Queen Alexandra Cottage Homes

We found the following examples of good practice.

The home was clean, tidy and well maintained. There was regular cleaning throughout the day and this included high-touch areas. There were systems in place to ensure that people who had tested positive for Covid-19, were unwell or self-isolating were cared for in their own rooms to minimise the risk of spreading the virus. Before people were admitted to the home, they were required to have a negative Covid-19 test and isolate in their rooms for 14 days.

Staff were provided with adequate supplies of personal protective equipment (PPE) and staff were seen to be wearing this appropriately. Staff had received specific Covid-19 training and this included guidance for staff about how to put on and take off PPE safely. They were seen to be following correct IPC practices. Hand sanitiser was readily available throughout the home. Regular testing for people and staff was taking place.

Most people chose to spend time in their rooms, they were supported by staff to remain engaged with various activities. Staff also supported people to remain in contact with their families through phone and video calls. Staff told us a small group of people took part in activities in the lounge. Seating was arranged to ensure people could enjoy being with a group but maintain social distancing.

Queen Alexandra Cottage Homes 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.

Queen Alexandra Cottage Homes accommodates up to 28 older people in one adapted building. At the time of the inspection there were 24 people living there. People were living with a range of complex health care needs which included diabetes and Parkinson’s disease. Queen Alexandra Cottage Homes is a nursing home run by a charity. Accommodation was provided over two floors with two passengers lifts that provide level access to all parts of the home. The home was part of a complex, which includes independent living flats and bungalows, however these are not regulated or inspected by CQC.

There was a registered manager at the service, who was known as Matron. 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.

Improvements were needed to ensure people’s care plans reflected the care and support they needed. Although staff knew people really well the lack of detailed care plans for some people meant they were at risk of inconsistent care. The registered manager was well thought of by people, visitors and staff. She was supportive to staff and had a high profile in the service. However, improvements were needed to ensure the culture was positive between staff and the provider. These issues had been identified and action was being taken to address them.

Quality assurance systems were in place. These identified where improvements were needed across the service. Actions plans were in place to demonstrate what was needed to address the shortfalls.

People were protected from the risks of harm, abuse or discrimination because appropriate safeguarding procedures were in place. Staff knew what steps to take to ensure people were protected from the risks They were aware of their individual responsibilities in relation to reporting concerns.

There were enough staff, who had been safely recruited, to meet people’s needs. Staffing levels were reviewed regularly. There were systems in place to ensure medicines were ordered, stored administered and disposed of safely. Individual and environmental risk assessments were in place. Staff had a good understanding of people’s needs and the risks associated with supporting them. They knew what action to take keep people safe.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. There was a complaints policy in place and people and visitors told us they would raise any concerns with staff.

Staff had received the training they needed to support people and deliver care in a way that responded to people's changing needs. They received regular supervision and appraisal.

People were provided with a choice of food and drink throughout the day and were supported to maintain their nutritional and hydration needs. Their health was monitored and staff responded when health needs changed. People's individual needs were met by the adaptation of the premises.

People’s privacy and dignity were respected. Staff knew people well. They had a good understanding of them as individuals, their needs and their choices. People were and treated with kindness, understanding and patience. Staff cared about the people they looked after and supported them to make their own decisions and choices.

Staff knew people really well and people received care that was person centred and met their individual needs. People were able to take part in a variety of activities each day. They told us they were never bored and had enough to do each day. Activities were meaningful and reflected people’s interests and hobbies.

There was a genuine commitment by all staff to ensure people received excellent care and support during their final days. This was supported through the Gold Standard Framework.

People we spoke with told us they were well looked after at the home. One person told us, 'I am looked after ever so well, they're very good.' Another person told us, 'I'm really happy here, I can do what I like.' People told us that they enjoyed the activities and were able to choose what they took part in. We were told, 'I like to stay in my room but if there's something I want to join in with I can.'

We saw that staff asked for people's consent before they provided any care or treatment. One person said, "The staff ask me if I need any help. I can usually manage but sometimes I need help." People told us that staff were very kind and understood their needs.

We examined four care plans. We found that there were inconsistencies in the information recorded, which impacted on the care and support provided by the staff.

We looked at the policies and procedures for medicine management and how the service ensured people were safe.

We reviewed the staff rotas and staffing levels. We found that the shift patterns and number of care workers, nurses and supporting staff on each shift were flexible, to meet people's needs.

A complaints procedure was in place. People were aware of this and told us they did not have any complaints at the time of the inspection

We visited the home and spoke with eight people who used the service. People who spoke with us said the staff were very good and one person said, 'I have everything I want.'

We spoke with one visitor and they told us the staff provided the support that people needed. They said people who used the service were involved in decisions about their care and, 'the staff always talk to me about what they are doing, they are very good.'

We examined three care plans, for people who had a dementia type illness. We found evidence that the people who used the service, and their relatives were fully involved in making decisions about the care provided.

We looked at the staff rota and spoke with two care workers. They said that there were enough staff working in the home, and they felt able to offer the support and care that people needed and wanted.

We found the home clean and the people we spoke with said they were very comfortable. We saw that appropriate infection control systems were in place.