27 March 2018
During a routine inspection
Alexandra Court Care Centre is registered to provide care for up to 84 people who need nursing care and who may be living with dementia. The building is purpose built, over three floors accessed by passenger lift and stairs. All the bedrooms are for single occupancy and all of them have an en-suite shower, sink and toilet. Recent changes had taken place; the provider decided to close the top floor and use it for storage. People who required nursing care were now located on the first floor and those that required residential care were on the ground floor.
Alexandra Court Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a registered manager in post. A registered manager is a person who has registered with the CQC 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.
We had concerns with how some people’s specific health conditions were managed so that they received timely oversight from professionals involved in their care.
Although improvements had been made in the quality monitoring system and more effective audits were carried out, there remained an issue with audit of records; some records were not up to date and had gaps which made it difficult to check if the care had been delivered. Management of the service was described as open and approachable. However, the move of people to different bedrooms to assist in the restructuring of the service was hurried and could have been managed more effectively.
We also had concerns about shortfalls in staff training, updated skills and supervision to ensure they were knowledgeable about how to manage people’s specific health care needs.
These issues were breaches of Regulation 12 Safe care and treatment, Regulation 17 Good governance and Regulation 18 Staffing, of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. You can see what action we have told the provider to take regarding these issues at the back of the full version of this report.
The provider had policies to guide staff in safeguarding people from the risk of harm and abuse. Staff knew how to raise safeguarding alerts if they had concerns. People had risk assessments and these were kept under review.
People received their medicines as prescribed. There had been some administration errors in the past, but when these occurred, staff acknowledged them, sought medical advice and informed the person and their relatives. Staff who administered medicines had received updated competency checks.
People were supported to make their own decisions and choices. The registered manager and staff had a much improved understanding of mental capacity legislation. People had assessments of capacity and best interest decisions made on their behalf if they lacked capacity; documentation regarding best interest decisions had been completed. Appropriate applications had been made to the local authority when people’s liberty was deprived due to their lack of capacity and need for continual supervision.
People liked the meals provided to them. The menus gave people choices and alternatives and specialist meals were provided for people’s diverse needs. We discussed with the regional manager how mealtimes could be held over two sittings to ensure people who required full support were assisted more effectively. They assured us this would be addressed.
There were mixed comments about the number of care staff deployed and whether this was sufficient. There had been a very recent staff rota change and the closure of six beds on one floor; staffing levels were to be monitored by the registered manager and regional manager to see if this impacted on the comments received from people.
People who used the service and their relatives we spoke with all had very positive comments about the caring approach of staff. They confirmed staff respected their privacy and dignity, delivered care which was person-centred and treated them as individuals.
People could remain in the service to receive end of life care. This had improved since a concern was raised last year. Staff attended meetings with other professionals to discuss people’s needs at the end of their life and to make sure the right equipment and medicines were in place.
There were lots of activities for people to participate it within the service. There were also trips arranged to local venues and visits from entertainers and primary school children to help people feel part of the community.
The provider had a complaints procedure which was displayed in the service. People told us they felt able to raise concerns and these would be addressed.
The environment was safe and clean. Staff used personal, protective equipment to help prevent the spread of infection. Equipment used in the service was checked and maintained to ensure it was safe.