Alistre Lodge Nursing & Care Home

We found the following examples of good practice.

Staff had received training to help ensure their knowledge on infection prevention and control was up to date. Personal protective equipment (PPE) and infection control hand gel was available throughout the home for all staff and visitors. The registered manager and staff told us enough stocks of PPE were available and we confirmed this on the visit. One staff member told us, “If we need it [cleaning products], the provider gets it. During COVID-19 she got everything we needed. She really does look after us.”

The home was clean and hygienic. Cleaning schedules were in place with additional cleaning protocols to ensure all high touch points were regularly sanitised. One person told us, “They [staff] all wear the masks, they have to, registered manager makes sure they have their masks. When they come into my bedroom they have to wear masks and gloves. They are very thorough, it's always clean.”

People were supported to maintain contact with those who were important to them, in line with current government guidance. Face to face visits took place in designated areas of the home or in bedrooms. Relatives who were essential care givers were welcomed into the home. These visits were risk assessed on an individual basis. Window visits, internet messaging, video and telephone calls were also available and used to maintain contact with loved ones. One relative commented, "I think they are all doing a great job in difficult circumstances."

People living in the home and the staff were tested regularly for COVID-19. There were no staff employed who had not been vaccinated as is now required. The provider’s IPC policy was up to date and had been audited during the pandemic to reflect best practice and current guidance.

Alistre Lodge Nursing Home is a nursing home providing personal care to 38 people aged 65 and over at the time of the inspection. The service is registered to support up to 43 people.

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

People were protected from the risk of abuse and avoidable harm by staff who understood how to recognise and respond to concerns. People told us they felt safe when supported by staff. Risk assessments had been developed to minimise the potential risk of avoidable harm to people during the delivery of their care. People were safely supported to receive their medicines as prescribed. The registered manager had robust safe recruitment procedures.

People were positive about the service and said staff were kind and caring. People were treated with dignity and respect and their right to privacy was upheld. The registered manager worked in partnership with people’s advocates.

People's care and support had been planned in partnership with them and their relatives. Staff had received regular training and supervision to support them in their roles. 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.

People received person-centred care which was responsive to their needs. People's communication needs had been assessed and where support was required these had been met. The registered manager managed people's concerns and complaints appropriately.

The service worked in partnership with a variety of agencies to ensure people received all the support they needed. People were happy with how the service was managed. Staff felt well supported by the registered manager and management team.

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 good (published 14 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Alistre lodge is registered to provide personal and nursing care for 43 people. It is situated close to St Anne’s town centre. There are a number of communal rooms including lounges, dining rooms and a conservatory.

People who lived at Alistre Lodge told us they felt safe and supported by staff and the management team. Assessments took place to ensure people’s needs could be met by the service. Care records included detailed risk assessments, which provided staff with guidance on how risks to people were minimised.

Systems were in place to reduce people being at risk of harm and potential abuse. Staff had received up to date safeguarding training and understood the provider's safeguarding adult’s procedures. People told us there was enough staff on duty and the staff came quickly to any requests for support.

People were protected by suitable procedures for the recruitment of staff. We saw records which showed the provider had undertaken checks. These checks ensured staff had the required knowledge and skills, and were of good character before they were employed at the service.

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 support this practice.

People received care which was relevant to their needs and effective because they were supported by an established staff team. They had received appropriate training such as moving and handling and had a good understanding of people’s needs.

We found the service was pro-active in supporting people to have sufficient nutrition and hydration. People said the quality of the food was good. One person said, “I do enjoy the meals, you will never go hungry”. Care plans showed where appropriate the staff had made referrals to health care professionals such as the community nursing team and doctors.

We received consistent positive feedback about the care provided at Alistre Lodge from people who lived at the home and their relatives. We saw, from care records, that staff had discussed people's preferences for end of life care. We found assessments were undertaken by the registered manager and nursing staff prior to any person being accepted into the home.

The registered manager and staff told us they fully involved people and their families in their care planning. People we saw were well presented and staff sought to maintain people's dignity throughout the day.

People were encouraged to raise any concerns or complaints. The service had a complaints procedure. People we spoke with said they felt comfortable raising concerns if they were unhappy about any aspect of their care.

Alistre Lodge had procedures in place to monitor the quality of the service provided. Regular audits had been completed. There were quality-monitoring systems in place to help drive up improvements in the service. We did find these were mainly looking at quantitative data which was obtained for other stakeholders. This was discussed with the registered manager, upon our second inspection visit alternative audit paperwork had been sourced to be used moving forward. This helped to ensure people were living in a safe environment.

The registered manager kept up to date with current good practice guidelines by attending provider forums at which they shared learning and discussed new developments in care. We found the management team receptive to feedback and keen to improve the service. The registered manager worked with us in a positive manner and provided all the information we requested.

At this visit, we found written records to show what the arrangements were to provide safe and effective care in the event of an emergency such as a fire. Staff were now fully aware of the fire evacuation procedure, as all had now read the updated fire evacuation procedure and related documentation. Training records showed that staff had received training in fire safety. Service user records showed that individual fire evacuation plans were in place for people living at the home, and we found that staff were aware of these, and knew how to access them.

The processes in place within the home for identifying and responding to signs and allegations of abuse were found to be appropriate. The systems relating to safeguarding vulnerable people were found to take into account both local and national guidance. Risk assessments and care plans had been updated following incidents such as falls or illness. We found that when people’s needs changed over time due to deteriorations in their health, their risk assessments and care plans reflected these changes. People at risk of losing weight had risk assessments in place for the staff to follow in order to minimise or eliminate the possibility of weight lost.

We found that there were sufficient staff with the right skills, qualifications and experience on duty to meet the assessed needs of the people at all times. Information held within the personnel records showed that staff had been trained and held relevant qualifications in either nursing or social care. The Registered Manager explained that the staffing numbers and arrangements were reviewed routinely, sometimes on a daily basis, in response to the needs of people who lived at the home.

The processes for the safe and secure handling of medicines were found to be appropriate and in line with the relevant guidance and legislation. The service was found to have a clear process in place for the handling of controlled drugs. The Registered Manager explained that the nursing staff received training in the safe administration of medicines, and information within the training records confirmed this.

Is the service safe? People were 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 ensure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. The home had 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 was safe. Policies and procedures were in place to make sure that unsafe practice was identified and people were 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 their care plans and they reflected their current needs. People’s needs were taken into account with signage and the layout of the service enabled 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. We found that people's nutritional needs were met. 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 one 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.

There appeared to be a friendly and welcoming atmosphere within the home. One person told us,” The laundry is very good. All our clothes are returned well laundered. They keep our room very clean. It’s a well-run home. There’s nothing upsets us here at all. We have never had need to complain.” A second person told us,” The staff think highly of my husband and care very well for him. They are invariably kind and considerate. He’s happy to be called by his first name. Staff always come quickly when I need help for him.” A third person told us, “The staff let me do things by myself but I’ve problems moving around. I go on the exercise machine with the carers to try and strengthen my legs. We have our own chiropodist. He comes every six weeks or so”.

Our discussions with staff confirmed they were aware of their responsibilities and what actions to take if they suspected someone was at risk of harm or abuse. People we spoke with told us they felt safe.

We looked at the staffing rotas over a four week period and they showed us there was sufficient staff on duty with a range of skills and experience to meet the needs of the people who lived at the home.

There were a range of audits and systems in place to monitor the quality of the service being provided.

People living with dementia had information recorded using the Alzheimer’s Society ‘This is me’ publication. These were very well written and supported staff to provide a person centred approach to people’s care.

People told us they were involved in decisions about their daily routines and lifestyle choices. “I get out quite a bit. I like to visit friends. No one tells us what we have to do”. And “I think the staff are great. I like the men. I pull their leg, all in good fun you know. We have laugh”.

People told us the food was good. Fresh produce was used with fresh meat and vegetables ordered from local suppliers.

People told us there were no rules to follow and no rigid routines. They got up when they wanted and went to bed when they wanted. Staff spoke to them properly and they were respectful. One person said “When I’m feeling down they are there for me. I lost my husband and I do miss him yet. They really care and will find time to chat to me and cheer me up”.

People had their medication when they needed it and in a safe way.

Good recruitment practices meant only staff of good character were employed to look after people.

Arrangements in place to ensure people could have their say and influence how the service was run.