This inspection took place on 25, 26, 28 July and the 15 August 2016 our visit on the 25 July was unannounced. The Alexandra Nursing home was last inspected in August 2013 and was compliant with the regulations we assessed against at that time.
The service is registered to provide the regulated activities, accommodation for persons who require nursing or personal care and the treatment of disease, disorder or injury, for up to 35 people. At the time of this inspection there were 29 people living at the home.
The Alexandra Nursing home is located ½ mile from Oldham town centre, adjacent to a park and accessible by public transport. There is a secure car park at the rear of the property and maintained gardens to the front.
Accommodation is provided over 3 floors, which are accessible by a passenger lift. Single and double rooms are available, some with an en-suite washing facilities.
Our inspection was brought forward as a result of a Coroner’s regulation 28 report for avoidable deaths. Coroners have a legal power and duty to write a report following an inquest if it appears there is a risk of other deaths occurring in similar circumstances. This is known as a “Report under regulation 28” or “Preventing Future Deaths report”.
We found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, affecting people’s safety, well-being and the quality of service provided to service users. CQC is considering the appropriate regulatory response to resolve the problems we found. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. We may also take other enforcement action proportionate to the seriousness of any shortfalls and breaches at any time, including within the six month timescale of a revisit.
The service had a registered manager. 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.
The service had a nominated individual. An organisation needs to have a nominated person who acts as the main point of contact for us.
We looked to see how the provider and registered manager had responded to concerns raised by the Coroner in the regulation 28 report issued in May 2016, in relation to staff responding appropriately to people's needs, the administration of medicines, seeking medical attention and the home's admission criteria for residential placements. The registered manager had on receipt of the report attended a safeguarding strategy meeting with the Local Authority to discuss the regulation 28 report. The nominated individual and registered manager confirmed that they had not completed an investigation in relation to the Coroner’s verdict and had not completed an appraisal as to the competencies, skills and fitness of staff to ensure the safe delivery of care. We found that the provider and registered manager had failed to implement all the necessary actions they had identified within the timeframes they had set out in their response to the regulation 28 report. Following the inspection CQC placed conditions on the provider’s registration, to which the provider co-operatively responded to. CQC is considering the appropriate regulatory response to address this concern.
Medicines were not safely managed. The provider did not have fully effective systems in place to ensure the safe disposal of medication. In addition we could not be sure that people using the service received their medicines as prescribed by their General Practitioner (GP).
Staff understood the different types of abuse and were confident in raising concerns with the registered manager. However, safeguarding incidents had not been investigated to ensure the on-going safety of the people involved. Nor had they been reported to the CQC.
Accidents and incidents were recorded but no analyse was being carried out by the provider or the manager.
We found that several people using the service did not have a Personal Emergency Evacuation Plan in place. A PEEP is a document, which advises of the support people need to leave the home in the event of an evacuation-taking place.
On review of staff files we found that some staff did not have adequate references in place to confirm their suitability for the job they had been employed to undertake at the home.
The principles of the Mental Capacity Act and conditions on authorisations to deprive a person of their liberty were not always met.
Following the inspection the provider placed a voluntary embargo on new admissions to the home, to focus on addressing concerns identified.
We found the home to be clean and tidy and relatives we spoke with confirmed this.
People who used the service said that they felt safe and staff were trained to provide them with appropriate support. However, we found that staff were not always appropriately supported and trained in relation to their responsibilities to provide safe care and treatment.
Staff did not always encourage people to make choices for themselves.
We observed some caring and patient interactions between staff and people who used the service.
Complaint and concerns raised by people who use the service and their relatives were recorded, investigated and action was taken in response.
Governance systems for the running of the home were not effective. We found that where issues had been identified, the registered manager had not ensured these were addressed in a timely manner.