We undertook an unannounced inspection of Alton House on 30 August and 4 September 2018.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.”

Alton House is a care home, providing accommodation and support for 23 adults including people who may have a diagnosis of dementia. At the time we inspected there were 22 people living at the service.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. This service provides personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had 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 on 5 and 6 January 2017 the service was rated ‘Requires Improvement’ overall. We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service did not manage and administer all medicines, safely. The lack of detailed and specific information about people's needs placed them at risk of not consistently receiving the care that they required. The service did not have adequate governance systems in place to ensure people were receiving a service that safe, effective or responsive to their needs.

At this inspection, we rated the service as now being ‘Inadequate’. We found that these previous breaches had not been addressed and we found further breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and of the Registrations Regulations Act 2009. 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.

The service did not oversee people's medicines in a safe way. Covert medicines and PRN medicines were not managed in a way that was safe and in line with best practice. Individual risk assessments were not detailed and not kept up to date. People's changing support needs were not reviewed and staff were not provided with enough information about h

This unannounced inspection took place on 5 and 6 January 2017.

Alton House is a 23 bed care home providing accommodation and care for older people, including people living with dementia. The service is accessible throughout for people with mobility difficulties and has specialist equipment to support those who need it. When we visited, 21 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 and associated Regulations about how the service is run.

At the last inspection in November 2015, we found three breaches of regulations. The arrangements for managing medicines were not robust. Peoples care plans were not detailed and the quality of service was not robustly monitored. Initial action had been taken to address the breaches but this had not been structured or completed. At this inspection, we found that although people were very happy with the service provided, the breaches had not been rectified.

Medicines were monitored and audited and were safely stored but staff competency to administer medicines, had either not been assessed or was not current. Limited information was available to enable staff to make decisions about when and how to give certain medicines. People who received their medicines without their knowledge (covertly) did not have their rights protected.

The process to improve care plans had continued and additional information had been gathered about people but care plans were still not person centred. They did not contain sufficient detail to enable staff to provide an individualised service that safely met their needs and preferences. However, there was a consistent staff team who knew people well and were aware of their needs and likes.

Management systems had not supported the necessary improvements to address the shortfalls identified at the last inspection.

Staff had received training and additional training was scheduled. They told us they received the right training to carry out their duties and that it was kept up to date.

Systems were in place to ensure that people were not unlawfully deprived of their liberty and the necessary applications had been made to the supervisory body when this was required.

We saw that staff supported people patiently and with care and encouraged them to do things for themselves. Staff knew people’s likes, dislikes and needs and provided care in a respectful way.

People were happy to talk to the registered manager and felt they would listen and address any concerns that arose.

We have recommended that staff, relatives and ‘residents’ meetings be held to ensure that everyone has the opportunity to discuss the service and to give feedback on future plans and changes.

The provider’s recruitment process ensured that staff were suitable to work with people who need support.

People were happy with the food and said they had a choice of food and drink and their nutritional needs were met. If there were concerns about their eating, drinking or weight, they were discussed with the GP. We have recommended lunchtime arrangements be reviewed, changed and monitored to ensure that everyone is fully supported in a timely manner.

People’s healthcare needs were monitored and they were supported to receive the healthcare they needed.

People said they were satisfied with the activities staff provided.

People told us they felt safe at Alton House and that there were always staff available to help them.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

This unannounced inspection took place on 12 November 2015.

Alton House is a 23 bed care home providing accommodation and care for older people, including people living with dementia. The service is accessible throughout for people with mobility difficulties and has specialist equipment to support those who need it. 20 people were using the service when we visited.

The service has 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 and associated Regulations about how the service is run.

At the last inspection in February 2015, we found five breaches of regulations. The arrangements for managing medicines were not safe. Standards of cleanliness and hygiene were not satisfactory. Staff had not received sufficient training to provide a safe and appropriate service that met people’s needs. Systems were not in place to ensure that people’s human and legal rights were respected. People’s care plans were not detailed and the quality of service was not robustly monitored.

Since then improvements had been made. Medicines were monitored and audited and were safely stored. However, further work was needed to ensure that all staff who administered medicines had been tested as competent to do so. Also that information was available to enable staff to make decisions about when and how to give ‘as required’ medicines.

The staff team had received training to give them the skills and knowledge to support people who used the service. They told us they received the right training to carry out their duties.

The standards of cleanliness and hygiene had improved. Communal areas and bedrooms were clean and free from odours and smells of urine.

Staff supported people to make some choices about their care. They had received Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards training. The manager was in the process of identifying people who possibly did not have the capacity to make informed decisions about their care and who might need decisions made on their behalf for their best interest.

The registered manager monitored the quality of the service provided to check that people received a service that met their needs. This included spot checks outside of their normal working hours.

The process to improve care plans had started but further work was needed to ensure that care plans were person centred and contained sufficient detail to enable staff to provide an individualised service that safely met people’s needs and preferences.

Although the provider asked people for feedback about the service they did not have adequate systems in place to monitor and improve the quality of service provided.

We saw that staff supported people patiently and with care and encouraged them to do things for themselves. Staff knew people’s likes, dislikes and needs and provided care in a respectful way.

People were happy to talk to the manager and to raise any concerns that arose.

People told us that the food was good and that they had a choice of food and drinks. One person said, “The food is excellent. All nice and fresh and we have large dinners.” We saw that people’s nutritional needs were met.

We found that activities were limited and staff told us that they were limited with activities because of “people’s dementia”. We have recommended that the provider sources guidance and training to support staff to provide suitable activities for people living with dementia.

People told us they felt safe at Alton House. One person said, “Yes I am safe. I love it here and they all look after me well.”

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People expressed their views and were involved in making decisions about their care and treatment. People we spoke with told us they were treated with dignity. One person said "the staff here are wonderful, nothing’s ever too much trouble, they’ve helped me settle in here with their kind ways." We observed that staff interacted with people in a polite and respectful manner during the course of our inspection. We found that medications were stored, administered and recorded appropriately. Staff undertook an induction program on commencing work at the service, and had access to on-going training support.

People told us they were able to make choices over their daily lives and that they were treated well by staff. Comments included "they (staff) are very polite" and "the staff help, asking me what I want." We observed staff interacting with people in a polite and respectful manner. People told us that the service was able to meet their care needs. One person said "they treat us all right, look after us." We found that care plans and risk assessments were in place, but some of these contained only very basic information.

People told us they were happy with the food at the service. One person said "the food is quite good. Plenty enough to eat, good variety" and "it's all right (the food), I've not turned anything down yet."

We found that medications were stored securely. However, there were concerns with the recording and administration of medications. We also had concerns in relation to staff training and induction.

People told us that their care needs were being met. One person said "they know what they are doing" when asked about their personal care. We found that care plans had being developed for people with their involvement and that of their relatives. We found that people were supported to access health care professionals. People told us that they received support with taking their medication. One person said "they give them (medications) to me four times a day." We found that medications were stored securely, but that when errors were made with administering medications these were not addressed. We found that the home's physical environment was safe and accessible to people. People told us they were happy with the staff at the home. One person told us "the staff are kind. I can't fault them in any way." A relative said "they (staff) have got great tolerance." We found that people knew how to make a complaint, and that there was a complaints procedure in place.

People told us that Alton House offers a friendly and cheerful atmosphere. One person told us “I am looked after well and cared for”. Another person living at the service with their relative said “We are enjoying it. We are being well looked after and we are happy”. “Since X has been cared for by Alton House, I have seen a marked improvement. Very friendly staff, the food is good”. (Comment from a relative).

This unannounced inspection took place over two days on 27 February and 11 March 2015.

Alton House is a 19 bed care home providing accommodation and care for older people, including people living with dementia. The service is accessible throughout for people with mobility difficulties and has specialist equipment to support those who need it. 19 people were using the service when we visited.

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 and associated Regulations about how the service is run.

During this inspection, we found that the arrangements for managing medicines were not safe. Staff did not have information to enable them to make decisions about when to give certain medicines. People had not always received all their medicines as prescribed which was a risk to their health and welfare.

The standards of cleanliness and hygiene were not satisfactory. Although the communal areas were clean and free from odours we found three bedrooms with very strong smells of urine. This was because mattresses had not been appropriately cleaned. We also found dirty cloths and a dirty wall in the kitchen.

Staff had not received sufficient training to provide a safe and appropriate service that met people’s needs.

We have made a recommendation about the management of safeguarding.

Staff supported people to make some choices about their care but did not have a good working knowledge of the Mental Capacity Act 2005 or the Deprivation of Liberty Safeguards.

Although care plans contained information about people’s needs and wishes they were not comprehensive. They did not contain specific or sufficient detail to enable staff to provide personalised care and support in line with the person’s wishes. People said that they were not happy with the activities offered. One person said, “We play ball sometimes, otherwise we sit doing nothing and it gets boring.”

The systems in place to monitor the service and to obtain people’s feedback were not robust and this placed people at risk of receiving a service that was not responsive or effective.

We saw that staff supported people patiently and with care and encouraged them to do things for themselves. Staff knew people’s likes, dislikes and needs. They provided care in a respectful way.

People told us they felt safe at Alton House. One person said, “Care that you wouldn’t get anywhere else.”

People told us that the food was good and that they had a choice of food and drinks. One person said, “Excellent food. I’ve not left a dinner since I started here.” We saw that people’s nutritional needs were met. If there were concerns about their eating, drinking or weight this was discussed with the GP. Any support and advice from healthcare professionals was followed by staff in order to maintain people’s well-being.

People were happy to talk to the manager and to raise any concerns that arose. They told us that the manager and deputy were “good”.

You can see what action we told the provider to take at the back of the full version of the report.