• Care Home
  • Care home

Cuerden Developments Limited - Alexandra Grange

Overall: Good read more about inspection ratings

Alexandra Grange, Howard Street, Wigan, Lancashire, WN5 8BH (01942) 215222

Provided and run by:
Cuerden Developments Ltd

All Inspections

6 June 2023

During an inspection looking at part of the service

About the service

Cuerden Developments Limited – Alexandra Grange is a care home providing personal care to older people and people living with dementia. The service accommodates 54 people in one adapted building. At the time of the inspection 46 people were using the service.

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

We found daily records were not always comprehensive. We have made a recommendation about effective recording of daily observations. The provider managed medicines safely; however, some processes around medicines administration were not always robust at reducing the need for ‘as required’ medicines. We have made a recommendation about effective ‘as required’ medicine protocols.

Staff were trained to recognise potential risks and signs of abuse. Risks to people's safety and wellbeing were assessed and reviewed by managers. Staffing levels were safe. Staff used personal protective equipment (PPE) appropriately when supporting people and infection prevention and control processes were in place.

Managers ensured systems were in place to monitor the running of the service. The provider had procedures in place to receive feedback on how to improve support. Managers audited support records, including accidents and incidents to assure themselves of quality. Lessons were learned when concerns were raised, and these outcomes were communicated to staff. Staff worked well in partnership with other agencies to deliver effective support.

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 (CQC) website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was good (published 11 December 2019).

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of infection control and record keeping. This inspection examined those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this 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 Cuerden Developments Limited – Alexandra Grange on our website at www.cqc.org.uk.

Recommendations

We have made recommendations about improvements in daily care records and the safe management of medicines.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

12 November 2019

During a routine inspection

About the service

Alexandra Grange is a care home providing personal care to 51 people at the time of the inspection. The service accommodates up to 54 people in one building split over two floors.

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

People’s outcomes were consistently good, and people’s feedback confirmed this. One person told us, “I do everything I can for myself [regarding personal care] and the staff do the rest. They listen to you and everything and talk to you.”

Medicines were managed safely. One relative told us, “I would say they manage my [relative’s] medication very well.”

People told us they felt safe. Staff had a good understanding of how to safeguard people from abuse.

People enjoyed the food they ate and told us they had choices in the menu. A relative told us, “By all accounts, the menu is very good; very varied. The carers have to feed [my relative] and say they are eating well.”

Person-centred care was promoted and people told us the staff knew them well and responded to their needs in a person-centred way.

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 told us staff were kind and sensitive. One relative said, ‘[The staff] are decent people. They treat [my relative] very well and do things like mess around dancing with them, which they love.”

Person-centred assessments and care plans had been completed which reflected people’s needs, wishes and preferences. Staff knew people well and told us how they identified if people's needs changed or if they needed additional support.

Best practice guidance was not being implemented in regard to modified diets which was not flagged on the provider’s quality processes prior to our inspection. We have made a recommendation about the provider reviewing their audit processes.

We found the service required refurbishment and areas of flooring required replacing. The provider told us they had a plan to address this.

People and relatives told us the laundry process required improving as people had clothing items misplaced or missing on a regular basis We have made a recommendation about the provider reviewing their laundry processes.

Staff said they were happy working at the service and spoke positively about the management team.

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 9 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

17 May 2017

During a routine inspection

We carried out an unannounced inspection of Alexandra Grange on 17 May 2017. We last inspected the service on 29 March 2016 when we found three breaches of regulations. These were in relation to person-centred care, safe care and treatment and good governance.

The service sent us an action plan identifying the actions they intended to take to address the breaches of regulations identified. At this inspection we found improvements had been made and the service was now meeting all regulatory requirements.

There was a registered manager in place. 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 used the service, their relatives and professionals we contacted, told us they felt the service was safe. There were appropriate risk assessments in place with guidance on how to minimise highlighted risks. Safeguarding policies were in place and staff had an understanding of the types of abuse and procedures for reporting concerns..

The environment was effective for people living with dementia and provided stimulation. There was signage to aid people’s orientation and help them to be as independent as possible.

The home worked within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff had a good understanding of DoLS and the MCA, the importance of consent to care and treatment and how to act in peoples best interests.

People who used the service and their relatives told us the staff were caring and kind. We observed care in the home throughout the day. Staff interacted with people who used the service in a kind and considerate manner, ensuring people’s dignity and privacy were respected.. Relationships between people who used the service and staff members were warm. Conversations were of a friendly nature and staff’s attitude to people was polite and respectful using their chosen names, to which people responded positively.

There was an appropriate complaints procedure in place. Complaints were followed up appropriately and people who used the service and their relatives knew how to make a complaint.

A number of audits were carried out by the service, issues were identified and action plans put into place. Medication policies were appropriate and medicines were administered, stored, ordered and disposed of safely.

People’s care plans showed evidence of effective partnership working and we saw information in peoples care files that showed the involvement of relatives where appropriate.

People’s nutrition and hydration needs were met appropriately and they were given choices with regard to food and drinks. Care plans included appropriate personal and health information and were up to date.

We observed the lunchtime meal. There was a relaxed unrushed atmosphere and we saw that staff interacted with people in a respectful and dignified manner, recognising people as individuals’ and encouraging their engagement. There was a four week, seasonal menu cycle in use which was nutritionally balanced and offered a varied selection.

The home had a Service User Guide and this was given to each person who used the service in addition to the Statement of Purpose, which is a document that includes a specific set of information about a service.

The home had an End of Life Care Policy in place and people’s wishes regarding end of life were recorded in their care files, including any updates.

There was evidence of multi-disciplinary team reviews in people’s care files and evidence of best-interest decisions and discussions.

We saw that prior to any new admission a pre-assessment was carried out with the person and their relative(s).

People’s spiritual needs were met through the provision of regular visits from different faith groups.

There was a ‘key worker’ system in operation for both day and night shifts. There was a person centred care policy in place. We saw that information about personal preferences, social interests and hobbies was recorded in people’s care files. The service produced a monthly newsletter for people and their relatives. We found that resident’s surveys were also undertaken.

The home employed an activities coordinator. A wide variety of information and photographs of previous activities was displayed throughout the home.

Staff supervisions were undertaken regularly and we saw these were used to discuss issues appropriately on a one to one basis. The manager carried out a registered nurse competency check under the home’s competency framework.

There was a business continuity management plan in place that identified actions to be taken in the event of an unforeseen event.

Throughout the course of the inspection we saw the registered manager walking around the home observing and supporting staff.

29 March 2016

During a routine inspection

This comprehensive inspection took place on 29 March 2016 and was unannounced. We returned to the home on 21 April 2016 in order to check progress against an action plan that the service sent to us shortly after the date of the inspection. At the time of the inspection, there were 53 people living at the home. Alexandra Grange is registered to provide personal care and support for 54 people.

The care home is a purpose built two storey building with bedrooms on both floors. There is a car park at the front of the home. It is located in Pemberton, near Wigan and is close to shops and public transport links.

At the last inspection on 10 January 2014 we found the service to be compliant with all regulations we assessed at that time. At this inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of the safe management of medicines, having due regard to people’s well-being when meeting nutritional and hydration needs, and effectively assessing, monitoring and improving the quality of services provided.

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 we spoke with who lived at Alexandra Grange and their relatives, told us they felt safe.

We looked at five staff personnel files and there was evidence of robust recruitment procedures in place. Staff were subject to a formal induction process and probationary period.

Staff we spoke with told us they thought access to training and opportunities for on-going development were good.

We looked at staff training, staff supervision and appraisal information. Annual appraisals had either taken place or where scheduled for after the date of the inspection and supervision sessions for care staff were conducted by the manager.

We saw people had risk assessments in their care plans in relation to areas including falls, mobility and moving and handling. Accidents and incidents were recorded correctly.

There was an up to date safeguarding policy in place, which referenced legislation and local protocols. The home had a whistleblowing policy in place, recently reviewed in January 2016.

Staff who administered medicines had all completed appropriate training in the safe handling of medicines. There was a medicines administration policy in use, recently reviewed in January 2016 but this did not refer to the latest guidance from the National Institute for Health and Care Excellence (NICE) regarding the administration of ‘covert’ medicines and guidance on safeguarding in relation to medicines.

The home had a homely remedy procedure within their medication policy. The registered manager informed us that the home did not use homely remedies and where people required medicines for example for pain relief this would be prescribed by the GP.

Fridge temperatures in which medicines were stored were recorded daily, but the fridge which contained medicines was unlocked, which meant that people could potentially access these medicines. ‘Over-stock’ medicines were stored in the clinical room in an unlocked cabinet. This meant that they were potentially accessible by anyone entering the room.

We found that surfaces in the medicines room were unclean with a fine residue of powder which could be seen when wiped and an unclean floor, which was a potential infection control issue.

Not all of the medication administration records (MAR’s) that we reviewed on the day of the inspection had people’s allergy status recorded on. However allergy status was documented on the front cover sheet of each person’s MAR chart. NICE guidance states that allergies should be recorded on MAR charts.

The home was adequately maintained and we saw evidence recorded for the servicing and maintenance of equipment used within the home to ensure it was safe to use. We undertook a tour of the building to ensure that it was safe for the people who lived there and found that it was secure.

We observed several people being transferred with the use of a hoist and sling. The same sling was used for different people which meant there was a potential for the transfer of an infection from one person to another.

We checked whether the service was working within the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. We found that the service was complying with the conditions applied to the authorisations. Staff told us they had received training in the MCA and DoLS and most were able to explain the principles of this legislation to us.

Staff were aware of how to seek consent from people before providing care or support and told us they would always asked before providing care.

We looked at the meal time experience for people who used the service on the ground floor unit at Alexandra Grange. One person who used the service was being assisted to eat their main course but they were not given sufficient time to chew their food in-between mouthfuls which resulted in this person experiencing an episode of coughing. After lunch, we looked at this persons care plan and found it clearly indicated that this person must be allowed extra time when eating and drinking.

We also enquired about five other people whose meal had been taken to them in their own rooms. Staff told us that each of these five people required help and support with eating and drinking but their meals had been placed in their rooms by a member of staff, who then left the rooms until such time that the main lunch time service had ended, and a member of staff was then available to go and support these people.

Staff told us that the meal time service was frequently rushed because no additional help was available from the kitchen and because care staff were expected to serve food as well as support people who needed help to eat and drink.

We saw there were some adaptions to the environment, which included pictorial signs on some doors, such as bathrooms, which would assist people living with a dementia to orientate around the home. There were assisted bathrooms with equipment to aid people with mobility problems. New flooring in some of the en-suite bathrooms in people’s rooms had been ordered and was due to be installed shortly after the date of the inspection.

People we spoke with and their relatives told us they felt staff were kind and caring. We observed that interactions between staff and people living at Alexandra Grange were positive and staff were kind and considerate to people.

Staff we spoke with had a good understanding of how to ensure dignity and respect when providing care and support and people we spoke with confirmed that they felt staff respected their privacy and dignity. Residents and relatives meetings were held regularly and people were able to freely contribute to issues about the home.

End of life care training at Alexandra Grange was delivered via a distance learning package for staff and through ‘learning tutor’ visits to the home to support staff undertaking the training. The manager told us that all staff had undertaken EOL training, with the exception of staff who were currently undertaking an NVQ qualification, but staff training records that were provided to us indicated that only 35% of care staff had completed training in end of life care and palliative care. At the time of the inspection no person living at Alexandra Grange was receiving EOL care.

There was a ‘key worker’ system in operation under which each care staff member had specific responsibility for approximately seven people during the day. Alexandra Grange benefited from an activities co-ordinator who worked flexibly at the service over five days. A number of themed days had been undertaken throughout the year to fund raise for a variety of charities and the service also had a year round programme of excursions to various attractions

We looked at the care and support plans of six people who used the service. In each plan we found the quality of documentation and recording was not of a consistently good standard with gaps in information present throughout.

People’s care plans lacked good quality person-centred information. Some of the care plans we looked at were not always dated correctly, some care plans were not signed in every section, some were not dated in every section and others required updating.

The staff we spoke with were all positive about the care home manager. We saw that the registered manager was very visible within the home and actively involved in the provision of care and support to people living at Alexandra Grange.

There was a business continuity management plan in place that identified actions to be taken in the event of an unforeseen event such as the loss of utilities supplies, loss of catering, staff disruption, flood and fire.

We looked at the systems in place to monitor the quality of service provided at the home. There were a range of monthly audits and checks in place.

We saw evidence of recent staff meetings in January and March 2016 and staff supervisions were undertaken regularly.

The views of people who accessed the home for short periods of respite care were also sought and comments from these were largely positive.

10 January 2014

During a routine inspection

During this inspection visit we have found that action has been taken to address the issues identified during the previous inspection visit that took place on the 27 September 2013. The outstanding compliance actions have now been met.

27 September 2013

During a routine inspection

We did identify a registration issue during the inspection visit, the Care Quality Commission's IT system and website states that the home is registered to provide nursing care when in fact it is a care home that does not provide nursing. This will be followed up as a separate issue and has not had any effect on this inspection visit.

The people using the service who were able to tell us said that they were happy living in the home. Comments included; 'I really like it here', 'I am happy here and the staff are looking after me.'

We also received wholly positive comments about the home from visiting relatives, comments included; 'belting, cannot fault the place' and 'they look after my family member marvellously.'

We spoke to a district nurse who was visiting patients in the home, she said, 'staff are caring and are good at communicating with us. They always ask us for help and advice.'

The home had an adult protection procedure that was designed to ensure that any possible problems that arose were dealt with openly and people were protected from possible harm.

Action was needed to ensure that the premises had a suitable layout and were free from odours.

The staff training matrix which showed us that staff had received mandatory training in areas such as safeguarding and moving and handling.

Information about the safety and quality of service provided was gathered on a continuous and on-going basis.

12 January 2013

During a routine inspection

We talked with six people using the service and relatives of two people living at Alexandra Grange care home. We also talked with the senior carer on duty who was in charge on the day of the inspection visit and we talked with the registered manager by telephone. People told us they were happy with the care and treatment provided at Alexandra Grange.

People who used the service told us the care provided met their needs. They said:

'It's alright, jolly good really.'

And

'I find it great, I enjoy being here.'

Relatives also felt that the service met the needs of people who used services. We were told:

'My (relative) is in a much better position than when they came in.'

And

'There's good liaison and they do come into (my relatives) room to provide care.'

People also made general statements about living at Alexandra Grange.

A person who used the service told us:

'There are a lot of really poorly people here who I think are well cared for.'

A relative told us:

'The staff are very, very friendly. When (my relative) came back from hospital staff were prompt in welcoming them back and dealing with any immediate needs. It's a nice place and they respect my relatives' wishes.'

We observed that people who used the service were provided with support that met their personal, physical, emotional, and recreational needs.

We found that more action was needed to ensure that the premises was free from preventable and offensive odours.

16 November 2011

During a routine inspection

The staff and visitors we spoke with told us that the manager was very approachable and were confident that she would deal with any issues they had.

Staff told us that the training was good.

Staff told us that the manager is very supportive.

Relatives told us: 'The carers are brilliant'.

People told us that they were satisfied with their rooms.

People told us that they were happy living at the home.