About the service:

Allambie Court Nursing Home is a care home, providing personal and nursing care and accommodation for up to 26 people. There were 22 people with frailty due to older age and / or dementia living at the home at the time of the inspection.

What life is like for people using this service:

• People felt well cared for and described staff as kind and compassionate toward them.

• Staff knew people well and how they liked to be cared for.

• There were some risks of potential infection posed to people. Cleanliness was not consistently good and improvements in hygiene were needed in the kitchen and to soft furnishings in communal lounges.

• Food safety guidelines were not always followed and a food handling practice posed potential risks of infection to people.

• People felt care staff were kind towards them and looked after them well. Activities were planned for and took place during the afternoons which met people’s needs.

• People had individual plans of care, so staff had the information they needed to care for them.

• Risks were identified, and actions taken to reduce the risks of harm and injury. However, monitoring records were not always in place to support effective monitoring of identified risks.

• Medicines were managed safely. People’s prescribed medicines were available to them and records had been completed as required.

• Staff had the necessary skills to meet people’s needs.

• Care staff understood the need to gain people’s consent before personal care was provided. The registered manager understood, and worked within, the requirements of the Mental Capacity Act 2005.

• People were supported to eat and drink adequately.

• Staff interacted positively with people, showing a caring approach.

• People and relatives were, overall, complimentary about staff. No written complaints had been received, however, concerns about cleanliness were shared with us.

• The provider had systems and processes in place to assess the quality and safety of the service. Most actions were taken to make improvements where needed. However, we found occasions where actions for improvement identified were not always implemented.

Rating at last inspection: The last report for Allambie Court Nursing Home was published on 28 June 2018 and we gave an overall rating of Requires Improvement.

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection we found some improvements in how effective the service was and how people were cared for. However, improvements continued to be needed in the safety, responsiveness and how well led the service was. The rating continued to be Requires Improvement.

Follow up: We will continue to monitor intelligence we receive about the service.

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

This inspection took place on 24 and 26 April 2018. The visit on 24 April was unannounced.

Allambie Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Allambie Court is registered to provide accommodation with nursing and personal care for up to 30 older people who are living with dementia. At the time of our inspection visit there were 25 people living there.

The home 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.

When we inspected Allambie Court in October 2017, we gave a rating of ‘inadequate.’ At that inspection, we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.’ We found there were not enough staff to keep people safe, and that risk was not properly managed. Medicines were not administered safely or as prescribed and the systems in place to quality assure and check the care provided were ineffective. Furthermore, people, relatives and staff were not confident the home was well led.

The service was placed in ‘Special Measures’. Services in special measures are kept under review and inspected again within six months.

At this inspection, we found sufficient improvements had been made to remove the service from special measures, and the rating changed to ‘Requires Improvement’. However, we found continued breaches of the regulations related to the safe and effective management of medicines. This was because guidelines for people prescribed medicine to control their diabetes had not been reviewed by a clinician, the application of prescribed creams was not properly recorded, and guidance in place for people in receipt of ‘as required’ medicines was not sufficiently detailed.

Action had been taken to ensure risks were assessed and plans were in place to manage those risks. Risks relating to weight loss were now tracked and recorded, with action taken to protect people where there were concerns. People’s needs for supervision had been reassessed and the registered manager regularly calculated and reviewed the level of need throughout the home to ensure there were enough staff to keep people safe.

Some action had been taken to improve the systems used to check and audit the quality of the care provided at the home. Maintenance was better managed, and the home environment had been improved. However, the provider’s system of checks and audits had not identified some of the issues we found, particularly around medicines management and infection control.

People told us they felt safe with the staff who supported them, and we saw people were comfortable with staff. Staff received training in how to safeguard people and understood what action they should take in order to protect people from abuse. The provider ensured staff followed safeguarding policies and procedures. The provider conducted pre-employment checks prior to staff starting work, to ensure their suitability to support people. Staff told us they had not been able to work until these checks had been completed.

Whilst the provider had taken action to identify gaps in training and had plans in place to address them, there remained significant gaps in some staff training such as dealing with behaviour that challenges, as well as supporting people living with dementia. Not all staff demonstrated confidence in dealing with behaviours effectively. Staff induction still did not included national recommended standards, but plans were in place to introduce these.

Staff were supported to maintain their skills throug

This inspection took place on 26 October 2017 and was unannounced.

Allambie Court is registered to provide accommodation with nursing and personal care for up to 30 older people who are living with dementia. At the time of our inspection visit there were 23 people living in the home.

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.

The home was last inspected on 22 February 2017, when we found the provider was compliant with the fundamental standards described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However, the home was awarded an overall rating of 'requires improvement'.

At this inspection, we checked to see if improvements had been made. We found improvements had not been made, and we had increased concerns as to the safety of the care provided and the leadership and oversight of the manager and provider.

People did not always receive their medicines safely and as prescribed. Systems designed to record and check medicines administration were not effective.

Assessed risks were not always managed effectively, and staff knowledge of how risks should be mitigated was not always consistent. This posed a risk to people’s health and safety.

There were not enough staff to support people safely and meet their needs effectively.

Staff did not always receive the training required to ensure their skills and knowledge remained up to date. The risk of malnutrition and dehydration was not always well managed, and records designed to monitor and help address these risks were not always completed consistently.

Care records were not always updated or completed, which meant we could not be sure people were supported consistently. People were not consistently supported to maintain activities, hobbies or interests.

There were quality monitoring systems in place to identify any areas needing improvement, but these were not used consistently or accurately. They had not identified the concerns we found during our inspection, and governance of how the home was run was weak and ineffective which meant it had not improved.

People were comfortable with the staff who supported them. Staff received training in how to safeguard people from abuse and understood what action they should take in order to protect people from harm. The provider conducted pre-employment checks prior to staff starting work, to ensure their suitability to support people who lived in the home. Staff told us they were not able to work until these checks had been completed.

The provider ensured staff had information on the level of support people needed with decision-making so people were protected. The registered manager had a good understanding of the Mental Capacity Act (MCA), and the need to seek informed consent from people before delivering care and support. Staff had a limited understanding of the MCA, but understood the importance of consent. Where restrictions on people’s liberty were in place, legal processes had been followed to ensure applications for legal authorisation had been sent to the relevant authorities.

Staff were respectful and treated people with dignity and respect, but staff did not always take opportunities to engage with people to enhance their well-being. People experienced a lack of interaction and engagement, as support focussed on tasks to be completed.

Complaints were managed effectively.

Staff and relatives did not always feel well supported by the registered manager

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Se

This inspection took place on 22 February 2017 and was unannounced.

Allambie Court is registered to provide accommodation with nursing and personal care for up to 30 older people who are living with dementia. At the time of our inspection visit there were 23 people living in the home.

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.

The home was last inspected on 23 March 2016, when we found the provider was compliant with the fundamental standards described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However, the home was awarded an overall rating of 'requires improvement'. This was because procedures and policies were not always followed to ensure people consistently received safe and responsive care. The provider’s quality assurance checks did not identify when improvements needed to be made.

At this inspection, we checked to see if improvements had been made. We found some

actions had been taken and improvements had been made, but there were still areas where improvement was needed.

People were comfortable with the staff who supported them and relatives were confident people were safe living in the home. Staff received training in how to safeguard people from abuse and understood what action they should take in order to protect people from harm. Risks to people’s safety were assessed, and risk assessments were updated in response to incidents or changes in need. Staff knew how to support people safely. However, risk assessments were not always clear or detailed enough to ensure consistency.

Risks associated with fire or other emergencies required review, but the provider had already identified a number of measures required to improve people’s safety in the event of fire.

People were supported with their medicines by staff who were trained and assessed as competent to give medicines safely. Medicines were given in a timely way and as prescribed.

There were enough staff to meet people’s basic care needs. The provider conducted pre-employment checks prior to staff starting work, to ensure their suitability to support people who lived in the home. Staff told us they were not able to work until these checks had been completed.

The provider ensured staff had information on the level of support people needed with decision-making so people were protected. The registered manager had a good understanding of the Mental Capacity Act, and the need to seek informed consent from people before delivering care and support. Where restrictions on people’s liberty were in place, legal processes had been followed to ensure applications for legal authorisation had been sent to the relevant authorities. However, ‘best interests’ decisions were not always clearly documented and we could not be sure this requirement had always been met.

People had access to health professionals when needed and we saw the care and support provided in the home was in line with what had been recommended. Risks around eating and drinking had been assessed and staff ensured people received the support they needed to remain well.

Staff were respectful and treated people with dignity and respect. People were supported to make choices about their day to day lives.

Care planning and reviews took place, but there was not always evidence of how the views of people and their relatives had been taken into account. The service was not always responsive to the needs of people living with dementia, and the care plans in place did not contain sufficient person centred information to enable this to happen. Staff did not always take opportunities to engage with people and the support provided continued to be task fo

The service was last inspected in October 2013. It was found to be compliant in all outcomes we looked at. This inspection took place on 23 March 2016 and was unannounced.

Allambie Court is registered to provide accommodation with nursing and personal care for up to 30 older people who are living with dementia. At the time of our inspection visit there were 26 people living in the home.

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.

People were comfortable with the staff who supported them and relatives were confident people were safe living in the home. Staff received training in how to safeguard people from abuse and understood what action they should take in order to protect people from harm. Risks to people’s safety were assessed, but risk assessments were not always updated in response to incidents or changes in need. The provider’s checks had not identified this.

People were supported with their medicines by staff who were trained and assessed as competent to give medicines safely. Medicines were given in a timely way but in some cases were not given as prescribed. Checks designed to ensure medicines were administered safely had not identified this.

There were enough staff to meet people’s basic care needs. However, it was difficult for staff to find time to interact with people outside of completing care tasks. People were not routinely engaged in activity which had been identified as being meaningful to them. The provider conducted pre-employment checks prior to staff starting work, to ensure their suitability to support people who lived in the home. Staff told us they were not able to work until these checks had been completed.

The provider ensured staff had information on the level of support people needed with decision-making so people were protected. Staff and the registered manager had a good understanding of the Mental Capacity Act, and the need to seek informed consent from people before delivering care and support. Where restrictions on people’s liberty were in place, legal processes had been followed to ensure they were in people’s ‘best interests’, and applications for legal authorisation had been sent to the relevant authorities.

Staff were respectful and treated people with dignity and respect. People were supported to make choices about their day to day lives.

People had access to health professionals when needed and we saw the care and support provided in the home was in line with what had been recommended.

Relatives told us they felt able to raise any concerns with the registered manager. They felt these would be listened to and responded to effectively and in a timely way. Staff told us the management team were approachable and responsive to their ideas and suggestions. There were systems in place to monitor the quality of the support provided in the home. However, these systems had not always worked as intended as gaps and inconsistencies in the quality of care people received had not always been identified.

All of the people who lived at the home had complex needs and were not able to tell us whether they received the care and support they needed. We observed how staff supported people throughout our visit and spoke with three relatives.

Relatives told us, “It is very nice here. The staff are nice. I see staff singing to people” and “The manager sorted it out so we could we could spend time privately together.”

We saw that staff were thoughtful and compassionate toward people. Staff checked that people consented to being assisted.

In the four care plans we looked at, we saw people’s needs were assessed and risks to their health and well-being were identified. Care staff told us the care plans were detailed and they knew people well.

A nurse told us that the provider’s medicines policy was effective. They told us they were given clear guidance and the manager checked that medicines were administered appropriately and safely.

Care staff told us they felt well supported by the manager and nurses. They told us they had training and plenty of opportunities to discuss people’s needs and their own practice. One member of staff told us, “If you need a chat with the manager, you just ask.”

The records we looked at accurately reflected people’s needs and staff’s skills and abilities. We asked the manager to send us additional records to demonstrate that they have effectively analysed staff’s training and support needs.

When we visited Allambie Court no one at the home knew we were coming to visit. We spoke with two visitors, five members of staff as well as the manager and two people who live in the home.

We spent time observing the interaction between staff and people who live in the home. We did this to understand people's experience of living at Allambie Court where they were unable to speak with us.

The staff team on duty were polite and respectful when offering care and support to people. We observed that people sought out the company of members of staff and it was evident from people's body language and facial expression that they were comfortable with them.

People told us the staff team were "kind" and "very lovely." A visitor commented that the staff team were "excellent."

There were enough staff on duty during our visit to make sure that people were not kept waiting should they need assistance. Staff responded promptly when people used their call bells to summon assistance.

We saw that people had opportunities to make decisions about where they spent their time, whether to join in with planned activities and what to eat and drink at lunch time. Some people chose to eat in their bedrooms, which was respected by the staff team.

People told us they felt safe and comfortable in their home. A visitor commented, "I am absolutely happy with the care here."