Alexander Court Care Centre

We found the following examples of good practice

The provider implemented visiting arrangements that were safe and helped to control and prevent the spread of infections. Visitor protocols included a lateral flow test (LFT) for COVID-19 at the entrance or proof of a negative LFT test taken shortly before their arrival. Visitors were given access to Personal Protective Equipment (PPE), such as face masks to make sure the risk of catching and spreading infections was minimised. Hand sanitiser was available for use at the entrance. Visitors had their temperature taken by staff to check they were not symptomatic of COVID-19.

Visiting professionals were asked to provide evidence of their COVID-19 vaccinations prior to entering the home. All care home staff took a daily LFT test as a precaution to check if they had the virus before starting their work in the home. The registered manager recorded all test results of staff and people. They followed national guidance when staff tested positive.

During a recent outbreak of COVID-19 in the home, people that had tested positive self-isolated in their rooms to manage the spread of infection. Policies, procedures and government guidance related to COVID-19 were followed to help staff continue to support people safely. There were suitable arrangements for zoning and closing off each unit where an outbreak occurred to minimise the spread of infection through the building. Ventilation and temperature control systems helped to ensure COVID-19 droplets could be dispersed outside. The registered manager also followed recommendations made by an infection, control and prevention professional to help prevent future outbreaks.

The provider followed visiting guidance for outbreaks. There was allowance for relatives of people receiving end of life care in the home or essential care givers of people in the home. Other relatives or friends of people in the home were permitted window visits from a visitor's pod located on the ground floor. People were supported to keep in contact with relatives by telephone or video calls while they were self-isolating.

The service had enough staff to meet people’s needs. There were some staffing pressures due to a high number of staff that had to self isolate after catching COVID-19. Agency staff were recruited to cover when needed and records showed the provider was able to maintain their assessed staffing levels. At the time of our inspection, all permanent staff had returned to work after their period of self isolation.

Staff and people took part in a COVID-19 testing programme according to government guidance. All staff had completed relevant training in infection control and PPE. We saw staff using PPE correctly and safely. Handwashing guidance was displayed throughout the home and additional PPE was available for staff and visitors. The registered manager carried out infection control audits of all areas within the home in accordance with the provider’s infection control policies. There was a daily cleaning schedule in place to ensure the premises was kept clean and to maintain hygiene, which helped prevent the spread of infections.

The provider kept up to date with government and local guidance on vaccinations, self isolation, visiting and outbreaks to ensure they were following it correctly.

Alexander Court Care Centre is a care home that is registered to accommodate up to 82 people across five units, each of which have separate adapted facilities. Three of the units specialise in providing care to people living with dementia. The home provided personal and nursing care to 75 people, aged 65 and over, at the time of the inspection.

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

People were protected from the risk of abuse. There was a safeguarding procedure for staff to follow and staff understood how to identify and report safeguarding concerns. People had risk assessments in place to manage their care and support needs to keep them safe.

There was a procedure for reporting accidents and incidents and learning lessons to prevent reoccurrence. The management team ensured lessons were learned when things went wrong in the service following incidents and complaints.

Systems and procedures were in place to prevent the spread of infections, including the risk of COVID-19 transmission. There were procedures such as temperature checks and rapid COVID-19 testing for visitors entering the home. We observed the service to be clean and free of odours. There was a daily schedule for cleaning and disinfecting the home. Personal protective equipment (PPE) was in sufficient supply and people and staff were tested regularly to help prevent the spread of infection. The provider facilitated visitors to people, such as relatives or friends, in accordance with government guidance. Premises and equipment were maintained and serviced to ensure the home’s environment remained safe.

Staff meetings were held with the management team to discuss important topics and go through concerns. There were quality assurances systems to ensure the home remained safe.

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 Good (published 14 June 2019).

Why we inspected

We undertook this targeted inspection to check a specific concern we had about infection prevention and control procedures and the management of the service. The overall rating for the service has not changed following this targeted inspection and remains Good.

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.

CQC have introduced targeted inspections to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

Alexander Court Care Centre is a care home that registered to accommodate up to 82 people across five separate units, each of which have separate adapted facilities. Three of the wings specialise in providing care to people living with dementia. The home provided personal and nursing care to 76 people, aged 65 and over, at the time of the inspection.

People’s experience of using this service:

The provider had made improvements since our last two inspections. The home provided more person-centred care to people and people’s consent to care was now being obtained. People were provided their medicines as prescribed. There were safer systems in place for the storage, administration and management of medicines. There were more effective governance systems to ensure the home was being managed to a good standard.

People spoke positively about the care and support they received. They felt safe using the service. Staff had a good understanding of what constituted abuse and how to report any concerns to keep people safe.

Risks associated with people’s care and support had been assessed and there was guidance in place to keep them safe. Accidents and incidents in the home were reviewed to learn from any lessons. However, we have made a recommendation around supporting people with behaviour that may challenge because records did not always indicate how staff supported them following incidents, to minimise re-occurrence.

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.

People were supported with their nutritional needs and had choices with meals. People had access to health care professionals such as GPs, when required.

People received care from staff who were kind and compassionate. Staff treated people with dignity and respected their privacy. People's independence was promoted.

Staff understood people's needs, preferences, and what was important to them. Staff had developed positive relationships with the people they supported.

People were supported to engage in meaningful activities and pursue their interests, where they were able.

Care plans were person-centred and detailed people's support needs.

A complaints procedure was in place. People and relatives were supported with complaints they wished to make and the registered manager investigated them.

Staff were recruited safely and were supported with the necessary training and development to increase their skills. Staff felt supported by the management team and told us there was a positive culture.

There was a system in place to monitor the home and ensure consistent and good quality care was provided to people. The registered manager and provider demonstrated they were able to run the home effectively and were committed to making continual improvements to the home where required.

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

Rating at last inspection:

At the last comprehensive inspection on 28 February 2018 and 6 March 2018 the service was rated Requires Improvement (published 9 May 2018).

We carried out a focused inspection on 1 November 2018 (report published 18 December 2018) to follow up on specific breaches of regulations; safe care and treatment and good governance. We found improvements in the service but did not change our overall rating.

Previous breaches:

At the last comprehensive inspection, the service was in breach of two other regulations in relation to obtaining consent to care and providing person-centred care to people. We asked the provider to complete an action plan to show what they would do and by when, to improve. At this inspection, we found improvements had been made and the provider is no longer in breach of regulations.

Why we inspected:

This inspection was carried out to follow up action we told the provider to take at the last comprehensive inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

We undertook this unannounced focused inspection on 1 and 2 November 2018, to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to those requirements. At this inspection, we found these requirements were met.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk

Alexander Court Care Centre is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Alexander Court Care Centre is registered to accommodate up to 82 people across five separate units, each of which have separate adapted facilities. There are three units for people living with dementia and one unit for young people with physical disabilities. There is also a residential unit for older people. At the time of our inspection, 78 people were living in the home.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the home. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the legal requirements in the Health and Social Care Act 2008 and the associated regulations on how the home is run.

The registered manager was committed to improving the service and had demonstrated the work they had carried out since the last inspection. We saw that improvements had been made in ensuring people were safer.

Medicines were being managed safely. Nursing staff and trained senior care staff administered medicines to people. They signed medicines administration record (MAR) charts to evidence that medicines were given as prescribed and at the correct times. All staff received medicines administration training and were assessed as competent before being allowed to administer medicines.

Risks to people were assessed and guidance was in place for staff to follow to help minimise these risks.

The provider's quality assurance systems and processes had improved to assess, monitor and improve the quality and safety of people in the home.

However, further time and work was needed to ensure these changes were fully embedded and that the home was well managed and safe. For example care plan audits had not identified that some had not been updated and the recording of prescribed creams for people was not always effective.

Staff were recruited appropriately and the necessary background checks were undertaken to ensure they were persons of good character and suitable to support people. There were enough staff in the home across each of the units.

People were protected from abuse and staff understood safeguarding procedures.

The premises was safe and equipment was serviced and checked according to the manufacturer guidelines.

Infection control procedures were followed to protect people from contamination.

Staff ensured there was learning from accidents and incidents to prevent reoccurrence.

The registered manager ensured feedback was received from people and relatives to check they were satisfied with the home.

Staff told us they were supported by the management team and could approach them with any concerns.

We were assured that the registered manager and provider would be able to achieve a level of consistency in achieving high standards going forward and over a period of time. We will check this at our next comprehensive inspection.

Alexander Court Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Alexander Court Care Centre accommodates 82 people across five named separate units, each of which have separate adapted facilities. There are three units for people living with dementia and one unit for young people with physical disabilities. There is also a residential unit for older people. At the time of our inspection, 76 people were living in the home.

The home has a newly appointed 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. The previous registered manager had left their position a few weeks before our inspection. The deputy manager was managing the service at the time of our inspection and completed their registration as manager shortly after our inspection.

Each unit in the home was managed by a registered nurse who was supported by the newly registered manager and a new deputy manager.

At our inspection, we found breaches of health and social care regulations. This was because people did not always receive safe care. They did not always receive their medicines as prescribed and when needed. Risks to people, such as diabetes and other conditions, were not always adequately assessed or identified to ensure they remained safe. This meant that the provider did not always assess, monitor and mitigate risks associated with the service to ensure people received safe care.

The provider’s systems to support people who lacked capacity to make decisions for themselves were not effective. Staff received training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). However, 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; the policies and systems in the service do not support this practice.

The provider did not always ensure people had access to appropriate healthcare when needed because their appointments with health care professionals were not always followed up. This meant people’s health needs were not being managed effectively to ensure they remained in the best of health and their wellbeing was maintained.

Most people told us they were treated with dignity and their choices were acted upon. However people were not always treated with respect. They were not always involved in their care planning. We have made a recommendation for the provider to look into establishing a more caring and sensitive environment.

People did not receive care and support to ensure their individual needs were met. Care plans were not person centred and did not contain sufficient information on people’s backgrounds and preferences. Complete, accurate and contemporaneous records were not being kept for each person.

The registered manager was committed to developing the service, although significant improvements were required with quality assurance systems to ensure people received a safe, effective, caring and responsive service. Feedback was received from people and relatives in the form of questionnaires and surveys to help drive quality improvements.

The premises were clean and regularly maintained. The environment was suitable for people who had specific needs such as dementia.

Infection control procedures were followed to ensure the home remained safe from the spread of infections. Records of accidents and serious incidents showed that the provider learned from mistakes to prevent reoccurrence.

Staff received training on how to safeguard people from abuse. Staff were also aware of the whistleblowing policy. They were able to describe the actions they would take if they had any concerns about people’s safety, both internally and externally.

The provider had safe recruitment procedures in place and carried out checks on new employees. Staff were supported with regular training, meetings and supervision. Staff performance was reviewed on a yearly basis and they were encouraged to develop their skills.

People were provided with a choice of meals on a daily basis. Staff had an awareness of equality and diversity and challenged any discrimination they encountered. People were encouraged to participate in activities and remain as independent as possible.

Staff were able to communicate with people in order to understand their needs. People and relatives were able to make complaints and have them investigated by the registered manager.

Staff felt supported by the management team. They were aware of their responsibilities when providing care.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we have asked the provider to take at the back of the report. 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.