About the service: Alan Morkill House is residential care home that was providing personal care to 49 people aged 65 and over at the time of the inspection, including people living with dementia.

People’s experience of using this service:

Feedback from people using the service and their relatives reflected the significant improvements the home has made since the last inspection.

People were cared for by staff who knew how to keep them safe and protect them from avoidable harm.

Staff were kind and compassionate, and we saw evidence of good caring relationships between people and staff. There was a good atmosphere at the home. A relative told us, “The staff here are fantastic, very keen, very enthusiastic, very caring.”

People’s needs and wishes were assessed and documented, and care plans were reviewed regularly. Staff knew the people they cared for and understood their communication needs.

People were provided with a nutritious diet. Support with eating was provided in a caring and dignified way.

People were supported to have choice and control in their lives and were supported in the least restrictive way possible. The principles of the Mental Capacity Act 2005 were followed.

The home was clean, recently decorated, and well maintained.

People were supported by staff who were safely recruited and trained.

People and their relatives spoke very highly of the registered manager who had successfully led the improvements to the home. Staff spoke highly of the home as a workplace.

More information is in the full version of the report.

Rating at last inspection: At the last inspection the home was rated Requires Improvement. At this inspection the rating has improved to Good.

Why we inspected: This was a planned inspection based on previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

This comprehensive inspection was carried out on 21 and 22 December 2017 and 5 January 2018. The inspection was unannounced on the first day and we informed the provider of our intention to return on the second and third day. Alan Morkill House is a ‘care home’ for older people, including people living with dementia. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. This three storey care home is divided into seven separate units. There is a large communal lounge, main kitchen, courtyard and garden on the ground floor; additionally there are communal facilities on each floor. At the time of the inspection there were 47 people living at the service and two vacancies.

The service had a registered manager. A registered manager is a person who has registered with 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 2008 and associated Regulations about how the service is run. The registered manager joined the service in June 2017 following the previous inspection and was present on the three days we visited.

At our previous comprehensive inspection on 29 and 31 March, and 3 April 2017, the service was given an overall rating of Requires Improvement. Caring and Responsive were rated as Good, Effective and Well-led were rated as Requires Improvement and Safe was rated as Inadequate. We had found five breaches of regulations in regards to how the provider ensured the safety of people who used the service, staff training and supervision, ensuring appropriate arrangements for people using the service to consent to their care, meeting people’s nutritional and hydration needs and ensuring that effective auditing practices and accurate record keeping were in place to improve the quality of the service provided to people.

Following this inspection we had issued a warning notice due to the issues of concern we had found in relation to people’s safety. The concerns were in regards to the safe management of medicines, the inaccurate completion of positioning charts for people who were at risk of developing pressure ulcers and the failure of the provider to ensure that people were consistently protected from the risk of accessing areas used for the storage of cleaning chemicals. We received an action plan from the provider to explain how they would address the warning notice and breaches of regulation within a specified timescale.

At this inspection we found that the provider had met the warning notice and the breaches of regulation.

We saw that improvements had been made and people received their medicines safely. Risks to people’s safety and wellbeing had been identified; however, some of the risk assessments we looked at required additional information to demonstrate how the provider guided staff to address these risks. We observed that actions had been taken to provide people with a warm environment although the provider’s risk assessments for the use of portable heaters in people’s bedrooms needed further details to meet people’s individual needs. This was addressed by the provider during the inspection.

Staffing levels were satisfactory although we received comments from two people who used the service and the relatives of two other people that they did not think there were always enough staff. People were protected from the risk of harm and abuse as staff understood the provider’s safeguarding procedures and employees were subject to appropriate pre-employment checks before they were offered positions at the service.

Improvements had been achieved in relation to staff training and supervision. Records showed that the provider ensured staff undertook their required training and had reg

This inspection took place on 29 and 31 March and 3 April 2017 and was unannounced on the first day.

At our last comprehensive inspection on 5 April 2016 we rated this service “Requires Improvement” and found breaches of regulations relating to safe care and staff training. We carried out a follow up inspection in December 2016 and found that the provider had made some improvements but was still not meeting these requirements. We received concerns about the quality of care provided by the service and brought forward this scheduled inspection in order to look into these. At this inspection we rated the service “Requires Improvement”.

Alan Morkill House is a care home for up to 49 older people and people with dementia. There is a large kitchen and communal lounge on the ground floor and a shared courtyard and garden, and each floor includes a communal lounge, kitchen and dining room. The service is divided into seven units, three of these units provide care for people with dementia. At the time of our inspection there were 39 people 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 2008 and associated Regulations about how the service is run.

We found that the building was not always safe and potentially unsafe issues with premises were not always addressed in a timely manner, for example kitchens and cupboards storing cleaning materials were left unlocked. Although staff carried out checks of water temperatures and fridge temperatures, there were not always clear guidelines in place, and in some cases people were bathed in water which was too hot, which was not checked by managers. Where people were at risk of pressure sores, turning charts were not correctly completed or checked. Medicines were not managed safely, and we found that in many cases people did not receive their medicines as prescribed. Managers did not carry out sufficient checks to detect these issues.

Call bells were checked to ensure that they were operational, and these were responded to promptly, although staff could not always hear these in some areas of the building. Units for people living with dementia did not use dementia friendly design to aid people’s orientation around the building. We have made a recommendation about this.

The provider had assessed people’s capacity to make decisions, but did not always review these regularly, and when people were deprived of their liberty in their best interests the provider had acted lawfully. However, the provider did not ensure that people had appropriately consented to their care.

Staff training had improved, but some staff had not received training in mandatory areas, and the provider did not have a clear assessment of the training needs of the service. Many staff did not receive regular supervision and team meetings were not well attended enough to ensure good communication.

People received good support at mealtimes and food was nutritious and varied, however recommendations from dietitians were not always followed, and people’s weights were not audited in a way which would detect and address weight loss. Where people required food and fluid charts these were not always correctly completed or checked by managers.

People’s needs were assessed and reviewed regularly, and people’s wishes and preferences were identified by staff, including their wishes for the end of their lives. We found that people benefitted from caring and attentive staff and from a varied and interesting activity programme.

People told us they were treated with respect by staff and we observed friendly and caring interactions. Staff worked to maintain a suitable and friendly environment for people. Staffing levels were not unsafe, but staff told us

We carried out an unannounced comprehensive inspection of this service on 5 April 2016. Breaches of legal requirements were found regarding safe care and treatment and staff training. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. After that inspection we received concerns in relation to the heating not working and issues with pest control.

We undertook this focused inspection to check that they had followed their action plan, to confirm that they now met legal requirements and to look into these concerns. This report only covers our findings in relation to these areas. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Alan Morkill House on our website at www.cqc.org.uk.

There was a registered manager at the service. 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 received information that the building was not safe due to mice infestation and that the heating was not always working correctly. We saw that the provider had taken measures to address these issues.

At our previous inspection we found that the provider was not carrying out satisfactory measures to ensure water safety and the safe functioning of the call system. We found that the provider was still not fully meeting these requirements. Although the provider was carrying out satisfactory measures to protect people from legionella, there was not sufficient checking of water temperatures to protect people from the risk of scalding. The provider was not always carrying out checks to ensure that the call bell system was working correctly.

At our previous inspection we found that staff were not receiving sufficient training. We found that the provider was still not fully meeting these requirements. Although many staff had received training in key areas there were still some staff who had not received this training, and some staff did not undertake refresher training in line with the provider’s requirements. Some staff who had recently joined the service did not receive training in important areas such as safeguarding.

We found that the provider was still breaching regulations with regards to safe care and treatment and staff training. You can see what action we have told the provider to take at the back of the full version of this report.

This inspection took place on 5 and 7 April 2015 and was unannounced on the first day. We last carried out an inspection on 9 November 2015, where we found that the service was in breach of regulations with regards to providing safe levels of staffing. At this inspection we found that the service had made the improvements we required.

Alan Morkill house is a residential service providing accommodation for up to 49 older people and people living with dementia. At the time of our inspection there were 36 people living in the service. The provider had recently closed the dementia unit on the ground floor, meaning that there were now six units across the three upper floors of the building. Each of these units had a dining room and shared kitchen. On the ground floor there was an activities room, lounge and kitchen.

The service had a registered manager, who had registered in February 2015. 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.

There had been significant improvements in staffing since our last inspection. Staff and people who used the service told us that this had made them feel safer and better supported. The provider had measures in place to manage the risks of people falling or leaving the building in a way which may be unsafe and these were reviewed regularly and in response to accidents.

We saw that the provider used a monitoring system to notify staff when people may have fallen and to allow people who used the service to call for help. Staff responded quickly to calls from this system, however the service did not have measures in place to ensure the system was working effectively, which meant there were times when people were not safe. There was also a large number of vacant rooms in the service, where the provider had not carried out appropriate measures to reduce the risk of legionella from unused taps and showers. The provider has since put measures in place to manage these risks.

The new registered manager had an improvement plan in place for the service. As part of this, staff training was being reviewed and training was arranged when necessary, and a new timetable was in place for staff supervision. However, at the time of our inspection staff training and supervision was still not adequate to ensure that staff were able to carry out their roles effectively.

We saw that people were treated with respect and appeared clean and well-cared for. People had the opportunity to attend activities which were appropriate for people living with dementia and carried out in an inclusive and sensitive manner. Care plans provided detailed information about people’s support needs and wishes, these were routinely reviewed every month. People’s nutritional needs were assessed monthly and measures were in place where people were at risk of dehydration or malnutrition to manage these risks. We saw that people were able to choose their own meals, and the kitchen had systems in place to ensure that people received food of their choice which met their nutritional and health needs.

Where people may be deprived of their liberty due to restrictions such as door locks, the provider had carried out its responsibilities to apply to the local authority and demonstrate that these restrictions were proportionate and in the person’s best interests. However, staff were not working in line with the Mental Capacity Act 2005 to demonstrate that a person’s care plan was in the person’s best interests where they did not have capacity to consent to their own care.

We saw a number of compliments about the service, and relatives and people who used the service were positive about the care staff and management. Where people had complained about the service

We carried out an unannounced comprehensive inspection of this service on 18 and 20 November 2014.Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to care and welfare; assessing and monitoring the quality of the service and cleanliness and infection control.

We then carried out an unannounced focused inspection on 21 and 23 April 2015 to see whether these improvements had been carried out. At this inspection, we found that the provider had made the required improvements, however we found that the service was in breach of legal requirements with regards to staffing levels. Following the publication of this report, the provider contacted us to say which measures had been taken to meet these requirements.

After that inspection we received concerns in relation to staffing levels and training of staff. As a result we undertook a focused inspection to look at these concerns and check if the provider had taken action to meet legal requirements around staffing. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Alan Morkill House on our website at www.cqc.org.uk

Alan Morkill House is a residential care service providing care for up to 49 older people, many of whom have dementia or mental health needs. At the time of our inspection, there were 43 people living in the service. The service consists of three floors with two units on each floor, and a further unit on the ground floor. Each unit accommodates 7 people. The units on the second and ground floor accommodate the people with the highest needs.

The service is required to 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. There has not been a registered manager since August 2014. The service appointed a manager in August 2015, but at the time of the inspection she had not yet submitted her application to become the registered manager.

We found the service was not safe. Staffing levels were inadequate to meet the needs of people who used the service. Dependency tools did not take account of the need to provide 2:1 support to people who required it. Floating support staff were required in order to ensure that two members of staff were available to support people when needed, however this was not adequately provided, and at times absent.

The provider did not have an adequate system in place for monitoring the training and competency of staff who administered medicines, which meant they could not be certain that staff had received this training. Steps had been taken to address this, but not all staff had had observations of their competency to administer medicines.

We made one recommendation in relation to the observation of staff competency in administering medicines. We found one breach of the Regulations around staffing. You can see what action we told the provider to take at the back of the full version of the report.

People told us there were lots of activities to choose from. They said “there’s lots’ going on, I can pick and choose what I want to join”.

The service had implemented a new care planning system and had consulted people who use the service about how their needs should be met. The new care planning system enabled staff to identify risks to people health and welfare and address them promptly. There were suitable arrangements for dealing with foreseeable emergencies.

The provider had reviewed and increased staffing levels following our inspection in June 2013 so there were sufficient people on duty to meet people’s needs. Staff were supported by a new senior team who had provided supervision, support and training.

At local and provider level there were robust monitoring processes in place and evidence that the service sought feedback for people who use it.

People did not always experience care that was appropriately planned. We were informed by staff and the manager that care plans were not always reviewed on a monthly basis in accordance with the provider’s guidance. Therefore we could not be assured that people’s care was being delivered in line with their changed needs.

There were not always enough staff to meet people’s needs. People we spoke in the home were complimentary about the staff. One person said when talking about staff ''they do their best for us.'' However on the day of the inspection we observed that on one floor of the home people had been left unsupported with personal care for over four hours.

We were not assured that people's needs were being met by competent staff as there were no appropriate arrangements in place to identify where staff needed support and what their training needs were.

We found that there were arrangements in place to give people their medication. However we found some discrepancies in how some information was being recorded. On each box of people’s medication there was a dispensing date however there was no record of the date for when the medication was started.

We identified concerns in the quality monitoring within the home and found that the provider’s own management audit systems were insufficient to pick out the inconsistencies we found across a number of areas. For example we found gaps in information in how accidents / incidents were being recorded.

Overall, people we spoke with were happy at the home and thought that they were well cared for. They told us they felt safe at Alan Morkhill House and would speak to the manager if they had concerns. People told us that they were given the choice of how they would like to spend their day and what they would like to eat. One person said ``the care is very good here, very good carers’’, and that they felt respected and listened to.

We carried out an unannounced comprehensive inspection of this service on 18 and 20 November 2014. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to care and welfare; assessing and monitoring the quality of the service and cleanliness and infection control.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report covers our findings in relation to those requirements and in relation to staffing levels and fire safety. We looked at staffing levels as so many staff members, people who used the service and their relatives raised it as a concern with us. Fire safety was checked due to an incident at another of the provider’s care homes. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Alan Morkill House on our website at www.cqc.org.uk

Alan Morkill House provides residential care for up to 49 older people, many of whom are living with dementia or severe and enduring mental ill-health. Most people stay long term, a few are there for shorter periods for respite care or after hospital stays. The home has four floors and people occupy small flatlets organised into seven units. There is one unit on the ground floor and two units on all the other floors. Although each person has their own shower room and small kitchen area, the kitchen areas we viewed were unused. Meals are provided from the main kitchen with snacks and drinks available from the kitchenette on each unit. Previously the building was used to provide sheltered housing.

The manager of the service started in post just before Christmas 2014 and had started the process to become 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.

Immediately upon arrival we saw that the environment of the communal areas had improved since our last inspection. New carpets, curtains and chairs had been purchased for most areas and had been ordered for other areas. The kitchenettes in each unit had been upgraded or were about to be upgraded. New pictorial signs to help people to find their way around the building arrived during the inspection period and were being installed. Some of these new features made it easier to maintain a high standard of cleanliness and this was observed to have improved so the provider was no longer in breach of this regulation.

Last time we found that the service was admitting people with complex needs which the service found hard to meet. We found that the provider was now only admitting people with needs that staff at the service were able to meet.

We saw that progress had been made in the area of care and welfare as up-to-date care plans and risk assessments were now in place. We attended a well-structured handover meeting between shifts during which useful information was passed on to incoming staff to ensure they were up-to-date with people’s well-being and appointments. The provider was no longer in breach of the regulation for care and welfare. However we found that further progress in this area was hindered by the staffing levels within the service. Although an additional Head of Care post had been created and filled since our last inspection, there were insufficient staff to reliably carry out the care and support detailed in people’s care plans, in particular in relation to social and emotional care. You can see what action we told the provider to take at the back of the full version of the report.

The service had developed a service improvement plan and senior managers were closely monitoring to ensure improvements were actually taking place. We found that they were now well-informed about the service’s strengths and weaknesses and had plans in place to address the weaknesses. Therefore the provider was no longer in breach of the regulation for quality assurance. However, the format of the audit forms still impacted on quality assurance within the service as they were not easy to complete or analyse. We have made a recommendation about keeping safety records.