Background to this inspection
Updated
13 April 2017
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
Prior to the inspection we looked at information about the service including notifications and any other information received from other agencies. Notifications are information about specific important events the service is legally required to report to us.
The inspection took place on 15 February 2017. This was an unannounced inspection, and was carried out by one adult social care inspector. The last comprehensive inspection of the service was on 16 July 2014 and there were no breaches of regulation at that time.
As part of our inspection we spoke to seven members of staff, one relative and we spoke to, or had feedback via email from four health and social care professionals. This included community nurses who visited the service daily and the Local Authority who had carried out a quality review the week before our inspection. The registered manager was not available on the day of our inspection. An ‘acting manager’ who had commenced employment the day before our inspection was available on the day. We spoke to a team of three members of staff from another Lifeways service who had been asked to support us with records on the day of our inspection.
During our visit we spoke to two people using the service. Because we were unable to speak to everyone because of their communication or learning disabilities we spent time observing what was happening at the home.
We looked at the care records for three people living at the service, six personnel files, organisational records, staff rotas and other records relating to the management of the service.
Updated
13 April 2017
This inspection was unannounced and took place on 15 February 2017. The last comprehensive inspection of the service was on 16 July 2014 and there were no breaches of regulation at that time. Alstone House is a residential care home and provides accommodation and personal care for up to four people with learning and physical disabilities and acquired brain injuries. At the time of our inspection three people were using the service.
There was a registered manager in post. However, they had not been working in the home since January 2017 when an internal quality audit by the provider had identified some concerns. The registered manager was not available on the day of our inspection. The registered manager was still employed but was currently on ‘gardening leave’ from the service. 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 responsibilities for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. The provider had employed an ‘acting manager’ from another service who had been working at Alstone House since the day before our inspection.
We received information prior to this inspection from a health and social professional telling us that people were at risk. This was because staff were not adequately trained to administer medicines and that people were being placed at risk due to high numbers of agency staff being employed. The local authority had completed a visit to the service on 31 January 2017 and found concerns relating to people’s safety. An action plan had been produced, however many of the concerns found had not been rectified when we visited. Our inspection highlighted shortfalls where some regulations were not met. We also identified further areas where improvement was required.
People did not receive a service that was safe. The provider did not have effective systems to assess, review and manage risks to ensure the safety of people. One person was at risk of falls and there was no assessment to determine risks associated for them. Guidance was not available for staff on how to support people safely. People’s medicines were not being managed safely and the medicines were not always secure as the keys were not always looked after by staff. Fire checks and fire drills were not being carried which meant people were at risk in the event of an emergency. Harmful chemicals were not being stored correctly. We found hazardous chemicals in the unlocked communal airing cupboard which could be extremely harmful for people. Staff recruitment was unsafe. Checks were not always carried out on staff to ensure they were safe to work with vulnerable people. The premises were in need of decoration, were not fit for use for one person with a physical disability and were not always clean.
Sufficient numbers of staff were available to keep people safe and meet their needs; however a high number of agency staff were being employed. This reduced staff consistency and this in turn negatively impacted on people’s care. Some people were not being supported to reach their full potential.
The service did not provide effective care and support. Staff had not received suitable training enabling them to effectively support the people living at Alstone House such as people living with an acquired brain injury. Staff were not receiving regular supervisions or appraisals. The service was not adhering to the principles or requirements of the Mental Capacity Act 2005 (MCA) or Deprivation of Liberty Safeguards (DoLS). This meant the people’s rights were not being protected.
The service was not responsive to people’s needs. Support plans and risk assessments were out of date and lacked detail required to provide consistent, high quality care and support. People did not always have sufficient activities to support them to socialise and lead a fulfilling life. Complaints were not documented or dealt with appropriately.
The service was not well led. The registered manager and provider had governance systems in place to monitor the quality of the service provided. However, these systems had not identified the concerns we found around medicines management, recording of information and assessing risks. There was no leadership from the senior staff team. Quality assurance checks and audits were inconsistent and put people at risk. Confidential records were left for anyone to read in the communal living area. This included information on people’s finances.
Staff we spoke with said they felt anxious about the service provided and that the morale was low. We observed staff trying to support people in a caring and patient way during the inspection; however staff appeared rushed and did not appear to know the people they were caring for well.
Following our inspection, the provider for this location submitted an application to cancel the registration to provide a regulated activity at Alstone House. We will be following our processes to de-register the service.
We found a number of breaches 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 this report.