Alexandra Lodge Care Home

Updated 17 November 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

This was a targeted inspection to check whether the provider had made improvements following our previous inspection.

Inspection team

The inspection was completed by 2 inspectors.

Service and service type

Alexandra Lodge Care Home is a 'care home'. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Alexandra Lodge Care Home is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Notice of inspection

We gave the service 24 hours' notice of the inspection. This was because the service was not currently supporting any people. So, staff were not routinely in the building.

What we did before the inspection

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

We reviewed the concerns observed at the last inspection and reviewed information the provider had sent us. We then created an inspection plan, to specifically look at what changes had been made to these previous risks.

Since our last inspection, the service has not supported any people. We have therefore not received any updates from external professionals or members of the public.

During the inspection

We walked around the care home, to assess what changes had been made to the environment since the last inspection. We also reviewed governance records, to assess whether systems and processes had been altered since our last inspection. We spoke to 3 care staff and the responsible person for the care home.

Updated 17 November 2023

About the service

Alexandra Lodge is a residential care home providing personal care to up to 19 people. People are supported in 1 adapted building. The service supports older people, some of whom are living with dementia and mobility needs. On the day of our inspection, there were 8 people using the service.

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

The premises and environment were poorly maintained, and staff training and competency was poor, this put people at risk of significant harm. Action identified in previous urgent enforcement action had not been taken and further risk was identified. The provider failed to take action to mitigate significant risk to people. This meant the environment and risk management was ineffective, which placed people at risk of harm and therefore, following this inspection, people were transferred to alternative care homes.

The home was not safe. Environmental risks were not managed. The provider had not been carrying out health and safety checks where they should, to ensure risks relating to windows, hot surfaces, and infection control were safely and appropriately managed.

The service failed to protect people from poor care and abuse. The provider had failed to have systems and processes in place to monitor and review incidents and the quality of the care provided to people. This resulted in poor care and no action taken to prevent reoccurrence of incidents.

Medicines were not managed safely. The provider failed to appropriately stock check medicines. Multiple medicines could not be accounted for meaning people were at risk of under or over administration of medicines.

People received poor quality care, due to staff not having the required skills and abilities to meet people’s needs. Staffing levels were consistently low, some staff were expected to fulfil dual roles, which meant people received inconsistent care from staff due to insufficient time to meet people’s needs.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

There was a poor culture at this home. Staff told us the home was not safe and the provider did not listen when they raised concerns. This meant there was no focus on continued improvement and assessment of the quality of care at this home.

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 service was inadequate (published 28 June 2023)

At this inspection we found the provider remained in breach of regulations.

This service has been in Special Measures since 28 June 2023. During this inspection the provider did not demonstrate improvements have been made. The service remains rated as inadequate overall. Therefore, this service remains in Special Measures.

Why we inspected

The inspection was prompted in part due to previous urgent enforcement action resulting in conditions added to the registration. Concerns were received these conditions were not being met in regards of risk oversight and governance improvements, additionally concerns with the environment, infection control, staffing and leadership. A decision was made for us to inspect and examine those risks.

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.

The overall rating for the service remains inadequate. This is based on the findings at this inspection. We found evidence the provider needs to make significant improvements. Please see the safe and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Alexandra Lodge on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to risk management, staffing, safeguarding people from risk of abuse and good governance at this inspection.

Following the inspection we suspended the providers registration. This means the provider cannot support any people for a period of time.

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.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.