Alexandra Court Care Centre

Alexandra Court Care Centre is a residential care home providing accommodation and personal care. The care home can accommodate 84 people across three floors. At the time of the inspection, 77 people were living at the care home.

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

Quality assurance systems had not highlighted or addressed all shortfalls identified during the inspection. Not all safeguarding concerns were appropriately reported on the provider’s monitoring system or reported to the local authority safeguarding team. People, their relatives and staff raised concerns about staffing levels at the service. We made a recommendation about staffing levels. People’s care plans and risk assessments were not always in place or up to date. We made a recommendation about monitoring and reviewing care plans. The provider had not ensured the Care Quality Commission (CQC) were informed of all notifiable incidents.

People’s medicines were administered safely, and staff responded appropriately to accidents and incidents. Staff were recruited safely, and the resident ambassador helped with interviewing potential staff. The home was clean and well maintained.

Staff received an appropriate induction, regular training and development to ensure they had the relevant skills and knowledge to support people. Staff made appropriate referrals to relevant professionals and worked closely with them.

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.

Systems were in place to gather people’s feedback which was used to help improve the service.

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 1 April 2022).

Why we inspected

We received concerns in relation to staffing levels, falls management, food and drink quality, and not providing person-centred care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. During the inspection we found concerns with the availability of fluids and opened up the focused inspection to also include effective.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Alexandra Court Care Centre on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have made recommendations regarding staffing systems, risk monitoring and food and fluids.

We have identified breaches in relation to safeguarding processes, the governance of the service and informing CQC of notififable incidents at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Alexandra Court Care Centre is a residential care home providing accommodation and personal care. The care home can accommodate 72 people across two floors. The ground floor has 32 bedrooms for people with residential care needs. The first floor has 40 bedrooms for people living with dementia. At the time of the inspection, there were 49 people living at the care home, 31 people receiving personal care, and 18 people living with dementia.

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

People were kept safe from the risk of abuse and avoidable harm. People and their relatives said they could always go to a staff member or the manager if they were not satisfied, and they spoke positively of staff

and managers.

Staff were recruited safely and there were enough staff to keep people safe. People received their medicines on time and as prescribed. The environment was clean, safe and maintained to a good standard. Staff followed good infection control practices.

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.

The manager was approachable and staff felt supported. People told us they felt confident they could talk with staff or the manager if they needed to. Audits were used to continually monitor the quality and safety of the service and to help drive improvements.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 23 September 2021) and there were 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 we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended that the provider reviewed their processes for maintaining equipment and the environment and to update their practices as required. At this inspection we found the provider had acted on the recommendations and had made improvements to the monitoring processes in place.

Why we inspected

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

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. 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 Care Centre 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.

Alexandra Court Care Centre is a residential care home providing personal and nursing care. The care home accommodates 72 people across three separate areas. The ground floor has 32 bedrooms for people with residential care needs. The first floor has 20 bedrooms for people who need nursing care and a separate wing with 20 bedrooms to care for people living with dementia. At the time of the inspection, there were 68 people living at the care home, 30 people receiving personal care, 18 receiving nursing care and 20 people living with dementia.

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

Medicines were not always safely managed. We could not be assured people had received their medicines as prescribed due to missing signatures on medicine administration records (MAR) and lack of stock. Some medicines and topical creams did not have the appropriate MAR in place to ensure people were receiving their medicines as prescribed.

Staffing levels were not always sufficient. People using the service, staff, relatives and professionals all raised concerns about the staffing levels and the risks to people using the service.

Risks to people were not appropriately managed, people did not always receive the appropriate support with skin care and pressure relief. We have made a recommendation about tissue viability

The service was not well-led. Leadership was poor and ineffective; staff lacked support and guidance. The provider’s quality assurance systems were not always effective in identifying and addressing issues.

Staff ensured people lived in a clean and tidy environment. Infection prevention and control (IPC) practices had been updated to follow government guidance.

Staff were trained in safeguarding and appropriate referrals had been made to the local authority.

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.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 4 March 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection sustained improvement had not been made and the provider was again in breach of the regulation found at the previous inspection and another breach was found.

Why we inspected

We undertook this focused inspection to check the provider 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.

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 remains requires improvement. This is based on the findings at this inspection. This service has been rated requires improvement for the last two consecutive inspections and the inspection prior to these the service was rated inadequate.

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 Care Centre on our website at www.cqc.org.uk.

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 will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to medicine management, staffing and good governance at this inspection. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 Care Centre is a residential care home providing personal and nursing care. The care home accommodates 72 people across three separate areas. The ground floor has 32 bedrooms for people with residential care needs. The first floor has 20 bedrooms for people who need nursing care and a separate wing with 20 bedrooms to care for people living with dementia. At the time of the inspection, there were 23 people receiving personal care, 11 receiving nursing care and 18 people living with dementia.

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

The provider and registered manager had made improvements in how the service was overseen and managed. These improvements were in areas such as staffing levels, risk management, accurate and up to date recording, and ensuring people received person-centred care. However, these improvements now needed to be sustained and more analysis was needed about medicines management. We have made a recommendation regarding this.

Although there had been improvements in some areas of medicines management, not everyone had received their medicines as prescribed, which could affect their treatment.

Staff knew how to safeguard people from the risk of harm and abuse. They completed training and followed risk assessments to help minimise accidents and incidents from occurring.

There were positive comments about the staff team and their approach when supporting people. They were described as kind and caring. Staff supported people to maintain their privacy and dignity. 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 had their needs assessed and care plans were developed. These described people’s needs and gave staff guidance in how to meet them in ways they preferred.

People’s health and nutritional needs were met. Staff ensured people saw health professionals in a timely way. The menus provided people with choices, alternatives and special diets when required.

Staff were recruited safely, and they received appropriate training, supervision and support.

The provider had a system to manage complaints. People were aware of how to complain and told us any concerns would be listened to and addressed.

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 and update

The last rating for this service was inadequate (published 26 July 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, we found improvements had been made. However, the provider remains in breach of one regulation.

This service has been in Special Measures since 2 May 2019. During this inspection, the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a continued breach in regulations in relation to the management of medicines at this inspection.

Please see the action we have told the provider to take at the end of this 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.

People’s experience of using this service: The provider took over the running of the service in February 2019. Until very recently there had been insufficient staff on duty; the new provider had used a care staffing tool which was not sufficiently accurate when calculating people’s complex health care needs. Staffing levels had been reduced and this had impacted on the delivery of care to some people and affected their health and welfare.

For example, people had not always received their medicines as prescribed, which affected their treatment. Risk had not always been managed to ensure people’s safety. This had impacted on their safe care, health and wellbeing. In one instance a person’s pain and distress had not been well-managed and another person had not been provided with the correct pressure relieving cushion.

People had not always had their needs met in ways they preferred, and in a timely way; this had resulted in one person being admitted to hospital for treatment that could have been provided in the service. The reduction in staffing numbers also impacted on the way the service was managed and the time available for the new registered manager to have oversight of the care of people with nursing needs.

There was a delay in the introduction of the new provider's own quality monitoring system. There was also a crossover regarding documentation, which left a newly registered manager and staff team managing different systems of recording. Records were not consistently accurate and up to date. The initial transition from previous provider to new provider could have been managed much more effectively. The provider’s audit system will need time to be fully carried out.

Complaints had been received about the levels of personal care and health care and treatment delivered to people; these had resulted in safeguarding investigations. Some of these were still being investigated by the local safeguarding team. In discussions, staff knew the different types of abuse and knew to report concerns to management.

There were positive comments about the care staff approach but there were also comments from relatives that this could be improved to be more caring and sensitive. Staff had not consistently gained consent before carrying out tasks such as placing clothes protectors on people. However, people were supported to have maximum choice and control of their lives were possible and staff supported them in the least restrictive way; the policies and systems in the service supported this practice.

People’s nutritional needs were met and menus provided them with choices for the main meals. Those people on textured meals such as pureed, due to swallowing difficulties, had limited choices for desserts.

Staff received training and supervision. There were gaps in training records when staff required courses or updates in training. However, these had been identified by the registered manager. A supervision and appraisal system had just been started following the new provider’s way of working. The provider had a safe system of staff recruitment.

Following the inspection, the registered manager and senior management had reflected on the concerns raised by relatives, the local authority contract monitoring team and the inspection findings. They told us they will produce an action plan and lessons learned document to share with staff and improve practice going forward.

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

Rating at last inspection: This was the first inspection of the service since the new provider was registered with the Care Quality Commission (CQC) in February 2019.

Why we inspected: We received information from the local authority regarding an escalation of concerns about the service; they had been completing monitoring visits. We completed this inspection based on these concerns. At the time of the inspection, we were aware of incidents being investigated by another agency.

Enforcement: The service met the characteristics of Inadequate in two key questions of safe and well-led, and Requires Improvement in effective, caring and responsive. There were breaches of regulations in delivering person-centred care, safe care and treatment, staffing and good governance. We have issued four Requirement Notices for these breaches. These can be found at the back of the full report.

Follow up: We will continue to monitor the service closely and discuss any ongoing concerns with the local authority. We have requested specific information about what action the provider is to take to make improvements and regular updates on this action.

The overall rating for this registered provider is 'Inadequate'. This means that it has been placed into 'Special Measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Another inspection will be conducted within six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded. We will have contact with the provider following this report being published to discuss how they will make changes to ensure the service improves their rating to at least Good.