Background to this inspection
Updated
25 July 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The first day of the inspection was carried out by two inspectors. The second day was carried out by inspector.
Service and service type
Alpha House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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 had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
We spoke with one person who used the service. We spoke with the area manager, the operations manager, a senior care worker, and four care workers
We reviewed a range of records. This included all the care records and medication records. We looked at all staff files in relation to staff supervision and training. We also looked at a variety of records relating to the management of the service, including policies and procedures. We looked at the quality assurance records.
After the inspection
We spoke with two relatives and an advocate who regularly visits the service. We also spoke with a social worker.
Updated
25 July 2019
About the service
Alpha House is a residential care home providing personal and nursing care to three people with autism and/or a learning disability. The service can support up to four people.
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 and what we found
Medicine management had not always followed best practice and audits had not identified areas which required improving. Day staff had been trained to administer medicines and had their competency assessed. Night staff had not been trained and although this had not presented an issue, it had been highlighted as a requirement but not yet actioned.
Some improvements were required in how the service assessed and managed risk, as some risks were managed well, but others had not been identified to ensure the necessary risk reduction measures were in place.
Improvements were needed in how the service recorded behaviours that challenged others. More detailed records would help ensure the effectiveness of the resources available to reduce these behaviours.
Staff were recruited safely. Staff training, supervision and appraisal were not all up to date.
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. However, formal decision specific capacity assessments and best interest decisions had not always been undertaken which meant the service was not acting within the legislative framework.
People were supported to prepare meals of their choice and weights were recorded regularly to ensure their wellbeing. Staff supported people with hospital appointments, and professional visits. Professional advice was sought when required.
People using the service and relatives spoke highly of the caring support provided by the staff and told us people were treated as if they were a member of the family. They were happy with the service provided.
Audits and checks were carried out; however, these were not always effective in identifying areas which needed to be improved. The provider had not notified CQC of significant events as required which showed an issue with the overview of the service.
The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. Some people's support focused on them having as many opportunities as possible for them to gain new skills and become more independent. However, for other people the service had identified they needed to look again at their outcomes to ensure goals were continuously reviewed.
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 5 December 2019)
Why we inspected
The inspection was prompted in part due to concerns received about the safety of people at the service. A decision was made for us to inspect and examine those risks.
The inspection identified areas where the provider needs to make improvements. These included how they assessed and managed risk, ensuring lawful consent, records and how they assess and monitor the quality of the service they provide. The provider had failed to notify CQC of all occurrences that affected the people who use services
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Alpha House on our website at www.cqc.org.uk.
Enforcement
We have identified breaches in relation to safe care and treatment, good governance, staffing and failure to notify. The provider has taken immediate action to mitigate the risks.
Please see the action we have told the provider to take at the end of this report.
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.
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.