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Alexandra Park Requires improvement

The provider of this service changed - see old profile

We are carrying out checks at Alexandra Park using our new way of inspecting services. We will publish a report when our check is complete.

Reports


Inspection carried out on 18 September 2017

During a routine inspection

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 carried out on 7 December 2016

During a routine inspection

This inspection took place on 7, 12, 15 December 2016 and 17 and 18 January 2017. Visits on 7 December 2016 and 17 January 2017 were unannounced. This meant that the provider and staff did not know we would be visiting.

Alexandra Park is registered to provide accommodation 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.

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.

The service was last inspected in August 2015 and at that time we rated the service as ‘requires improvement’ but it was found to be meeting all legal requirements.

During this inspection we found people had not been protected from the risk of abuse and improper treatment. We found entries within two people's care records which detailed safeguarding incidents. These records had been signed by a team leader but staff had not identified the improper treatment or informed the registered manager. During our inspection two safeguarding referrals were made to the local authority who are investigating the incidents.

Accidents were monitored and reviewed by the registered manager. Action had been taken to reduce the risk of them reoccurring.

People, relatives and our observations confirmed there were enough staff to meet people’s needs. Records showed safe recruitment processes had been followed.

Staff had been trained to administer medicines and followed good practice. Before our inspection the provider had noted there had been an increase in medicine errors, but action had been taken to address this, staff were in the process of receiving additional training in this topic.

Care Quality Commission (CQC) is required by law to monitor the operations of the Mental Capacity Act 2005 (MCA), and to report on what we find. MCA is a law that protects and supports people who do not have the ability to make their own decisions and to ensure decisions are made in their ‘best interests’.

The MCA had not always been followed. Some decisions had been made on people’s behalf, however the provider could not demonstrate how the person’s capacity had been assessed or that they had considered the principles of MCA and ‘best interests’ in determining the decisions. Where capacity assessments had been undertaken these were often broad, and not decision-specific. People's care plans described their routines, and stated these plans were in people's best interests, but information had not been provided for staff about how to balance people's right to make choices with their planned routines.

Where people displayed behaviours which may challenge staff, such as anxiety or aggression, detailed care plans were in place to describe to staff how they should respond to people. However these had not always been followed. Staff had introduced new responses which were not based on an assessed need, care planned or evaluated. This meant people could be at risk of receiving inconsistent or inappropriate care.

Where restraint was practiced, additional recording was in place to monitor the use. We found two incidents where people had been restrained but these additional monitoring records had not been completed. On one of these occasions and non-approved method had been used.

Staff received training and supervision to ensure they had the skills and knowledge to meet people’s needs.

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.

Whilst we found records which showed two people who used the service had not always been treated with dignity and respect, relatives we spoke with told us staff were kind and caring. We observed positive interactions between staff and people who used the service. People appeared relaxed and staff were knowledgeable about their needs.

People's independence had not always been promoted when restrictions had been put in place to maintain people's safety. Staff and relatives told us people were encouraged to be independent. Relatives told us they were included in planning people's care and that they were kept up to date with any changes to their relative’s needs.

Care plans were varied. Some were very detailed and gave clear information for staff. Other decisions about people's care had not been communicated well to staff which meant people were at risk of inconsistent care.

Care records were large, it was difficult to know where specific documents were stored, and some documents were poorly completed. However they did contain personal information about people's needs and personal preferences.

The provider, registered manager and staff within Alexandra Park undertook a schedule of audits and quality checks. However this system was not effective and robust in monitoring the quality of the service provided. None of the shortfalls which we identified during this inspection had been highlighted by internal checks.

Since our last inspection the management structure had been reduced. The registered manager had taken on additional responsibilities for the provider organisation, and the support manager positions within Alexandra Park had been reduced from three to two.

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.

We have identified 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.

Inspection carried out on 27 August and 1 and 4 September 2015.

During a routine inspection

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.