Athlone House Nursing Home

Athlone House Nursing Home is a residential care home providing nursing and personal care for up to 23 people with continuing and palliative care needs. The service is set out over two floors and is fully accessible, with a lift serving both floors. There were 19 people living in the home at the time of this inspection.

People’s experience of using this service and what we found

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.

People were protected from the risk of abuse. Risk assessments had been carried out to identify the risks people faced. These included information about how to mitigate those risks. There were enough staff working at the service to meet people's needs and the provider had robust staff recruitment practices in place.

Medicines were stored, managed and administered safely. Infection control and prevention systems were in place. The premises were suitable, well maintained and ‘fit-for-purpose’. Accidents and incidents were reviewed to see if any lessons could be learnt from them. Staff understood how to support people in a way that promoted their privacy, independence and dignity. The service sought to meet people's needs in relation to equality and diversity.

The service assessed people's needs before they began living at the service, so they knew whether they could meet their needs. Staff were supported through training and supervision to gain knowledge and skills to help them in their role. People were supported to eat a balanced diet and were able to choose what they ate. Systems were in place for dealing with complaints. People were supported to maintain relationships with family and friends, and to engage in meaningful activities.

When a person was at end of life, appropriate guidance and input was sought from the GP and other healthcare practitioners to make sure the person was comfortable, dignified, pain free and reassured at all times.

People were supported with care that was person-centred. There was strong and visible leadership and a positive staff culture in the service, which helped to achieve good outcomes for people. People told us the registered manager was approachable and supportive. The provider was aware of their legal obligations and worked with other agencies to develop best practice and share knowledge.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (Published 21 May 2018).

Why we inspected

We undertook this inspection based on the date of the last inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Athlone House Nursing Home accommodates people in one building across two floors, with each person having their own bedroom and en-suite bathroom. There were also communal living and dining rooms, a main kitchen and external access to a garden so visitors did not need to enter the home.

We found the following examples of good practice.

There were clear procedures in place to ensure visitors could enter the home safely, with a requirement to complete a screening questionnaire and to provide a negative lateral flow device (LFD) COVID-19 test before entering the home. There was a designated testing area where visitors could enter via a separate entrance. The provider had also recruited a dedicated member of staff to help facilitate the testing process.

Relatives were given information about visiting and were kept updated about any changes in visiting procedures in the home. Relatives were given information about becoming an essential care giver in line with current guidance. This ensured every person in the home would be able to have a visitor even if the home was advised to restrict visits in the event of a COVID-19 outbreak.

The home was very clean, hygienic and free from odour. There were clear guidelines for domestic staff to follow to ensure cleaning schedules and best practice was followed. This included detailed guidelines for enhanced cleaning schedules to be implemented in the event of a COVID-19 outbreak.

Staff were confident about the actions they had to take if there were new positive cases of COVID-19 in the home. Staff had discussed their recent outbreak and used it as a learning experience. There were clear guidelines in place with outbreak management plans for staff to follow. One staff member said, "If we get a positive case, we are fully aware of what we need to do to keep everybody safe and we always discuss this.”

The provider carried out regular stock checks to ensure there were sufficient supplies of personal protective equipment (PPE) across the home. Staff had ongoing IPC training and we observed staff following best practice during the inspection. There were also helpful posters displayed throughout the home reminding staff about the correct way to wear their PPE and to challenge their colleagues if they observed any poor practice.

The service was taking part in regular COVID-19 testing for people and staff in line with current guidance. The provider was aware of recently updated testing guidance and had discussed this with staff to ensure they were all aware of the new testing regime.

The management team carried out regular IPC audits, which included spot checks and observations across the home to help ensure staff understood their responsibilities and were following best practice. A senior nurse said, "All staff complete training and we check they are aware as it is one of my duties as the nurse to ensure everybody knows how to wear their PPE."

Staff told us they felt supported in their role and had been kept regularly updated with any changes throughout the pandemic. Staff had access to an employment assistance programme and 24 hour helplines if needed, with wellbeing discussed during staff supervision. The registered manager said, "I discuss this in monthly staff meetings and my door is always open, staff do not need to wait for a supervision if they want to speak with me."

The registered manager told us they had continued to be well supported by the provider, the local authority and a range of health and social care professionals. They received weekly updates from the provider with any updates or significant changes in guidelines which helped to discuss across the staff team. We saw monthly team meetings also covered a COVID-19 update, which included important updates related to testing, visiting guidelines and updates in guidance.

Athlone House Nursing Home accommodates people in one building across two floors, with each person having their own bedroom and en-suite bathroom. There were also communal living and dining rooms, a main kitchen and external access to a garden so visitors did not need to enter the home.

We found the following examples of good practice.

¿ There were robust protocols in place for visitors upon entry, with temperatures taken and a questionnaire to be completed covering COVID symptoms, whether a recent COVID test had been taken and if any other care setting had been visited that day. Due to a recent positive test result for one person who had been taken to hospital, socially distanced garden visits had been temporarily suspended and the provider had set up window and balcony visits via a booking system.

¿ Posters were displayed across the home and guidance was available to provide advice and top tips for staff to help them communicate more effectively with people whilst they had to wear a face mask. There were also guidelines and advice for staff to help support people during this COVID period if they were living with dementia.

¿ The home had implemented innovative use of technology to benefit people and the staff team. Staff supported people to have video calls with their relatives, with booked sessions to help families stay in touch. The provider also sent out a monthly newsletter to update relatives. Text messaging was used across the staff team to help share important updates and changes in relevant guidance and keep them updated about information within the home.

¿ The registered manager received weekly updates from the senior management team with any important updates or changes to guidance. It also included examples of best practice or shared learning that had been identified in the provider’s other homes. For example, there was a reminder about the correct use of personal protective equipment (PPE) for visitors where one home had allowed a relative to visit with only a face visor and not a mask.

¿ The home was further supported by the North West London Clinical Commissioning Group (CCG) who provided advice, further training and support, which included a home visit to review infection and prevention control practices.

¿ Staff had been able to manage and contain any outbreaks within the home with the processes they had in place. Despite having an outbreak during the pandemic, there have been no COVID related deaths, which the whole staff team were very proud of.

At a focused inspection on 2 September 2016 we found that the provider was meeting the legal requirements in relation to safe care and treatment.

At this inspection we rated the service ‘Good’.

Athlone House Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is set out over two floors and provides nursing and accommodation to 23 adults with continuing and palliative care needs. The home is fully accessible, with a lift serving all floors. There were 19 people living at the home at the time of inspection.

The service had 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.

People told us they felt safe and were happy with the care provided. Staff were appropriately trained and skilled to care for people.

Where possible, people were involved in decisions about their care and how their needs would be met. Where appropriate, relatives and healthcare professionals contributed to the care planning process.

Systems were in place to identify and reduce risks to people living in the home. Risk assessments and management plans were in place to mitigate risks in relation to people’s mobility, nutrition, personal care, physical and mental health and well-being.

People were protected from avoidable harm and abuse because the provider had effective safeguarding systems in place. Staff understood how to recognise the signs of abuse and told us they would speak to a manager if they had concerns about a person’s safety or welfare.

Staff had a good understanding of mental health legislation. Where possible, staff supported people to make their own decisions and sought consent before delivering care and support.

People’s care records included written evidence of best interests decisions having been made in accordance with the Mental Capacity Act 2005 and relevant safeguards.

People's medicines were managed, stored and administered safely. Medicine audits were completed on a daily, weekly and monthly basis.

The service was complying with the Accessible Information Standard (AIS). The AIS applies to people using the service who have information and communication needs relating to a disability, impairment or sensory loss.

The service employed a full-time activities co-ordinator and a range of one to one and group activities took place within the home.

People were supported to eat and drink. People provided a mixed response when asked if they enjoyed their meals. Food and fluid charts were completed when risk of poor eating and drinking had been identified.

Staff supported people to attend healthcare appointments as required and liaised with people’s relatives, GPs and other healthcare professionals to ensure people’s needs were met appropriately.

Staff sought advice and guidance from palliative care teams when needed to ensure people remained comfortable and supported at the end of their lives.

People and their relatives, visitors and staff were asked for their views about the running of the service via regular meetings, feedback forms and annual surveys. People and their relatives felt able to raise concerns and were confident that any issues would be dealt with satisfactorily and in a timely manner.

Staff provided care that was responsive to people's needs. The service worked well with external health professionals. Monthly audits were carried out across various aspects of the service. Lessons were learnt from incidents and accidents to minimise a recurrence.

Recruitment practices ensured the right staff were recruited to support people to stay safe. Staff understood their roles and responsibilities.

The home was clean and tidy. However, the management of unpleasant odours was not always effective.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on the 2 September 2016 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Athlone House Nursing Home’ on our website at www.cqc.org.uk’

Athlone House Nursing Home is registered to provide accommodation, nursing and personal care for up to 23 older people, some of whom may have dementia and end of life care needs. The home is divided over two floors with lift access. Rooms are wheelchair accessible and have ensuite bathroom facilities. At the time of our inspection 22 people were 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.

At our focused inspection on the 2 September 2016, we found that the provider had followed their plan which they had told us would be completed by the 25 May 2016. Legal requirements had been met in relation to infection control. The provider had carried out quality audits on a monthly basis covering areas such as care planning and care reviews, risk assessments, safeguarding and infection control. Audits were detailed in scope and had identified shortfalls in some areas.

However, not all care records and risk assessments were being completed in full. Information gathered from initial assessments was used to develop a plan of care for each person moving into the service. Care plans outlined people's individual needs and preferences and provided information to staff as to how people's needs should be met. However, we found minor inconsistencies, omissions and inaccuracies across three out of the six sets of care records we reviewed.

Staff maintained daily records about people's care and welfare. We saw that support was responsive to people's changing needs and staff recognised how to adjust the care provided dependent on whether a person was having a good or bad day. We observed an afternoon handover meeting taking place and we noted that people’s needs were discussed in a respectful and caring manner.

19 members of staff had completed training in care planning and 10 staff members had attended a training session delivered by a tissue viability nurse to learn about pressure ulcer prevention and management. Refresher training sessions on tracheostomy care, enteral feeding, venepuncture and enteral feeding were scheduled to take place throughout September 2016.

During our visit we saw that the home was clean and tidy and that staff had access to disposable gloves, hand gels and aprons. Posters reminding staff and visitors of infection protocol were on display throughout the home. We observed the correct bins being used to dispose of clinical and household waste. Bathrooms were clean and free of personal items. Staff we spoke with were aware of the provider’s infection control policies and procedures and knew how important it was to follow these guidelines.

People we spoke with, relatives and family friends told us that the care provided by Athlone House Nursing Home was, "very good" and that staff treated people well and were "kind", "helpful" and "all very caring."

Athlone House Nursing Home is registered to provide accommodation, nursing and personal care for up to 23 older people, some of whom may have dementia and end of life care needs. The home is divided over two floors with lift access. Rooms are wheelchair accessible and have ensuite bathroom facilities. At the time of our inspection 22 people were 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.

Safeguarding adults from abuse procedures were available and staff understood how to safeguard the people they supported. Staff had received training on the Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act 2005 (MCA). These safeguards are there to make sure that people receiving support are looked after in a way that does not inappropriately restrict their freedom. Services should only deprive someone of their liberty when it is in the best interests of the person and there is no other way to look after them, and it should be done in a safe and correct way.

Where possible, people were involved in decisions about their care and how their needs would be met. Where appropriate, family members and health and social care professionals contributed to the care planning process. Staff knew what to do if people could not make decisions about their care needs in line with the MCA.

Risk assessments were in place and covered areas such as falls, pressure ulcers and nutritional needs. However, not all risk assessments had been completed in full, or reviewed in line with the provider’s policies and procedures.

Staff were not always following policy and procedure in relation to the prevention and control of infection.

Medicines were managed safely. Following a discussion with the registered manager we were informed that systems to better manage people’s pain relief would be implemented to ensure that people consistently received their medicines safely, and as prescribed.

Monthly audits were carried out across various aspects of the service; these included the administration of medicines and health and safety checks. However, where these audits identified that improvements were needed action, improvements were not always being implemented in a timely manner.

People were provided with a choice of food and drink, and were supported to eat when this was needed. Staff treated people with kindness, patience and understanding.

People told us they were happy with the care provided. Staff were appropriately trained and skilled to care for people. They understood their roles and responsibilities as well as the values of the service.

People were kept safe from the risk of abuse. Risks to people were identified and staff took action to reduce those risks.

Staff supported people to attend healthcare appointments as required and liaised with people’s family members, GPs and other healthcare professionals to ensure people’s needs were met appropriately.

Staff received supervision and guidance where required. Staff confirmed they felt supported by the manager who we were told was accessible and approachable.

Sufficient staff were available and they had the necessary training to meet people's needs. Staff responded to people’s needs promptly.

There was a complaints policy which the registered manager followed when complaints were made to ensure they were investigated and responded to appropriately. People and their relatives felt confident to express any concerns, so these could be addressed.

We identified one breach of the Regulations in relation to risk management. You can see what action we told the provider to take at the back of the full version of the report.