Archived: Alexander Court (Sheffield)

Alexander Court (Sheffield) is a residential care home which provides accommodation and personal or nursing care to adults with a range of support needs. The home can accommodate up to 60 people in an adapted building across two floors. At the time of this inspection there were 35 people using the service.

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

People and their relatives were happy with the quality of care they received. A relative commented, “When my [family member] moved into the home, they were so poorly, I didn’t think they would survive. They are so bright and healthy now. I honestly can’t thank the staff enough.” People received person-centred care which was responsive to their individual needs and preferences. Staff knew people very well. A range of activities were provided to keep people occupied and entertained. People's relatives were being supported to visit the home in a safe way, in line with governance guidance during the COVID-19 pandemic.

People told us they felt safe and we found the provider had systems in place to protect people from avoidable risks. People’s medicines were managed safely. The home was clean and people were protected from the risk of infection. There were enough staff to keep people safe and meet people’s needs, though some people told us there were occasions when they had to wait for support.

The service was well-run. Everyone we spoke to told us the registered manager and representatives of the provider were approachable and listened to any issues they raised. Any complaints were appropriately managed. The provider and registered manager had implemented suitable systems to monitor and improve the safety and quality of the service. There was a friendly, welcoming culture within the service. Staff felt well-supported and they were aware of their responsibilities. Staff worked closely with relevant health and social care professionals which helped to ensure people received effective care and support.

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

Rating at last inspection

The last rating for this service was requires improvement (published 25 April 2019). At that inspection we identified one breach of regulation in respect of the recruitment of staff. We asked the provider to complete an action plan to explain what they would do and by when to improve.

We completed a targeted inspection (published 5 March 2021) to check whether the provider had made the necessary improvements. We found improvements had been made and the provider was no longer in breach of regulations.

At this inspection we found the provider had sustained those improvements and the provider was not in breach of any regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the key question of ‘is the service safe?’. 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.

This was a focussed inspection to review the key questions of ‘is the service safe?’, ‘is the service responsive?’ and ‘is the service well-led?’. This report only covers our findings in relation to these key questions.

We did not review the key questions of ‘is the service effective’ or ‘is the service caring?’. The ratings for these key questions, which were awarded at the last comprehensive inspection (published 25 April 2019), were used to calculate the overall rating at this inspection.

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

The overall rating for the service has changed from requires improvement to good. This is based on our findings at this inspection.

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.

Alexander Court Nursing home is a providing personal and nursing care to 30 people aged 65 and over at the time of the inspection. The service can support up to 60 people.

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

The provider had taken steps to address issues raised at the last inspection to ensure staff were recruited safely. Infection prevention and control measures were in place and we were assured they were being followed. People told us they felt safe and relatives told us they thought their relations were safe in the home. Medicines were managed safely.

Training was up to date and staff felt well supported. Clinical staff kept their knowledge and skills up to date and were provided with additional training to meet any patient care related activity.

Changes had been made to the management of the service since the last inspection. The manager was developing the communication in the home through the involvement and development of staff. Staff were positive about the manager and changes that had taken place. Systems and processes to monitor the quality of the provision were in place and effective.

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 was requires improvement (published 25 April 2019) and there was a breach 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 we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about medication administration, records in relation to medicines and delivery of care. A decision was made for us to inspect and examine those risks.

We also undertook this targeted inspection to check whether the Requirement Notice we previously served in relation to Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

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.

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.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective and well-led sections of this full report.

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.

Alexander Court (Sheffield) is a care home that provides accommodation for people who require personal or nursing care. The home can accommodate up to 60 people. At the time of this inspection there were 42 people using the service.

People’s experience of using this service:

The service had improved since the last inspection.

There were enough staff deployed to keep people safe and meet their needs. However, some staff recruitment records did not contain all the information required by regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; fit and proper persons employed.

Risks to people were assessed and kept under review. This supported people to remain safe. Staff were aware of their responsibility to safeguard people from the risk of abuse. People received their medicines as prescribed from trained and competent staff.

Staff were trained, supervised and supported by the management of the service. People told us they thought staff had the right skills to care for them. Staff supported people to meet their nutritional and hydration needs and they worked closely with health professionals to achieve good outcomes for people. We have made a recommendation about the support given to people at meal times.

Most staff knew people well and we observed staff interacted with people in a positive, friendly and respectful manner. People’s care records were person-centred and supported staff to provide personalised care to people. Most people told us staff were kind and caring. Relatives raised no concerns about how their family member was treated.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were involved in reviews of their care so their choices and preferences could be recorded and acted upon.

People and their relatives knew how to complain. Complaints had been appropriately recorded and acted upon.

A range of activities were on offer to people, however people told us they would like more to choose from. We have made a recommendation about the involvement of care staff with the activity provision in the service.

A new manager had recently started working at the service. Without exception we received positive feedback about the manager and the way the service was run. People, relatives and staff all told us the service had made improvements since the last inspection and we found this to be the case.

The provider, manager and senior staff completed a range of audits and checks on the quality of the service. A home improvement plan was reviewed and updated weekly to ensure the service continued to improve. However, we found further improvements were required to the provider’s systems and processes to ensure compliance with all regulations.

More information is in the full report.

Rating at last inspection:

At the last inspection the service was rated requires improvement (published 21 September 2018). We identified the service was in breach of six regulations: regulation 10, dignity and respect; regulation 11, need for consent; regulation 12, safe care and treatment; regulation 14, meeting nutritional and hydration needs; regulation 17, good governance; and regulation 18, staffing.

Following the last inspection, we asked the provider to send us an action plan to show what they would do and by when to improve the rating to at least good. At this inspection, we checked whether the provider had complied with their action plan. We found improvements had been made to the service and it was no longer in breach of the six regulations identified at the last inspection. We identified a new breach of regulation 19; fit and proper persons employed.

Why we inspected:

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

Enforcement:

Please see the 'action we have told the provider to take' section at the end of the full report.

Follow up:

We will continue to monitor the intelligence we receive about this service until we return to visit as part of our re-inspection programme for those services rated requires improvement. If any concerning information is received we may inspect sooner.

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

We carried out this inspection on 21 June and 3 July 2018. The inspection was unannounced, which meant the people living at Alexander Court and the staff working there didn’t know we were visiting.

Our last inspection at Alexander Court took place in December 2015. At that inspection, we found a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Staffing. This was because the staff did not have regular supervision in line with the registered providers own policy.

The registered provider sent an action plan detailing how they were going to make improvements. At this inspection, we checked improvements the registered provider had made.

We found sufficient improvements had been made to meet the requirement of this Regulation. However, we had received concerns about this service prior to this inspection. We identified the service had declined at this inspection. The registered manager had left and there had been a period with a turnaround manager until the registered provider had recruited another manager. The registered provider had identified the concerns and was taking action to ensure improvements were made.

Alexander Court (Sheffield) is a care home providing nursing and personal care for up to 56 adults. It is within easy distance of the local amenities and on the bus route making it easy for people to access. At the time of our inspection there were 43 people living at Alexander Court.

The service had a registered manager. 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 we spoke with gave mixed views about whether they were safely cared for in the home on the first day of the inspection, however people were feeling more positive about the level of safety on the second day.

People we spoke with gave us mixed opinions about how the registered manager handled their concerns. Some people did not feel listened to, but others felt their concerns had been dealt with satisfactorily. We found changes within the management team had impacted on the performance of the team.

The registered provider had safe recruitment procedures in place which helped to keep people safe.

Not all care records showed that risks to specific to people’s health and wellbeing had been assessed and planned for so that staff had information needed about how best to support the person to help reduce or eliminate such risks.

People are 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 do no support this practice.

People told us they were not happy with the quality, quantity and variety of meals offered. Some people required a fortified diet to ensure they received adequate nutrition. There was little evidence to show this need had been fulfilled and systems to monitor people’s nutritional intake were ineffective.

Not all care records showed that risks to people’s health and wellbeing had been assessed and planned for so that staff had the information they needed about how best to support the person to help reduce or eliminate the risk.

Staff had received supervision and training and an ongoing programme was being developed. Staff training completion rates were found to be high.

Staff had a good understanding of safeguarding and whistleblowing procedures.

Staff worked with healthcare professionals to ensure people received appropriate care and treatment.

There were safe and effective systems in place for managing medicines at the service.

People were provided with activities and opportunities to help promote their community presence as well as develop and maintain their independent living skills.

There were effective systems in place for infection prevention and control.

There were processes in place to monitor the quality and safety of the service. Some of the issues we had identified had been picked up and a service improvement plan was being implemented by the new manager to resolve the issues

The registered manager was aware of their obligations for submitting notifications in line with the Health and Social Care Act 2008. The newly registered manager confirmed that any notifications required to be forwarded to CQC had been submitted.

During our inspection, we found six 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.

We wrote to the provider and they rectified this by ensuring that they notified us of the incidents and accidents.

We visited the home on 09/12/2013 to check this outcome and found them to be compliant.

People and their relatives said they were encouraged to make choices in aspects of care, treatment and support. Staff told us they offered people choices and involved them when making decisions about care and treatment.

Care was planned and managed by staff with the help of regular reviews of people's needs. One person said, 'Staff showed me the folder where they keep all the information about me. I know I can read it if I want.'

People said they were able to choose what they wanted from the menu. Two people said although they chose the meals, they often forgot what they had ordered when the meal arrived.

Staff said they worked as a team with partner agencies such as community health workers. A relative said staff had co-ordinated with external agencies to make sure their family member received appropriate services.

Two people who lived at the home said their bedrooms were cleaned most days. One person said, 'I like my room. The girls empty my bins and keep it clean and tidy for me.'

The manager had followed their company policy when recruiting staff.

Qualified, skilled and experienced staff were employed to meet people's needs.

People who lived at the home told us they were able to raise any concerns with staff. The relatives said they were confident that staff would help their family members to make a complaint to the manager if they wanted to.

The provider wrote to us and told us that they would review the staffing levels and make changes so that more staff were available at the peak times so people received the appropriate care and support promptly.

We carried out an unannounced inspection around tea time on 27 November 2012. We spoke to people who used the service, visitors to the service and staff.

There were enough qualified, skilled and experienced staff on duty to meet people's needs. People said staff were hard workers and strived to do their best. Two people said they had noticed more staff were around at meal times. One relative said, 'Most days there seems to be reasonable number of staff around.'

We spoke with seven people and four visiting relatives. People told us they liked living at Alexander Court. They made positive remarks about the manager saying that she was caring and the staff worked hard. They also said staff treated them with respect. They told us staff were friendly and did their best. However, there were some negative comments made by three relatives and four people about the lack of available staff during the day to care for the needs of the people. One person said, 'Most people here need a lot of care and care takes time. These girls don't have the time to give the care properly." Another person suggested that we should do our best to increase the staffing levels on days.

To address these comments we looked at the staffing levels at the service and we have reported our findings under staffing.