We carried out this inspection on 9 August 2017 and it was unannounced. Alexandra House provides care for up to 36 older people in Solihull. At the time of our inspection there were 27 people living at the home. Some people lived with dementia.
We last inspected this service October 2016 and gave an overall rating of ‘Requires Improvement’. We found the service required improvement in how it kept people safe, was responsive to their needs and how it was led. We also found a breach in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to governance and how the service managed.
The provider sent us an action plan outlining the improvements they intended to make. At this inspection we found some improvements had been made and the service was no longer in breach of the regulations. However we found some improvements were still required.
The date of this inspection was brought forward because we had received concerns about the management of people’s medicines, updating of risk assessments and the amount of activities available to people.
There was no 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 2008 and associated Regulations about how the service is run.
The previous registered manager left the provider’s employment shortly after our inspection and the service had been supported by an interim manager with support from another of the provider’s Registered Manager’s and the Sheltered Housing and Care Services manager. The provider had made robust attempts to recruit a new manager and one had been appointed in April 2017. They officially joined the service in June 2017 following a delay in part of their application process. This person had begun their application to register with us.
People received medicines from staff who were trained; however some medicines were not always administered correctly and record keeping was not always accurate. For medicine taken ‘as required’ (PRN), guidelines were not available to tell staff when people needed this.
Risks to people’s safety had been identified by staff and ways to manage and reduce these risks were mostly in place to ensure a consistent and effective approach was taken. Staff were knowledgeable about people’s risks and how to support them safely.
Care records contained information for staff to help them provide personalised care, however updated information, that staff needed, was not always clearly recorded. The provider was actively addressing this at the time of our visit.
Most people told us there were enough staff to provide the support they needed and the provider assessed staffing levels daily to ensure there were sufficient staff available for people. We saw sufficient staff were available to support people and keep them safe.
Checks were carried out prior to staff starting work to ensure their suitability to work with people who used the service. New staff received an induction into the organisation, and completed relevant training to support them in meeting people’s health and care needs.
Staff had a good understanding of what constituted abuse and knew what actions to take if they had any concerns. People and relatives told us staff were caring and had the right skills and experience to provide the care required. People were supported with dignity and respect and people spent their time how they wanted to. Staff encouraged people to be independent.
Staff understood the principles of the Mental Capacity Act (2005) and how to support people with decision making. People told us they had enough to eat and drink. They enjoyed the meals provided and special dietary needs were catered for. People were assisted to manage their health needs. Referrals to other health professionals were made when this was required.
Some people told us they had enough to do to keep them occupied, however there continued to be limited activities arranged for people. The provider was actively addressing this. People were given the opportunity to feed back their views about the service they received through surveys and meetings for people and relatives were held.
Most people knew how to complain if they wished to and the complaints procedure was on display in the home. The provider was aware of their responsibilities in relation to managing complaints received about the service.
The provider had improved systems, and audits, in place to review the quality and safety of the service provided and to drive forward improvements. Staff told us they found the constant changes in the management unsettling. However, they were positive about the new manager and people and their relations felt the service was mostly well led.
There were formal opportunities for staff to feedback any issues or concerns at team meetings, one to one meetings and staff surveys. Checks of the environment were undertaken and staff knew the correct procedures to take in an emergency.
We had received the required notifications to enable us to monitor the service. The provider was able to tell us which notification we were required to receive such as safeguarding referrals and of serious injuries.