Alandale Residential Home

We conducted this inspection to review if breaches of regulation, identified at the previous inspection, had been met, and following on from information of concern shared with us by the provider. We found that people were exposed to significant risks of harm due to failures in safeguarding, governance and leadership.

Following our inspection, the rating of the service remains “Requires Improvement”. The provider remained in breach of regulation in relation to safe care and treatment and good governance, and we identified further breaches of regulation regarding dignity and respect, safeguarding people from abuse and employment of fit and proper persons.

There were significant risks posed by the culture at the service. A large proportion of the workforce were related to other members of staff including leaders, and feedback was that there were cliques, divisions and hostilities within the workforce. Some staff did not feel comfortable in raising concerns or that they would be listened to, and we saw that incidents were not always been appropriately learned from or reported. The provider had not identified or mitigated against the risks of a closed culture at the service.Following the inspection, the provider informed inspectors that they were developing an action plan to ensure a positive and open culture within the service

Although there were sufficient staff employed, appropriate processes had not always been followed to ensure they were safe to work with people. Where staff had criminal convictions, these were not appropriately risk assessed to ensure they posed no risk to people. Staff were generally knowledgeable about the people they supported but had not always received crucial training, such as safeguarding children, despite their being frequent child visitors.

Risks were managed inconsistently, particularly around falls where the safety of the stairs to people who were at greater risk of falls was not sufficient and placed people at risk of harm. The management of other risks to people posed by their health and wellbeing was stronger, and there was generally a good level of guidance set out how people should be supported safely. However further improvements were still needed to ensure this was consistent.

The environment was largely in a good state of repair and was regularly checked, however we received mixed feedback about the standard of cleanliness.

People received their medications when they needed them, and if their health needs changed the service worked in partnership with wider health and care professionals to ensure people got the support they needed.

There was a good level of person-centred care, with people able to spend their day in a way that was meaningful and tailored to them. There was a wide variety of choice such as around food and activities, and people could have visitors whenever they chose. People were generally supported to be independent, however stronger governance was needed on how decisions were made on people’s behalf, where they lacked capacity to do so themselves.

Staff interactions with people were kind and caring, however the actions of the provider in some areas demonstrated the opposite. People gave mixed feedback about communication with the service and how any issues raised were responded to, as well as the timeliness of support they received.

In instances where CQC have decided to take civil or criminal enforcement action against a provider, we will publish this information on our website after any representations and/or appeals have been concluded.