About the service:

Alma Court is a care home that provides nursing and personal care for older people, most of whom are living with dementia. At the time of the inspection, 61 people lived at the service. The home is divided into six separate units, each with its own communal areas.

People’s experience of using this service:

¿ At the last inspection in November 2017, we rated the service as Requires Improvement and found that improvements were needed in a number of areas including moving people safely, ensuring people’s records were kept securely and making sure all checks were carried out effectively.

¿ At this inspection, we found some improvements had been made but further improvements were needed to improve the quality of the service.

¿ At the time of this inspection, the home was going through a period of significant change. A new manger was in post who was starting to address areas of concern that had been raised by relatives and visiting professionals.

¿ We found that improvements were underway but more time would be needed to complete all the required actions and work to ensure people received a consistently good service.

¿ People received their medication at the right time but improvements were needed to some aspects of the management of medicines. Staff had a good understanding of the risks people faced and knew how to identify and report concerns.

¿ We saw that most units had sufficient staff to keep people safe but people were left unsupervised on occasions and some relatives and staff thought staffing levels needed to be increased.

¿ Some people required more encouragement and support to ensure they ate meals but people had access to food and drink and were now maintaining healthy weights.

¿ People’s consent was obtained before care and support were delivered and the service was working within the principles of the Mental Capacity Act. Staff were well trained but needed to access more regular supervision to reflect on and improve their practice.

¿ People were treated with respect and dignity and staff were patient with people when they were distressed or upset. Relatives were made to feel welcome in the home at any time and improvements were being made to the environment to ensure it was more stimulating and relevant to people’s needs.

¿ Improvements were still needed to ensure care plans and paperwork were kept up to date and reflected people’s needs. Relatives told us they thought communication could be improved to ensure they were kept up to date with any issues or concerns. Relatives were also concerned about how the laundry service was being run.

¿ Complaints were promptly and thoroughly investigated and people had the choice to take part in activities that were on offer in the home. Improvements were required to ensure end of life care was properly planned for.

¿ The provider and managers were open and honest about the improvements that were required and the leadership team has the capacity and ability to take the necessary steps to improve the service.

¿ Staff and relatives were generally happy that the service was moving in the right direction and that improvements were being made.

More information is in the detailed findings below.

Rating at last inspection:

Requires improvement (report published 11 January 2018).

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Enforcement:

No enforcement action was required.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as 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

We commenced the inspection of this service on 14 November 2017 and the inspection was unannounced. We completed the inspection on the 17 November 2017. Alma Court is a care home that provides accommodation and personal care. Alma Court is registered to accommodate 73 people in one adapted building. At the time of our inspection 71 people were using the service. Alma Court accommodates people in one building and support is provided on three floors across six separate units, each of which have separate adapted facilities. A garden and enclosed patio area were available that people could access. All of the units specialise in providing care to people living with dementia who demonstrate behaviours that put themselves and others at risk of harm.

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.

Our last comprehensive inspection was undertaken on the 14 October 2015 and the service was meeting the regulations that we checked and received an overall rating of Good. We undertook a focused inspection on the 21 July 2016 following concerns received regarding the numbers of staff available to support people. We found there were enough staff available but some agency staff did not have sufficient knowledge about the people they were supporting; to ensure they could provide safe care. We rated the safe domain as requires improvement and asked the provider to take action to address this. The overall rating remained Good. At this inspection we found improvements had been made in this area but further improvements were required.

This is the first time the service has received an overall rating of Requires Improvement.

Systems were in place to monitor the quality and safety of the service but they were not always effective in identifying areas for improvement. For example, staff had received training to support people; this included moving and handling training to enable them to move people safely and in accordance with current guidelines. However we observed two occasions when unsafe practices were undertaken. This had also been raised by Staffordshire quality monitoring team in July 2017 and fed back to the registered manager at that time. This meant that the provider’s actions to address this had not been effective. People were supported to take their medicines but records to demonstrate that people’s prescribed creams had been applied were not always completed. This meant we could not be assured that people received these creams to protect their skin. Confidential records were not always stored securely to ensure they were only accessible to authorised people. The majority of staff interacted well with the people they were supporting; however some agency staff did not provide sufficient interaction with people to ensure their social needs were met and their well-being maintained.

Staff understood their responsibilities to report any concerns and enough staff were available to support people. Before staff started work checks were made to confirm they were suitable to work with people. Assistive technology was in place to support people to keep safe. Systems were in place to prevent and control the risk of infection.

We found people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. When decisions were made in their best interests their rights were protected. People were supported with their dietary needs and to access healthcare services to maintain good health. The design of the building enabled easy access for people to walk around independently and improvements to outdoor spaces were being addressed by the provider.

People's

We carried out an announced comprehensive inspection of this service on 14 October 2015. After that inspection we received concerns in relation to staffing levels and. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Alma Court Care Centre on our website at www.cqc.org.uk

Alma Court can provide support and accommodation for up to 73 people with complex behaviours who require nursing care. There were 69 people living in the home on the day of our inspection.

There was 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 the focused inspection we found that there were sufficient staff to care for people however some agency staff did not have all of the information they needed to provide people’s care in the way it was planned. Some agency staff were unable to explain how they would support people to leave the home quickly in the event of an emergency or where to access fire fighting equipment. The provider had recognised there were shortfalls in their staffing levels and demonstrated they had plans in place to mitigate the risks this presented to the consistent care of people. A staffing review had been completed and a recruitment drive was in progress.

This inspection took place on the 14 October 2015 and was unannounced. This was the service’s first inspection under the management of Avery Homes (Cannock) Limited.

Alma Court provides support and accommodation to up 61 people with complex behaviours who require nursing care. At the time of the inspection 60 people were using the service. People who used the service had complex needs and limited communication skills due to their mental health needs.

There was a registered manager in post. The registered manager had remained the same with the change of provider. 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 were assessed and minimised through the effective use of risk assessment and staff knowledge of people and their risks.

There were sufficient numbers of suitably trained staff to keep people safe. When people required one to one staff support they received it. Staff knew what constituted abuse and who to report it to if they suspected abuse had taken place.

The Mental Capacity Act (MCA) 2005 is designed to protect people who cannot make decisions for themselves or lack the mental capacity to do so. The Deprivation of Liberty Safeguards (DoLS) are part of the MCA. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. The provider followed the guidelines of the MCA to ensure that people were not being unlawfully restricted of their liberty and that people consented to their care, treatment and support.

People’s nutritional needs were met. People received adequate food and fluids. When people had been identified as losing weight or with difficulty in eating, referrals were made to the appropriate health agency and plans put in place to manage the concerns.

People’s health care needs were met. When people became unwell or their needs changed, people were supported to attend appointments and with specific health care interventions.

People were treated with dignity and respect and their right to privacy upheld.

Care being delivered was personalised and met people’s individual needs and preferences. People’s care needs were regularly reviewed with people and their representatives.

Opportunities to engage in hobbies and activities were available dependent on people’s needs and preferences. People’s refusal to participate or engage was respected.

Relatives and representatives knew who to and how to complain if they had concerns.

Staff felt supported and motivated to fulfil their role. They knew how to whistle blow and felt assured that their concerns would be taken seriously.

The provider had systems in place to monitor the quality of the service and to ensure a continuous improvement plan was in place.

We inspected Alma Court Care Centre on a planned unannounced inspection, which meant that the service did not know we were coming. We looked to see: 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 our finding based on our observations, speaking to relatives of people who used the service, 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 Caring?

People were observed to be treated with respect by the staff supporting them. Individual choices and preferences were respected. People were dressed in their individual style and appeared well cared for. A relative of one person told us: “My wife receives brilliant care here”.

Is the service Responsive?

People were generally observed to be involved in activities within and outside of the service. Relatives told us that they were fully involved in their loved one's care and if they had any concerns they would speak to the manager who would deal with them.

Is the service Effective?

People’s health and care needs were assessed and where able to people or their representatives were involved in the process. Specialist equipment and specific health needs had been clearly identified in their care plans.

The premises were well adapted and maintained to meet the individual needs of people who used the service.

Is the service Well Led?

The manager had not registered with us as is required. This was discussed at the time of the inspection. The manager and provider assured us this would be dealt with promptly.

The service had several quality monitoring systems to ensure a continuous improvement of quality care.

Staff we spoke were knowledable in their role and in their ability to care for people.

Is the service Safe?

Relatives of people we spoke with told us they felt their loved one was safe at Alma Court. One relative told us: “I feel comfortable leaving my dad here”.

The service had systems in place to monitor accidents and incidents. Where appropriate other agencies had been involved in people’s care such as Deprivation of Liberty Assessments.

Staff told us and we saw that there were enough staff to safely meet the needs of people who used the service.

We inspected Alma Court on a follow up inspection. At our previous inspection in August 2013 we had concerns that people’s care and welfare needs were not always met, people were not always safe and staff were not supported to fulfil their role effectively. We had asked the service to take action to improve. Following the inspection the registered manager sent us an action plan telling us what they had done to meet the required standards. We returned unannounced which meant the service did not know we were coming, to check that the improvements had been made.

We spoke with two people who used the service and observed their care. We spoke with six members of staff and three relatives of people who used the service.

We found at this inspection that people’s care and welfare needs were being met. A relative told us: "I've got no complaints, it's good here".

We saw that the service had implemented new systems to recognise and report concerns of possible abuse.

We saw and staff told us that the service had implemented systems to support the staff to fulfil their role. Staff we spoke with told us they felt supported and equipped to fulfil their role effectively.

We inspected Alma Court on a responsive inspection as we had received information of concern. The inspection was unannounced which meant the service did not know we were coming.

People at Alma Court had complex needs and limited communication skills. As part of the inspection process we spoke with six staff, two visiting relatives, the manager, operational manager and the provider. We observed people’s care and interacted with people as much as we were able to dependent on their needs.

We looked to see if people’s care and welfare needs were being met. We observed people had to wait for their personal care needs to be met and staff did not always show compassion when communicating with people.

We checked to see if people who used the service were safe from abuse or the risk of abuse. We found that one person's needs had not been reviewed following a serious incident and this may have placed this person at further risk.

We observed that there were sufficient numbers of staff but people's needs were not always being met.

We looked to see if staff felt supported in their role. Five out of six staff told us they did not feel supported and were unable to communicate this with the management.

We inspected Alma Court on a planned unannounced inspection which meant the service did not know we were coming. We were supported throughout the inspection by the manager of the service.

At our previous inspection in January 2013 we had concerns over the lack of activities on offer for people who used the service. At this inspection we found that improvements had been made. We found that people were being engaged in meaningful activities. A relative of one person who used the service told us; "There has been an astonishing difference in my relative since they have been here".

We checked to see if people who used the service consented to their care, treatment and support. We found the service had systems in place to support people to be involved in and agree with their care planning.

We looked to see if the service was clean. We found the service was clean and followed the correct infection control policies.

We found that the service operated effective recruitment procedures for the employment of new staff.

We saw that the service had a complaints procedure. The manager showed us that they investigated complaints appropriately.

Alma Court was compliant in the five outcome areas we looked at.

We inspected Alma Court on a planned unannounced inspection which meant the service did not know we were coming.

We were not able to talk to many of the people who used the service due to their complex needs but we observed that people appeared comfortable and relaxed in their environment. We saw staff knock on bedroom doors before entering and speak with people in a respectful manner.

The service had a safeguarding policy and the manager showed us safeguarding referrals they had made to the local authority to keep people safe.

Staff we spoke with told us they felt supported and suitably trained to fulfill their role and were happy working at Alma Court.

Relatives of people who used the service told us they were happy with the level of care provided to their relatives.

The service had implemented numerous quality monitoring systems to ensure a continuous improvement in the quality of the service required.

We had concerns over the level of activities that were available to people who used the service.

We carried out this review to check on the care and welfare of people using this service. Information we hold about Alma Court showed us that we needed to undertake a monitoring visit, in order to update our records, and to establish that people's needs were being met.

We concentrated on finding out how the care was provided and looked at the quality of the service, including making sure there were enough staff available to meet people’s needs.

The home was warm, comfortable, clean and welcoming. We saw that the staff were kind, respectful and polite. They gave support in ways that respected people's dignity and privacy for example, we saw and heard the staff knocking on bedroom doors and observed the staff listened to people and spent time with them, talking and carrying out activities, as well as providing care.

People spoken with told us they felt the staff treated them well and respected them. One person told us, “I am very satisfied, it is clean and tidy and a very nice place to be.”

Everyone had a plan of care that identified their needs. This included information about communication needs and any support people needed to manage their behaviour. People's daily preferred routines were identified.

People who lived at the home were supported to have their health and personal care needs met. We saw people had regular checks with care specialists to monitor their health and well being.

Staff were trained to understand and manage any complex behaviours through the use of redirection and de escalation methods. This meant people using the service were supported in the least restrictive and safest way.

People were supported to make choices and to be as independent as possible. Some people helped around the home doing household tasks and were encouraged to do so. People chose what they wanted to eat and wear and the activities they wanted to do.

The home had systems in place to monitor and evaluate people's care. Care records were reviewed monthly through key worker meetings. A risk management system was in place which assessed and put in place plans to make sure people were kept safe.