Archived: Alphington Lodge Residential Home

There is a registered manager in post. At the time of this inspection the registered manager also managed another home another home owned by the providers and split their working week between the two homes. A trainee manager was employed on a full time basis to support the registered manager. 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 last inspection of the home took place on 12 and 15 January 2016 when the service was rated as ‘requires improvement’. There was one breach of Regulation 12 of the Health and Social Care Act: Safe care and treatment. We found that risks to people's health and safety were not managed effectively, some aspects of medicine administration and recording were potentially unsafe, and daily reports did not always show that care had been carried out in accordance with each person's agreed plan. We also found that safe recruitment procedures had not always been followed. We recommended the provider looked at guidance and best practice in respect of quality monitoring and audits to ensure these were used effectively to improve the quality of care and support. At this inspection we found these issues had not been fully addressed. We also found further breaches of regulations.

Before this inspection we received concerns from a number of sources relating to various issues including low staffing numbers and allegations that incidents of abuse had been reported to a member of the management team but had not been investigated or acted upon. We passed these allegations of abuse to the local authority safeguarding team for investigation and we heard shortly afterwards that a member of staff had been dismissed for poor conduct during handover sessions. However, during this inspection we found that the provider had not carried out any further investigations into the alleged abuse to find out why the matters had not been taken seriously as soon as they had been reported. This meant the provider had failed identify failings in their safeguarding systems or take actions to improve them. The local authority safeguarding team also shared with us further concerns they had received and investigated, including concerns about end of life care, prevention of pressure sores, and the prevention and management of falls.

Before this inspection we had passed concerns relating to low staffing levels to the provider. We asked them to investigate the concerns and to provide evidence to show how they determined safe staffing levels, which they did promptly. They told us they had increased the staffing levels as a result of their findings. At the time of this inspection they were in the process of recruiting new staff. However, we found staff rotas had at times been poorly managed. Staff rotas for the week of our inspection showed unfilled shifts leaving short notice to obtain cover from agency staff or from the existing staff team. We heard of recent occasions when staff had arrived on duty to find shifts had not been covered, leaving them short staffed. When this had occurred staff told us they had managed to complete all essential tasks, but it had been difficult.

Before the inspection some staff told us they did not always feel well supported. Staff meetings had been held in recent weeks to enable staff to raise concerns and issues and some staff told us they felt things were improving. However, professionals who visited the home regularly told us that communication systems were sometimes poor resulting in messages not always being passed on or acted upon.

While most medicines were stored, administered and recorded safely we found records of creams and lotions contained unexplained gaps. This meant there was insufficient evidence to show that staff had followed instructions issued by medical professionals for the prevention or treatment of skin problems such as pressure sores. At the time of this inspection one person was suffering from a pressure sore. After the inspection we received information to show they had taken prompt action to address this concern.

The provider had failed to fully address issues found at the last inspection relating to safe recruitment procedures. Their recruitment procedures had improved by ensuring Disclosure and Barring Service checks had been carried out before new staff began working in the service. This ensured the applicant did not have serious criminal convictions and had not been barred from working with vulnerable adults. However, they had failed to ensure they had received references that provided evidence of satisfactory previous employment conduct, or evidence of the applicant’s trustworthiness, honesty or suitability for the post. We looked at three recruitment files and found that no references had been obtained for two members of staff, and in one instance the references had not been received until many weeks after they had begun working in the service. The provider amended their recruitment procedures during the inspection and gave us assurances that references will be obtained before new staff are employed in the future.

People’s legal rights were not fully respected and protected. Staff had received training on the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) but did not fully understand how this should be applied. Care records contained some evidence that people’s capacity to make decisions had been considered. However, the records did not show that the service had assessed people’s capacity to make specific decisions in line with the mental capacity act or that a best interest process had been followed

Before this inspection we received concerns relating to poor end of life care. During the inspection we found that staff had not received training on end of life care. There had been poor communication with the local community nursing team which meant that guidance provided by the community nursing team had not always been followed or acted upon promptly.

The provider and registered manager carried out checks and audits to make sure the service was running smoothly. Where they had identified problems they had taken measures to improve the service However, these measures had not been fully effective and had failed to ensure that issues found at the last inspection had been fully addressed.

During our inspection we saw that people were relaxed with staff and enjoyed some laughter and banter. Comments included, “I’m quite happy. The staff are excellent. They always help if they can and are kind, but they’ve got a lot to see to.” “They [staff] always ask if there’s anything they can do to help”. “A lot of them are really caring, I think they do treat me with respect”. A relative told us “We are very happy with (the service)”.

We found three breaches of the regulations. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The service provides accommodation and personal care for up to 28 older people. At the time of this inspection there were 23 people living there.

There is a registered manager in post. At the time of this inspection the registered manager spent one day a week at Alphington Lodge and four days a week managing another home owned by the providers. A new manager had been appointed at Alphington Lodge and was working in the home on a full-time basis, although they had not yet submitted an application to register. 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.

Since the provider took over the ownership of the home in April 2015 they had implemented many improvements to make the home safer, more comfortable, and more efficient. On the first day of our inspection we found there were still some areas where further actions were needed. However, on the second day of our inspection we found the staff had taken prompt action to address many of the issues we had noted on the first day.

Many of the staff team had been recruited since the new providers purchased the home. The staff were beginning to establish good team working practices and they spoke positively about their work. People who lived in the home said the staffing levels were adequate to meet their needs and felt staff responded to their requests for assistance promptly. However, most of the staff said they had to rush to complete tasks. The manager told us they were reviewing the staffing levels closely. After the inspection the provider told us they had monitored the tasks staff were expected to complete. They had implemented training for senior staff to enable them to manage their teams effectively, and they had found this had resulted in greater efficiency and improved care.

Staff had received a range of training to meet the needs of people living in the home and further topics relating to people's health needs were being planned for the coming year.

Safe procedures had not always been followed when recruiting new staff. 11 staff had been recruited since the last inspection. Recruitment records for two staff did not include evidence of checks and references completed before they began working with people. However, by the second day of our inspection the manager had obtained the checks and references that were outstanding. After the inspection the provider gave us evidence that safe procedures had been carried out for the other nine staff recruited since the last inspection. We were also given assurances that safe recruitment procedures will be followed in future.

Records were not always stored securely to maintain confidentiality. By the second day of our inspection most records of a confidential nature were stored securely, although we saw staff had forgotten to store one record securely when not in use. The manager assured us they would be carrying out checks in future to ensure good practice will be followed at all times.

On the first day of our inspection we found some aspects of medicine administration were not entirely safe. There were unexplained gaps in the medicine administration records, including the records of prescribed creams and lotions. Staff had failed to identify the missed signatures or take actions to check that medicines, creams and lotions had been correctly administered. We also found medicines were not always stored securely. By the second day of our inspection actions had been taken to address these issues. All medicines were stored securely. They had investigated the reasons for gaps in the administration records and had put in place a plan of actions designed to improve all areas of the administration procedures.

A new care planning and risk assessment system had been implemented a few months earlier. This included a range of tools to help staff identify risks to people’s health and to help them draw up a plan to support the person to reduce the risks where possible. The risk assessment tools covered areas such as skin care and pressure sores, mobility and falls, weight loss, dehydration, and choking. Procedures were in place to review the risks regularly, for example people were weighed regularly. However, where the information showed there was a change in the risks staff had not always reviewed and updated the care plan. This meant care plans did not always provide detailed or up to date information on the current risk level or give instructions to staff on actions necessary to help people maintain good health. The managers and provider told us they were aware of care plan gaps and had already taken measures to address them. .

People told us they felt safe. Staff had received training and information on how to protect people from the risk of abuse and neglect. Staff had received information and training to effectively support each person’s mental and physical health needs.

The staff were caring. We saw staff speaking with people in a caring and gentle manner. One member of staff arrived early for their shift so that they could spend time sitting and chatting with people. They understood the importance of seeking consent before carrying out care tasks and had an understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). Where people were at risk of their liberty being deprived applications had been submitted to the local authority DoLS team..

People had been involved and consulted in drawing up and agreeing a plan of their support needs. Their care plans were detailed, well laid out and easy to read. The care plans explained each person’s daily routines and how they wanted staff to support them. The plans were regularly reviewed and updated. People were supported to access healthcare professionals when needed.

The home was well maintained, clean, warm and comfortable. The providers were in the process of redecorating and improving all areas of the home both internally and externally.

People participated in a variety of social activities within the home and in the community. There were activities organised in the home every morning and afternoon to suit most interests.

The provider had a range of monitoring systems in place to ensure the home ran smoothly and to identify where improvements were needed,. However, these had not been fully effective as they had failed to pick up some of the issues we found during this inspection. People were encouraged to speak out and raise concerns, complaints or suggestions in a variety of ways including resident’s meetings, surveys and care plan reviews.

We found one breech 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 the report. We have also made two recommendations relating to guidance in respect of best practice in maintaining people’s weight and guidance and best practice in respect of quality monitoring and audits.