This inspection visit took place on 22 and 24 August 2017 and was unannounced. At the last inspection in July 2015 the service was rated Good. At this inspection we found the service Required Improvement.
The Alexandra Nursing Home is a listed building and stands in its own grounds on the outskirts of Poulton-le-Fylde. The service has their own car parking facility within the grounds. The service has three separate units that provide nursing care and support for people who live with dementia. There is lift access to the two floors in the main building. Alexandra Nursing Home is registered to provide care for 117 people.
During this inspection we made recommendations for the management team to improve people’s safety and welfare. These issues related to safe medication recordkeeping, care plan information for people who lived at the home and recruitment procedures. In addition we recommended the management team continued to develop their quality assurance systems to ensure the home was continuously monitored.
When we undertook our inspection visit the manager had applied to be registered with the Care Quality Commission. 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 manager informed us the process was ongoing and the registration team at CQC was processing the application. The manager is already a registered manager with another location within the organisation.
We found medication procedures at the home were not consistently safe. However the new management team was in the process of implementing more robust systems in relation to medication procedures. Medicines were safely kept with appropriate arrangements for storing in place. However recording systems required improvement to ensure people received their medication correctly and on time.
We have made a recommendation about safe medicine procedures.
Care plans had changed and were altered by staff. However they were not identified as to who changed and updated the care plan. This could cause concerns if problems occurred in a person’s care and the management team were unable to identify the staff who changed the caring support. Although care plans were up to date we saw gaps in information which put people at risk of unsafe care. The management team had started to implement new care plan documents to ensure all care and nursing information was in place for staff to support people with their assessed needs as required.
We have made a recommendation about record keeping.
Recruitment procedures required improvement and this had been identified by the management team and additional administration staff were now in place. However one record had not explored gaps in employment and two records did not contain photographs of the new staff member. These checks were required to reduce the risk of employing unsuitable staff to work with vulnerable people.
We have made a recommendation about recruitment.
New auditing systems had recently been introduced and improved. However audits had not identified issues that had we had highlighted during this inspection visit. For example care plan audits did not always identify any mistakes and ensure people who lived at the home were kept safe.
We have made a recommendation about efficient monitoring and quality assurance systems.
Staff told us the management team were supportive in their work and approachable should they wish to discuss any issues. They felt part of the team to improve the home for people who lived at the Alexandra Nursing Home.
Staff spoken with had received safeguarding training and understood their responsibility to report unsafe care or abusive practices.
We looked around the building and found it had been maintained, was clean and hygienic and a safe place for people to live. We found equipment had been serviced and maintained as required
We observed staff providing support to people throughout our inspection visit in all three units. We saw they were kind and patient and treated people with dignity and respect.
Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and social needs.
Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. A staff member said, “We are getting there with care and risks assessment plans, the new ones are much better.”
People who lived at Alexandra Nursing Home told us they had choices of meals and there were always alternatives if they did not like what was on the menu. We observed at lunchtime in all units people who required support were attended to in a sensitive, caring manner. Comments about the quality of food included, “The food is very good. “ And, “The food is good we do get a choice.”
People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.
People who lived at the home told us staff were all caring, kind and respectful. Relatives also commented in surveys how caring staff were.
Staff knew people they supported and provided a personalised service in a caring and professional manner.
The service had a complaints procedure which was made available to people on their admission to the home and their relatives. People we spoke with told us they were happy and had no complaints.
The manager used a variety of methods to assess and monitor the quality of the service. These included, staff and resident meetings. In addition relative surveys were collected to seek their views about the service provided.