About the service:

• Alma Lodge care home is a residential care home in the Meads area of Eastbourne. The home provides accommodation for up to 14 older people who may have some physical health needs but do not require nursing care. Some people are living with dementia. At the time of the inspection there were seven people living at the home.

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

People’s experience of using this service:

• Medicines were not always given at the prescribed time. Some medicines were time specific and these were not always given at the correct time although staff were seen to record the time as if they had been. One person in receipt of time specific medicines had experienced several falls and any potential link between these falls and medicines had not been investigated by the registered manager. There were no protocols in place for medicines required now and again like pain relief. Staff were not consistently recruited safely.

• Mental capacity assessments had been completed for everyone despite only a few people lacking capacity . People were not supported to have maximum choice and control of their lives and staff did not support supported them in the least restrictive way possible; the policies and systems in the service did not support supported this practice.

• The assessments were not decision specific. The registered managed was not aware that people with capacity did not require an assessment or that assessments had to be decision specific.

• The provider had not notified CQC of some deaths and incidents as required.

• Care plans were disorganised, and it was not always easy to find important information and sometimes used language that was disrespectful. Some care plans lacked specific detail about important health or care needs that people had.

• Audits that were carried out contained some inconsistencies for example in relation to sensor mat use.

• No minutes had been recorded from meetings with people, staff or relatives so there was nothing to share with those who could not attend and no record of any actions. No questionnaires had been sent out to people and relatives to enable them to give their views and opinions.

• People told us they felt safe. Staff had knowledge of individual people and they were aware of what to do should a safeguarding situation arise. Staffing levels were sufficient to provide a good level of care and support for all people.

• There were regular health and safety checks of the environment and people had person centred evacuation plans. Staff had the skills and knowledge to meet people’s needs in most areas. Staff received appropriate training and support to enable them to look after people. They received supervision to support them in their roles.

• People and their relatives thought that staff were caring, and that people were well cared for. Staff interactions were observed throughout the inspection and it was clear that all were very attentive and understanding of people’s needs. People’s dignity and privacy was promoted. People were asked discreetly if they needed help with personal care. Staff would knock before entering people’s rooms.

• Staff responded well to people’s needs. Person centred care was evident and people were provided with choices throughout each day. There was an activity programme and the feedback from people was positive. Staff responded to people in a way that suited their needs. People’s communication needs were met by talking to them in a way they understood and by taking time with people.

• The registered manager was very well thought of by staff, people and relatives. It was clear that they knew all the people well and that they spent time helping with day to day care and support when needed. Links with the local community had been established.

Rating at last inspection:

• At the last inspection the service was rated Requires Improvement (March 2018). This inspection

Alma Lodge Care Home is a ‘care home’. People in care 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.

Alma Lodge Care Home provides facilities and services for up to 14 older people who may have some physical health care needs but do not require nursing care provided by the staff working in the service.

At the time of this inspection seven people were living in the service. This inspection took place on 18 and 19 January 2018 and was unannounced.

There is a registered manager at the home who is also one of the partners and registered providers that own the service. 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.

At the last inspection in January 2016 the provider was found to be meeting all of the regulations and was rated ‘good’. However at the previous inspection completed in October 2014 the service was rated Requires Improvement. This is now the second time that the service has been rated Requires Improvement since our new methodology was introduced in October 2014.

At this inspection we found the provider had not ensured all equipment had the correct safety checks completed. Fire risk assessments and emergency evacuation procedures had not taken account of the people’s limited mobility and their wish to have doors open. This meant people could be put at risk from unsafe equipment and unsuitable fire arrangements including the lack of effective evacuation procedures. The registered manager confirmed they were having equipment checked for safety and would seek specialist fire advice to ensure appropriate procedures and safety measures were established. We found not all medicines were handled safely. Procedures for the safe administration of medicines were not followed in all cases and there was no evidence to clarify how and when topical creams were applied. The provider could not be assured all medicines were given appropriately. .

New staff were not trained to support people in a safe and effective way. There was no evidence to demonstrate that new staff completed any induction training. This meant not all staff were trained appropriately to care for people living in the service.

The quality monitoring and management systems did not ensure safe and best practice was followed in all areas or identify areas for improvement. This included the lack of safety checks, full effective emergency procedures and safe medicine handling at all times. The monitoring of accidents did not identify appropriate responses and actions taken following falls. Quality monitoring systems had not identified when records were not accurate or completed consistently, and when policies and procedures were out of date and not adhered to.

People were happy with the care they received and they appreciated the contact and friendly relationship they had with staff. Staff were kind and attentive and demonstrated a caring approach to people.

Recruitment records showed there were systems which ensured as far as possible staff were suitable and safe to work with people living in the service. Staff understood the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The managers had an understanding of DoLS and what may constitute a deprivation of liberty and followed procedures to protect people’s rights.

There was enough staff to ensure that people’s needs were responded to in a timely manner. People were supported to maintain good health with the support of local community resources.

Staff assessed people's nutritional needs and responded to them. Preferences and specific

We carried out an unannounced comprehensive inspection at Alma Lodge on the 20 and 21 October 2014 where we found improvements were required in relation to the safe management of medicines, infection control, consent and notifying the commission of the deaths of people and other incidents that occurred at the home. A notification is information about important events which the provider is required to tell us about by law. The provider sent us an action plan and told us they would address these issues by May 2015. We undertook an inspection on 18 January 2016 to check that the provider had made improvements and to confirm that legal requirements had been met. We found improvements had been made and the provider was now meeting the regulations.

Alma Lodge is a care home that provides accommodation for up to 14 older people who require a range of personal and care support. Some people lived reasonably independent lives but required support for example with mobilising safely due to their age and general frailty. At the time of the inspection six people lived there.

There is a registered manager at the home who is also the provider and owner. 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 were looked after by staff who were patient and kind. They understood people’s individual care and support needs and knew people really well as individuals. People were supported to make choices and staff respected their right to make decisions. They were cared for by staff who treated them with dignity and demonstrated a genuine interest in their needs and views.

There was an audit system in place however this was not yet fully embedded into practice. It did not identify where some information was missing from people’s care plans.

Staff supported people to see their GP when they were unwell or when they wished to. People were asked for their consent before they were provided any care or support. Staff understood their responsibilities in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

There were risk assessments in place and staff had a good understanding of risks and what steps they should take to reduce risks to people. People were supported to maintain a healthy diet, they were involved choosing what they would like to eat. Nutritional assessments identified people who may be at risk of malnutrition. People received their medicines safely when they needed them.

There was a robust recruitment procedure in place which helped to ensure staff with the appropriate experience, skills and character were employed to work at the home. There were enough staff, with the appropriate training, on each shift to meet people’s needs.

There was an open and relaxed atmosphere within the home. People and relatives told us if they had a problem or were worried they were happy to talk with any of the staff. Whenever concerns or issues were raised action had been taken to address them.

During our inspection we spoke to six people and observed the care provided to people living in the home. We also reviewed records to gain an insight into the support given to people who used the service. People we were able to speak with living at the home were very positive about the service and told us they were very happy living at Alma Lodge. One person told us, "I like it here. They know what I like." Another said, "The staff are very good. I can't fault them." We also spoke with a visitor who told us, "The home is very nice and the staff are very friendly."

We examined the systems and processes in place for the safe management and administration of medicines and found they were effective and took account of people's preferences. There were appropriate recruitment and training systems in place for staff.

The premises were homely, safe and met the needs of people who used the service. None of the people at the home were subject to deprivation of liberty safeguards.

People were enabled to express their views and were involved in making decisions about their care and treatment. We found that care and treatment was planned and delivered in a way that ensured people's safety and welfare. We saw documentation showing that the provider responded appropriately to any allegation of abuse. We saw that complaints were taken seriously and there was an effective complaints system available.

During our visit we spoke with four people who lived at the home, three staff members and one visiting relative. People we spoke with were happy living at the home and felt cared for by the staff there. One person told us “nothing is too much trouble for them, I like it here.” Another said “I have no complaints.”

We observed staff dealing with people in a respectful but friendly manner and ensuring their dignity was maintained by always knocking before entering rooms and seeking people’s permission before doing anything for them.

Records we examined showed that the service had training and audits in place which ensured that staff were able to deliver care and treatment safely. We saw quality assurance systems in place to assess the service’s performance and ensure improving standards.

We spoke with people who live in the home and some of their relatives and friends.

People who live in the home told us that they could make their own decisions about their day to day routines and could make some choices around the food they eat. People told us that food portions were very good although one person said they thought the range of meals offered could be monotonous.

All the people in the home commented on the care and friendliness shown towards them by staff. One person said “staff are brilliant”

Relatives and friends we spoke with commented positively about the homely and welcoming atmosphere of the home. They said the home was good at communicating with them about their friend/relative’s well being.

One person said they thought the home needed to improve the décor and furnishings in some areas of the home.

This was an unannounced inspection and took place on 20 and 21 October 2014.

Alma Lodge is a care home that provides accommodation for up to 14 older people who require a range of personal and care support. Some people were living with a dementia type illness and others lived reasonably independent lives but required support for example with mobilising safely. At the time of the inspection seven people lived there.

There is a registered manager at the home who is also one of the owners. 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.

Medicines were not managed safely or appropriately and there were not enough appropriate hand washing facilities available to staff throughout the home to help prevent cross infection.

When people’s needs had changed not all the information had been recorded in their care plans which meant staff did not have up to date information about people’s care needs. However, staff knew people well; they had a good knowledge and understanding of the people they cared for. They were able to tell us about people’s care needs, choices, personal histories and interests.

Staff had a basic understanding of the Mental Capacity Act 2005 but the use of mental capacity assessments for people who had limited or fluctuating capacity were not in place. This meant that staff did not have recorded information about people’s mental capacity.

There was always a manager on duty and staff had a clear understanding of their roles and responsibilities. The registered manager had not notified us of deaths of people, both expected and unexpected, or any allegations of abuse or injury to people as legally required.

Throughout the inspection we saw staff talking with people in a caring and professional manner. People were happy and comfortable in the company of staff. Visitors were made welcome when they arrived at the home. One visitor said, “Staff are very approachable and they listen to what we say.” Another visitor said, “My friend is very happy here.”

Everyone we spoke with told us they were happy with the food provided. One person said, “The only problem with it is it’s so nice I am eating too much.”

Everyone told us staff were friendly and approachable and if they had any concerns they would talk to them and were confident they would be investigated.

Staff had received training in how to recognise and report abuse. They were clear about how to report any concerns and were confident they would be investigated. Staff told us they received regular training and supervision. They said they felt supported by the managers and other staff. One member of staff said, “If there’s ever a problem you can always talk to them, they’re very good.” Recruitment records showed that there were systems in place to ensure staff were suitable to work at the home.

People had access to health care professionals including GP’s, district nurses and chiropodists to meet their specific needs. Staff told us how they would refer people to the appropriate health care professionals to help them meet their health care needs. Staff told us they would always phone the doctor or district nurse for advice if they were concerned about anybody.

There were a number of breaches of the regulations. You can see what action we told the provider to take at the back of the full version of the report.