Alveston Leys Care Home

Alveston Leys is registered to provide accommodation, nursing and personal care for up to 60 people, including people living with dementia and a physical disability. At the time of our inspection visit there were 32 people living at the home. Care is provided across three floors that included a residential and nursing unit. A communal lounge and dining area are located on the middle floor. People’s bedrooms are ensuite and there are further communal bathroom facilities located on each floor.

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

People were complimentary about the quality of the care and support they received. Some people felt staff went above and beyond which helped them to feel well cared for. People gave us positive comments about the management of the home.

People told us they felt safe. Staff understood their safeguarding responsibilities to keep people protected from poor practice. Staff were aware of the signs that might indicate a person was worried or anxious and how these could be an indicator of potential abuse or discrimination.

People received their medicines safely. People who required ‘as and when’ medicines had a protocol in place to tell staff, when, how and at what dose, these medicines should be given safely. Medicines were stored safely, and people received their medicines from staff who were trained and competent. Any medicines people required at specific times were administered when needed.

The provider continued to follow safe recruitment processes and staff told us they were trained and competent to complete tasks.

Risks were assessed and updated to ensure staff supported people with the right levels of care. We found some improvements could be made to ensure staff had enough information to support safe diabetes care on the residential unit of the home. This was addressed immediately during our inspection visit.

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.

Most people told us they felt there were enough staff on duty to meet their needs. However, some people felt staff did not always arrive promptly when they called for assistance. Reliance on agency staff had reduced and people felt staff response was better, but still needed improving. During our visit we heard alarm bells were ringing for periods of time. We discussed this with the registered manager who agreed to investigate this to assure themselves there were enough staff at key points of the shift.

The registered manager and provider completed regular audits and checks, including clinical, quality and environmental checks. We found when some of those checks were delegated to others, there was limited scrutiny to ensure those checks were completed correctly and any improvements were addressed. The provider contacted us after our visit and plans to address improvements for some environmental checks had commenced.

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

Rating at last inspection and update

The last rating for this service was good (published 06 February 2018).

Why we inspected

The inspection was prompted in part due to concerns received about the standards of care and staffing levels within the home. We had not inspected for some time, so a decision was made for us to inspect and examine those risks.

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

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has stayed the same. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Alveston Leys on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Alveston Leys Care Home is registered to provide nursing and residential care for up to 60 people. People in care homes receive accommodation and nursing and/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 home has a residential unit and a nursing unit which is spread over three floors. At the time of our inspection visit, 43 people lived at the home.

A requirement of the service’s registration is that they have a 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 and the associated Regulations about how the service is run. At the time of our inspection visit there was a registered manager in post who was supported by a deputy manager.

At the last inspection on 7 February 2017, the service was rated as requires improvement. We found a breach of the regulations because improvements were needed in the deployment of staff. We also found improvements were needed in the processes and procedures to support the provision of quality care within the home. Following the last inspection visit, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe and Well led to at least good.

This inspection visit was a comprehensive inspection and during this inspection we checked to make sure improvements had been made. Whilst some improvements had been made, we found improvements were still needed to ensure daily records were accurate and clearly evidenced the care provided.

There were enough staff to provide safe and effective care that met people’s needs. Recruitment procedures ensured staff were qualified and safe to work with people who lived in the home. Staff understood their safeguarding responsibilities and the action they should take if they were concerned a person was at risk of harm.

The provider used a variety of risk assessment tools to identify any potential risks to people’s health and safety and risk management plans guided staff on how to manage those identified risks. However, daily records to support risk management were not being consistently or accurately completed.

Accidents and incidents were recorded by staff and analysed by the registered manager to identify any emerging trends or patterns so appropriate action could be taken to minimise identified risks.

People received care from staff with the knowledge, skills and competencies to support their health needs. Medicines were ordered, received, stored, administered and disposed of in accordance with good practice and overall, staff understood their role and responsibilities in relation to infection control and hygiene.

The provider assessed people’s capacity to make their own decisions if there was a reason to question their capacity. Staff and the registered manager had a good understanding of the Mental Capacity Act. Where possible, they supported people to make their own decisions and sought consent before delivering care and support. Where people’s care plans contained restrictions on their liberty, applications for legal authorisation had been sent to the relevant authorities as required by the legislation.

Staff supported people to eat and drink enough to maintain their health and referred people to other healthcare professionals when a need was identified. Managers and staff worked with other healthcare professionals to ensure people could remain at the home at the end of their life and receive appropriate care and treatment.

Staff were caring and compassionate. They knew people well so they could deliver care in the way people preferred and in a way that was meaningful to them. The atmosphere in the home was warm and friendly and conducive to building and maintaining relationships with others in the home as well as family and family. People’s diversity was respected and staff responded to people’s social and emotional needs in a person centred way. People told us their needs were met because they were supported and cared for in accordance with their wishes and choices.

There were processes and procedures for monitoring the quality of care provision in the home. However, some improvements were needed to ensure action was promptly taken when issues were identified. People and staff were positive about the leadership of the service, but some staff and relatives felt the management team could be more visible on occasions.

Alveston Leys Care Home provides nursing and personal care for up to 60 older people. On the day of our inspection there were 43 people living in the home. One side of the home was a residential unit and the other side was for people who required nursing care. The nursing unit consisted of three floors. The provider had opened the Lavender Unit in October 2016 for people living with dementia on the ground floor.

The manager had worked at the service since December 2016 and was in the process of completing their registration with CQC. 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. Both the manager and deputy manager had previous experience of managerial roles.

People were happy with the care and support they received at Alveston Leys and found staff to be caring, polite and professional. People told us they had a positive relationship with care staff who knew them well. Staff were committed to providing a friendly, homely environment for people and their visitors. They received the training and support they needed to meet people's needs effectively.

People felt safe living at Alveston Leys and we saw people were comfortable and relaxed in their surroundings. Staff knew what to do if they thought someone was at risk of abuse or avoidable harm. The provider's recruitment process was thorough which meant risks to people's safety from unsuitable staff were minimised.

The managers understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff had completed training in the MCA and understood how to support people to make decisions about their daily lives. Where restrictions on people's liberty had been identified, the appropriate applications had been made to the authorising body. People were given choices about how they lived their lives and received support in line with their preferred routines.

Staffing within the home needed improvement. The deployment and management of staff affected the standard and consistency of care people received and meant there were times when there was no staff presence in some areas of the home.

People received food and drink which met their needs. Staff were aware of those people who needed specialist support to maintain their nutritional needs. People were supported to maintain their health and obtain healthcare advice when a need was identified.

People received care that was responsive to their needs and staff understood how they preferred to spend their time. Staff responded to and acted on changes in people’s needs and abilities. People enjoyed the opportunities they had to engage in activities that were of interest to them.

After a period of significant change with staffing and at management level, new staff had been recruited and a new management team were in place. People and staff spoke positively about the new home manager and the deputy manager who shared an enthusiasm to drive through improvements within the service. The new manager was aware that staff morale needed to be improved. They had put processes in place to ensure staff felt listened to and had plans to improve training so staff felt more confident and valued.

We found a 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.

We spoke with three relatives of people who used the service and saw staff welcome and chat with others. They told us that they felt comfortable in the home. A regular visitor was very happy with the care and said staff were 'friendly and caring.'

People who used the service told us they had enjoyed their lunch time meal and we saw staff assisted those people who needed help.

We spoke with six staff and found they were knowledgeable about the needs of people who used the service and their responsibilities. Assessments and care plans identified the care that people needed and guided staff in the delivery of appropriate care.

Medication was safely managed and recruitment checks were sufficiently robust to guard against employing unsuitable staff.

We also spoke with the manager and the area manager. We found that Alveston Leys Nursing Home was well managed with good systems in place to assess and monitor the quality of care.