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Alexandra Park Requires improvement

The provider of this service changed - see old profile

Inspection Summary


Overall summary & rating

Requires improvement

Updated 8 February 2018

This inspection took place on 18, 20 and 29 September 2017. The first visit was unannounced. This meant that the provider and staff did not know we would be visiting. Following the inspection visits we requested and reviewed further information from the service. We concluded these inspection activities on 11 October 2017.

Alexandra Park is registered to provide accommodation and personal care for up to 32 people with learning difficulties and mental health needs. It is comprised of 28 single occupancy bungalows and a four bedroomed house, located within extensive grounds. Support is provided over a 24 hour period by staff who are based in individual bungalows and managed from the on-site resource centre. The resource centre is also used for training, social activities and administration of the site. There were 21 people using the service at the time of the inspection.

A registered manager was 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 last inspected in January 2017 when we carried out an unannounced comprehensive inspection of this service. At that time we rated the service as ‘requires improvement’ and found it was in breach of five regulations. We had found people were not protected from the risk of abuse, the Mental Capacity Act 2005 (MCA) was not being followed, care was not always person-centred, people were not always treated with dignity and respect and the provider’s quality assurance system was ineffective. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. During this inspection we checked that they had followed their plan to confirm that they now met legal requirements.

The inspection was prompted in part by notification of an incident of a safeguarding nature. These incidents had been brought to the attention of the police and local authority. At the time of the inspection the police were carrying out an investigation into the incident. The information shared with CQC about the incident indicated potential concerns about how people were safeguarded from abuse. This inspection examined those concerns.

At this inspection we found the provider was no longer in breach of any regulations. The provider and registered manager had made significant improvements, but some areas for improvement remained. The rating for the service remained 'requires improvement'.

Since our last inspection the provider had strengthened their safeguarding procedures. Staff had undertaken more training focusing on people's rights, and what constitutes institutional abuse. More stringent checks were carried out of records, and support plans were reviewed to ensure they were promoting people's rights. We have recommended safeguarding training is provided to people who use the service, appropriate to their needs.

Risks were monitored and mitigating actions to reduce potential risks had been identified. Records were repetitive and risks assessed across multiple care documents. We recommend the provider reviews their records to ensure key information is consistently recorded.

The areas of good practice which we found at the last inspection had been maintained. Accidents continued to be monitored and where possible action taken to reduce future risks. There were enough staff to meet people’s needs and robust recruitment processes had been followed.

Medicines were administered safely, by staff who had undertaken training and competency assessments.

The provider had reviewed all decisions made on people's behalf to ensure they were in line with the MCA. Restrictions placed on people had also been audited and many had been reduced or removed altogether. 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.

The provider had shown a commitment to investing in training so staff could support people in a way which promoted their rights. Since our last inspection staff had followed a programme of training designed around the needs of people at the service. All staff had received positive behaviour support training. Which focussed on how by understanding fully people's needs, preferences and backgrounds, staff could present themselves and provide support in a way which minimised people feeling anxious or aggressive. The detailed care plans in place to describe to staff how they should respond to people when they displayed behaviour which might be challenging were now being followed, and reviewed more regularly to ensure they stayed up to date.

Restraint was practiced when people were putting themselves or other people at risk of harm. The use of restraint was monitored and any usage was reflected on after the incident. Staff had all had training in how to restrain people safely.

Staff received training, supervision and annual appraisals to ensure they had the skills and knowledge to meet people’s needs. Supervision records showed the frequency of training differed across the staff team, and not all staff received it as often as detailed in the provider's policy. The registered manager told us they would address this.

People were involved in planning their meals and shopping for their food. External healthcare professionals were involved to ensure people’s general health and well-being was maintained.

People told us they liked their staff team, and relatives we spoke with told us staff were warm, friendly and had good relationships with people who used the service. We spent time in people's own homes and in the communal areas and saw people enjoyed positive relationships with staff. They knew each other well, and we saw lots of examples of people and staff laughing and joking. Staff were knowledgeable about people's needs.

Staff supported people to identify and work towards goals, many of these focussed around being more independent. We saw that due to the reduction of restrictions, that people were able to be more independent in their own homes.

Care records remained vast, with areas of duplication, and documents where key information had been omitted. Overall care records were detailed and individualised to the person supported.

The provider had introduced more robust ways of monitoring the service. People's daily records of their care and support were monitored on each day by managers to ensure any issues would be identified and rectified quickly. A number of audits were carried out to ensure risk assessments and support plans were up to date and meeting people's needs. Representatives from the provider's quality team visited the home regularly to carry out in-depth audits of the quality of the service. We could see actions from these quality checks were identified and shared with staff to drive improvements.

Our last inspection identified a reduction in the number of managers. The provider told us this would be reviewed, however management staffing remained the same at this inspection. Some staff fed back they felt managers did not have enough time as their responsibilities within the service had grown. After our inspection the registered manager informed us two new posts within the management team had been created. However the registered manager still had to split their time between registered manager for Alexandra Park and area manager for two other of the provider's services. We were advised this was still under review.

Relatives and staff spoke highly about the management team. They told us the registered manager and support managers were making improvements within the service and were a visible presence.

People who used the service, relatives and staff had been asked for their feedback on how the service was run.

Inspection areas

Safe

Requires improvement

Updated 8 February 2018

The service was not always safe.

Safeguarding procedures were more robust. Staff had received additional training and more checks were in place. However in one instance staff had not immediately reported concerns. People who used the service had not been offered training in how to protect themselves from abuse.

People and relatives told us the service was safe. Medicines were well managed.

There were enough staff to meet people's needs and robust recruitment processes were in place.

Risks were assessed and accidents were monitored. Improvement actions were identified when possible to minimise future risks.

Effective

Good

Updated 8 February 2018

The service was effective.

People’s rights under the Mental Capacity Act 2005 were protected. The service had worked to reduce restrictions where possible.

Staff were supported with regular training, supervision and appraisal.

People's food and hydration needs were met. People were included, where possible, in meal planning and preparation.

Bungalows were decorated to people’s personal choice and modified to their individual needs.

Caring

Good

Updated 8 February 2018

The service was caring.

People were treated with dignity and respect.

People and their relatives spoke positively about the support they received. We observed kind and caring relationships between people and staff. .

People were supported to identify goals to work towards to develop skills to maintain and increase their independence.

Responsive

Good

Updated 8 February 2018

The service was responsive.

People's records were individualised and contained good detail of how people should be supported. Care records were vast and it was sometimes difficult to find some information.

Activities were planned based on people's choices and preferences.

There had been no complaints since our last inspection, but historic complaints had been well managed.

Well-led

Requires improvement

Updated 8 February 2018

Not all aspects of the service were well led.

The home had made significant improvements to their quality and governance systems. But some areas for improvement remained.

Staff talked positively about the support they received from the management team, and described positive changes in how the service was run.

Staff meetings and meetings with people who lived in the service took place. People told us managers listen to their suggestions and acted upon them.