Archived: Alexander House Private Nursing Home

About the service

Alexander House Private Nursing Home is registered to provide accommodation for persons who require nursing or personal care and treatment of disease, disorder or injury for up to a maximum of 25 people. At this inspection 8 people were using the service, some of whom were living with dementia, had a mental health condition, were autistic and had a learning disability.

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

The provider was not able to demonstrate how they were meeting the underpinning principles of ‘Right support, right care, right culture’.

Right Support:

• The registered manager and staff team did not support people to have choice, control and independence or focus on people’s strengths and abilities.

• There were not enough staff to fully support people to have a fulfilling and meaningful everyday life.

• The registered manager and staff did not support people to take part in activities and pursue their interests within their local area.

• Suitable arrangements were in place to ensure the proper and safe use of medicines.

Right Care:

• Staff were observed to deliver task-based care and support.

• Not all people’s nutritional needs were being met in line with their care needs or care plan.

• Recommendations and advice by healthcare professionals were not always implemented or followed up.

• The registered manager and staff did not protect people from poor care and abuse.

• People did not routinely take part in activities or pursue interests that were tailored to them.

Right Culture:

• The leadership, management and governance arrangements did not provide assurance that the service was well-led, that people were safe, and their care and support needs could be met.

• The registered manager and staff team did not help people lead inclusive and empowered lives.

• The registered manager and staff team did not ensure people are always put first. People did not receive care that was person centred or protected and promoted people’s rights.

• A ‘closed culture’ had been developed at Alexander House Private Nursing Home, whereby there was a risk of harm for people living there.

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 December 2021]. The provider did not complete an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended that the provider seek guidance to ensure the premises were suitable to meet people’s needs. At this inspection we found the provider had not fully acted on this recommendation and only minor improvements had been made.

Why we inspected

The inspection was prompted in part due to continued concerns received about people living at Alexander House Private Nursing Home not having access to professionals and stakeholders. involved in their care. The provider was continuing to not allow professionals and stakeholders to access the service to carry out their statutory obligations to ensure people’s safety and wellbeing. 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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to person-centred care, consent, risk management, safeguarding, meeting people’s nutritional needs, governance and staffing at this inspection.

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.

Follow up

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.

We found the following examples of good practice.

• At this inspection the provider was enabling relatives to visit their family members. However, the provider had a lack of understanding regarding facilitating visits from professionals.

• Appropriate infection prevention control practices were observed by staff, such as the wearing of masks, gloves, aprons and included good hygiene practices.

• Training information provided to the Care Quality Commission prior to this targeted inspection recorded all staff had attained infection, prevention and control training.

•The environment was visibly clean and odour free.

Alexander House Private Nursing Home is registered to provide accommodation for persons who require nursing or personal care and treatment of disease, disorder or injury for up to a maximum of 25 people. At this inspection 13 people were using the service, some of whom were living with dementia and had a mental health condition.

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

Information relating to people's individual risks was not always recorded or did not provide enough assurance that people were safe. People were not consistently protected by the service’s prevention and control of infection practices and procedures. We were not assured the provider was admitting people safely to the service and compliant with COVID-19 testing for people newly admitted to the service. Information relating to Personal Emergency Evacuation Plans [PEEPs] for people using the service were not accurate or up to date.

Not all staff employed at the service had up to date training or training that met the specialist needs of people using the service. Additional staff training information was submitted on 14 December 2021 and this demonstrated staff had received updated training following our inspection. 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. People's needs were not assessed prior to their admission to the service. Relatives were not kept up to date about their family members needs and the outcome of health-related appointments.

The leadership, management and governance arrangements did not provide assurance that the service was well-led, that people were safe, and their care and support needs could be met. Quality assurance and governance arrangements at the service were not reliable or effective in identifying shortfalls in the service. There was a lack of understanding of the risks and issues and the potential impact on people using the service. The lack of effective oversight of the service has resulted in continued breaches of regulatory requirements.

We have made a recommendation about staff training and environment.

There were sufficient numbers of staff available to support people living at the service. Most records relating to staff recruitment practices were in place and this had improved since our last inspection to the service in February 2021. People received their medicines as prescribed and staff met good practice standards when administering people’s medicines. The provider told us staff received regular supervision and received good support. People received sufficient food and drink to meet their needs.

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

Rating at last inspection

The rating at our last inspection was Requires Improvement (published May 2021). There was one breach of regulation cited and this related to a breach of Regulation 17 [Good governance]. At this inspection enough improvement had not been made and the provider was still in breach of this regulation.

Why we inspected

The inspection was prompted in part due to concerns received about people being transferred from one of the provider’s other locations to another service without appropriate processes being followed, including adequate consultation with people and the Local Authorities. A decision was made for us to inspect and examine those risks.

The overall rating for the service has changed from Requires Improvement to Inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Alexander House Private Nursing Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the management of safeguarding, risk, consent and governance arrangements at this inspection.

Please see the action we have told the provider to take at the end of this 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.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore 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 of 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.

Alexander House Private Nursing Home is registered to provide accommodation for

persons who require nursing or personal care, treatment of disease, disorder or injury for up to a maximum of 25 people. At this inspection 13 people were living there, some of whom were living with dementia.

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

Staff told us they felt staffing numbers were suitable to meet people’s needs and our observations during the inspection supported this. However, we were concerned about the number of suitably qualified nursing staff available to meet people’s nursing needs. We have made a recommendation in this area.

Staff recruitment files were not kept at the service. Following the inspection, we requested the recruitment files for all staff recruited in the last three months to be sent to us. We have made a recommendation in this area.

Infection control and prevention measures were in place although some improvements were required.

Risk assessments for people included information about how to mitigate the risks they identified. However, we did identify two care plans that required further work. Whilst both these care plans were for people that had been admitted recently risk plans were either incomplete or not present.

Most staff knew the signs and symptoms of abuse and told us they always reported their concerns to senior staff however, we did find two staff that could not tell us who to report to externally. The registered manager told us they were arranging for additional support for these staff whose first language was not English.

Steps had been taken to ensure the premises were safe. Medicines were managed safely.

Following our inspection, we requested further documentation from the provider to assure us that there were suitable systems in place to assess and monitor the quality of the services provided. The provider was given specific timescales to send us this information but some of these records have still not been received.

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 requires improvement (published 20 September 2019). The service remains rated requires improvement. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to wound care, staffing, medicines, infection control and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified a continued breach in relation to the governance of the service.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

People, relatives and health care professionals told us they felt the service was safe and people received care and support in a safe way.

Risks assessments about people’s safety and welfare were well developed and explicitly described how to manage the risks. Equipment used for people was well maintained. However, people who required the aid of a hoist for transfers had no individual slings provided for them which meant there was a risk of cross infection.

Staff knew the signs and symptoms of abuse and told us they always reported their concerns to their seniors, however they were unfamiliar with specific terminology as safeguarding and whistleblowing and the procedure they had to follow. Staff in more senior roles were knowledgeable about external safeguarding authorities and knew when and how they had to report any safeguarding concerns.

People received their medicines safely, administered by staff who received training and had been observed to be competent by the provider. However, medicines were not stored in line with nationally recognised best practice guidelines.

People told us there were enough staff to meet their needs safely. People living in Alexander House Private Nursing Home had different needs. Some people lived with a learning disability, mental health needs, dementia and physical disabilities. Staff had not been trained sufficiently to understand current best practice guidance for the different needs people had. Although staff were knowledgeable about people, they needed more training to enable them to meet people`s needs.

The outcomes for people with learning disabilities living in the home did not fully reflect the principles and values of Registering the Right Support. There was a lack of planned outcomes for people, limited choice and control about where people wanted to reside, limited independence and limited inclusion in the community. People were not supported to develop life skills or to work towards a goal of moving to less supported care environment although some people had capacity and expressed their wish to live independently.

The service was going through organisational changes and these included implementing new care plans, more training for staff, new governance and audit systems, and a new organisational management structure. The provider issued staff with clear guidance about their roles and responsibilities. The local funding authority had been involved in re-assessing people`s needs to ensure people were supported in the right environment.

Feedback we received from people, health and social care professionals and family members was positive, they told us the service was safe and met people`s needs.

Rating at last inspection and Update: The service had a comprehensive inspection on 18 December 2018 and placed into special measures with an overall rating of Inadequate with breaches of regulation. The report for the inspection was published on 8 February 2019. On 04 June 2019 we carried out a focused inspection and found that the provider remained in special measures. The overall rating remained Inadequate. The report had been published on 24 July 2019.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

This service has been in Special Measures since 08 February 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected: This was a focussed follow up inspection based on the previous rating to review whether those domains rated as inadequate had sufficiently improved.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Alexander House Private Nursing Home on our website at www.cqc.org.uk.

People’s experience of using this service:

The service was not safe. People’s identified needs were not always managed safely. Staff did not always know what people’s identified needs were.

Medicines were not always stored in line with best practice. Staff did not administer time specific medications on time, and times administered were not accurately documented in records.

The environment was not safe and where risks were present they were not always identified and mitigated.

Poor governance systems were in place to manage the quality of the service provided and the registered provider had not identified failings found at this inspection.

The service had not carried out daily quality checks or observations of staff practice, and those related to the care provided to people.

The registered provider and registered manager had a poor understanding of what constituted good quality care. They had failed to implement changes needed in a timely way to improve the service provided.

Rating at last inspection and Update: The service was previously inspected on 18 December 2018 and placed into special measures with an overall rating of Inadequate with breaches of regulation. The report for this inspection was published on 8 February 2019.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected: This was a focussed follow up inspection based on the previous rating to review whether those domains rated as inadequate had sufficiently improved.

Enforcement: Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up: The service remains in special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Alexander House Private Nursing Home on our website at www.cqc.org.uk.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

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.

People were at risk of harm as fire safety procedures and checks were not effective and the maintenance of fire doors did not keep people safe from the risks of fire.

People were at risk as the infection prevention and control systems were not effective and did not reflect best practice.

Medicines were not stored safely.

The physical environment did not contain appropriate signage to help people orientate themselves to their surroundings.

People’s individual protected characteristics were not clearly identified.

Staff members did not feel supported by the management team and did not feel there was appropriate guidance on how to provide ‘best care’.

People’s privacy was not always respected.

People’s individual communication needs had not been assessed in line with best practice.

The provider did not have effective systems in place to monitor the quality of the service they provided or to drive improvements where needed.

People had care and support plans which gave staff members the information that they needed to provide care but staff members did not routinely read them.

People felt that the activities that were available were limited and that at times they felt unstimulated.

Staff members had access to training. New staff members completed a structured introduction to their role. However, staff members did not demonstrate the practical application of their training in terms of the support they delivered.

People were referred to additional healthcare services when it was required.

The provider had systems in place to respond to complaints or compliments from people or visitors.

Rating at last inspection: Good (Last report published 22 June 2016). Following significant concerns regarding people’s safety the current rating is ‘inadequate’ overall.

About the service:

Alexander House Private Nursing Home is registered to provide accommodation for persons who require nursing or personal care, treatment of disease, disorder or injury for up to a maximum of 26 people. At this inspection 22 people were living there some of whom were living with dementia.

Why we inspected:

This was a planned inspection based on the rating at the last inspection, ‘Good.’

Enforcement.

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.

Follow up:

We will monitor Alexander House Private Nursing Home and re-inspect as part of our published inspection programme timetable. In addition, we will receive regular updates from the provider on the progress they are making in addressing the concerns we have raised with them.

Alexander House private nursing home is registered to provide accommodation and care for up to 26 people some of whom may be living with dementia. There were 23 people living at the service at the time of our inspection.

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.

Staff had the necessary skills and knowledge to meet people’s assessed needs safely. Staff were well trained and supported. There were sufficient staff who had been recruited safely to ensure that they were fit to work with people.

People told us that they felt safe and comfortable living at Alexander House. Staff had a good understanding of how to protect people from the risk of harm. They had been trained and had access to guidance and information to support them in maintaining good practice.

Risks to people’s health and safety had been assessed and the service had support plans and risk assessments in place to ensure people were cared for safely. People received their medication as prescribed and there were safe systems in place for receiving, administering and disposing of medicines.

The registered manager and staff had an understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). They had made appropriate applications to the relevant authorities to ensure that people’s rights were protected.

People were supported to have sufficient amounts of food and drink to meet their needs. People’s care needs had been assessed and catered for. The support plans provided staff with good information about how to meet people’s individual needs, understand their preferences and how to care for them safely. The service monitored people’s healthcare needs and sought advice and guidance from healthcare professionals when needed.

Staff were kind and caring and treated people respectfully. Families were made to feel welcome and people were able to receive their visitors at a time of their choosing. Staff ensured that people’s privacy and dignity was maintained at all times.

There were good systems in place to monitor the quality of the service although these were not always completed timely.

We thought about what we found and asked the questions that we always ask; Is the service safe, effective, caring, responsive and well-led?

This is a summary of what we found:

Is the service safe?

When we arrived at the service we were asked to sign the visitor's book and our identity was checked. This meant that people were protected from unwanted visitors or others who may pose a risk to their safety.

People told us that they felt safe living in Alexander House. One person said, 'They are all lovely, they know everything I need to make sure I am looked after." Another person said, 'I am very happy and I know that I can tell the staff any worries that I might have."

Staff had received training in safeguarding vulnerable adults from abuse (SOVA), the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). This meant that staff had been given the information that they needed to ensure that people were cared for safely.

Is the service effective?

People told us that they felt that the service met their needs. One person who used the service said, 'The staff are very good and so caring, they help me with anything I need.' Another person said, 'They really look after me."

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure their safety and welfare. The care records were well written and had been reviewed and updated monthly. This meant that staff had up to date information about how to meet people's needs.

Is the service caring?

Staff's interaction with people who used the service was good. They spoke with people respectfully and supported them in a kind and caring way. Staff had a good knowledge of people's likes and dislikes. People told us that all of the staff treated them well. One person said, 'The staff are kind.' Another person told us, "The staff are very good, they help me with anything I need."

People told us that the staff treated them respectfully. People's preferences and diverse needs had been recorded in their care files and care and support had been provided in accordance with their wishes. This showed that people were cared for by kind and caring staff.

Is the service responsive?

People we spoke with told us that the service had been responsive to their needs. One person said, "If I want anything, I only have to ask and the staff and manager will help me."

People were supported to see other professionals such as a general practitioner, community dentist, chiropodist, optician, and district nurse. This showed that people's general health care needs were met and that the service responded to people's changing needs.

Is the service well-led?

People had been asked for their views and opinions on a regular basis. People told us that they received a good quality service. One person said, 'The staff are all very nice and are kind and friendly towards me.' Another said, 'I have everything I want here and my family comes to visit me too.'

People who used the service told us that the staff and manager asked them for their opinions on the quality of the service. We saw evidence of meetings held with staff and residents. This showed that there was an effective quality assurance system in place and that the service was well-led.