Archived: Alexandra Care Home

About the service

Alexandra Care Home is a nursing home providing personal and nursing care to 29 people aged 65 and over at the time of the inspection. The service can support up to 40 people.

The accommodation is provided over two floors. The upper floor has its own communal space, bedrooms toileting and bathing facilities. The downstairs also has bedrooms and toilet and bathing facilities with the addition of two large communal spaces. These are used for dining, relaxing and activities. The garden was well maintained and provided an accessible space which was safe for people to use.

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

A range of audits and systems were used to monitor the service; however, these had not always identified changes, or the changes implemented had not been effective. Staff had received training in many areas and it was effective in supporting their role. However, we have made a recommendation the provider ensured staff received the training required to support people with behaviours that challenge.

Daily records had not always been completed or cross referenced with incidents and so we could not be sure these had been responded to as required. Risk assessment had not always identified the required support people needed and some areas of care had not been monitored consistently. There were some medicine errors in relation to recording and stock.

People’s health needs were monitored, and referrals made to a range of health professionals. Partnerships had been established with some of these, however further developments were required to provide ongoing clinical support.

Staff had established positive relationships with people and this enabled people to spend time each day as they wished. We observed respect for people’s dignity and personal needs being responded to. People were able to follow their spiritual beliefs and consideration was made to individuals’ preferences.

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 were encouraged to make choices and their independence was encouraged.

There was a relaxed atmosphere in the home and people enjoyed the lunchtime experience. Assistance was provided if required and there were many choices to promote people’s dietary needs. People had the opportunity to enjoy entertainment or follow areas of interest. A partnership had been established with a local school for a joint exercise session.

The care plans were detailed, and person centred. It covered all aspects of the persons care requirements and people and those important to them had been included in this process. The plans included their wishes to be considered for their end of life needs.

There was a complaints policy which had been followed when any concerns had been raised. The provider had displayed their rating on their website and at the home. People and relatives were consulted and informed about the care and any changes.

There was a new manager at the home and staff felt supported by them. There were sufficient staff to support people’s needs and additional support for the nurses had been introduced. All staff had received the required recruitment checks.

The environment had been enhanced by many changes to the layout and the decoration. Additional sensory features were now in place and signage or objects of reference had been used to help orientate people.

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 March 2019 and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection improvements had not been made, however the provider was still in breach of some regulations.

Why we inspected: This was a planned inspection based on the rating at the last inspection which was Requires Improvement with Inadequate in Well-led.

Enforcement: At our last inspection we placed positive conditions on the provider in relation to this location. These required the provider to send us a monthly report on all the areas of concern reflected in the last inspection. Although improvements had been made, this did not reflect a sustained approach and we felt it to be appropriate for the conditions to remain at the location until our next inspection.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of the report.

Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals are added to reports after representations and appeals have been concluded.

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

You can see what action we have asked the provider to take at the end of this full report.

This inspection visit took place on 7 November 2018 and was unannounced. It was completed by one inspector, an assistant inspector, a nurse specialist and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

This service was selected to be part of our national review, looking at the quality of oral health care support for people living in care homes. The inspection team included a dental inspector who looked in detail at how well the service supported people with their oral health. This includes support with oral hygiene and access to dentists. We will publish our national report of our findings and recommendations in 2019.

Alexandra is a care home registered to support 39 people. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection 37 people were living at the home.

The accommodation is provided over two floors. The ground floor has a large dining area which has access to the outside space. There is also a large activity living space which also has access to the secure garden. Each floor has bedrooms with ensuite facilities with additional communal bathrooms. The upstairs is divided into to two areas, one has a lounge/dining area. The other has just bedrooms.

Since our last inspection in November 2017, the home has been transferred to a new provider, who retained the registration. This was the new providers first inspection at this location since their registration with us in December 2017.

There was a registered manager at this location. 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. This registered manager has remained constant from the homes previous registrations with other providers.

The governance of the home was insufficient to ensure that people received support to keep them safe and maintain their wellbeing. Audits had been completed, however were not always used to develop the quality and drive improvement. Partnerships had not always been developed to enhance the care available to support people and the staff.

There were not always sufficient staff to support people. The staff had not all received training in the areas they needed to support their role. The provider had not ensured that people were always protected from the risk of infection. Staff did not always feel supported by the registered manager.

Risk assessments had been completed, however for some areas of care the correct guidance had not been followed. Lessons had not always been learnt to drive improvement.

The environment had not been adapted to support those living at the home and the environment was in need of redecoration. We have made a recommendation that the provider looks at current guidance in relation to the environment for people living with dementia.

People were not supported to have maximum choice and control of their lives and staff do not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. We have made a recommendation that the provider looks at current guidance in relation to supporting people to make decisions.

When people received care, it did not always respect their dignity. People did not always receive the support to make choices and be active in their decisions. These were not supported by documented information. Care plans did not always include people’s preferences, cultural needs and life history.

When people’s needs changed this information was not always clearly communicated to ensure the care reflected people’s current needs. People’s wishes and needs had not always been included for their end of life care planning.

Some people required different communication methods and these had not been considered to ensure people had the information available to them.

People’s views had not always been considered and some improvements had been made. Relatives were welcome and people were supported to following their religious faith.

When people received care, staff made every effort to support people in a kind way. People enjoyed the meals and had been supported to have their health care needs met.

Medicine was managed safely and people received their medicine as prescribed. The registered manager had completed notifications. Complaints had been addressed and suitable recruitment processes were followed.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

This inspection visit was unannounced and took place on 12 October 2017. Due to concerns raised with regard to the level of staff, we brought our inspection forward and arrived early in the morning to review the staffing levels. We were satisfied with the deployment and number of staff on duty. Since our last inspection the provider has registered under a different registration with the same provider organisation. At our last inspection on May 2016 we rated the service as ‘Good’. At this inspection we found that some improvements were required. The service was registered to provide accommodation for up to 40 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection 34 people used the service.

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.

People who had behaviours that place themselves or other at risk of harm had not always been managed in a planned way. Some risk assessments had not reflected the support people received. Other risk assessments cover a range of areas and guidance had been provided. People were supported to make choices, however the assessments did not always reflect the person’s level of understanding in different situations. Staffing levels and regularity of the staff had not always provided a consistent approach to meeting people’s needs. This was being addressed by the provider. The staff employed had received a range of checks to ensure they were suitable to work in the home.

People were supported to make choices. We found staff had established positive relationships with people. Staff showed respect for people’s choices and supported them to maintain their privacy and dignity at all times. People were able to choose the meals they wished to eat and alternatives were provided. We saw that medicines were managed safely and administered in line with people’s prescriptions and preferences. Referrals had been made to health care professionals and any guidance provided had been followed.

Staff obtained information from the person and their relatives to support the completion of the care plan. People were encouraged and supported with activities or hobbies they wished to engage in. Complaints had been addressed and resolved in a timely manner.

The registered manager and provider had established a range of audits to monitor improvements within the home. Improvements plans had been developed and actioned. People and relative were consulted about the home and information about any changes was communicated.

Staff felt supported by the registered manager and felt they had the opportunity to contribute to the care people received. Staff had received training and the provider had invested time to expand the staff knowledge in supporting people living with dementia and the development of a senior role within the home.

We saw that the previous rating was displayed in the reception of the home as required. The registered manager understood their responsibility of registration with us and notified us of important events that occurred at the service; this meant we could check that appropriate action had been taken.