We carried out a review of the data available to us about Alice Grange on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Alice Grange, you can give feedback on this service.
We found the following examples of good practice.
The home had policies and procedures to assist the manager and care workers to manage any risks associated with the COVID-19 pandemic.
Care workers had received training to help ensure their knowledge on infection prevention and control was up to date.
The home had Personal Protective Equipment (PPE) stations for care workers to don and doff (put on and take off) PPE. Our observations during our visit confirmed care workers were adhering to PPE and social distancing guidance.
People were supported to stay in touch with their relatives and friends and the manager supported visiting at the home. There were clear processes in place for visitors to the service. They were screened for COVID- 19 symptoms, a negative LFD test was required on arrival and they were asked to wear appropriate PPE.
People living at the home and care workers were undertaking COVID-19 testing in line with Government guidance. Appropriate action had been taken if anyone contracted the virus including care workers who were supported to self-isolate. Care worker absence was being effectively managed where shift cover was required.
The home was visibly clean. Cleaning schedules were in place with additional cleaning protocols to ensure all high touch points were regularly sanitised.
The home maintained close links with healthcare professionals including the local GP practice. If medical advice was needed, this was obtained in a prompt manner.
Alice Grange is a care home providing personal and nursing care for up to 80 people across three floors. One of the floors provides care to people living with dementia. At the time of our inspection visit there were 41 people living at the home.
People’s experience of using this service and what we found
We had significant and multiple concerns at our last inspection and rated the home inadequate in four key questions and overall. We also found five breaches of the Health and Social Act 2008 (Regulated Activities) Regulations 2014 at that time.
Immediately following our last inspection, the provider took action to begin making the necessary improvements including placing a voluntary suspension on any new admissions to the care home. The provider brought in a team of senior support managers and clinical staff to help address the significant concerns and to put in place a plan of action to make the necessary improvements. This involved making improvements to governance and oversight arrangements, and implementation of systems and processes to safely assess and manage risks to people. Staffing levels were reviewed and immediately increased.
At this inspection we found significant improvements. The service had clear and improved leadership and there was increased stability and a changed culture which was commented on by many people, staff and stakeholders we spoke with.
People using the service told us they were happy living at Alice Grange and with the care they received. People felt safe and well-treated by staff. Staff were kind and considerate. Staffing levels were kept under review to ensure they were sufficent. Staff were recruited safely. We have made a recommendation regarding the on going monitoring of staffing levels by the provider.
Medicines were managed safely. Staff wore personal protective equipment (PPE) and clear guidance was in place regarding keeping people safe from the risks associated with COVID-19. The environment was clean and well maintained.
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.
Many people, relatives and staff were positive in their feedback about the leadership of the home and the quality of care delivered. A member of staff told us, “I can honestly say I have never been happier and more proud of my team than the one I’m in at Alice Grange. I would like to say that the knowledge of [people] and the dedication of the carers is outstanding, but it doesn’t stop there. From the domestic staff to the chefs, the hosts/hostesses and activities team, they all treat [people] as individuals, with dignity and respect. And even though the management team have not been in post long they too know the residents, the staff, [provider] policies and local guidelines but most of all they care.”
Feedback we received was positive about how the service was being managed and the significant improvements made. Staff felt very well supported by the registered manager. The registered manager and provider completed regular audits and checks, which ensured levels of quality and safety were maintained at the home. The registered manager understood and met their regulatory responsibilities.
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 Inadequate (published 31 March 2020) and there were multiple breaches of regulation. The provider completed a fortnightly action plan after the last inspection to show what they would do and by when to improve. We also held monthly virtual meetings with the provider to check on the progress being made. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
This service has been in Special Measures since 31 March 2020. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.
Why we inspected
We undertook this comprehensive inspection to check the provider had followed their action plan and to confirm they now met legal requirements. The overall rating for the service has changed from Inadequate to Good. This is based on the findings at this inspection.
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 coronavirus and other infection outbreaks effectively.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Alice Grange on our website at www.cqc.org.uk.
Follow up
We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.
People’s experience of using this service and what we found
There were not always enough staff effectively deployed to meet people's needs in a timely way. There was a staffing tool in place which the provider used to calculate the number of staff required however there was a discrepancy between the outcomes described by the tool and people's and staffs' lived experience. Recruitment practices were not robust.
Across the home we saw staff were under pressure to meet people’s needs and although it was evident, they were trying very hard, we saw instances of shortfalls. For example, people’s preferences of when to get up were not being met and a high number of people were being left in bed when this was not their wish. This affected the quality of the service people received in all our key questions.
People were left at risk of poor nutrition and hydration support and at significant risk of developing pressure ulcers due to staff not having sufficient time to provide care for people in the way they needed. Care plans did not accurately reflect people’s needs and any risks or how these were mitigated against.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the home did not support this practice. People's needs were not always assessed adequately. Although people spoke positively about the staff that supported them, it was found staff were not supported adequately.
The home was not well managed, and the provider lacked oversight of quality standards and the care that was being delivered. Audits were not effective and had not identified the issues found during the inspection.
We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of Care Quality Commission (Registration) Regulations 2009.
Following our inspection the provider took immediate action to address some of the concerns identified. These included taking a voluntary suspension on admitting any further people in to the home and increasing the staffing numbers.
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 Requires Improvement (published 21 October 2019). At that inspection we also found three breaches of the regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of the same regulations plus an additional further two regulations.
Why we inspected
The inspection was prompted in part by notification of a specific incident to CQC. Following which a person using the service died. This incident is currently subject to further police investigation. As a result, this inspection did not examine the circumstances of the incident. Prior to the inspection, we also received concerning information that people were not receiving safe care and treatment. Please see the safe, effective, caring, responsive and well-led sections of this full report.
Enforcement
We have identified breaches in relation to safe care and treatment including medicines management, management of risk, staffing, person centred care and how the service is managed at this inspection. Please see the action we have told the provider to take at the end of this report.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Special Measures
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.
People’s experience of using this service:
People who lived at Alice Grange and their relatives told us that the staff were kind but that there had been a lot of changes recently, which had disrupted the quality of service they received. Nor did they feel there were enough staff, particularly at weekends. One person told us, they had to wait an hour for help then after they had asked to get up.
Another person commented that they did not think there were enough staff because, “I miss out, when I want to go to other floors for activities they don’t always come to take me.”
Personal risks were assessed, and steps had been put in place to mitigate risks, around falls for example. However, they did not always contain enough information and detail so that staff knew how people should be supported during an epileptic seizure.
Staffing levels were not always enough to keep people safe, replacement staff were not always brought in if staff went sick at short notice or if they were on leave. Often staff were taken off their substantive role to cover a different role, carers were asked to cover the hostess post for example. Safe recruitment processes were followed.
Health and safety risks within the home were not always properly addressed. The food serving trollies were unattended while switched on, meaning that people were at risk of burning themselves.
Medicines were not managed in a way that ensured that people received them safely.
Staff were trained to recognise abusive situations and knew how to report any incidents they witnessed or suspected. Staff had access to equipment that protected them and the people they supported against cross infection.
People’s needs were assessed prior to them moving into the service, but the information was not always detailed and was not always reflected in their care plan. People did not always receive care that was personalised and responsive to their needs. The care plans did not always contain detailed explanations for staff on recognising people’s disabilities or how they could be supported with the difficulties associated with their illness.
Staff received training appropriated to their role, however it was not evident that staff were always given a proper induction.
People were supported to eat and drink enough to maintain a healthy weight for them and have a balanced diet, but people told us that the food quality was poor, and they did not always get their first choice. The staff worked to ensure that people received the care they needed when they used and were supported by different services.
Because there was not always enough staff to support people, the people were not always supported to have maximum choice and control of their lives. However, staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People were asked for their consent by staff before supporting them in line with legislation and guidance.
Staff who spoke with us talked about the people who used the service in a caring and positive way. People told us that staff were very busy and did not always have time to stop and spend time with them, but that they were kind, caring and protected their privacy. We saw evidence in records that people were able to express their views and staff listened to what they said.
The service had listened to people’s experiences, concerns and complaints. However, people and their relatives told us that in the past complaints were not always dealt with properly but hoped things would improve now there was a new manager in place.
There has been a quick succession of managers recently that has added to a fall in the quality of care people have received. The provider has taken steps to get a manager in place and a new manager started work on the same day as the first day of our inspection.
The service was not well led, paperwork was disorganised, and information and records asked for were not always available or just could not be found. Quality assurance systems were in place but have not always been robust, as reflected in the comments made by people who used the service and their relatives, and the concerns and omissions we have identified during this inspection.
Rating at last inspection: After the last comprehensive inspection, the service was rated Requires Improvement in the Safe key question and Good in the other four areas, meaning that the service was rated Good overall. (published on 15 June 2017).
On 21 March 2019 we carried out a focused inspection over two key questions, Safe and Well-led because we had received concerns raised by people’s relatives and the adult social care professionals. As a result, Safe was rated Good and Well-led was rated Requires Improvement, the overall rate remained Good (published 5 June 2019).
This inspection was prompted in part due to concerns received about the management of the service, medicines and staffing. A decision was made for us to inspect and examine those risks.
The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvement. Please see the Safe, Effective, Responsive and Well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Alice Grange on our website at www.cqc.org.uk.
People’s experience of using this service:
• Since the previous inspection, the service had made improvements to the safety of people’s care. The manager used a dependency tool to determine how many staff were needed to be deployed on Memory Lane over seven days a week to meet people’s individual needs.
• The provider had not always identified areas of concerns and supported the leadership of the service, although actions had been taken to address those points.
• The views of relatives were mixed regarding there being sufficient staff on duty and the quality of the service provided.
• Staff informed us there were sufficient staff on duty but sometimes the needs of the people varied from day to day and hence they were far busier with personal care on some days compared to others. On the two days of our inspection the number of staff on duty matched the staffing rota and we observed there were sufficient staff to meet the needs of the people living on Memory Lane.
• People were offered baths and showers or alternative support with washing and personal hygiene but this had not always been recorded in their notes. This can cause confusion regarding whether or not people’s personal hygiene needs were being achieved.
• The management of the service had deteriorated for a period of time since our last inspection. Relatives and staff informed us this had improved in the past two to three months, since the appointment of a dedicated manager, who was also a qualified nurse, to Memory Lane.
• The new manager of Alice Grange and the dedicated manager of Memory Lane had continued to arrange care reviews and relatives meetings to discuss any problems and agree the way forward with relatives.
• People’s care records were being re-written to ensure they were accurate and the staff would have clear information regarding the person’s needs and how these were to be met. The care records that had been completed reflected people’s needs accurately.
• Relatives told us they felt their relatives were safe living at Memory Lane. There was a relaxed atmosphere between the people living there and staff. Staff knew people well and were kind, caring and attentive.
• People were protected from the risk of harm. Risks were managed safely and safe processes were in place to guide staff to deliver the care to people. Where risks had been identified the staff had worked with other professionals to resolve these matters.
• Staff had enough time to meet people’s basic needs and usually spend time with them in conversation, but there were not yet organised acitivites for people. Staff had the skills and knowledge to meet people’s needs effectively.
• Not all staff had received training in the care needs of people with dementia but training had been planned for all staff.
• Quality assurance processes had been reviewed and were in operation to determine any areas in which the service could be improved.
• The service met the characteristics for a rating of “Good” the key questions of Safe we inspected while requiring improvement in the key question of Well-Led.
Therefore, our overall rating for the service after this inspection has not altered from “good”.
Rating at last inspection: Good (The report was published on 15 June 2017). All key questions were rated as Good other than Safe which was rated as requiring improvement.
Why we inspected: We received concerns about the service from Healthwatch Suffolk which had been reported to them. These matters were regarding the Memory Lane service within Alice Grange and included poor attention to personal care, insufficient staffing, lack of training in dementia care and people’s care plans not being kept up to date.
Follow up: We will continue to monitor intelligence we receive about this service until we return to visit as part of our re-inspection programme. If we have any concerns, we may inspect sooner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
There was a registered manager in post. 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.
At our last inspection in February 2016, we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to staffing arrangements not being consistent to ensure there was sufficient numbers of staff to meet people’s care and welfare needs. At this inspection we found that staffing levels had improved although views about this remained mixed. People told us they received attention promptly when they called for assistance. However some people raised concerns that there were times when staffing levels could be improved, particularly at weekends and at meal times.
There were systems in place to minimise risks to people and to keep them safe. However, there were some risks associated with people’s health conditions which needed further explanation. Care records needed to be strengthened to ensure all staff were aware of the risks and how they should support people accordingly.
There was a positive, open and inclusive culture in the service. The atmosphere in the service was warm and welcoming. The management team led by example.
Staff understood the importance of gaining people’s consent and were compassionate, attentive and caring in their interactions with people. They understood people’s preferred routines, likes and dislikes and what mattered to them. People were involved in making decisions about their care.
The management team and staff understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
People presented as relaxed and at ease in their surroundings and told us that they felt safe. Procedures were in place which safeguarded the people who used the service from the potential risk of abuse. People knew how to raise concerns and were confident that any concerns would be listened and responded to.
People were complimentary about the way staff interacted with them. Independence, privacy and dignity was promoted and respected. Staff took account of people’s individual needs and preferences and people were encouraged to be involved in making decisions about their care.
Care plans were written in a person centred manner and reflected the care and support each person required and preferred to meet their assessed physical needs. More information was needed to guide staff how to support people’s emotional and social needs. Shortfalls in the care plans had been identified by the providers own audits and these were in the process of being updated.
People’s nutritional needs were assessed and professional advice and support was obtained for people when needed. They were supported to maintain good health and had access to appropriate services which ensured they received on-going healthcare support.
People were provided with their medicines in a safe manner. They were prompted, encouraged and reassured as they took their medicines and given the time they needed.
The service had a quality assurance system in place which was used to identify shortfalls and to drive improvement. As a result the quality of the service was continually improving. This helped to ensure that people received a high quality service. The management team were open and transparent throughout the inspection and sought feedback to further improve the service provided.
Alice Grange is a purpose built care home providing nursing care for up to 85 younger adults and older people. The service provides support to people with a range of needs which include; people living with dementia, those who have a physical disability, and/or people who require palliative end of life care.
There were 67 people living in the service when we inspected on 24 February 2016. This was an unannounced inspection.
There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to ensuring people were consistently supported by sufficient numbers of staff who are effectively deployed and have the knowledge and skills to meet people’s needs. We found that there were occasions, for example at meal times where staffing levels were not sufficient to ensure people had a good mealtime experience. In addition that people with complex needs had staff available to support them to spend their day in a meaningful way. You can see what action we told the provider to take at the back of the full version of this report.
Improvements had been made to the leadership of the service. This had led to the overall quality of the service improving. The service’s development plan had been effective and was being added to ensure that this continued, was sustained and drove improvement. There was a more positive culture in the service which meant that staff were aware of the values of the service and understood their roles and responsibilities.
People and relatives were complimentary about the care and support provided. Staff respected people’s privacy and dignity and interacted with people in a kind and compassionate manner. They were knowledgeable about people’s choices, views and preferences and acted on what they said. The atmosphere in the service was friendly and welcoming.
Procedures were in place which safeguarded the people who used the service from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to.
Robust recruitment checks on staff were carried out. Staff were trained and supported to meet the needs of the people who used the service. They knew how to minimise risks and provide people with safe care. Procedures and processes guided staff on how to ensure the safety of the people who used the service. These included checks on the environment and risk assessments which identified how risks to people were minimised.
Appropriate arrangements were in place to ensure people’s medicines were obtained, stored and administered safely. However improvements were needed in the medicines administration records to ensure consistency and that people were protected.
People’s nutritional needs were being assessed and met. Where concerns were identified about a person’s food intake appropriate referrals had been made for specialist advice and support. People were encouraged to attend appointments with other healthcare professionals to maintain their health and well-being.
People or their representatives were supported to make decisions about how they led their lives and wanted to be supported. Where they lacked capacity, appropriate actions had been taken to ensure decisions were made in the person’s best interests. The service was up to date regarding the Deprivation of Liberty Safeguards (DoLS).
Care and support was based on the assessed needs of each person. However this information was not always reflected in people’s care records to ensure best practice was followed
People’s experience of how they spend their days was inconsistent. Whilst there were some areas of good practice with regards to activities and social stimulation there were also several instances where people were left for periods of time with little or no interaction. Improvements were needed to ensure people especially those living with dementia spent their time in meaningful and fulfilled ways
Processes were in place that encouraged feedback from people who used the service, relatives, and visiting professionals. There was a complaints procedure in place and people knew how to make a complaint if they were unhappy with the service.
We carried out an unannounced comprehensive inspection of this service on 27 November 2014. We found shortfalls in the recording and safe administrations of medicines, inappropriate documentation used for recording well-being checks on people. There were inconsistencies in the recording of people’s care plans to show how they were involved in decisions about their care and quality monitoring systems were not robust.
Following this inspection, the provider wrote to us to say what improvements they planned to make to address our concerns.
We undertook this focused inspection to check that they had followed their improvement plan. We found that some progress had been made to address our concerns. This report only covers our findings in relation to the sections Safe, Responsive and Well-led where we identified shortfalls. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Alice Grange on our website at www.cqc.org.uk
Alice Grange is a purpose built care home providing nursing care for up to 85 younger adults and older people. The service provides support to people with a range of needs which include; people living with dementia, have a physical disability, or require palliative care.
At the time of our unannounced focused inspection on 11 August 2015, there were 62 people living in the service.
There was no registered manager at Alice Grange. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. Since our last inspection another new manager had been appointed by the provider to run the service and was in the process of registering with the CQC.
Continued progress had been made to the management of medicines. Appropriate arrangements were in place for the recording and safe administration of medicines. However improvements were needed for the management of medicines that were prescribed ‘as required’ (PRN) and homely remedies to ensure systems are robust.
Appropriate documentation had been implemented to record well-being checks for people. However inconsistencies remained in the recording of how people were involved in decisions about their care. Care plan audits identified that people and relatives were involved in the review process but this was not consistently reflected in people’s care plans.
The provider had taken steps to mitigate the risks to people and address the shortfalls found at the last inspection. This included implementing systems to monitor the quality and safety of the service. However these need measures to be embedded and sustained over time to ensure people are provided with a consistently safe quality service.
Alice Grange is a purpose built care home providing nursing care for up to 85 younger adults and older people. The service provides support to people with a range of needs which include; people living with dementia, have a physical disability, or require palliative care.
This was an unannounced inspection which took place on 18 November 2014 and 27 November 2014. At the time of our inspection there were 63 people who used the service.
At the last inspection on 29 May 2014 and 5 June 2014, we asked the provider to take action to make improvements relating to the care and welfare of people who used the service, supporting workers and assessing and monitoring the quality of service provision. Following the inspection the provider sent us an action plan advising us of how they planned to address these shortfalls.
We carried out a focussed inspection on the 5 August 2014 after we received concerns about the management of medicines at the service. Our pharmacist inspector found that people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place for the recording, handling, using and safe administration of medicines. We had also been notified of concerns that indicated people had not received their medicines as prescribed. The provider sent us an action plan to tell us the improvements they were going to make.
During this inspection we looked to see if the shortfalls identified at the previous inspections had been made. We found that some progress had been made to address our concerns.
At the time of our inspection there was no registered manager at Alice Grange. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. A new manager had been appointed by the provider to run the service and was in the process of registering with the CQC.
People that we spoke with told us they felt safe, were treated with kindness, compassion and respect by the staff and were happy with the care they received.
Staff knew how to recognise and respond to abuse correctly. People were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Risks associated with people’s care needs were assessed and plans were in place to minimise the risk as far as possible to keep people safe.
There were sufficient numbers of suitably skilled staff to meet people’s care needs. Improved processes had been made and were on going to support staff and provide them with the knowledge and skills to carry out their roles and responsibilities.
While we found improvements in the management of medicines, people were not fully protected against the risks associated with the management of medicines because the provider did not have appropriate arrangements in place for the recording and safe administration of medicines. Improvements were required in the recording of medicines. People who were unable to give consent to their medicines being given to them disguised in food and drink should have a documented capacity assessment.
People were supported to access health care according to their individual needs. People’s care records provided information to staff on how to meet their needs, promote their independence and maintain their health and well-being. However not all the care plans reflected how people were involved in making decisions about their care.
While we found improvements had been made in the monitoring and recording of people’s nutritional needs, people were at risk of not receiving personalised care as the documentation used to record well-being checks were not always fit for purpose.
CQC monitors the operation of the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS), and to report on what we find. DoLS are a code of practice to supplement the main Mental Capacity Act 2005. These safeguards protect the rights of adults by ensuring that if there are restrictions on their freedom and liberty these are assessed by appropriately trained professionals. The provider was meeting the requirements of the DoLS. People who could not make decisions for themselves were protected. Where a person lacked capacity Mental Capacity Act (MCA) 2005 best interest decisions had been made. DoLS were understood and appropriately implemented.
People were supported to be able to eat and drink sufficient amounts to meet their needs and encouraged to be as independent as possible. Where additional support was needed this was provided in a caring, respectful manner.
Staff interacted with people in a caring, respectful and professional manner. Where people were not always able to express their needs verbally staff responded to people’s non-verbal requests promptly and had a good understanding of people’s individual care and support needs.
People were supported with their hobbies and interests and had access to a range of personalised, meaningful activities. People knew how to make a complaint and confirmed their choices were respected.
Improvements had been made to assess and monitor the quality of the service provided. The views of the people who used the service, their relatives, staff employed at the service and visiting healthcare professionals had been sought and acted on where required.
We looked at how information in medication administration records and care notes for people living in the service supported the safe handling of their medicines. We found that not all medicines could be accounted for numerically by records and so we could not be assured people's medicines were always being administered as intended by their prescribers. We found there to be evidence of a medicine given in error on the day of inspection. We noted inadequacies in supporting information and records which could have led to people not receiving their medicines appropriately and as intended by prescribers. The competence of some registered nurses handling and administering people's medicines had not recently been assessed although the manager had identified this and was taking action.
We spoke with seven people who used the service. We also spoke with 15 staff and received written feedback from three people’s relatives and four health and social care professionals. We looked at seven people’s care records. Other records viewed included information on staff training records, provider visit reports, staff rotas and health and safety policies. We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?
This is a summary of what we found;
Is the service safe?
One person told us how it had been difficult to make the decision to move into full time care, but were glad they had. They told us, “I feel safe here…well looked after, they (staff) pop in at night and say are you alright?”
People living in the service told us they were provided with a clean, safe, well maintained environment which met their needs.
Our observations identified that staff were not always maintaining good hand hygiene at meal times and we fed back to the manager that improvements were needed.
We found that people’s care plans records did not accurately reflect the level of support that staff told us that they had given. This meant there was a risk that care was not being provided in a consistent way.
Staff were provided with training in safeguarding vulnerable adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). We saw that the provider had put a system in place to assess if a DoLS referral was required to protect a person using the service. However, where required, staff had not made the referrals. The registered manager confirmed that action would be taken to ensure the referrals were made.
Is the service effective?
All the people we spoke with were positive about the quality of the food provided. One person told us at the lunch time and evening meal, “We have two choices of a starter and a main meal, a sweet and a cup of coffee.”
People confirmed that they were able to see their visitors in private and when they wanted to.
We found the quality of the information given in people’s care plans fluctuated. This was because some care plans provided guidance for staff, to support person centred care. However, the contents of other people’s care plans had not been updated and/or reflected people’s current care needs. Therefore it did not provide staff with enough guidance to provide appropriate personalised care. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.
Is the service caring?
The majority of the feedback we received showed that people were supported by kind and attentive staff. One person who lived in the service told us that the staff always treated them in a kind and polite way. Another person told us, “Wonderful carers, couldn’t ask for better care.” Information received from one person identified where staff had not acted in a respectful or appropriate manner.
When we spoke with staff they demonstrated their commitment to provide a good service. During the morning shift change over we heard staff discuss people needs in a kind and respectful manner.
Is the service responsive?
People’s preferences and choices were usually taken into account and listened to. The staff involved people in making decisions and acted on the information they received. One person living in the service told us, “Your wishes are carried out, rather than what they (staff) want you to do.” However, we also saw there were some instances where the service needed to make improvements to ensure that people always felt listened to and had confidence that staff would act on what they said.
People’s care records showed that where concerns about their health and wellbeing had been identified that staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from healthcare professionals which included a doctor and community dietician.
Is the service well-led?
Not everyone we spoke with, or received information from, felt that the registered manager always listened to feedback given to improve the service. We found improvements were needed to ensure that information was shared between all levels of management and staff, as well as between people living in the service, their relatives and advocates.
The service had quality assurance systems in place and records seen by us showed that shortfalls were being identified but not acted on in a timely manner. As a result, the quality of the service was not continually improving. Instead, we found previous shortfalls which had been addressed by the provider, had re-occurred. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.
We found improvements in the quality of information written in people’s care records to ensure it provided an accurate account of the level of care being provided. We saw that the quality of the information was subject to regular, on-going checks from external senior management. Where shortfalls were identified action was taken to address them through training and one to one supervision.
We found staff had a greater understanding of the individual support and environmental needs to support people living with dementia. One visitor described the care to support people living with dementia as, “Wonderful,” that staff, “Listen to what (name) says, they encourage (Name) to speak.”
We found improvements in the staffing levels at meal times. This meant where people required assistance at meals times; they were assisted in a timely manner. People told us that they had seen improvements in call bell response times, but there was still room for improvement at busy times. One person told us, “I ring the call bell and they (staff) come as quickly as they can.”
We found that people were protected from unsafe practices, as improvements had been made in the recording and storage of medication.
People we met during our inspection told us that they were generally satisfied with the service they were provided with and said staff treated them well. One person said, “Not bad at all, could be worse.” Another person said, “I am away from home, but it is still homely…staff very good.” Another said that staff had, “Been very good.”
One relative praised the level of care given and told us that they had seen an improvement in their relative’s health and welfare. One relative told us that they, “Have no concerns,” over the standard of care their next of kin received as they felt they were, “Well looked after.”
We found there were issues with the staffing levels in the service, staff's knowledge of dementia care and information given in people’s care plans to support people’s dementia related needs. This had an effect on the care and support provided to the people used the service.
People we spoke with said they were happy with the way the service managed their medicines. We found that people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place for the safe keeping, recording, obtaining and the management of medicines.
All were positive about the staff, the quality of care they received and quality of the environment. One person told us, “Night staff are very good.” One person told us that they were, “Treated with the utmost respect.” Another person said, “There are little faults, but nothing outrageous.”
We found an inconsistent approach to the completion of people’s care records. This meant that not all records evidence the level of support and care offered.
We asked people if they would recommend Alice Grange to others, they told us they would. One person who lived in Alice Grange replied, “If I want anything done they (staff) will do it for me.” Another person said, “It’s the security of knowing someone is there.” One relative said, “Oh definitely.” Another relative told us, “Yes, I think it is a good place.”
People said that staff gave them their medication when they needed it, and confirmed that staff had never missed a dose. One person told us, “Sometimes they are a little late, but we have never gone without.”
People told us if they had any concerns, that they felt comfortable to tell staff or a family member.