Archived: Princess Alexandra House

Following our inspection we received an action plan from the provider that told us processes were in place that ensured compliance with this standard. This inspection was carried out to check that the home had complied with the compliance action made at our previous visit. We read three care records in detail, which showed us how the service was working with people who presented risks in respect of pressure area care, nutrition and hydration, and mental health issues. We spoke with the deputy manager, a member of care staff and a person who lived in the home. We spoke with the provider, who is also manager, by telephone during the inspection.

We found the home had updated and improved its risk assessment and care planning processes. This included provision for regular meaningful reviews of people's care needs and evaluation of how the service was meeting these. A member of staff told us the care plans gave them the information and guidance they needed to provide for people's individual care needs. We saw that people were protected from risks of pressure damage. People's needs related to physical and mental health conditions were identified and planned for, using external professional advice and guidance appropriately.

When we inspected this service on 29 August 2014 we found the home's statement of purpose had not been updated to reflect the range of needs they supported, and how people's health needs would be maintained and monitored by the service. We asked the provider to review their Statement of Purpose and supply a copy to the Commission, which they have done.

We spoke with seven people who lived at the home and a visiting relative. During the inspection, we spoke with the provider, manager, deputy manager, care staff and the chef. We also obtained feedback from the local authority after the inspection.

Below is a summary of what we found. The summary describes what people who lived at the home told us, what staff told us, what we observed and the records we looked at. If you want to see the evidence supporting our summary please read the full report.

Is it safe?

Care staff had a comprehensive understanding of the Mental Capacity Act 2005 (MCA). Before people received care, staff obtained consent and acted in accordance with the person's wishes. People were supported and enabled to make day to day decisions. Observations of care found staff provided people with sufficient information to make informed decisions and respected their decisions made.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). This is where restrictions may be placed on some people to help keep them safe. While no DoLS applications had needed to be submitted, we found that suitable policies and procedures were in place. People's freedom was not restricted in any manner. People were seen freely coming and going from the home as they pleased.

People received care in an environment that was clean and tidy. The home employed a dedicated cleaner who maintained high standards of cleanliness. A dedicated infection control lead was in post that monitored and improved standards of infection control at Princess Alexandra House.

Is it effective?

Care plans had been devised and developed. However, we found that people's health needs had not been factored into the planning of their care. Therefore guidance and support was not recorded or available to care staff. A compliance action has been set for this and the provider must tell us how they plan to improve.

For people experiencing mental health needs, risk assessments did not sufficiently detail their needs. The support required to manage their mental health or any triggers which may cause their mental health to relapse. A compliance action has been set for this and the provider must tell us how they plan to improve.

People's health needs were not monitored by the home. For people with diabetes, the home did not monitor people's blood sugar levels or have an awareness of what their normal blood sugar level should be. Where risks of dehydration or poor nutritional intake had been identified, we could not see how staff were monitoring the person's nutritional intake. A compliance action has been set for this and the provider must tell us how they plan to improve.

Is it caring?

Care records contained personalised information which helped staff to know the people they supported. People told us that the staff treated them well, were kind and friendly.

Observations of staff interactions saw that staff clearly knew people living at the home and had built rapports with people.

People were dressed in accordance with their own wishes. People had their hair neatly done. Women had their jewellery and make up on as they so wished. Rooms were made individual to the person. We saw that people had their pictures and ornaments around them.

Is it responsive?

People's needs had been assessed before they moved to Princess Alexandra House. This meant that the home had the skills and facilities to meet their identified needs.

Information was available on how to make a complaint and people told us they would feel happy approaching staff with any concerns.

People were encouraged to give their views and opinions on the running of the home and the home encouraged this. People's views were listened to and the home acted upon any feedback received.

Is it well-led?

The home had quality assurance systems intended to monitor and improve the service provided. Monthly and six monthly audits were completed. Where any shortfalls were identified, a plan of action was implemented.

Staff spoke positively of management and the provider. Staff received regular supervision and training. This ensured staff had the skills and knowledge to provide care that meet people's needs.

We have asked the provider to review its Statement of Purpose and make it clearer to people who use the service what types of care they provide and how they intend to provide this care.

One person we spoke with told us 'I have a lovely big room and the staff are so caring'. Another person who used the service told us 'I have everything I need, I am happy here'.

Staff we spoke with felt supported in their roles and enjoyed working at Princess Alexandra House. One member of staff told us 'we are caring and make sure people have choices'. Another member of staff told us 'I would put my own family here, we work in a great care home'.

We also looked a care plans, risk assessments, staff records and policies and procedures.

People's needs had been assessed and care and treatment had been planned and delivered in line with their individual care plan. Care plans contained detailed guidance for how the care should be provided. Care and support plans we saw were clearly based on people's preferences.

People we spoke with spoke highly of care workers and the care delivery at the home. They told us that they had been treated with dignity and respect and had spent their time as they chose.

One person told us "The girls here are wonderful" "I consider them friends, I respect them and they respect me for who I am."

Another person told us"The girls came straight away when I needed to use the call bell." "They organised for me to see the doctor when I wasn't well."

People who use the service had been protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People who use the service, their representatives and staff had been asked for their views about their care and treatment and they were acted on.

People were cared for by staff who had been supported to deliver care and treatment safely and to an appropriate standard.