Old Alresford Cottage

Old Alresford Cottage provides accommodation and personal care for up to 44 people. The home is an older style building arranged over three floors with rooms accessed by lift or stairlift. The home describes itself as specialising in supporting people living with dementia. There were 35 people using the service when we inspected.

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

Improvements were needed to ensure the premises were kept clean and hygienic throughout and the interior of the home maintained and decorated to an acceptable standard. We received mixed feedback about staffing levels and there was an inconsistent approach to managing some of the risks to people’s health and wellbeing. Staff understood their responsibility to raise concerns and report safety related incidents. People told us they felt safe at Old Alresford Cottage and staff had clear guidance about what they must do if they suspected abuse was taking place.

We made a recommendation about seeking ways in which to make the environment more supportive of people living with dementia, or other sensory deficits.

The governance systems in place were not being fully effective at ensuring the quality and safety of the service. Staff understood the values of the service and spoke of a positive culture and of the importance of providing people with person-centred care. Overall people told us staff were kind, caring and friendly and we observed interactions where staff engaged with people in a cheerful and positive manner. Feedback from relatives and professionals about the registered manager was mostly positive, with a professional praising the registered manager for the hard work and support they and his team had provided with a case that was very challenging at times.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 31 August 2021) and there were two breaches of Regulations. At this inspection we found that insufficient improvements had been made and the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced inspection of this service on 24 and 27 May 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do, and by when, to improve the safety of recruitment procedures and the robustness of the governance arrangements.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Old Alresford Cottage on our website at www.cqc.org.uk.

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 COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment and good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Old Alresford Cottage is a residential care home providing accommodation for up to 44 people with personal care needs. There were 38 people using the service at the time of the inspection.

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

Safe recruitment procedures were not always followed. The Schedule three requirements of the Health and Social Care Act 2008 (Regulated Activities) 2014 had not always been met. This meant staff had not always been safely checked to ensure they were suitable to care for people. Relatives and staff confirmed that there were sufficient staff deployed to meet people’s needs.

Risks to people were mostly recorded in their care plans. However, care plans and risk assessments relating specifically to health did not always contain sufficient clarity of detail to enable staff to carry out the support safely.

Medicines were administered by staff who knew people well and there were appropriate policies and systems in place to protect people from abuse. We were assured that the provider was preventing visitors from catching and spreading infections, and we were assured that the provider was making sure infection outbreaks could be effectively prevented or managed. The provider had utilised different communication methods to support people to maintain contact with their relatives and friends throughout the pandemic.

The provider had some systems in place to monitor and assess the quality of the service and to drive improvements. However, these were not always effective. The COVID-19 pandemic had placed additional pressures on the service and the provider told us the priority had been ensuring people and staff were safe during the pandemic. They were open and transparent about the challenges and the plans for improvements.

The provider was passionate about ensuring people felt at home and comfortable in the service. The registered manager and staff got to know people and their individual likes and preferences. We saw multiple examples of how people had been supported in a person-centred way. Relatives told us they received regular communication from the service and confirmed they were able to feedback and felt listened to. The emotional wellbeing of people was a priority for the provider during the pandemic. We saw how they had adapted their activities programme to ensure people remained engaged throughout.

The relationship between management, staff and people was positive. Staff told us that they felt involved in the service and that the management were supportive. The provider had continued to work closely with professionals throughout the pandemic to ensure best outcomes for people. They had strengthened their relationship with the local community and had created a virtual community for people to access throughout the pandemic.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last

The last rating for this service was good (published 21 December 2018).

Why we inspected

We received concerns in relation to the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. The inspection was prompted in part by notification of a specific incident following which a person using the service sustained a serious injury. This incident is subject to an investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of falls.

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 COVID-19 and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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 improvements. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Old Alresford Cottage on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe recruitment procedures and governance of the service, at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

We found the following examples of good practice:

¿ The home locked down 13 days prior to the Government announcement in March 2020 to keep people safe.

¿ The home used a 'fogger' to decontaminate the visiting area in between visits. A 'fogger' is a device which creates a chemical fog which destroys bacteria and viruses.

¿ Both staff and people using the service have been offered counselling by the provider, to support them with their emotional needs as a result of the COVID-19 crisis.

¿ The home has an ultra-violet (UV) light to assist with good handwashing practices. Staff's hands were spot checked for cleanliness using the light.

¿ The home engaged in regular webinars from 'Partners in Care' Clinical Commissioning Group (CCG) and other local providers to learn and share good practice.

The provider had taken action to ensure sufficient cleaning of the service took place whilst a new housekeeper was being recruited. The registered manager ensured learning took place from incidents to improve people’s safety.

People’s care and treatment was delivered in line with current, national legislation and guidance to ensure effective outcomes for people. The provider ensured staff had the required skills, knowledge and experience to provide people with effective care.

People were supported by staff to eat and drink sufficient amounts for their needs. The registered manager listened to our feedback with regards aspects of the lunch service which required attention and took immediate action to address them for people.

Staff worked both as a team within the organisation and across other services to ensure people received effective care. People were supported by staff to access health care services as required. The building was not originally designed to meet the needs of people living with dementia, but relevant equipment was in place and staff supported people where required.

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.

Staff treated people with kindness and compassion when delivering care. Staff supported people to make decisions about their care and people’s choices were respected. People’s privacy, dignity and independence were upheld during the provision of their care.

People received personalised care that was responsive to their individual needs. People were provided with opportunities for social stimulation. People were supported by staff to receive their end of life care at the service if this was their wish.

The provider had a clear set of values which underpinned the provision of people’s care. People and their relatives told us the registered manager and the deputy manager were visible and supportive, which we observed. There were clear staff responsibilities and accountability within the service. People and staff were encouraged to provide their views on the service. People felt their concerns and issues were listened to and dealt with to their satisfaction.

There were processes in place to monitor the quality of the service and to identify areas for improvement. The service worked in partnership with external agencies to ensure people received effective care.

Further information is in the detailed findings below.

Old Alresford Cottage House provides accommodation and care for up to 44 older people, some of whom may also be living with dementia. At the time of the inspection 42 people were using the service.

Old Alresford Cottage has 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.

People said they felt safe. Staff had received safeguarding training and were able to explain how to protect people from abuse and how to report suspected abuse.

People’s individual risks were appropriately assessed and care plans were in place to mitigate against known risks. Staff were knowledgeable about risks to people and what actions needed to be taken to keep people safe.

There were sufficient staff on duty. People’s needs were met whether they were in communal areas or being cared for in bed.

Staff recruitment and induction practices were safe. Relevant checks were carried out to ensure that suitable staff were recruited.

Medicines were stored and administered safely. Records in relation to medicines were accurate and staff had received training in medicines administration, and had their competency checked regularly.

Staff had received appropriate training to meet people’s needs. Records showed that staff had received training in key areas such as fire training, moving and handling, food hygiene and first aid. Staff were supported to study for health and social care vocational qualifications. Staff told us they felt supported in their role.

Staff were knowledgeable about people’s needs and how to support them. Staff said they knew about people’s needs from handovers, care plans, risk assessments, people themselves and their families. We saw that staff interacted with people appropriately and kindly, appearing to know them well as individuals, and treating them accordingly.

People were asked for their consent before care or treatment was provided and the provider acted in accordance with the Mental Capacity Act 2005 (MCA). People made their own decisions where they had the capacity to do this, and their decision was respected.

People were supported to have sufficient to eat and drink and maintain a balanced diet. Drinks were readily available throughout the day and staff encouraged people to drink. For lunch a choice of main meal was offered, with alternatives available. The chef was knowledgeable about people’s individual requirements such as those people who required a soft diet or a diabetic diet.

People were supported to maintain good health through access to ongoing health support. Records showed that district nurses, continence and falls specialists and the GP had been involved in people’s care and referrals were made where appropriate.

Staff were kind and patient with people, using gentle persuasion and encouragement to support them. They took time to listen to people and understand how they were feeling. People’s dignity was respected. People were supported to be as independent as possible.

People were involved in decisions about their care and were offered choices in all aspects of their daily life. Where they had capacity, people had signed their care plans showing that they agreed with the plan of care.

Staff were able to respond appropriately to people’s needs because they knew them well and understood their care needs. Staff had taken the trouble to get to know people personally so they could respond to their preferences, likes and dislikes in order to provide personalised care. Care plans were reviewed and updated every six months and when necessary to ensure that staff were always aware of people’s needs.

People were able to engage in different activities, such as music, quizzes or visiting the gardens. People enjoyed being able to visit the aviary and the chicken coup.

The provider had a complaints procedure which detailed how complaints should be dealt with. There were a small number of complaints and all had been dealt with appropriately.

The atmosphere in the home was friendly and easy going. The registered manager was passionate about the home and keen to make improvements. There was a family feeling amongst staff who were united and keen to ensure people were happy and well cared for. Staff felt valued and involved in decision-making and this reflected in the care delivered.

Feedback was sought regularly from people, staff and relatives and was responded to, ensuring continuous improvement to the home.

The registered manager demonstrated good management and leadership. He ensured he was visible ‘on the floor’ on a daily basis. People knew and trusted him.

Policies and management arrangements meant there was a clear structure within the home which ensured the service was effectively run and closely monitored.

The quality of the service was closely monitored through a series of audits and checks. These included medicines, infection control and environmental audits.

During our visit we saw that people were being treated with dignity and respect and people's independence was encouraged. People were spoken to in a respectful way. People we spoke to told us that the staff were very understanding, they always had time to listen, were approachable and helpful, and that their privacy was respected whilst they were supported to maintain their independence. One person told us "we get a lot of choice here - I can have sausages every day if I want" and another said "they are very good here, friendly."

We observed that staff asked people about how and when they wanted their care and support. This indicated that people were involved in planning their care on a daily basis. One person spoke about a particular member of staff saying "she is wonderful - very considerate."

A family member told us "they are very good here - if I have concerns they get the doctor straight away."

We were able to look at care plans and discuss the care planning process and found that the needs of people were being met through the processes that were in place.

The premises appeared safe and well maintained, and we were able to check the record of works and refurbishment, which indicated that there was a system for managing ongoing maintenance.

We were able to look at staff rotas, and training records, which showed that there were sufficient numbers of staff with suitable skills to provide the care and support to people using the service. We observed staff interactions with people who used the service and staff appeared to relate to people in a courteous and appropriate manner.

We found that the service had a complaints procedure in place and saw evidence that people were encouraged to raise concerns and complaints, which they did through talking to staff members or to relatives.