvements were seen in relation to staff support, supervisions and training. A process was now in place to understand progress and to monitor this area. We saw induction for permanent staff and agency workers was not always evidenced, which meant we could not determine the quality of induction they had received to enable them to keep people safe and respond in an emergency during their induction period.

Each person had a care plan which outlined the care they required and described the way in which they wanted their care to be delivered. This meant they were person centred. Reviews had taken place but the staff did not review whether the outcome or goal a person wanted to achieve had progressed. It was difficult to determine from records whether people were receiving care which afforded them to achieve outcomes such as access to activities and social stimulation.

People had access to a wide range of activities if they chose this. People told us they enjoyed them and where possible people were supported to access the community. Staffing levels enabled people to have their care needs met, but not always to access activities or to develop / maintain relationships needed to prevent social isolation.

Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. This enabled staff to have the guidance they needed to help people to remain safe.

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 in the service supported this practice. We made a recommendation that the provider use best practice information about promoting environments for people with physical disabilities which afford them maximum independence.

We saw people were provided with a choice of healthy food and drinks which helped to ensure their nutritional needs were met. People were supported to maintain good health and had access to healthcare professionals and services.

There were positive interactions between people and staff. We saw staff treated people with dignity and respect. Observation of the staff showed they knew the people very well and could anticipate their needs. People told us they were happy and felt very well cared for.

The registered provider had a system in place for responding to people’s concerns and complaints. Relatives knew how to raise concerns but some people who used the service were not sure. The manager was working to improve people’s understanding and ensure complaints documents were available in the service.

Alne Hall is a care home that is registered to provide nursing or personal care for up to 30 people with physical disabilities. The home is a detached listed building, set in its own grounds. The home has 28 single rooms and one shared room, which is currently used for single occupancy. At the time of our inspection the service was full with 29 people using the service, one of whom was on respite (short term stay).

The provider is required to have a manager in post. The manager who was employed at the home was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like 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 have referred to the registered manager as ‘the manager’ throughout this report.

At our last inspection in July 2016 we identified a breach of Regulation 17 – Good governance. We found that effective management systems were not in place to assess the quality of the service and to evaluate and take the necessary steps to improve. We asked the provider to take action to improve the service. At this inspection we found evidence to indicate there was insufficient progress to meet the breach of regulation.

We found that staff on duty were disorganised with no clear leadership from the nurses or team leaders. The deployment of staff was ineffective and care delivery was not person-centred.

The clinical lead and team leaders had not received appropriate training to enable them to effectively and efficiently carry out their job roles and duties. Competency checks of staff performance were not being completed and meetings with staff to discuss their work performance (supervisions and appraisals) were not taking place. There was a lack of effective communication between the care staff, team leaders, nurses and management team.

The assessment, monitoring, review and mitigation of risk towards people who used the service with regard to accidents/incidents, hydration, bowel care, falls and pressure care was not robust.

People told us they were happy in the service, but had little opportunity to discuss or make decisions about their personal care and support. Care was task based and people who could not verbalise their wishes had little choice or say in what happened to them.

There was an activity programme taking place within the service and those people who could communicate their wishes to join in activities were well catered for. However, for other people with less capacity or poor communication the opportunities were not as abundant.

People who used the service did not receive person centred care. Risk assessments were not updated in the care files and did not reflect the current needs of people who used the service. Care plans within the care files were not being reviewed, evaluated or updated on a regular basis.

At the end of our inspection we asked the manager to send us information to show that risks within the service were being addressed as a priority by the management team. We received this information within the given timeframe. We received an action plan from the head of operations to show what changes were taking place in the service to improve the working practices and leadership. We were also given written evidence to show how the quality of life for people who used the service was to be improved immediately. We continue to receive a weekly update of the progress being made within the service.

We have found breaches of Regulations 9, 12 and 18 during this inspection in relation to person centred care, safe care and treatment and staffing. You can see at the end of the report the action we have asked the provider to make.

We found a continued breach of Regulation 17 in relation to good governance. We are currently considering our regulatory response to this breach and will report on any action once it is completed.

Alne Hall is registered to provide nursing care for up to 30 people with physical disabilities. When we visited there were 25 people living at the home. People at Alne Hall were living with complex physical conditions such as multiple sclerosis and motor neurone disease, which cause multiple symptoms.

There was a registered manager in place. 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 2008 and associated Regulations about how the service is run.

At our last comprehensive inspection on 15 November 2015 we found the provider was in breach of one regulation. Records relating to the care and treatment of people who used the service required updating. We made a number of recommendations with regard to staff training and medicines management.

We found that remedial action had been taken to address shortfalls identified at our previous inspection.

People said they felt safe. Staff and volunteers were recruited following a robust selection process, to ensure they were suitable for their role and responsibilities in the home. Although person centred care planning and equality and diversity training required updating we found that staff training was mostly relevant and up to date.

A number of staff including the registered manager had worked at the service for a long time and were familiar with people who lived there and their care needs. Although we raised one issue with regard to maintaining people’s dignity we observed that staff demonstrated a positive regard for the promotion of people’s personal dignity and privacy.

Staffing levels were assessed according to the individual needs and dependencies of the people who used the service. Although the home had experienced some staffing difficulties the registered manager used agency staff who were familiar with the service wherever possible and this helped to minimise any disruption to people using the service.

The registered manager and staff followed the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and ensured people were not being deprived of their liberty in an unlawful way.

People told us the quality of their food was good and their nutritional status was monitored to ensure risks from malnourishment and dehydration were acted on with involvement of specialist health care professionals when required.

There were effective arrangements in place for the maintenance and upkeep of equipment and the premises.

However, we identified that auditing systems were not sufficiently robust to ensure the quality of the service could be effectively monitored and assessed on an on-going basis and that people could be confident that their care needs would be consistently met. We found that people’s care was not always planned to ensure that people received appropriate care that met their individual preferences and promoted their wellbeing. We asked the registered manager to make a safeguarding referral with regard to the care of one person living at the service.

There was a committed staff team. However we found that where individual complaints and differences of approach had been raised with managers these had not always been dealt with effectively and this had impacted adversely on staff morale.

We found the home was in breach of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to good governance and person centred care. You can see what action we told the provider to take at the back of the full version of the report.

People told us that they received a varied diet and they enjoyed the meals provided. Comments included "The food is very good. We have a chef and a cook. We get a choice." Another person said "I have food allergies, they work around this."

We looked at staff recruitment files and saw that appropriate checks were carried out before people started work.

People told us that there were enough staff to care for them. All of the people we spoke with said that their call bells were answered quickly and staff responded to their needs. They told us they liked the staff who cared for them. One person said "The staff are lovely, they always knock on your door and they speak nicely to you."

We looked at quality monitoring systems and found that there were good systems in place which helped to gain the views and opinions of people living at the home.