About the service:

Allambie House provides residential personal care for up to 30 older people over the age of 65. During our visit 23 people lived at the home.

People's experience of using this service:

• Staffing arrangements sometimes meant people received delayed care as the provider had not reassessed staffing levels when people’s needs increased.

• Staff were aware of risks associated with people’s care and how to manage them safely but sometimes staffing arrangements impacted on them working safely and effectively.

• People had care plans to support staff in meeting their needs and overall people were positive about the care they received. Some care plan information required more detail to ensure consistent care was provided to them by staff.

• Recruitment checks were completed for new staff but records were not always clear to show checks had been completed thoroughly.

• Medicines were mostly managed safely, sometimes medicine records were not sufficiently clear to show medicines applied to the skin had been administered as prescribed.

• Some social activities took place at the home but these were limited. An activity organiser had been appointed to increase people’s access to activities.

• Health and safety audits were completed to keep the environment safe for people. Work was ongoing to further improve quality monitoring and people’s experiences of living at the home.

• Staff worked within the principles of the Mental Capacity Act 2005. People were given day to day choices and staff sought people’s consent before care interventions.

• People and relatives were complimentary of the staff and spoke positively about the leadership of the service.

• People needs were assessed before they moved into the home to make sure it was the right place for them to live.

• People were able to access healthcare support they needed to keep their health conditions stable and knew staff would seek further support if necessary.

• Representatives from different faith groups and local school children visited to spend time with people at the home.

• People felt safe because staff had completed training and had the skills needed to support them.

• Staff knew to report any concerns such as potential abuse to the registered manager. Action was taken to manage safeguarding concerns to keep people safe.

• The home was clean and bedrooms and communal areas had been decorated and improved since the last inspection. The provider had considered how the environment could better support people living with dementia and had created a reminiscence area with pictures and tactile aids.

• Staff spoke positively of the registered manager and provider and felt supported in that they could approach them both for help and support when they needed it.

More information in 'Detailed Findings' below.

Rating at last inspection: The report from our last inspection was published on 22 March 2018 where we rated the service as 'Requires improvement' overall. There were two breaches in the regulations.

Whilst the overall rating has not improved at this inspection, improvements have been and continue to be made and one of the breaches has been addressed.

Why we inspected: This was a planned comprehensive inspection that was scheduled to take place in line with Care Quality Commission scheduling guidelines for adult social care services.

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

Allambie House 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 House provide accommodation and personal care for up to 30 older people. This can be people who have a learning disability, physical disability, live with dementia or sensory impairment.

At the time of our inspection visit there were 21 people living in the home. The inspection visit took place on 23 and 26 January 2018, both visits were unannounced.

When we last inspected the home on 19, 21 July 2017 and 21 August 2017 we found improvements were required in all key questions. There were four breaches in the regulations and the provider was rated as ‘Inadequate’ and was placed in Special Measures. We added a condition to the provider’s registration so that they were not able to admit further people to the home until improvements were made.

Following the last inspection, we asked the provider to complete an action plan to show what they would do, and by when, to improve the key questions Safe, Effective, Caring, Responsive and Well Led.” We also met with the provider who confirmed the actions they planned to take to ensure the home improved.

During this inspection, we found sufficient action had been taken to address three of the previous breaches in the regulations and to improve so that the home was no longer rated inadequate. However, there continued to be areas needing improvement, including person centred care, which we identified as a breach in regulation 9. We also found there were some risks associated with people’s care which meant there was a continued breach of regulation 12. Action was ongoing by the provider to areas of improvement we identified.

The registered person (provider) had been in post since June 2016. The manager in post at our previous inspection had since left and a new manager appointed. They had submitted their application to register with us. Following our inspection visit, we were told the application had been approved. 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 provider’s recruitment system required a series of checks to be made before new staff could work with people at the home. People told us they felt safe living at Allambie House and spoke positively of the staff team that supported them. They told us staff were caring and approachable and we saw enough staff to support people’s needs.

We had been notified of reportable accidents and incidents as required. This included incidents related to safeguarding people from potential risks to their health and safety.

Risks associated with people’s care were not always sufficiently detailed in care plans to ensure these were managed safely by staff. Information in care plans was also limited in regards to people’s backgrounds and interests to assist staff in providing person centred care. Some people told us they wanted more opportunities to go out of the home and to participate in activities that were of interest to them. Where people had identified healthcare needs, sometimes records didn’t support staff to help ensure they effectively addressed them.

Staff who administered medicines had completed the necessary training to do this safely. However, we found medicine records were not consistently completed to show that creams and lotions had been applied as prescribed.

People were positive about the food provided and a daily choice was provided. Staff knew about people’s nutritional needs and took advice from health professionals when required. St

Allambie House is registered to provide accommodation and personal care for up to 30 older people. This can be people who have a learning disability, physical disability, dementia or sensory impairment. At the time of our inspection visit there were 26 people living in the home.

The inspection visit took place on 19, 21 July and 21 August 2017. The first and third day of the inspection was unannounced and the second day, announced.

During our last inspection on 4 October 2016 we found there were improvements needed in three areas, these being, Effective, Responsive and Well led. We rated the service ‘requires improvement’ overall. During this inspection we found there had not been sufficient improvements made to improve the ratings. We also found additional areas needing improvement. We have rated this service ‘Requires Improvement’ three areas and ‘Inadequate’ in Safe and Well Led.

The registered person (provider) had been in post since June 2016. The manager had been in post for approximately 11 months but had not registered with us. The provider had not taken the necessary action to ensure the manager had applied for registration with CQC. 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.

Risks to people’s health were not effectively managed to ensure people remained safe. Risk assessments were not always accurate or easily accessible to staff to ensure they used them to manage risks safely. The provider’s health and safety risk assessments had not identified risks associated with the environment such as unprotected hot surfaces and access to stair wells. Where risks had been identified, there had been delayed action to address them and audit checks to monitor the quality and safety had not always identified areas needing improvement.

People told us they sometimes felt safe living at the home and we saw people shared positive interactions with staff when supported. Staff were clear about the different kinds of potential abuse and had completed training so they knew how to protect people from harm. They knew about the procedures to follow if they had any concerns about people’s safety which included reporting them to the provider. However, we found the provider had not always followed safeguarding procedures by forwarding the required notifications to the Local Authority and us, so that we could be assured people were protected.

The provider had not ensured they carried out their responsibilities to comply with the requirements of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). Where people could not always make decisions themselves, mental capacity assessments had not been completed. Some staff had not received training in MCA and DoLS so that they understood how to apply the principles of this when delivering care.

Staffing arrangements at the home were not always effective to ensure people’s needs were met and people, staff and relatives commented there were times when there were not enough staff available to support people. Recruitment checks carried out by the provider were not sufficiently robust to make sure staff employed to work at the home were safe and suitable to work with people. New staff were provided with an induction to the home and completed training to prepare them for their role. Refresher training was provided to all staff on an ongoing basis but there were gaps in some training. Training linked to people’s needs such as medicines and dementia care was not routinely provided to ensure staff updated their knowledge and skills to meet people’s needs.

Each person had a care plan that contained information about their needs, but these were not always up-

Allambie House is registered to provide accommodation and personal care for up to 30 older people. This can be people who have a learning disability, physical disability, dementia or sensory impairment. At the time of our visit there were 25 people living in the home.

The inspection visit took place on 4 October 2016 and was unannounced.

During our last inspection on 12 February 2015, we found the provider was not fully meeting the standards required. We identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to safeguarding people from abuse and improper treatment. We rated the service as “Requires Improvement” overall. We asked the provider to make improvements and they sent us an action plan stating they would take the necessary action to comply with the legal requirements. During this inspection we found improvements had been made by the new registered person and new manager.

The new registered person had been in place since June 2016. The manager had been in post for approximately two months at the time of our visit and was not registered with us. However, the provider was aware of the need to ensure any manager of the service was registered and plans were in place to address this. 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.

Staff understood their responsibilities to keep people safe and protect them from harm. They had completed training so they knew the procedures to follow if they had any concerns. People told us they felt safe living at the home and we saw people shared positive interactions with staff when supported.

Where there were risks associated with people’s care, risk assessments had been completed with instructions to staff about how to minimise them to keep people safe. However, some risk assessments had not been updated to ensure information about how risks should be managed was clearly identified.

The provider carried out a range of recruitment checks to make sure that staff employed to work at the home were safe and suitable to work with people. New staff were provided with an induction to the home and completed induction training to prepare them for their role. Refresher training was provided to all staff on an ongoing basis to keep their skills and knowledge updated. We found some staff had not completed all of their training, but this was ongoing to ensure they met people’s needs safely and effectively.

The provider and manager understood their responsibility to comply with the requirements of the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS). Staff knew to seek people’s consent before giving care and to support people’s independence where possible. Work was ongoing to update care plans to ensure people’s needs and wishes were fully identified and met.

Staff were caring in their approach towards people and aimed to provide care in accordance with people’s choices and preferences although sometimes this did not happen. People were provided with a choice of meals and drinks but some people felt meals could be improved, such as, there being more variety. People were supported in a range of social activities within the home and there were some also provided outside of the home when possible.

Each person had a care plan that contained information about their needs and how they needed to be supported. Some of the care plans were in the process of being reviewed and updated to contain more detailed information about people to support staff in delivering person centred care.

Staff told us they felt supported by the provider and manager and were positive about working at the home. There w

This inspection took place on 12 February 2015 and was unannounced.

Allambie House is registered to provide personal care and support to a range of people. This includes older people, people with learning disabilities, dementia, a physical disability and a sensory impairment. We found people within all of these categories living at the home. It is registered to accommodate up to 30 people and on the day of our inspection there were 26 people living there.

A registered manager was in post and was present during our 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.

People who lived at Allambie House told us they felt safe but we found improvements were needed to make sure they were kept safe. This included making sure people had access to call bells, were assisted to move safely and ensuring health and safety checks within the home were completed thoroughly. There was a lack of storage space within the home and the inappropriate storage of items impacted on people’s safety. Cleanliness and management of infection control within the home also needed improvement.

People were supported to make some choices about their lifestyle and their independence was supported where possible. However, where people refused care, there was not always a clear management plan for staff to follow to make sure they worked in the person’s best interests.

Care staff understood some of their responsibilities to keep people safe and the importance of reporting any suspected abuse. Staff did not have a good understanding of how the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) affected their practice. The MCA sets out how to support people who do not have capacity to make a specific decision. DoLS are safeguards used to protect people where their freedom to undertake specific activities may be restricted. We received conflicting information from the registered manager and staff about the number of people who needed support in making certain decisions.

People were mostly positive about the staff. We observed staff were sometimes caring in their approach and at other times their interactions with people were mostly based around giving instructions to carry out care tasks. We observed call bells were answered promptly but there were some occasions when there was a delay in staff responding to people’s requests for staff support during the morning.

People received the support of health professionals such as the GP, chiropodist and district nurse to ensure their health needs were met. A visiting health professional was positive in their views of staff and the support provided to people.

There were some systems in place to monitor the quality of care and services provided but we did not see clear processes to seek people’s opinions and suggestions to help improve the care and service they received.

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

We visited the home unannounced and spoke with three staff and the manager. We spoke with six people who lived at the home and observed care and interactions. We also spoke with a visiting heath professional.

We saw there were sufficient staff to maintain people’s care and welfare. We saw that people were protected against the risks of infection. We saw that medicines were administered safely. We saw that complaints were responded to.

People we spoke with were very positive in their views of the home. One person told us,“It’s very pleasant here.” Another person told us, “I like it here it here. I like my room.” A visiting health professional told us they were “More than happy” with what they saw and added “The staff are really good and really caring.”

Staff showed in discussion and in their interactions they were committed to the welfare and well-being of people who lived in the home. We saw good care practices and warm and friendly interactions between staff and people receiving care and support.

We visited the home without letting anyone know in advance. We saw that the home catered for people with a wide variety of needs. Some people chose to stay in their rooms much of the time. A dozen people spent much of the time in the communal lounge, where some people were very chatty. We saw no-one showing any signs of distress.

People told us that the home was good, they liked it and that the staff were good. “I like it here” and “we’re well looked after” were two comments made to us by people who lived at the home. A visiting health professional told us that staff and management were efficient, informative, co-operative and knew what to do.

The manager and staff told us that staff turnover was low and that most staff had worked there for a number of years. They were familiar with the needs of people who lived at the home.

A visiting relative told us that they had no worries about the home, and that people always appeared happy.

We saw that people remaining in their rooms were regularly checked and that people who spent most of their time in the lounge were content with each other’s company and were supportive of each other. We saw warm, friendly interactions between staff and people who lived at the home.