The inspection took place on 21 September 2017 and was unannounced. Alvington House is a residential care home providing accommodation, personal care and support for up to 25 people. There were 8 people living at the service at the time of our inspection.

There was a registered manager in post who 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 were protected from the risk of abuse as staff understood their responsibilities in safeguarding people. Risks to people’s safety were assessed and control measures implemented in order to keep them safe. Records of accidents and incidents were maintained and action taken to minimise the risk of them happening again. The provider had developed a contingency plan to ensure that people would continue to receive their care in the event of an emergency.

People were supported by sufficient staff to meet their needs and did not need to wait for their care to be provided. Robust recruitment processes were in place to ensure that only suitable staff were employed. Staff received an induction when starting work at the service and regular training and supervision was provided. There was an open culture within the service and staff felt able to discuss any concerns openly with the registered manager and provider.

People received their medicines in line with prescription guidelines and medicines were stored safely. People received support from healthcare professionals and guidance provided was followed by staff. People’s weight was regularly monitored and a choice of nutritious food provided. People were involved in decisions regarding their care and the principles of the Mental Capacity Act 2005 were followed by staff.

Staff treated people with kindness and were attentive to their needs. There was a relaxed atmosphere in the service and people were able make choices regarding how they spent their time. Staff knew people well and spent time socialising with people. People were encouraged to maintain and develop their independence. Visitors were made to feel welcome and there were no restrictions on the times people could receive visitors.

People’s needs were assessed prior to them moving into the service and people’s care records were regularly reviewed with them. Guidance was available to staff regarding how people preferred their care to be provided and we observed this was followed. A range of activities were provided which reflected people’s individual hobbies and interests.

Quality assurance systems were in place to monitor the service provided and action was taken where any concerns were identified. There was a complaints policy which gave guidance on how to raise concerns which was prominently displayed. People and relatives told us they were confident that any concerns would be addressed by the registered manager. People were able to contribute to the running of the service and regular feedback was sought. Records were well maintained and securely stored.

The inspection took place on 18 July 2016 and was unannounced. This inspection was to follow up on actions we had asked the provider to take to improve the service people received. Alvington House is a residential care home providing accommodation, personal care and support to up to 25 people. There were 12 people living at the service at the time of our inspection.

There was a registered manager in post who supported us with 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.’

At our inspection in September 2015, breaches of the legal requirements were found and enforcement action was taken against the provider. We issued warning notices in relation to safe care and treatment and good governance. The provider wrote to us to say what they would do to meet the legal requirements in relation to the above concerns.

This comprehensive inspection was conducted to check that the actions taken by the provider meant they were now meeting their legal requirements. We found that the provider had made improvements in some areas which had made a positive difference to people they support. The improvements made means the overall rating is now ‘Requires Improvement’.

Risk assessments were completed and control measures implemented to monitor people’s safety. However, this was an area which required continued development to ensure risks to people safety were continually reviewed.

Systems were in place to assess people’s capacity to make decisions in line with the Mental Capacity Act 2005 although work was on-going to ensure that people’s legal rights were protected. Staff spent time with people to ensure that consent was gained prior to delivering care

The range of activities offered to people had improved and people told they enjoyed the activities provided. However, continued work is required to develop activities in line with people’s needs and interests.

Safe recruitment procedures meant that people were supported by suitable staff. Staff were knowledgeable about their responsibilities in protecting people from abuse and where concerns had been raised these were reported to the relevant authorities. Induction and training were provided to staff to enable them to carry out their role effectively. Staff told us that they received support from the registered manager and records showed that regular staff supervisions took place.

The home had taken steps to ensure that people would continue to receive care in the event of an emergency. A contingency plan was in place and fire evacuation drills were carried out regularly. Equipment was regularly service and regular audits of the premises and health and safety systems were completed.

People told us they enjoyed their meals and were offered a choice of food and drinks. People’s nutritional needs were monitored and reviewed and staff were knowledgeable about their likes and dislikes. The service worked with a range of healthcare professionals to ensure that people’s healthcare needs were met.

People told us that staff treated them with care and compassion. Staff interacted with people in a positive and respectful manner and. Staff knew people well and were observed to chat with people about their family members and past lives.

Care plans were completed with people’s involvement and were reviewed regularly. Details about people’s likes, dislikes and preferences were recorded along with personal information about the people’s lives. We observed that staff cared for people in line with their wishes.

Quality assurance systems had been developed to continually monitor the quality of the service provided. The registered manager and provider worked together to make improvements to the serv

Alvington House is a residential care home providing accommodation, personal care and support to up to 25 people.

The inspection took place on 2 and 4 September 2015 and was unannounced.

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 and associated Regulations about how the service is run. The registered manager was not present during the first day of our inspection.

Suitable arrangements were not in place to ensure that medicines were managed safely. The medicines cupboard was found unlocked on the day of the inspection and out of date medicines were stored in an unlocked fridge. The service did not carry out stock checks of medicines held within the service and there was no guidance provided to staff regarding when PRN medication should be administered.

We observed that some areas of the home were not cleaned to a satisfactory standard and there was no cleaning schedule for staff to follow. Effective infection control systems were not in place and guidance was not available for staff. Staff told us there was one mop bucket for cleaning toilets, bathrooms and the dining room floors and staff carried soiled laundry through the dining room to access the laundry area.

Not all equipment provided in the home was maintained to a safe standard. For instance water from the basin used for hair washing was much hotter than recommended temperatures meaning people were at risk of scalding. Window restrictors were not fitted to all upstairs windows which presented a risk to people’s safety.

We found there were insufficient recruitment checks to ensure staff employed were suitable to work at the home. Not all staff files contained a reference from a past employer and there were no checks completed for one person who was involved in the service as an associate of the registered provider.

People’s care needs were not always assessed and care plans were not consistently completed and reviewed. We saw that one person whose needs had significantly changed did not have an up to date assessment or care plan in place.

Where risks were identified suitable risk assessments and control measures had not been implemented. For example we found that a number of people had been identified as being at high risks from falls although measures to keep them safe had not been recorded and referrals to the falls team were not always made in a timely manner.

Staff did not understand their responsibilities under the Mental Capacity Act (MCA) and had not received training in this area. We saw no evidence of mental capacity assessments or best interest decisions in people’s care files. The registered manger told us they were aware this was an area which required work.

People told us that there were enough staff deployed to support their care needs although they did not always have time to offer activities. People told us that activities had decreased over the past months and there was often nothing to do. Staff told us they didn’t have time to plan activities. The registered manager told us the service was in the process of recruiting an activity worker for the home.

The service did not undertake regular audits to monitor the quality and effectiveness of the service and systems were not in place to gather feedback from people and their relatives. There was a complaints procedure in place and we saw that complaints had been responded to in a timely manner.

We observed the atmosphere in the home was calm and relaxed and people told us staff were kind and caring. They said the manager and provider were approachable and listened to concerns. People told us they were supported to attend medical appointments and we saw evidence that health professionals were involved in people’s care.

People told us they enjoyed the food provided and they were always offered an alternative if they did not like something. Staff were available to support people at meal times should they need it

During the inspection we found nine breaches 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.