Alexandra Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The service was safe and people felt safe at the home. Staff and the registered manager understood how to protect people from abuse, understood risk and how to reduce it, whilst continuing to ensure people retained choice and independence. There were enough, suitable staff to care for people. People received their medicines safely and as prescribed.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People using the service and their relatives told us they knew who to speak with if they had a complaint. Two people told us they would immediately tell the staff if they were not happy about anything regarding their care. The other three people said they had not experienced any problems. We saw the provider's most recent satisfaction surveys completed by people using the service, and these confirmed what was said.

Staff told us following incidents or accidents they had meetings to discuss and learn where anything had gone wrong. The registered manager explained how she had investigated a safeguarding incident, identified the potential cause, and the actions taken to reduce the likelihood of recurrence. This had led to an increase in staffing, and refresher information circulated to all staff. This indicated the registered manager was reviewing incidents to learn how the service might need to improve.

The service had robust systems and processes in place to ensure learning took place following incidents and accidents. The manager shared learning outcomes with staff to minimise the risk of reoccurrence and improve staff practices. However, not all staff said they felt included and updated.

People told us staff supported them to access medical support when needed. People said they felt their care was managed and monitored safely, and overall felt they were provided with a good standard of care. One relative said; “When I go and visit, there is never anything mentioned that concerns me.”

Staff told us they were able to manage and monitor people’s care safely, through the electronic recording systems in place. The registered manager was aware of the risks to people’s health across services. They had implemented new systems for communication and recording, to try to improve better partnership working with some health professionals. The registered manager was aware of potential problems which might arise, if they accepted a person whose needs they could not safely meet and they made it clear, if they could not meet people’s specific needs.

We received mixed feedback from partner agencies about working with staff and the systems in place, with some healthcare professionals giving positive feedback, and others who felt there were further improvements for collaborative working to be made. One professional advised that there were often communication issues, which made it difficult at times, to get reliable consistent information and answers to questions regarding people’s care and treatment.

The service had effective systems in place for assessing, managing and monitoring safe systems of care. We found there was an initial assessment completed when people first entered the service, the assessment process continued, ensuring an accurate and up to date record of people's needs and preferences. We saw comprehensive care plans and risk assessments were in place. We were told there was a weekly meeting onsite, by the community based Frailty Team, as the GP surgery were unable to release a GP for weekly rounds regarding people's health. Engagement work was continuing with partnership working in this area. We saw incidents and notifications were made to the Local Authority and to the Care Quality Commission appropriately.

All five people we spoke with during our visit, confirmed they knew how to raise a concern and that they would be listened to. Three of relatives we spoke with, were aware of the process, to raise and escalate any safeguarding concerns. One relative explained, “She has had a few accidents and they tell me when she’s had them and what they’ve done about it.”

Staff had safeguarding training and knew how to keep people safe. Feedback received from care staff does not indicate any concerns that people at the service were at risk of abuse or neglect. We saw that accident/incident reports were completed by staff, and these were reviewed by the registered manager. We discussed safeguarding with the registered manager and operations manager, and they demonstrated a good awareness of the process, explaining which types of issues would need to be forwarded to safeguarding, and which would need to be notified to CQC.

Staff supported people in a safe way. We did not observe any poor or unsafe staff practice whilst on site on either day of assessment. We saw information was displayed about how to recognise and report abuse.

Staff had received training on safeguarding people from abuse and understood how to identify signs of potential abuse. Staff knew to help protect people from harm, and how they should report any concerns. There were policies and processes in place regarding safeguarding and these had been followed, including the involvement of other agencies, such as the local authority who investigate allegations.

People told us they felt included in managing risk and confirmed they were involved in their assessment and care plans. One relative had explained how they had been involved with creating the initial care plan and their relative was fully involved, but that they wouldn’t be able to do so now, due to the decline in their health.

Staff demonstrated an awareness of how to escalate any risks they identified, and from the conversations we had, it was evident they knew people well. The registered manager explained how they assessed and monitored risk and shared this with staff. For example, they reviewed people's weight regularly to identify any cause for concern, and they had robust processes in place to ensure any risks were mitigated and raised with appropriate agencies. We saw where there was input from a speech and language therapist (SaLT) information had been included in details of people’s care plan for their required food and drink and staff were aware of these needs.

We saw examples of risk assessments which reflected people’s current needs. Where people could not communicate their needs effectively, we saw staff were interpreting these through visual cues, interpretation or simple gestures which protected people’s rights and dignity. We saw staff supported people with moving and handling tasks in a safe manner. We observed a sample of care records and saw they were informed by comprehensive risk assessments and care plans. These were being regularly reviewed by staff and where applicable, had family involvement. This corroborated what the registered manager told us was in place.

Care plans were detailed and identified people's individual care and support needs. We reviewed four people’s care plans and relevant risk assessments. We saw evidence and people told us; they were involved in their care reviews (where they had the capacity to be involved). The digital system used, meant that information was collated and easily highlighted where any change was occurring, or staff could schedule a date to reassess or review specific areas. There was information about evacuation in the event of a fire, including the specific needs of each person.

People were supported by staff who were trained and recruited safely to meet their needs. None of the people we spoke with, had any complaints about staffing. No one told us they had to wait too long, to receive staff support. However, one relative told us they felt that there have been occasions where there had been an unacceptable wait for help. Other relatives were happy with the staffing numbers and felt there were enough staff to provide people with the support they wanted. People were supported by staff who had ongoing training and supervision.

Three nursing staff told us they had some concerns about the current staffing levels and the workload that they had. The feedback from ancillary staff generally felt that the staffing levels were adequate. Additionally, we found that where the comments from staff suggested staffing levels might not be adequate, they had also indicated that they had not always received a positive reaction when raising concerns with the registered manager. Staff told us and records showed, they received regular individual and group sessions of training and support and had received appropriate training and where there were gaps, these were being addressed with the individuals directly.

During our onsite visits, we did not observe any issues which might indicate the service was short staffed. We saw skilled and experienced staff engaging with people well, during mealtimes and during other care interactions. When buzzers sounded, they appeared to be answered in a timely manner. We also sampled four staff recruitment files and found them to contain all the basic required information, which would indicate the provider was following safe recruitment practices.

The service had tools in place to ensure adequate staffing levels were maintained. We reviewed two weeks’ worth of staffing rota's. These showed staff numbers were adequate to meet the needs of people using the service. When new staff were recruited, necessary checks ensured staff were suitable to work with people.

People were seen using a variety of environments, enjoying both communal and bedroom areas. Two people’s relatives highlighted to us they felt there were some areas of the service that needed to be repaired, or redecorated. One relative told us their family member used a wheelchair to move around, and that the equipment was maintained well.

Feedback received from staff indicated that the service had all the equipment staff needed to support people safely. The registered manager and provider told us about the various systems they had in place to ensure a safe environment, this included daily walkarounds. Staff knew how to report any concerns and none stated they were missing any important items of equipment and advised they were told to report any issues swiftly, so they could be addressed. This was corroborated by our observations that the service appeared to have enough hoists and mobility aids for people to use.

We saw the service was generally clean, tidy and well maintained; apart from the laundry and sluice rooms where inappropriate items had been stored. This was immediately addressed by the registered manager. There was adequate equipment to help reduce the risk of people falling, reduce risks of skin damage and to safely move people. We observed that equipment had been regularly serviced and checked for safety. There were call bells available in bedrooms and communal rooms for people to use when they needed to summon assistance.

Systems and processes were in place to ensure a safe environment. However, the issues raised above, had not been picked up by their quality audits. Since our inspection, we have been provided with evidence to demonstrate the actions taken to address these safety issues. We saw records electrical and gas appliances were maintained in line with company policy. The provider had a programme for planned refurbishment of specific areas within the service.

Infection prevention and control measures were in place. One person’s relative said the service was always clean, and staff appeared to be tidy with their uniforms and they had always wore gloves, aprons and other personal protective equipment (PPE) as needed.

Staff were aware of their roles and responsibilities around IPC. No adverse feedback was received from staff about the hygiene and infection control arrangements at the service. Staff told us they undertook training about good infection prevention and control to ensure people, and visitors were protected from catching, and spreading infection.

With the exception of the sluice rooms, other areas appeared clean and hygienic. We found the sluice rooms were not being effectively cleaned. There was a leak from the washing machine waste pipe, seeping onto the floor and a hole in the floor of the upstairs sluice room, which would make the floor almost impossible to effectively sanitise. The provider took immediate action, to unclutter and clean the sluice rooms. We have since been sent details of the work completed to fill in the hole in the sluice room floor. Staff were observed wearing PPE appropriately and there were stocks of PPE located around the care home for staff to use.

Procedures and processes were in place to prevent infections which were followed by staff. The provider's overall building risk assessment document demonstrated the sluice room posed an infection risk (generally), but didn't translate that into effective action; to ensure the rooms were clutter free, hygienic and clean. The audit tool we reviewed, identified ‘no areas for improvement’ and so gave the provider inaccurate reassurances that the service was effective in accordance with IPC requirements. Aside from the issues specifically mentioned, other health and safety checks were being carried out as expected.

People were given their medicines as prescribed and in a timely manner, by staff who were appropriately trained. People and their relatives were involved in making decisions about medicines. One relative told us, “I am always involved in any discussion about medication and kept informed of any changes”. Care plans had the necessary information for staff to support people with their health needs.

Staff were trained in medicines administration and had their competency assessed. Staff were aware of the support people needed to receive their medicines safely, including if medicines had been prescribed covertly, to help manage anxiety and agitation. Not all staff felt supported, when dealing with medicines, or with requests from clinical healthcare professionals around people’s care needs. One staff explained how difficult it was managing medicines, as this takes so much time. They said this drastically reduces the nurses time in contact with residents, their family and supervision of care given.

People’s medicines were being managed in line with current national guidance and legislation. Medicine systems were organised, staff were trained and monitored to ensure they followed safe practice. Medicines were stored securely, and staff followed safe protocols for the receipt, administration and disposal of medicines. We viewed the medicine policies which were in place, to guide staff in managing medicines safely.