Archived: Alexandra Nursing Home

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

From the two outcomes we looked at during this inspection of Alexandra Nursing Home we found the service was not safe.

On the day of our inspection the home was at an appropriate temperature, clean and mostly odour free. Appliances in the kitchen were in working order and items were replaced as necessary.

There were no hand washing facilities for staff in people's rooms. By the end of our inspection we were advised by the provider that 36 soap dispensers had been ordered and would be in every room by the 19/01/2015.

People did not have access to suitable and adequately maintained bathing facilities. Vital equipment in two of the four bathrooms was not in working order and another bathroom was not being used. This meant that there was only one functioning bathroom for all 25 people living in the home to use and this bathroom only had a bath and not a shower.

We have asked the provider to tell us what actions they intend to take to meet the requirements of the law in relation to the bathing facilities.

Is the service responsive?

From the two outcomes we looked at during this inspection of Alexandra Nursing Home we saw evidence to support a judgement that the service was not responsive.

Care and treatment was not planned and delivered in such a way as to meet people's individual needs. The sheets and covers on people's beds were very thin and worn and did not look comfortable or warm enough to sleep in. People living in the home were unable to tell us their view about this, but we concluded that the bedding was not of an acceptable standard to meet their needs.

People did not have sufficient access to meaningful activities that met their individual social and emotional needs.

We have asked the provider to tell us what actions they intend to take to meet the requirements of the law in relation to meeting people's needs by providing suitable bedding and meaningful activities.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

During our inspection of Alexandra Nursing Home we saw evidence to support a judgement that this service was safe.

People were treated with dignity and respect by the staff. During our inspection we spoke with two people living in the home and three visiting relatives. People told us they liked living in the home and felt safe. One person told us 'I am alright, I feel safe'.

Care plans were personalised to the individual and gave clear information about how the person wanted their care and support to be provided.

People were safe because staff knew what to do when safeguarding concerns were raised and they followed guidance. The service had policies in place to help minimise against the risk of abuse including financial abuse.

We saw Alexandra Nursing Home understood the legal requirements of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards.

There were enough qualified, skilled and experienced staff to meet people's needs. The service regularly monitored people's needs and adjusted staffing levels to meet people's needs if they changed.

Is the service effective?

During our inspection of Alexandra Nursing Home we saw evidence to support a judgement that this service was effective.

People's health and care needs were assessed and mobility and equipment needs had been identified in care plans where required. Staff we spoke with and observed showed they had good knowledge of the people they supported.

People were asked for their consent for any care or treatment and the home acted in accordance with their wishes. Where the home assessed people did not have the capacity to consent, they acted in accordance with legal requirements.

We spoke with three visitors and they all confirmed they were able to visit the home whenever they wished.

Is the service caring?

During our inspection of Alexandra Nursing Home we saw evidence to support a judgement that this service was caring.

People's individual care plans recorded their choices and preferred routines for assistance with their personal care and daily living. We saw staff provided support in accordance with people's wishes.

People we spoke with told us they were happy living in the home and staff were caring and attentive to their needs. One person told us 'they [staff] always ask me what I want' and a visitor told us 'staff are excellent'. We observed staff responded to people in a kind and sensitive manner.

Is the service responsive?

During our inspection of Alexandra Nursing Home we saw evidence to support a judgement that this service was responsive.

People were able to take part in a range of group and individual activities such as card games, listening to music and exercises. We observed staff responded to people's needs by spending one-to-one time with individuals when they requested it.

Alexandra House gave clear information to people about how to complain. People living in the home and their visitors told us they knew how to complain and would speak with the new manager if they had any concerns.

Is the service well-led?

During our inspection of Alexandra Nursing Home we saw evidence to support a judgement that this service was well-led.

The home worked with other services to ensure people's health needs were met. This included professionals such as GPs, dieticians and psychiatric nurses.

Communication between management, staff and people living in the home was good. People we spoke with told us there was an open culture and management was approachable and supportive.

Quality assurance systems were in place to monitor the service being provided. Care reviews had been held to ensure the care and support provided was still meeting the needs of the person.

At this inspection we did not observe care, or speak with staff or people who used the service. As we did not inspect other outcome areas the reader is referred to our previous reports dated December 2013 and June 2013. The previous inspections concluded people were well cared for. Since the last inspection the Care Quality Commission has not received any concerns about this service.

The Care Quality Commission completed an inspection in June 2013, and although we did not look at medication, we had no concerns about the other areas we inspected.

At this inspection we looked at how the home managed the care and welfare of people with complex needs, and the operation of the medication system. For our overall view of this service the reader should also refer to our previous report published in June 2013.

We judged overall that people were well cared for. On the day of the inspection there was a pleasant atmosphere and people's personal care needs looked well attended to. Care records were well maintained.

We had concerns about the operation of the medication system and have said it must be improved.

Many of the people could not speak with us due to their mental health needs. However from the people we did speak with, the majority said they were happy with the care they received. Comments included 'it is extremely good, I have been very happy with everything,' and 'It is like being in heaven.' People said they were provided with enough food and drinks. Most people were happy with the quality of the food provided.

All the people we spoke with were positive about the staff. For example one person described the support they received as 'above and beyond the call of duty' and the staff as 'very nice'. A minority of people said there could be improvements to the staffing levels, the food and planned activities.

Accommodation was furnished, decorated and maintained to a satisfactory standard, although it was clear there could be some cosmetic improvements to the outside and some of the shared spaces. The home was clean although there was an odour in some areas. The manager assured us the odour was not usually present and had been due to a specific incident. Health and safety standards were generally satisfactory. Staff recruitment checks, staffing levels and staff training were judged as satisfactory. There was evidence of a quality assurance system in place.

The home was comfortable and clean on the day of the inspection. People were using the lounges and dining room or had chosen to stay in their room, where they were regularly checked by staff. The registered manager told us there were plans for an area at the front of the home to be turned into a secured garden area which could be accessed by people who were independent with their mobility or used mobility aids.

The care records we saw were detailed and regularly reviewed. Medication administration systems in place were robust and in line with laid down guidance.

There were support systems in place for staff to ensure their ongoing welfare and training needs were met. We saw good audit systems in place. We were told staffing levels had increased in the early evening as a result of auditing falls. We saw ongoing maintenance and equipment checks were in place to ensure the safety of the premises and equipment in use. We saw up to date policies and procedures were in place to help staff carry out their roles appropriately.