Alverstoke House is a 'Nursing home'. People in nursing 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 home is registered to provide accommodation for 29 people. There were 25 people living at the home at the time of the inspection.

The home was based over two floors, connected by two stairwells. Bedrooms had en suite facilities and there were toilets and bathrooms available on each floor. There was a choice of communal spaces comprising of two communal lounges, a dining room and a conservatory where people were able to socialise.

The inspection was conducted on the 6 and 12 December 2018 and was unannounced. A registered manager was in place. 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 this inspection we identified two breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also identified one breach of Care Quality Commission (Registration) Regulations 2009. You can see at the end of this report the action we have asked to provider to take.

Safeguarding issues were not dealt with effectively to ensure that people were protected from abuse. Where reports of abuse had been raised the provider and the registered manager had failed to take responsive action to investigate concerns.

The management team adapted a staff based culture which resulted in the views and feelings of the staff taking priority over the need to safeguard, protect and consider the needs of the people living at the home.

People were not always involved in the development of the service and their views were not always considered or acted on by the management team. The provider had arrangements in place to deal with complaints, however these arrangements were ineffective and complaints were not always acted on appropriately.

Systems and processes used to monitor the quality and safety of the service had not been fully effective in identifying and preventing the shortfalls found at this inspection.

Staff were not consistently supported in their roles. Systems in place to monitor staff training were ineffective in identifying training that had been received or when it was required to be updated.

Staff did not follow the principles of the Mental Capacity Act 2005 (MCA). Capacity assessments had not been robustly completed for all people as required and those completed were not decision specific.

Individual and environmental risks to people were managed effectively. Risk assessments identified risks to people and provided clear guidance to staff on how risks should be managed and mitigated.

There were enough staff to meet people’s needs in a timely way and staff were able to support people in a relaxed and unhurried way. Appropriate recruitment procedures were in place to help ensure only suitable staff were employed.

People received their medicines as prescribed. The home was clean and staff followed best practice guidance to control the risk and spread of infection.

People's nutritional needs were assessed and people were supported to eat and drink. There was a choice of food.

People were supported to maintain good health and had access to appropriate healthcare services when required. Staff were aware of people’s health needs understood how people's medical conditions impacted their abilities. There were clear procedures in place to help ensure that people received consistent support when they moved between services.

People were supported to use technology and specialist equipment to meet their care needs and to support their independ

Alverstoke House is a family run ‘Nursing home’. People in nursing 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 home is registered to provide accommodation for 29 people. There were 24 people living at the home at the time of the inspection.

The home was based over two floors, connected by two stairwells. Bedrooms had en suite facilities and there were toilets and bathrooms available on each floor. There was a choice of communal spaces comprising of two communal lounges, a dining room and a conservatory where people were able to socialise.

The inspection was conducted on 30 November 2017 and was unannounced. There was a registered manager in place, however, they were on holiday on the day of the inspection. 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 the last inspection of the home we identified that the service had breached a regulation in relation to medicines management. At this inspection we found action had been taken to address all areas of concern and there were no longer any breach of the regulations.

Medicines were administered by staff who had received appropriate training and assessments. People received their medicines at the right time and in a way that met their needs.

People and their families told us they felt the home was safe. Staff and the registered manager had received safeguarding training and were able to demonstrate an understanding of the providers’ safeguarding policy and explain the action they would take if they identified any discrimination or concerns.

Staff knew the people they supported and were able to explain the risks relating to them and the action they would take to help reduce the risks from occurring.

The home was clean and hygienic and staff followed best practice guidance to control the risk and spread of infection.

People were supported by staff who had received an induction into the home and appropriate training, professional development and supervision to enable them to meet people’s individual needs.

There were enough staff to meet people’s needs in a timely way. Appropriate recruitment procedures were in place and pre-employment checks were completed before staff started working with people.

Staff sought consent from people before providing care. Although nobody at the home lacked the capacity to make a decision staff were able to explain the action they would take to ensure they followed legislation designed to protect people’s rights.

Staff developed caring and positive relationships with people and were sensitive to their individual communication styles, choices and treated them with dignity and respect. People were encouraged to remain as independent as possible and maintain relationships that were important to them.

People were supported to have enough to eat and drink. Staff who prepared people’s food were aware of their likes, dislikes and dietary needs. Mealtimes were a social event and staff supported people, when necessary in a patient and friendly manner.

People and when appropriate their families were involved in discussions about their care planning, which reflected their assessed needs. Healthcare professionals, such as chiropodists, opticians, GPs and dentists were involved in people’s care when necessary.

Staff took account of people’s end of life wishes and preferences. They supported people to remain comfortable and pain free.

There was an opportunity for people and their families to become involved in developing the service. They were encouraged to provide feedback on the service p

This inspection took place on 6 December 2016 and was unannounced.

Alverstoke Nursing Home is a service that is registered to provide accommodation and nursing care for up to 30 older people, some of whom are living with dementia. Accommodation is provided over two floors and there are lifts to provide access for people who have mobility problems. There were two communal areas on the ground floor that people could choose to spend their time in. At the time of our visit 27 people lived at the home.

A registered manager was in place. 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 and associated Regulations about how the service is run.

Following our last inspection on 3 December 2015 requirement notices were issued for breaches in Regulation 9, 12, 17 and 18. The registered person had not ensured personalised care was planned and delivered, risks associated with people’s care were not assessed, staff had not received the training they needed to undertake their roles effectively and the quality systems had not been effective in identified poor records.

At this inspection improvements had been made and these areas were no longer a breach.

Improvements had also been made to the management of risk and the plans of care for people.

Care records contained information to guide staff about the management of risk associated with people’s needs. Staff were knowledgeable of people’s needs and the support they required. They were no longer in breach of this element of Regulation 12. However the management of medicines needed to be improved as this was not always safe, errors had not been identified, and we were not assured medicines were always stored within safe temperature’s because these were not consistently checked.

People felt safe and staff knew their roles and responsibilities in safeguarding people.

Thorough recruitment checks were carried out to check staff were suitable to work with people. Staffing levels were mostly appropriate to meet people’s needs.

Training had improved for staff who described this as beneficial to the role and always available. Staff were supported to develop their skills through training and the provider supported staff to obtain recognised qualifications. Staff were supported through supervisions and appraisals and felt support by the manager. We have made a recommendation about setting staff development objectives.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found the provider had suitable arrangements in place to establish, and act in accordance with people’s best interests if they did not have capacity to consent to their care and support. The manager understood their responsibility with regard to Deprivation of Liberty Safeguards (DoLS) and they had applied for authorisation under DoLS to ensure people were protected against the risk of being unlawfully deprived of their liberty. We have made a recommendation about the recording of best interest decisions.

People’s views on the choice of food were varied. Care plans were in place to guide staff and we saw that staff took action. People’s intake was monitored and additional health professional input was sought. However, we have made a recommendation that the service seek guidance about the management of weight in the elderly as they did not always contact external professionals promptly. Staff supported people to ensure their healthcare needs were met.

People told us the staff were kind and caring. No one had any concerns and said they were happy with the care and support they received. Staff respected people’s privacy and dignity and used their preferred form of address when they spoke to them. Observations show

This unannounced inspection took place on 3 December 2015. Alverstoke House Nursing Home provides nursing care and accommodation for up to 30 people. On the day of our inspection 28 people were living at the home.

At the last inspection in October 2014 we found there was a breach with a minor impact regarding records. Whist we could see the format of care plans had changed at this inspection there was still concerns over records.

The service does not have 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 service had a manager, who in this report will be referred to as the manager. They had applied to the Commission to become registered but now have withdrawn their application. The provider was already seeking to appoint a replacement manager.

People had risk assessments but these were not in all relevant sections of care planning and had not always been updated as people’s needs changed. Staffing levels were consistent and there were enough staff on duty to meet people’s needs. Staff had undergone recruitment checks but attention was needed to ensure all documentation was available and we have made a recommendation about photographic ID being available. Staff had a good understanding of how to keep people safe and what action they should take if they had any concerns. Medicines were administered, stored and recorded safely.

All staff had not received training to ensure they could meet people’s needs. Staff had knowledge of the Mental Capacity Act but people’s records did not show people’s capacity to make specific decisions had been assessed. People enjoyed their meals but records of people’s nutritional intake were not adequate to know a person’s food and fluid intake. People were supported to access a range of health professionals.

People were supported by caring and kind staff who knew them well.

People did not always have their individual needs met in a personalised way. People felt confident they could make a complaint and it would be responded to.

The home had an open culture where staff felt if they raised concerns they would be listened to. Staff felt supported by the manager and provider. Records were not always accurately maintained and the quality assurance process had not identified the shortfalls we identified.

We found breaches in four 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.

In this report the name of a registered manager appears who was not managing the regulatory activities at this location at the time of our inspection. We were advised the person who was managing the home would be applying to the Commission to register with us. The provider was aware of the need to have a registered manager.

One inspector carried out this inspection. At the time of our visit 25 people were using this service.

At our last inspection we found concerns in relation to medication, quality assurance and record keeping. The purpose of this inspection was to check the provider had made the required improvements to ensure the safe management and administration of medicines, accuracy of records.

During this inspection we found the provider had taken appropriate action in relation to the management of medicines and quality assurance ensuring people were safe. However, a concern remained with regards to the maintenance of accurate record keeping in relation to the care people were receiving. We found there had been some improvements with record keeping but there were still gaps in recording in relation to the care given to people.

During this inspection we spoke with seven people who lived at the home, five staff members and one visiting professional. All made positive comments about the care people received and the attitude of the staff. One person told us, "This is my home and it is very pleasant. The carers are very good and they always listen to me". A professional from the speech and language team who was visiting told us, "The staff know people well and people receive a good level of care. I can leave instructions and know staff will follow these instructions".

Our inspection team was made up of an inspector and a pharmacist. We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe within the home. Systems were not in place to make sure that the manager and staff learnt from events such as accidents and incidents, concerns and investigations.

We found the service was not safe because people were not protected against the risks associated with medicines. The provider did not have appropriate arrangements in place to manage people's medicines safely.

There were enough staff on duty that had the skills to care for people. There was a qualified nurse on duty at all times.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place.

Is the service effective?

People’s health and care needs were assessed and there were clear care plans in place. We could see that people’s specialist dietary needs had been identified in care plans where required. We could see that staff members had access to the care plans and were able to follow the plans of care.

Staff told us they felt they had adequate training to equip them to do their job. The training matrix identified there were some areas where staff needed training.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers and nurses showed patience and gave encouragement when supporting people. People commented, “Staff are kind and caring”.

People’s preferences, had been recorded and care and support was provided in accordance with people’s wishes.

Is the service responsive?

People completed a range of activities in and outside the home. People told us they felt they were consulted on how the home was organised. People told us they would feel very comfortable telling the staff and manager if they were unhappy. One person told us they regularly fed back to the cook on whether the meals were good or could be better.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a coordinated way. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home. We found that records were not well maintained and did not always provide evidence of the care each person was receiving.

You can see our judgements on the front page of this report.

People told us their views were listened to and they were involved and consulted on how the home was run. We saw interactions between people, visitors and staff which reflected staff knew people well. We observed interactions which demonstrated staff treated people with dignity and respect.

People told us they were well looked after. They told us they felt safe living at Alverstoke nursing home. Assessments and care plans had improved and reflected the needs of people and gave information on how staff should meet people's needs. People told us they enjoyed a range of activities within the home and the community. One person told us how staff had escorted them to a local restaurant so they could have a meal with friends.

One person told us a member of staff was, "Attentive and always listened", and another person then told us, "They all do, I can talk to all the staff". We sampled the recruitment records for staff members and found all necessary checks and references had been undertaken, ensuring the safety of people was considered.

The manager and provider had taken steps and had procedures to ensure people were receiving a safe and effective care in a well maintained environment. People and visitors told us the home was always clean and tidy.

Records regarding people's care and staffing recruitment records were adequately maintained.

People spoken with told us their consent was always established before they received any care or treatment. Staff also ensured they considered peoples consent when people were unable to give verbal or written consent. One person told us, “I will ask if I don't understand and staff will always take time to explain things to me".

People told us their care needs were met. One person told us, “I am getting very well looked after, there is enough staff and they are always polite and respectful”. We found that staff members were not always following details in the care plan, which could put people and them at risk. Care plans did not always reflect the current care needs for each person to follow.

The home had suitable information available to staff on abuse to ensure staff were aware of how to identity and protect people from abuse. People told us they felt safe living at Alverstoke House.

People told us they were happy with the staff and found them to be "polite, helpful and respectful". We found that recruitment records were not adequate to ensure the safety of people.

People told us if there were unhappy with any aspect of their care or environment they would complain to the manager. People told us they had confidence the manager would be able to resolve their complaint.

We found that service user' records and staffing records were inadequate and did not ensure the safety of people living in Alverstoke House.

During the visit we spoke with five people who use the service. People said they felt they were well treated by staff, who were respectful of them and listened to their requests. People said they received the care they needed in the way that they wanted it to be provided. People told us staff responded promptly when they used their call bells and helped them to resolve any problems they had.

People we spoke with said they felt safe in the home and said they were confident that staff would respond appropriately to any concerns they raised. People told us the manager regularly asked them how things were and took prompt action to resolve any concerns.