Alma Court Care Home

Alma Court Care Home is a care home that provides nursing and personal care for older people, most of whom are living with dementia. At the time of the inspection, 44 people lived at the service. The home is divided into six separate units, each with its own communal areas.

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

The provider had assessed the risks to people associated with their care and support. Staff members were knowledgeable about these risks and knew what to do to minimise the potential for harm to people.

When incidents, accidents or other significant event occurred the provider had systems in place to identify any learning and to review their systems to minimise the risk of reoccurrence. Any learning was effectively passed on to staff members to improve people’s safety.

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 24 April 2019).

Why we inspected

The inspection was prompted in part by notification of a specific incident. The information CQC received about the incident indicated concerns about the management of the risk of scalding. This inspection examined those risks.

We found no evidence during this inspection that people were at risk of harm from this concern.

The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on a Warning Notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

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.

Alma Court is a care home that provides nursing and personal care for older people, most of whom are living with dementia. At the time of the inspection, 61 people lived at the service. The home is divided into six separate units, each with its own communal areas.

People’s experience of using this service:

¿ At the last inspection in November 2017, we rated the service as Requires Improvement and found that improvements were needed in a number of areas including moving people safely, ensuring people’s records were kept securely and making sure all checks were carried out effectively.

¿ At this inspection, we found some improvements had been made but further improvements were needed to improve the quality of the service.

¿ At the time of this inspection, the home was going through a period of significant change. A new manger was in post who was starting to address areas of concern that had been raised by relatives and visiting professionals.

¿ We found that improvements were underway but more time would be needed to complete all the required actions and work to ensure people received a consistently good service.

¿ People received their medication at the right time but improvements were needed to some aspects of the management of medicines. Staff had a good understanding of the risks people faced and knew how to identify and report concerns.

¿ We saw that most units had sufficient staff to keep people safe but people were left unsupervised on occasions and some relatives and staff thought staffing levels needed to be increased.

¿ Some people required more encouragement and support to ensure they ate meals but people had access to food and drink and were now maintaining healthy weights.

¿ People’s consent was obtained before care and support were delivered and the service was working within the principles of the Mental Capacity Act. Staff were well trained but needed to access more regular supervision to reflect on and improve their practice.

¿ People were treated with respect and dignity and staff were patient with people when they were distressed or upset. Relatives were made to feel welcome in the home at any time and improvements were being made to the environment to ensure it was more stimulating and relevant to people’s needs.

¿ Improvements were still needed to ensure care plans and paperwork were kept up to date and reflected people’s needs. Relatives told us they thought communication could be improved to ensure they were kept up to date with any issues or concerns. Relatives were also concerned about how the laundry service was being run.

¿ Complaints were promptly and thoroughly investigated and people had the choice to take part in activities that were on offer in the home. Improvements were required to ensure end of life care was properly planned for.

¿ The provider and managers were open and honest about the improvements that were required and the leadership team has the capacity and ability to take the necessary steps to improve the service.

¿ Staff and relatives were generally happy that the service was moving in the right direction and that improvements were being made.

More information is in the detailed findings below.

Rating at last inspection:

Requires improvement (report published 11 January 2018).

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Enforcement:

No enforcement action was required.

Follow up:

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

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

We commenced the inspection of this service on 14 November 2017 and the inspection was unannounced. We completed the inspection on the 17 November 2017. Alma Court is a care home that provides accommodation and personal care. Alma Court is registered to accommodate 73 people in one adapted building. At the time of our inspection 71 people were using the service. Alma Court accommodates people in one building and support is provided on three floors across six separate units, each of which have separate adapted facilities. A garden and enclosed patio area were available that people could access. All of the units specialise in providing care to people living with dementia who demonstrate behaviours that put themselves and others at risk of harm.

The service had a registered manager in post. 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 last comprehensive inspection was undertaken on the 14 October 2015 and the service was meeting the regulations that we checked and received an overall rating of Good. We undertook a focused inspection on the 21 July 2016 following concerns received regarding the numbers of staff available to support people. We found there were enough staff available but some agency staff did not have sufficient knowledge about the people they were supporting; to ensure they could provide safe care. We rated the safe domain as requires improvement and asked the provider to take action to address this. The overall rating remained Good. At this inspection we found improvements had been made in this area but further improvements were required.

This is the first time the service has received an overall rating of Requires Improvement.

Systems were in place to monitor the quality and safety of the service but they were not always effective in identifying areas for improvement. For example, staff had received training to support people; this included moving and handling training to enable them to move people safely and in accordance with current guidelines. However we observed two occasions when unsafe practices were undertaken. This had also been raised by Staffordshire quality monitoring team in July 2017 and fed back to the registered manager at that time. This meant that the provider’s actions to address this had not been effective. People were supported to take their medicines but records to demonstrate that people’s prescribed creams had been applied were not always completed. This meant we could not be assured that people received these creams to protect their skin. Confidential records were not always stored securely to ensure they were only accessible to authorised people. The majority of staff interacted well with the people they were supporting; however some agency staff did not provide sufficient interaction with people to ensure their social needs were met and their well-being maintained.

Staff understood their responsibilities to report any concerns and enough staff were available to support people. Before staff started work checks were made to confirm they were suitable to work with people. Assistive technology was in place to support people to keep safe. Systems were in place to prevent and control the risk of infection.

We found people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. When decisions were made in their best interests their rights were protected. People were supported with their dietary needs and to access healthcare services to maintain good health. The design of the building enabled easy access for people to walk around independently and improvements to outdoor spaces were being addressed by the provider.

People's rights to privacy and dignity were respected and they were supported to maintain relationships with people that were important to them. People’s representatives were involved the assessment and development of their care plans.

People and their representatives were consulted regarding their preferences and interests and these were incorporated into their support plan to promote individualised care. The staff employed by the provider knew people well to enable them to meet people’s needs.

People were supported to take part in social activities and be part of the local community. The registered manager sought and included people and their representatives in the planning of care. There were processes in place for people to raise any complaints and express their views and opinions about the service provided.

People who used the service and their relatives were involved in developing the service; which promoted an open and inclusive culture. The provider and registered manager understood their legal responsibilities and kept up to date with relevant changes.

We identified one breach 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.

Alma Court can provide support and accommodation for up to 73 people with complex behaviours who require nursing care. There were 69 people living in the home on the day of our inspection.

There was a registered manager in post. 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.

At the focused inspection we found that there were sufficient staff to care for people however some agency staff did not have all of the information they needed to provide people’s care in the way it was planned. Some agency staff were unable to explain how they would support people to leave the home quickly in the event of an emergency or where to access fire fighting equipment. The provider had recognised there were shortfalls in their staffing levels and demonstrated they had plans in place to mitigate the risks this presented to the consistent care of people. A staffing review had been completed and a recruitment drive was in progress.

Below is a summary of our finding based on our observations, speaking to relatives of people who used the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service Caring?

People were observed to be treated with respect by the staff supporting them. Individual choices and preferences were respected. People were dressed in their individual style and appeared well cared for. A relative of one person told us: 'My wife receives brilliant care here'.

Is the service Responsive?

People were generally observed to be involved in activities within and outside of the service. Relatives told us that they were fully involved in their loved one's care and if they had any concerns they would speak to the manager who would deal with them.

Is the service Effective?

People's health and care needs were assessed and where able to people or their representatives were involved in the process. Specialist equipment and specific health needs had been clearly identified in their care plans.

The premises were well adapted and maintained to meet the individual needs of people who used the service.

Is the service Well Led?

The manager had not registered with us as is required. This was discussed at the time of the inspection. The manager and provider assured us this would be dealt with promptly.

The service had several quality monitoring systems to ensure a continuous improvement of quality care.

Staff we spoke were knowledable in their role and in their ability to care for people.

Is the service Safe?

Relatives of people we spoke with told us they felt their loved one was safe at Alma Court. One relative told us: 'I feel comfortable leaving my dad here'.

The service had systems in place to monitor accidents and incidents. Where appropriate other agencies had been involved in people's care such as Deprivation of Liberty Assessments.

Staff told us and we saw that there were enough staff to safely meet the needs of people who used the service.

We spoke with two people who used the service and observed their care. We spoke with six members of staff and three relatives of people who used the service.

We found at this inspection that people's care and welfare needs were being met. A relative told us: "I've got no complaints, it's good here".

We saw that the service had implemented new systems to recognise and report concerns of possible abuse.

We saw and staff told us that the service had implemented systems to support the staff to fulfil their role. Staff we spoke with told us they felt supported and equipped to fulfil their role effectively.

People at Alma Court had complex needs and limited communication skills. As part of the inspection process we spoke with six staff, two visiting relatives, the manager, operational manager and the provider. We observed people's care and interacted with people as much as we were able to dependent on their needs.

We looked to see if people's care and welfare needs were being met. We observed people had to wait for their personal care needs to be met and staff did not always show compassion when communicating with people.

We checked to see if people who used the service were safe from abuse or the risk of abuse. We found that one person's needs had not been reviewed following a serious incident and this may have placed this person at further risk.

We observed that there were sufficient numbers of staff but people's needs were not always being met.

We looked to see if staff felt supported in their role. Five out of six staff told us they did not feel supported and were unable to communicate this with the management.

At our previous inspection in January 2013 we had concerns over the lack of activities on offer for people who used the service. At this inspection we found that improvements had been made. We found that people were being engaged in meaningful activities. A relative of one person who used the service told us; "There has been an astonishing difference in my relative since they have been here".

We checked to see if people who used the service consented to their care, treatment and support. We found the service had systems in place to support people to be involved in and agree with their care planning.

We looked to see if the service was clean. We found the service was clean and followed the correct infection control policies.

We found that the service operated effective recruitment procedures for the employment of new staff.

We saw that the service had a complaints procedure. The manager showed us that they investigated complaints appropriately.

Alma Court was compliant in the five outcome areas we looked at.

We were not able to talk to many of the people who used the service due to their complex needs but we observed that people appeared comfortable and relaxed in their environment. We saw staff knock on bedroom doors before entering and speak with people in a respectful manner.

The service had a safeguarding policy and the manager showed us safeguarding referrals they had made to the local authority to keep people safe.

Staff we spoke with told us they felt supported and suitably trained to fulfill their role and were happy working at Alma Court.

Relatives of people who used the service told us they were happy with the level of care provided to their relatives.

The service had implemented numerous quality monitoring systems to ensure a continuous improvement in the quality of the service required.

We had concerns over the level of activities that were available to people who used the service.