Berkeley Park

Alexandra Court is an intermediate care home providing a time limited period of assessment and rehabilitation for people who have had a hospital admission but are not ready to be discharged home safely. Some people were also referred to the home from the community. It is a purpose built building on 2 levels, with bedrooms, shared communal areas and bathrooms on both floors. The service can support up to 40 people and was providing care to 35 people at the time of the inspection.

People’s experience of using this service and what we found

We identified issues with the environment: Managers responded immediately and put in place an immediate action plan to address the issues we raised. Safeguarding concerns were managed appropriately, and staff knew how to recognise and report any issues. Staff felt well supported by managers.

Systems for managing medicines were safe and staff had completed appropriate training. Individual risks to people were assessed and monitored. Appropriate health and safety certificates were in place. Measures were in place to help ensure the safety of people using the service. Infection control and prevention measures were in place.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People told us staff were caring and kind.

Care plans included relevant health and personal information. Systems were in place to ensure audits were recording and addressing any shortfalls identified. Staff engaged well with people who used the service and their relatives. Staff worked alongside a number of other professionals and agencies.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 25 August 2021)

Why we inspected

We received concerns in relation to staff attitudes, staff not responding to nurse-call buzzers, and people’s hydration needs not being met. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the Safe and Well-led sections of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Alexandra Court on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice:

Our inspection was prompted due to concerns raised by a relative where they had been denied entry to the home due to not having received both dosages of the COVID-19 vaccine. At the time of our inspection, this was not in line with government guidance. We spoke with seven relatives as part of our inspection, some of whom provided similar feedback, although felt this had not impacted on theirs, or their family members well-being as a result of not being able to visit.

On arrival to the home, proof of a negative lateral flow test (LFT) and vaccination status were required and personal protective equipment (PPE) needed to be worn.

Social distancing was encouraged where possible and zoning arrangements were used if people needed to self-isolate in certain areas of the home, such as bedrooms. The home had a designated area of the home for people who were COVID-19 positive.

Testing arrangements were in place for both staff and people using the service. All staff working at the home had received their COVID-19 vaccination which is now a condition of employment.

Enough PPE was available and we saw staff wore it at all times during our visit.

We observed the home to be clean and tidy, with domestic staff carrying out their duties throughout the day. Windows were opened at various times during the day to assist with ventilation and outdoor facilities were used when better weather allowed.

There were enough staff to care for people safely, with staff receiving additional infection control training during the pandemic. The home had experienced some workforce issues, such as recruiting full-time registered nurses, although this did not impact the care people received.

Risk assessments were in place where certain groups may be at higher risk of contracting the virus. An appropriate infection control procedure was in place, with specific reference to COVID-19 and regular infection control audits were undertaken to ensure standards were maintained.

Further information is in the detailed findings below.

Alexandra Court is an intermediate care home providing a time limited period of assessment and rehabilitation for people who have had a hospital admission but are not ready to be discharged home safely. It is a purpose built two storey building with bedrooms on both floors. There is a car park at the front of the home. It is located in Pemberton, near Wigan and is close to shops and public transport links. The service can support up to 40 people and was providing care to 33 people at the time of the inspection.

People’s experience of using this service and what we found

The service managed safeguarding concerns appropriately and staff were aware of how to recognize and report any issues. Systems for managing medicines were safe and staff had completed appropriate training.

Individual risks were assessed and monitored. Appropriate health and safety certificates were in place and up to date. Measures were in place to help ensure the safety of people using the service. We were assured infection control and prevention measures were appropriate and effective.

People’s care needs were thoroughly assessed and their care plans included relevant health and personal information. A system had been implemented to ensure audits were accurately recording and addressing any shortfalls identified. Complaints were dealt with in a timely and appropriate way.

The service engaged well with people who used the service and their relatives. Staff felt well supported by the management team and had regular meetings and one to one supervision sessions. The service worked well with a number of other professionals and agencies.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 7 January 2021), with a recommendation around record keeping. At this inspection the rating has remained good and the recommendation had been met.

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

Processes were in place to prevent visitors from catching and spreading infections. This included the provision of personal protective equipment (PPE), such as masks, gloves, aprons, face visors, hand washing facilities and hand gel. Temperature tests were done in a secure entrance area, and a Covid-19 questionnaire was completed.

Lateral flow rapid Covid-19 testing was done.There was adequate access and take up of testing for staff and people using services and robust admission and discharge processes were in place.

Shielding and social distancing rules were complied with. The layout of the premises promoted safety and reduced the potential for the transmission of infections. There was clear signage throughout the home on social distancing rules and robust cleaning arrangements were in place. Staff wore a full range of PPE appropriately and consistently.

Staff training, practices and deployment showed the service could prevent transmission of infection and manage any outbreaks.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Alexandra Court is a 40-bed intermediate care centre that provides a time limited period of assessment and rehabilitation for people who may have had a hospital admission but are not ready to be discharged home safely or to be supported at home. It is a purpose built two storey building with bedrooms on both floors. There is a car park at the front of the home. It is located in Pemberton, near Wigan and is close to shops and public transport links. At the time of the inspection 18 people were using the service.

People’s experience of using this service and what we found

We have made a recommendation about record keeping and promoting communication between people and their relatives.

People's needs were assessed before starting with the service. People and their relatives, where appropriate, had been involved in the care planning process.

Risks to people's health and wellbeing were assessed and mitigated. People's medicines were managed safely.

The provider followed safe recruitment processes to ensure the right people were employed. There were enough staff to keep people safe.

People were protected from abuse. Staff understood how to recognise and report any concerns they had about people's safety and well-being.

The home was clean, and staff followed procedures to prevent the spread of infections.

The provider and registered manager followed governance systems which provided oversight and monitoring of the service. More robust quality assurance systems were now in place to ensure any shortfalls were identified and to drive continuous improvement within the service.

When required, people were supported to access healthcare professionals and receive ongoing healthcare support. People were supported to share their views and shape the future of the care they received.

Care plans provided staff with the information they needed to meet people's needs. People could choose how they wanted to spend their time.

Staff worked with other agencies to provide consistent, effective and timely care. We saw evidence that the staff and management worked with other organisations to meet people's assessed needs.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 27 June 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an announced targeted inspection of this service on 29 July 2020. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve governance arrangements.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Alexandra Court on our website at www.cqc.org.uk.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Alexandra Court is an intermediate “care home” providing a time limited period of assessment and rehabilitation for people who may have had a hospital admission but are not ready to be discharged home safely or to be supported at home. The home was providing care to 24 people at the time of the inspection. The service can support up to 40 people.

People’s experience of using this service and what we found

We found ‘dietary supplement charts’ and nutrition, diet and fluid charts were completed accurately. All relevant information was recorded on the charts although, in some instances, words were not legible, specifically when notes had been added.

Staff had a good understanding of the systems in place, for the management of prescribed creams. Some of the records checked, were completed inconsistently. However, the registered manager addressed this following the inspection.

People we spoke with provided mixed feedback around call bell response times, the general cleanliness of the home and communication. However, almost all people and relatives, felt there was a caring culture at the home.

We found auditing systems were not robust. New auditing systems had been implemented and tasks or errors were identified. However, actions were not always recorded.

During the inspection, infection control measures were in place and being followed. Hand hygiene stations were placed around the home. However, there was not an expectation or clear process for essential visitors’ on entering the home. The registered manager said this would be introduced for all essential visitors moving forwards.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 27 June 2019). Due to this inspection being targeted changes in ratings were not considered. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made or sustained and the provider was still in breach of regulation 17 (good governance).

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. This related to specific concerns we had about the registered person having systems or processes in place, that were operating ineffectively. The registered person had failed to ensure that accurate, complete and contemporaneous records were being maintained securely, in respect of each service user.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We have identified some improvements. However, we found some records were not completed accurately and auditing systems were not robust enough.

Enforcement

We are mindful of the impact of the Covid-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the Covid-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We issued a requirement notice around a breach of Regulation 17, which relates to good governance. We will continue to monitor the service throughout enforcement action, following this inspection.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Alexandra Court is a 40 bed intermediate care home that provides a time limited period of assessment and rehabilitation for people who may have had a hospital admission but are not ready to be discharged home safely or to be supported at home.

People’s experience of using this service:

At the last inspection there had been a continued breach of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found there had been some improvements and the provider was meeting the requirements of Regulation 12, safe care and treatment. However, we identified a continuing breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to Regulation 17.

The service completed audits of key areas of health and social care provision. Although the service had these checks in place, they were not sufficiently robust to have identified the shortfalls that were found during inspection in relation to record keeping.

We found there was a delay in obtaining supplement drinks for people when stocks were low. We made a recommendation about the provider reviewing the systems in place for ordering and obtaining supplement drinks.

A couple of people told us they had to wait for support when they had pressed their call bell. We made a recommendation about the provider seeking advice from a reputable source to implement call bell audits.

Staff feedback and their views were obtained from staff meetings, however there were no processes in place to document and analyse staff views. We made a recommendation about the provider reviewing how staff views are obtained and analysed.

Improvements had been made for managing medicines and medicines were managed safely.

People were cared for by staff who knew how to keep them safe and protect them from avoidable harm.

We observed positive interactions between staff and people. Staff had good relationships with people and were seen to be caring and respectful towards people and their wishes.

People’s outcomes were good, and people’s feedback confirmed this. One compliment stated, "The carers have been angels and I have been very fortunate to have such loving care shown to me."

The service did not meet the characteristics of Good in some areas; more information is in the full report.

Rating at last inspection:

At the last inspection the service was rated Requires Improvement (report published 09 May 2018). Following this inspection, the overall rating remains unchanged.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Enforcement:

We found a continuing breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to good governance.

We are currently considering our enforcement action in response to the regulatory breaches identified during this inspection. Full information about CQC's regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up:

We have asked the provider to send us an action plan telling us what steps they are to take to

make the improvements needed. We will continue to monitor information and intelligence we receive about the service to ensure good quality care and support is provided to people. We will re-inspect in line with our inspection timescales, where we will also follow up on recommendations made.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

In response to concerns about a specific incident, we carried out an unannounced comprehensive inspection of Alexandra Court on 8 and 9 January 2018.

The service had received a coroner's Regulation 28: Report to prevent future deaths. A person using the service had slipped from a standing hoist on three occasions, the coroner found this had contributed to the persons death. The coroner also found staff were not adequately trained and had failed to keep proper records of the events. We found the service had responded effectively to this and addressed the concerns raised about training in moving and handling and record keeping. Further improvements had also been made in relation to communication between the health and social care staff.

The service was last inspected in June 2016 when it was rated as good overall with a breach of Regulation 12 of the HSCA 2008, safe management of medicines.

At this inspection we found the service had made improvements in the management of medicines but there remained some risks in relation to the storage of medication for people who were self-medicating. The service addressed this immediately following the inspection and installed lockable cabinets in the bedrooms. We also found there were some anomalies and gaps in the records for medication and topical creams.

This was a continued breach of HSCA (2008) Regulation 12(2)(g) the proper and safe management of medicines. You can see what action we asked the service to take at the end of this report.

The people we spoke with reported feeling safe. There was a safeguarding policy in place and staff were familiar with what might be a safeguarding concern and how to report this. There was a whistleblowing policy displayed in communal areas, the staff we spoke with reported knowing how to raise concerns. People who used the service and visitors also had access to this information.

Risk assessments and plans to manage identified risks were completed for people using the service. We saw that these were reviewed and updated at regular intervals.

Assessments of health and social care needs were completed on admission and we could see that people were closely involved in these. Discharge and goal planning was completed within 48 hours and people using the service told us they had felt supported to get back home and kept informed of progress.

Staff had received appropriate training and records showed that they were up to date with refresher training. Staff were also encouraged to suggest areas of interest for training sessions to develop their knowledge further. Staff reported that they had received good training and felt confident that their practice had improved as a result of this.

The staff were knowledgeable about the Mental Capacity Act 2005 and their obligations under it. Staff were clear about seeking consent from people using the service. The provider was aware of their obligations under the Deprivation of Liberty Safeguards though at the time of inspection there was nobody who was subject to this.

People using the service said that the food was fine and they had plenty to eat and drink. Support was provided for people needing help to manage their food and drink intake. The records were not always completed by the staff. There had not been any harm identified, such as dehydration which indicated that this was a record keeping error.

This was a breach of Reg. 17 good governance, as accurate records had not been maintained for each person. You can see what action we asked the service to take at the end of this report.

The building was clean and well decorated. The furniture was in good condition and there were a few communal areas for people using the service including a garden. There was a gym area equipped for therapeutic use under the supervision of the therapy staff.

People using the service said they felt the staff were caring. We observed staff going about their work and saw that they were patient and caring towards people. People's dignity and cultural backgrounds were respected.

People received care that was personalised to them and reflected their preferences as well as their needs. Though there were not a lot of activities going on the people we spoke with felt that the focus on recovering and getting home was more important.

The staff had received training in End of Life care though this is not routinely provided at this service due to the focus on recovery and the relative shortness of the time people are there, usually three to six weeks.

The registered manager and other staff were accessible, approachable and responsive during the inspection. The staff reported they felt the service was well managed and that the registered manager and other team leaders were clear about the standards of care expected. Staff were deployed effectively and knew who they were supporting each day.

The service was seen to have responded to incidents effectively and learned from experience. There were on-going efforts to improve and standardise some processes such as assessments and records between the health and social care teams based there.

There was an auditing system in place to ensure that care and support had been provided as detailed in the care plans. We found that these audits had not identified some of the gaps we had found in record keeping during the inspection. There was no evidence that care had not been delivered but the gaps in the records meant we could not be certain. The home responded immediately and identified what they would do in an action plan.

This was a breach of Reg. 17, good governance, as monitoring systems had not identified gaps in record keeping. You can see what action we told the service to take at the end of this report.

We carried out this unannounced comprehensive inspection on 12 July 2016. This inspection was undertaken to ensure that improvements that were needed to meet legal requirements had been implemented by the service following our last inspection 09 and 11 September 2015.

At the previous inspection the home was found to have seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, the safe handling of medicines, staff supervisions and staff meetings, staff competency assessments, obtaining people’s consent to care and treatment, safe transfers between different care services, maintaining complete and contemporaneous records and good governance.

At this inspection on 12 July 2016 we found that improvements had been made to meet the relevant requirements previously identified at the inspection on 09 and 11 September 2015. However we found one continuing breach of regulations in relation to the safe handling of medicines, despite finding a significant improvement since the date of the last inspection. You can see what action we told the provider to take at the back of the full version of this report.

There was a 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.

We found the service had an internal safeguarding policy in place. The staff members we spoke with were able to explain the correct procedure for referring safeguarding concerns to the local authority.

The home had a whistleblowing policy in place. We spoke with staff about their understanding of this policy and they told us they were aware of the whistleblowing policy and understood how this worked in practice.

At the previous inspection on 09 and 11 September 2015 we had concerns that personal risk assessments related to people’s safety were not consistently available in all of the care plans we looked at. At this inspection we found the service was now meeting this requirement.

We saw that where accidents and incidents involving people who used the service had occurred, these were recorded and monitored.

At the last inspection on 09 and 11 September 2015 we found that medicines were not handled safely and the provider was instructed to take action to improve the safe administration of medicines. This was a breach of Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment. During this inspection, we found that although improvements had been made in the safe handling of medicines throughout the home, further improvements were still required to meet the requirements of regulations. People who used services and others were not protected against the risks associated with unsafe or unsuitable management of medicines. This was a continuing breach of regulations. You can see what action we told the provider to take at the back of the full version of this report.

Staffing levels were sufficient on the day of the inspection to meet the needs of the people who used the service. We looked at eight staff personnel files and there was evidence of robust recruitment procedures. The files included application forms, proof of identity and references. Disclosure and Barring Service (DBS) checks had been undertaken for staff in the files we looked at.

We observed that the service followed appropriate infection control and prevention practice, for example such as using personal protection equipment (PPE) when providing support to people and at meal times.

There was a staff training matrix in place which recorded a comprehensive range of training activity for all staff roles.

At the previous inspection on 09 and 11 September 2015 we had concerns about how staff received appropriate supervisions. This was a breach of Regulation 18(2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found that the service was now meeting this standard. The care staff we spoke with told us they had received an annual appraisal where training and development needs had been identified. We confirmed this by looking at appraisal and training and development records.

We looked at whether staff sought people’s consent. The people we spoke with told us staff always did this. During the inspection we saw that people had been given a choice about whether to have their room door open or closed. In the care plans we looked at there was documentary evidence that people who used the service had been involved in planning and agreeing their own care with consent clearly obtained.

Staff were able to give examples of MCA decision making and were aware of working in people’s best interests. At the time of the inspection no person staying at the home was subject to a DoLS.

The people we spoke with told us they liked the staff and found them to be caring. The people we spoke with said they felt treated with dignity and respect by the staff that cared for them.

During the day we saw that the staff were polite and courteous, warmly greeting people upon first meeting them. We observed staff engaging people in conversation, with all interactions appearing natural rather than forced. We observed two staff members supporting a person who was unwell. They encouraged them to take on fluids, explaining the importance and benefit of doing so.

We saw that the home had a visiting policy in place, which explained that they supported the NHS campaign to protect mealtimes.

We looked at the care records of 11 people who used the service and saw they had completed a self-assessment questionnaire on their first day of admission to the home. We looked at how information was shared and how explanations were provided to people who used the service. We found the service had a ‘meet and greet’ information pack, which was used by the care staff when people who used the service were newly admitted.

The service did not routinely provide end of life (EOL) care because as an intermediate care facility it provided a time limited period of assessment and rehabilitation for people with an average length of stay between three and six weeks.

We saw that each person’s bedroom had a television available and people were able to bring personal items of their choice such as family photographs.

We found detailed assessment and referral information was in place for referrals received from the hospital which provided detailed background and medical information and this had been incorporated into people’s care plans.

We saw there was a ‘complaints and concerns’ policy in place, which was displayed throughout the public areas on all units and a complaints book was in use. Details of how to make a complaint were also located in each person’s care file, located in their bedroom Nobody we spoke with had made any complaints.

At the previous inspection we had concerns regarding the frequency of baths and showers that people received. This was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the provision of care and treatment that was appropriate and met people’s needs. At this inspection we found the service was now meeting this requirement. People we spoke with told us that they were given a choice about whether to have a bath or shower and could choose when they wanted to do so.

At the previous inspection we had concerns regarding the monitoring of people’s care plans and the quality of information in them which included areas such as fluids taken, elimination and general care. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because complete and contemporaneous records were not kept for each person using the service. At this inspection we found the service was now meeting the requirements of this regulation. Each person had a nursing care plan and daily care chart in place which recorded food and fluid taken, and any repositioning or assistance with using the toilet.

Staff we spoke with all thought the service was well-led. We saw evidence that staff meetings took place in the form of minutes. We saw that the home had a comprehensive policy and procedures file in place. All policies were very detailed.

We saw that there were systems in place to regularly assess and monitor the quality of the service. We saw a variety of environmental risk assessments had been completed and were up-to-date The service had a ‘Statement of Purpose,’ a ‘Service User Guide’ and ‘Service User’s Handbook’ in place.

There was a comments and suggestions box on the wall in the downstairs corridor and suggestions were also encouraged through a ‘Quality Assurance and Patient Involvement’ initiative that was displayed in the entrance foyer to the home.

The service worked in partnership with Wigan Borough Clinical Commissioning Group (CCG) and Bridgewater Community NHS Trust.

We saw that the service had received numerous thank you cards and letters from people who had used the service and their families.

The provider had submitted an action plan to describe what they would do to meet legal requirements. We found that the provider had reviewed their complaints policy and procedure and this was on display. However systems were not in place to ensure an appropriate and timely response to complaints and we saw no audits of compliance to the revised policy. This means legal requirements had not been met.

During the inspection we looked at care and welfare, cooperating with other providers, supporting workers, quality assurance and complaints.

This is a summary of what we found, using evidence obtained via observations, speaking with staff, speaking with people who used the service and their families and looking at records:

Is the service caring?

During the visit we saw staff offering care with patience and courtesy. Staff made efforts to ensure people's dignity and privacy were preserved at all times.

The service provided people with information about the service and a questionnaire on admission to ensure their expectations were understood and needs met as far as possible.

We spoke with four people who used the service and six visitors. One person who used the service said, 'Staff have been great ' can't do enough for you'. Another told us, 'Staff are pleasant and polite. I have been here before but it is better this time'. A third person said, 'I like it here, I've only been in a short while, but staff are all nice and helpful'.

A visitor remarked, 'We have no complaints whatsoever. We are made welcome and staff have made drinks for us'. Another visitor commented, 'You are made very welcome, you can make a drink, which we appreciate as we come a long way'.

Is the service responsive?

Assessments were carried out prior to people being admitted, to ensure they were in the correct place to meet their needs. We were told that personal goals were agreed between people who used the service and therapy staff and all staff would then work towards these with the person.

Care plans were contributed to by the person and their family, the care staff and therapy staff. This helped ensure all were aware of the progress being made and plans being followed.

People's support needs and abilities were reassessed on a daily basis and risk assessments were reviewed on an on-going basis to ensure individuals' progress was on track.

Complaints and concerns were generally responded to appropriately. However, we found an example of a complaint that had not been addressed in a timely or appropriate manner and the omission had not been picked up in the audit process. We asked the manager to deal with this as soon as possible.

The service worked closely with other agencies, such as the Stroke Association, Think Ahead, Carer Support and Age UK to ensure people obtained all the assistance and support they needed to help them make a good recovery. Appropriate referrals were made to other services, such as falls service, when required.

Is the service safe?

We saw evidence that care staff were recruited safely and the induction procedure was thorough. Staff told us they were well supported by management.

There were sufficient numbers of staff on duty at the service to ensure people's needs were met safely. The service was looking at dependency levels of people who used the service, so that people with higher dependency levels could be accommodated on one floor. This would help inform staffing levels and expertise for each level.

Staff training was up to date and on-going and staff with whom we spoke had a good knowledge of care planning, care delivery and risk assessing. Staff with whom we spoke understood how to recognise deteriorating health and well-being and were aware of how to address this.

Areas of high risk, such as falls, were constantly monitored and methods implemented to try to minimise the risk.

Health and safety checks were carried out regularly and the building and equipment were well maintained.

Accidents and incidents were appropriately recorded and audited. Any patterns were analysed and problems addressed in a timely way.

Is the service effective?

The service had a mixture of care and therapy staff in order to try to meet both the social and health needs of people who used the service. There was also a GP who attended the service five days per week to contribute to the multi-disciplinary provision within the home. Staff with whom we spoke demonstrated a good understanding of their roles and responsibilities and all felt they worked well with other disciplines as a team. One staff member told us, 'Everyone plays their part, there is good communication, good rapport and team work'

Care plans we looked at included factual and up to date information about people's health and support needs.

Recent questionnaires filled in by people who used the service indicated a high level of satisfaction. Comments included, 'Lovely place, nice people', 'Meals were not terrible, but not wonderful, and, 'Staff were brilliant, kind, understanding and patient'.

Is the service well-led?

The home had a manager in place at the home, who was appropriately registered with the Care Quality Commission.

A significant number of audits were undertaken, some internal and some external. The results of these were analysed and any shortfalls addressed to help ensure consistent standards of care within the service.

Questionnaires were completed with people who used the service, to gain their opinions and suggestions and gauge their level of satisfaction. Results were analysed and used to inform continual improvement to the service.

We received positive comments about the home from visiting relatives, comments included; 'smashing, my relative feels relaxed here'.

We spoke to the GP who was based at the home for five days per week. He explained that he went to see each person when they were admitted and that in his opinion the quality of care was very good.

We asked people about the staff members, comments included, 'staff are very kind', 'staff are stupendous, marvellous, respectful and helpful. Nothing is too much trouble' and 'staff have been brilliant, nothing is too much trouble, could not ask for more'.

The staff members we spoke to were very positive about the home. Comments included; 'I love it here, it is very well run' and 'I love my job, good team'.

Alexandra Court had a quality assurance system available to assess the quality of the service it was providing. Questionnaires were given to people when they left the home and the home also produced statistics from daily, weekly and monthly record keeping. All of this information was reviewed quarterly and a summary of all the findings was passed to the Clinical Commissioning Group as part of the intermediate care contract monitoring process.

We found that people's needs were assessed and care was planned and delivered in line with their individual care plan. We saw that staff had a positive attitude towards the people who used the service and we observed throughout the visit that staff took time to answer questions and engage with people.

People who used the service said they were happy and felt safe. The people we spoke with knew who to speak to and would not hesitate to raise concerns if they had them.

The training records confirmed that all staff had completed training in safeguarding and were kept up to date in this area. This indicated that they were aware of their roles and responsibilities regarding the protection of vulnerable adults and the need to accurately record and report potential incidents of abuse.

The manager had a training matrix plan to ensure that staff received training that was specific to the needs of the people they were caring for.

We saw evidence that the provider had a system in place for tracking and responding to complaints received. People's complaints were fully investigated and resolved, where possible, to their satisfaction. We also saw evidence of compliments and thank you letters.