Archived: Alstone House (Registered Care Home)

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.

People's support was underpinned by care plans that were current and detailed. Staff were knowledgeable about people's needs and preferences. A healthy diet was very important to one person and they told us staff helped them to achieve this. Staff also monitored their diet to ensure they had enough to eat to keep them well.

One person told us that they felt safe and could share concerns with staff if they needed to. Staff were knowledgeable about safeguarding and related topics. The provider had managed allegations of abuse in a timely fashion and had investigated thoroughly. Medicines were stored and administered safely. Medicines records were fully completed and accurate. People were involved in administering their own medicines as far as possible.

People and staff felt that they were listened to by the provider. We saw evidence of complaints and incidents being well managed and learnt from. Quality and health and safety checks were in place to ensure people's safety and satisfaction.

We observed staff interacting well with the people living there and treating them with dignity. Staff told us that they felt well supported and had sufficient training. We looked at a number of care records and these were regularly reviewed, easy to read and focused on the needs and preferences of the people living in the home.

The building was fairly new and was generally in good repair. The provider had made the environment inviting and engaging for the people living there. We saw that there was a robust quality management system in place to ensure that potential problems were identified and resolved as soon as possible.