This inspection took place on 04 and 06 December 2018. The first day was unannounced.

Alderwood is a purpose built care home providing accommodation for up to 39 people over two floors. There are 31 single rooms,19 of which are ensuite and three are double rooms. There are three communal lounges and a dining room. The residents have access to well maintained, garden and patio areas. The home is situated in a quiet residential area of Boothstown, near to a range of local shops and transport links.

At the time of the inspection there were 34 people living at the home.

Alderwood 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.

We last inspected Alderwood care home in April 2018 and rated the home as ‘Requires Improvement’. This was because we identified regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to person centred care, safe care and treatment, safeguarding and staffing. Requirement notices were issued due to these breaches of the regulations. We also issued a warning notice regarding to good governance. Following the inspection the home sent us an action plan, detailing how the improvements they planned to make. We also met with the provider and registered manager in October 2018 to discuss the progress being made.

At our most recent inspection in December 2018, although we found improvements had been made in some areas, we identified three continuing breaches of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, for two of the regulations regarding person centred care and good governance (two parts of this regulation). You can see what action we have asked the provider to take at the back of the full version of this report.

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.

We found people did not always receive care that met their needs and reflected their preferences.

We found accurate and contemporaneous records were not always maintained. Records were not always stored securely and confidentially.

Further improvements were still required to overall governance systems to ensure the concerns from the inspection were identified and acted upon in a timely way.

We have also made three recommendations relating to the conditions within peoples DoLS authorisations, the accessible information standard and the quality assurance policy and procedure.

Medication was recorded, administered and disposed of safely.

The premises were being well maintained, with regular servicing checks of equipment and the building carried out. The home was clean and tidy throughout, with infection control procedures followed as required.

People who used the service and their relatives told us they felt the service was safe. There were appropriate risk assessments in place for people, with guidance on how to minimise risk. Staff recruitment was robust with appropriate checks undertaken before staff started working at the home.

We found staff received sufficient training, supervision and induction to support them in their role. The staff we spoke with told us they were happy with the training they received and felt supported to undertake their work.

We found the home worked closely with other health professionals and made appropriate referrals if there were concerns. Details of any visits from other professionals were recorded within people’s care plans.

People told us they enjoyed the food and we saw people being supported to eat and drink, t

This inspection took place on 24 and 26 April 2018. The first day was unannounced, however we informed staff we would be returning for a second and third day to complete the inspection which we announced in advance.

Alderwood is a purpose built care home providing accommodation for up to 37 people over two floors. There are 31 single rooms,19 of which are en suite and three are double rooms. There are three communal lounges and a dining room. The residents have access to well maintained, garden and patio areas. The home is situated in Worsley, Salford and is near to a range of local shops and transport links. At the time of the inspection there were 34 people living at the home.

Alderwood 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.

At our last inspection of Alderwood in January 2017, the home was rated as ‘Requires Improvement’ overall and for the key questions effective, responsive and well-led. Regulatory breaches were identified in relation to person centred care and meeting people’s nutrition and hydration needs. We issued requirement notices for these regulatory breaches . This inspection was scheduled to look at the improvements made since our last inspection and to determine whether the provider was now meeting the regulatory requirements.

At this inspection, we identified breaches of the regulations relating to person centred care, safe care and treatment, safeguarding people from abuse and improper treatment, good governance and staff. You can see what action we have taken at the back of this report.

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.

We looked at the systems in place to safeguard people from abuse. We found potential instances of abuse were not always being referred to the local authority for further investigation such as unexplained bruising found during personal care.

One person living at the home had been assessed as being at risk of choking and needed their drinks to be thickened so they could swallow safely. However during the inspection, we observed staff providing this person with a drink that was not made to the correct consistency. Fluid charts for this person indicated this was not an isolated occurrence as previous drinks had been documented as being made to different consistencies which could place this person at risk of choking.

Referals to other healthcare professionals were not always made in a timely way when there were concerns about people’s health and welfare. This included referalls to the falls team, dietetics and the podiatry service.

We found creams that needed to be applied to people’s skin were not stored securely and were accessible in both bedrooms and bathrooms. This presented the risk of them being wrongfully ingested by people who did not know what they were. We also found a person’s medication on the floor in their bedroom, yet this had been signed for on the MAR as having been administered. Staff said this person was able to take their medication themselves without observation but we found a risk assessment had not been implemented to determine this.

Two people also raised concerns that their creams were not always applied as prescribed and we found appropriate records were not in place to demonstate this was done consistently by staff.

Control measures were not consistently implemented to protect people at high risk of falls and observed people were not always supported when mobilising as identified in their care plan.

Actions recomme

We carried out an unannounced inspection of Alderwood on 23 and 24 January 2017. This was in response to concerns we had received regarding the management of medicines.

The home was last inspected on 05 March 2015 when the service was rated as good overall in four of the key lines of enquiry (safe, caring, responsive and well-led). The service was rated as requires improvement in effective and a recommendation was made in regards to the environment.

Alderwood is a care home in the Worsley area of Salford, Greater Manchester and is owned by Hill Care 1 Limited . The home is registered with the Care Quality Commission (CQC) to provide residential care for up to 39 people. There were 31 people living at the home at the time of the inspection.

At the time of our inspection, there was no registered manager in post. The home had a manager that had commenced in post 03 January 2017. The home manager had applied to the Care Quality Commission (CQC) to register. 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.

During the inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to person centred care and meeting people’s nutrition and hydration needs. We also made two recommendations regarding staffing and equipment. You can see what action we told the provider to take at the back of the full version of the report.

People told us they felt safe living at the home.

We found medicines were managed safely. Prior to conducting the inspection, we had received information of concern regarding the management of medicines. We found the issues had been as a result of external factors that had been resolved at the time of the inspection.

We received negative feedback from people living at the home and their visitors regarding staffing levels at the home. A formal dependency tool was used to determine staffing numbers but we observed people were left for periods of time and we have made a recommendation with regards to staffing levels in the detailed findings of this report.

The provider had suitable safeguarding procedures in place and staff were able to demonstrate they knew how to safeguard people and were aware of their roles, responsibilities and the alert process. Appropriate employment checks had been conducted before new staff commenced employment in the home, to make sure as far as possible that they were of suitable character to work with vulnerable people.

The service had a training matrix to monitor the training requirements of staff. Staff received appropriate training, supervision and appraisal to support them in their role.

People were supported in line with the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

We received poor reviews from people regarding the food choices offered and we saw instances were people’s preferences were not met. People’s hydration and nutrition needs were appropriately assessed but the provider could not consistently demonstrate that people’s needs were being met as the records didn’t demonstrate this and the person had not gained weight.

We observed people living at the home were living with sensory impairment, memory issues or living with dementia. In consultation with people, dementia friendly resources and minor adaptations had been made to support people’s orientation around the home.

Throughout the inspection we observed positive and appropriate interactions between the staff and people who lived at the home. Staff treated people with kindness and respect. People’s privacy and dignity was maintained and we observed people’s independence was promoted.

We looked at five care files which contained det

Alderwood is a care home in the Worsley area of Salford, Greater Manchester and is owned by Hillcare. The home is registered with the Care Quality Commission (CQC) to provide care for up to 37 people. The home provides care to those with residential care needs only. We last visited the home on 1 October 2013 and found the home was meeting the requirements of the regulations, in all the areas we looked at.

The registered manager for the home was not currently in post and was working at another home. The day to day running of the home was currently being done by an ‘acting manager’ who was hoping to register with CQC in the near future. 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.

The staff we spoke with spoke positively about the management and leadership of the home. One member of staff said; “The manager has really stepped up into the role well. She is very knowledgeable and fair with staff”.

During the inspection we spoke with five people who lived at the home as well as four visiting relatives. People living in the home told us they felt safe. One person said; “They keep the doors locked, and if anything is wrong the alarms go off”.

We looked at how the service managed risk. We found individual risks had been identified and recorded in each person’s care plan. These covered areas such as dependency, moving and handling, nutrition, pressure sores and falls. We noted actions for staff were recorded along with any interventions they needed to make.

People were protected against the risks of abuse because the home had a robust recruitment procedure in place. Appropriate checks were carried out before staff began work at the home to ensure they were fit to work with vulnerable adults. During the inspection we looked at five staff personnel files. Each file contained job application forms, interview notes, a minimum of two references and evidence of either a CRB or DBS (Criminal Records Bureau or Disclosure Barring Service) check being undertaken. This evidenced to us that that staff had been recruited safely.

We looked at how the service ensured there were sufficient numbers of staff to meet people’s needs and keep them safe. We looked at the staff rotas. We found the home had sufficient skilled staff to meet people's needs. Staff working on the day of our inspection included the manager, three senior carers and two care assistants. Other staff included kitchen, domestic and maintenance staff.

All staff were given the training and support they needed to help them look after people properly. There was a staff induction in place and any training undertaken was clearly recorded on the homes training matrix. We observed staff being kind, friendly and respectful of people's choices and opinions. The atmosphere in the home was relaxed and the staff spoken with had a good knowledge of the people they supported.

We found medicines were handled safely. The manager undertook random spot checks of staff administering medication to ensure they were competent. In addition, regular audits of medication were undertaken.

The Mental Capacity Act 2005 (MCA 2005) sets out what must be done to make sure the human rights of people who may lack mental capacity to make decisions are protected. The Deprivation of Liberty Safeguards (DoLS) provides a legal framework to protect people who need to be deprived of their liberty to ensure they receive the care and treatment they need, where there is no less restrictive way of achieving this. From our discussions with managers and staff and from looking at records we found staff had received training in relation to MCA and DoLS. The manager and staff spoken with expressed a good understanding of the processes relating to DoLS. At the time of our inspection, nobody living at the home was subject to a DoLS.

A large number of people who lived at the home lived with dementia and we found the environment had not been suitably adapted to meet their needs. For example, signage around the building was poor with nothing displayed to help people correctly locate the lounges or dining room. The corridors were long, difficult to negotiate and walls were very similar in colour to doors. Although people’s bedroom doors were numbered, there were no pictures of the person and no fixtures and fittings for them to specifically remember their bedrooms by. We raised this with the manager and area manager who acknowledged that this could be improved.

We have made a recommendation in relation to this within the detailed findings.

We observed both the breakfast and lunch time meals provided at the home. There were two people seated on the outside of the room, who staff told us were placed there due displaying disruptive behaviour towards others. People had particular behaviour care plans in place, however none of this had been recorded. These two people were isolated from everybody else and staff interactions with them were during these periods were poor. Another person was required to be prompted to eat their food, however we saw this was not provided and observed them eating their food with their knife at lunch time. We raised these issues with the manager.

We spoke with one person who lived at the home who was registered blind. Their care plan stated that it was important for them to look clean and be well presented at all times. Whilst speaking with them, we saw their clothing was stained and staff had not made this person aware, or offered them a change of clothes. We raised this issue with the manager who said she would speak with staff about this.

As part of our inspection we asked the people who lived at the home for their views on what the care was like at the home. Comments included; “They are very kind and caring” and “They do anything they can to help you” and “All the staff are lovely. You can have a bath every day if you want but I have to go in a wheelchair” and “They’re very good. You can’t really complain about anything”.

We spent time speaking with the activities coordinator during the inspection and also observed some of the activities which took place. People were given the choice of whether to participate or not and we saw people taking part in various arm chair exercises and also doing a quiz which people seemed interested in.

The complaints procedure was displayed near the entrance of the home and was also held on file. We looked at the complaints log and saw complaints had been responded to appropriately, with a response given to the individual complainant.

The home regularly sought the views and opinions of both people who lived at the home and their relatives. This was done using a survey which, once returns had been collated, was analysed detailing what had been done to improve the service provided to people.

There were effective systems in place to regularly assess and monitor the quality of the service. They included audits of the medication, the kitchen, health and safety, occupancy, care plans, staff training and activities. Where shortfalls were identified, they were then added to an action plan detailing what had been done to address the matter.

We looked at a sample of seven care files of people who used the service and found they were maintained to a good standard, with information readily available in chronological order.

Weekly activities were available to people who used the service.

We found staff were courteous and respectful towards people who used the service.

We spoke to people who used the service, some of whom with the onset of dementia, comments included “Staff alright”, “No complaints at all”, “All girls are very nice, will do anything for you” and “Staff brilliant”.

When reviewing care files we saw nutritional assessments and care plans had been completed and provided detailed instructions to staff where people were at risk of weight loss.

We did not observe anyone who used the service who gave any cause for concern in relation to nutrition and hydration.

We found medicines were safely administered and people who used the service received their medicines in the way they had been prescribed.

We looked at seven staff personnel files and saw evidence in each file of robust checks being undertaken prior to the commencement of employment by staff.

We found that the provider had effective systems in place to monitor the quality of the service provided.

We visited Alderwood Care Home on 16 November 2012 and found that the premises were clean, tidy and warm. The people who used the service were well presented and we saw that staff interacted with them politely and with respect. We saw that care was delivered in a timely and efficient way.

We spoke with four people who used the service and they all expressed satisfaction with the care they were given. One person said that the staff were “always polite, one and all” and went on to say “I don’t have to go out of my room if I don’t want to, I can just press the buzzer if I need anything.” Another person said “I’d rather be here than at home, I feel safe”. A visitor at the home said “they are looked after well and visitors are always made welcome.”

We looked at a sample of five care plans and found them to contain up to date and relevant information including; medical and health,care needs and personal preferences.

We saw that relevant policies and procedures were in place within the home and that staff spoken with were aware of them. We saw evidence of a comprehensive training programme for staff members and we saw evidence that staff members were encouraged to continually develop their knowledge and skills.

We saw that there was a complaints procedure in place and noted that complaints were taken seriously and followed up appropriately.

People living in the home told us they felt well cared for. One person said that the staff were "wonderful" and they had "no complaints". A visiting relative told us they were "satisfied" with the care provided.

Some people using the service were not able to communicate clearly enough to express an opinion.