This inspection took place on 29 and 31 March and 3 April 2017 and was unannounced on the first day. At our last comprehensive inspection on 5 April 2016 we rated this service “Requires Improvement” and found breaches of regulations relating to safe care and staff training. We carried out a follow up inspection in December 2016 and found that the provider had made some improvements but was still not meeting these requirements. We received concerns about the quality of care provided by the service and brought forward this scheduled inspection in order to look into these. At this inspection we rated the service “Requires Improvement”.
Alan Morkill House is a care home for up to 49 older people and people with dementia. There is a large kitchen and communal lounge on the ground floor and a shared courtyard and garden, and each floor includes a communal lounge, kitchen and dining room. The service is divided into seven units, three of these units provide care for people with dementia. At the time of our inspection there were 39 people using the service.
The service had 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 2008 and associated Regulations about how the service is run.
We found that the building was not always safe and potentially unsafe issues with premises were not always addressed in a timely manner, for example kitchens and cupboards storing cleaning materials were left unlocked. Although staff carried out checks of water temperatures and fridge temperatures, there were not always clear guidelines in place, and in some cases people were bathed in water which was too hot, which was not checked by managers. Where people were at risk of pressure sores, turning charts were not correctly completed or checked. Medicines were not managed safely, and we found that in many cases people did not receive their medicines as prescribed. Managers did not carry out sufficient checks to detect these issues.
Call bells were checked to ensure that they were operational, and these were responded to promptly, although staff could not always hear these in some areas of the building. Units for people living with dementia did not use dementia friendly design to aid people’s orientation around the building. We have made a recommendation about this.
The provider had assessed people’s capacity to make decisions, but did not always review these regularly, and when people were deprived of their liberty in their best interests the provider had acted lawfully. However, the provider did not ensure that people had appropriately consented to their care.
Staff training had improved, but some staff had not received training in mandatory areas, and the provider did not have a clear assessment of the training needs of the service. Many staff did not receive regular supervision and team meetings were not well attended enough to ensure good communication.
People received good support at mealtimes and food was nutritious and varied, however recommendations from dietitians were not always followed, and people’s weights were not audited in a way which would detect and address weight loss. Where people required food and fluid charts these were not always correctly completed or checked by managers.
People’s needs were assessed and reviewed regularly, and people’s wishes and preferences were identified by staff, including their wishes for the end of their lives. We found that people benefitted from caring and attentive staff and from a varied and interesting activity programme.
People told us they were treated with respect by staff and we observed friendly and caring interactions. Staff worked to maintain a suitable and friendly environment for people. Staffing levels were not unsafe, but staff told us they felt stretched at times. Managers addressed complaints effectively, and took appropriate action against staff where poor practice had taken place. The provider carried out appropriate pre-employment checks to ensure staff were suitable for their roles.
We found breaches of regulations regarding safe care, medicines, staff support, consent, nutrition and good governance. We issued a warning notice in relation to safe care and the management of medicines. You can see what action we told the provider to take at the back of the full version of this report.