Archived: Alfreton Residential Home

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. There was a registered manager in post, they had been registered since January 2015.

All medication records were completely legibly and had been signed for, however it was identified that a staff member had signed for medication they had left for staff to be administered by a different staff member at a later time. All staff giving out medication had been trained in medication administration.

All six people we spoke with said there was not enough going on with regard to activities and we were told that although the food was good and nutritious the choice of food was limited due to confusion about what choices had been made and what was available.

People who lived at the home were happy there and held the staff in high regard. They said they were well looked after. People told us they felt safe at the home and had no worries or concerns. From our observations it was clear that staff cared for the people they looked after and knew them well. People and relatives we spoke with said they would know how to make a complaint. No-one we spoke with had any complaints. The service was caring and people and their relatives confirmed this to us. The service was responsive to people’s individual needs and made sure any concerns were addressed.

We reviewed three care plans, these provided sufficient information on people’s needs and

risks and guidance to staff on how to meet them. Regular reviews of care plans took place to monitor any changes to the support people required

We found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had been followed. The registered manager told us that DoLS applications had been submitted to the Local Authority for some people.

Infection control standards at the home were good and standards were monitored and managed. Maintenance records were up to date and legible, this meant the home was a safe environment. The registered manager had systems in place to ensure that people were protected from the risk of harm or abuse.

Staff were recruited safely and there was sufficient evidence that staff had received a proper induction or suitable training to do their job role effectively. The majority of staff had been supervised in their role.

The home had quality assurance processes in place including audits and quality questionnaires. The home also had up to date policies in place that were updated regularly. The registered manager regularly checked the quality of care at the home through audits.

The majority of people we spoke with felt there was always enough staff on duty and during the inspection there was sufficient staff on duty to ensure peoples care needs were met.

The home required 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. There was a registered manager in post who had been registered since January 2015.

People who lived in the home told us they felt safe and had no worries or concerns. From our observations it was clear that staff cared for the people they supported and knew them well. People’s relatives and friends also told us they felt people were safe but also mentioned the low staffing levels. During our visit, however we identified concerns with the service.

We found a breach of Regulations 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to how risks were assessed. You can see what action we told the provider to take at the back of the full version of this report.

All medication records were legible and properly signed for. All staff giving out medication had been trained in medication administration.

We reviewed four care plans including risk assessments and found these needed to be more informative and person centred. They also did not give appropriate guidance for staff to meet people’s needs. Not all care plans had regular reviews to monitor any changes and so did not reflect the changes to people’s needs.

We found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had not been followed but the manager took immediate action to rectify this.

People and relatives we spoke with said they would know how to make a complaint, none of the people or their relatives we spoke with had any complaints.

People and staff told us that the home was well led and staff told us that they felt well supported in their roles. We saw that the registered manager was a visible presence in and about the home and it was obvious that they knew the people who lived in the home well and that the staff were well supported to carry out their duties.

We saw that infection control standards in the home were monitored and managed appropriately. Some audits were completed as necessary and maintenance records were up to date and legible.

People had access to sufficient quantities of nutritious food and drink throughout the day and were given suitable menu choices at each mealtime.

The focus of the inspection was to answer five key questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

One person told us that they felt 'Happy' and 'Safe' living in the home.

Robust recording processes were in place to account for money held on behalf of people living in the home.

However, we found that improvements were needed in the recording and management of medicines.

Is the service effective?

People's health and care needs were assessed with them. People who used the service and their relatives said that staff involved them in the planning of their care. Relatives told us that they were kept informed about their loved ones well-being.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Is the service caring?

People told us that they were happy with the service and well cared for.

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

Relatives told us that they had chosen the home as it was small and homely.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People knew how to make a complaint if they were unhappy. We looked at how complaints had been dealt with, and found that the responses had been open and thoroughly investigated.

We found that people had access to health professionals as required.

Is the service well-led?

Staff told us they were clear about their roles and responsibilities and had a good understanding of the ethos of the home.

The service had a quality assurance system and records seen by us showed that shortfalls were identified. However, the system had not been effective in picking up all the shortfalls we identified in the management of medicines.

On this inspection, we looked at five staff files and saw they contained current and training certificates where shortfalls had been identified previously. We found that processes were now in place for people to review their roles and look at their professional development. We saw that staff had the opportunity to gain further qualifications such as NVQ's levels 2 and 3. We spoke with two members of staff who were able to verify the training they had completed. They told us they had no concerns with the service and felt supported by the manager and the provider.

During this inspection we found that the systems for assessing and monitoring the quality of service provision were now in place. It was evident that audits throughout the home were carried out on a regular basis.We found that people who used the service, their representatives and staff were asked for their views about their care and they were acted on. We saw that surveys had been given out to people and their relatives. We saw that thank you cards and letters of appreciation were on display for people to see.

People who used the service told us they felt safe living at the home. Comments included: "I feel safer here than I did at home" and "I'm happy to live here. I feel safe and don't have to worry about anything".

Our observations showed that staff answered call bells promptly during the day of our inspection. Staff were continually in and out of the lounges and people's rooms to check on people's welfare.

We spoke with all three of the care staff that were on duty during the day of our inspection. They all told us they could not remember the last time when they had supervision or an annual appraisal. We looked at five staff files and saw the most recent supervision that took place was in May 2012. Another staff file showed that their last appraisal took place in 2009.

We found that people who used the service and / or their relatives' were not asked for their views about the care that was received at the home. The last surveys completed were in 2011. In addition to this we could not see if staff or visiting professionals had ever been asked for their views about the service.

'I feel like it's my home'.

'They couldn't treat me nicer if I was the Queen of England'.

'This is such a lovely home'.

We observed during our inspection that the people living at Alfreton appeared happy and content living there and that they were well groomed and suitably dressed. We found people were treated respectfully and given support to have their say in how they wanted to be helped and were supported to do the things they wanted to do.

The people who lived at Alfreton were cared for by staff who were appropriately recruited, well trained and experienced at supporting them.