Alexandra Nursing Home - Poulton-le-Fylde

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk people could be harmed.

The service was in breach of legal regulations in relation to the ways people’s medicines were managed safely and staff deployment and training.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a proactive and positive culture of safety. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

When incidents had occurred, the registered manager was transparent with people. When concerns had been raised during this assessment, the registered manager had immediately shared these with staff and acted to mitigate the risk.

The provider had introduced a new software system for audits and action plans. The group quality and compliance manager sent weekly audit outcomes to the registered manager, director and community managers. There was also a governance tracker to monitor audits of falls, weights, wounds, hospital admissions, deaths, infections, CQC notifications, and complaints. The wounds information was incomplete. We looked at accident and incidents and saw when they had occurred appropriate documentation completed, suitable action taken to mitigate further risk and information shared discussed with people, families and staff.

We saw evidence of the community manager responding to and acting on complaints in a timely way and using the duty of candour.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Where people needed to be lawfully deprived of their liberty to keep them safe, the provider ensured a deprivation of liberty safeguard (DoLS) was applied for through the relevant local authority. Staff had knowledge of who had restrictions in place.

Staff had received safeguarding training and knew how to identify and who to inform if they had any concerns.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Where people needed to be lawfully deprived of their liberty to keep them safe, the provider ensured a deprivation of liberty safeguard (DoLS) was applied for through the relevant local authority. Staff had knowledge of who had restrictions in place. However, we observed due to staffing concerns these were not always upheld. On day 2 of our assessment, we observed one person’s one to one support was not in place on 2 occasions . We shared this with the registered manager who was able to resolve the concern on the second instance.

Staff had received safeguarding training and knew how to identify and who to inform if they had any concerns.

The provider worked with people to understand and manage risks. Staff provided care to meet people’s needs that was supportive and enabled people to do the things that mattered to them.

However, care plans and risk assessments did not always include consistent information or guide staff how to manage risk or escalate concerns. One person had contradictory information in their care plan. Documentation required to manage the risks related to safe skin care and the use of ‘as and when required medicines’ was not completed or fully completed. This meant people were at risk of not having their needs met safely.

Although the provider had systems to record and monitor people’s behaviours, daily notes and behaviour charts were not always completed effectively by staff. When presented with distressed behaviours staff did not consistently record specific behaviours, any triggers to the behaviour, who else was involved and what strategies were used to support people. This meant staff could not learn from the incident to better support the person in future.

On day 2 of our assessment, we observed one person’s one to one support was not in place on 2 occasions, this placed people at risk of avoidable harm. We shared this with the registered manager who was able to resolve the concern on the second instance. There was no evidence one to one support was not available on other days.

We saw examples of people being supported to take managed risks to maintain their chosen lifestyle choices. However, not all the associated risks had been explored and mitigated. We shared this with the registered manager who took immediate action.

Staff had good knowledge about people’s needs and risks and could provide the right level of care and support to help someone if they experienced distress. Staff could access assessments easily in people’s care records using handheld devices.

The provider made sure equipment, facilities and technology supported the delivery of safe care, however there were not effective fire procedures in place.

Staff supported people on ground middle and top floors of Alexandra Nursing Home. There were people nursed in bed and due to their lack of mobility would require support to evacuate the home in an emergency. Not all staff had received training in the use of evacuation sledges. Those that had received training, were designated fire marshals and may not have used the sledges in the event of an emergency evacuation. They would be at the fire panel co-ordinating staff to deal with the emergency. This meant people were at risk of avoidable harm by not receiving suitable timely support to maintain their safety. The registered manager took immediate action to ensure staff received evacuation training.

Staff had good knowledge of fire safety procedures, and every person had a personal emergency evacuation plan (PEEP). The purpose of a PEEP is to ensure that all people can evacuate the building safely and promptly in the event of an emergency, regardless of their level of mobility or other health conditions.

Equipment was available and well maintained to meet people’s needs. We saw evidence fire equipment, lifting equipment and electrical safety checks were completed as required by regulation.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They were unable to make sure people consistently provided safe care that met people’s individual needs across the whole home.

There were not always enough suitably skilled staff deployed to meet everyone’s care needs. We observed one person did not receive their one to one support from staff as the staff member was also providing support to 2 people to eat their lunch. They also supported a third person to maintain their dignity when they became distressed. Later the same day, we observed the same person who required one to one support eating alone at the table. Their allocated staff member was not in the room. The registered manager took immediate action when it was brought to their attention.

On day 2 of our assessment, we observed 1 community was short staffed. The drinks and snacks trolley never appeared as breakfast was still being served. Daily notes for that day indicated 1 person had not received breakfast. The registered manager told us it was, “Unacceptable.” One staff member said staffing levels were regularly low and, “People are receiving the bare minimum at the moment.” A second staff member said, “There's a person with a pressure sore on her back upstairs and she's not having regular turns (repositioning). We looked at repositioning records and these were not consistently completed. This information was shared with the registered manager and nominated individual.

The provider did not always assess or manage the risk of infection, and they did not always detect and control the risk of it spreading.

There were dedicated housekeeping staff who had cleaning schedules to follow. However not all areas of Alexandra Nursing Home were clean. One laundry and one communal bathroom required a thorough deep clean to reduce the risk of people contracting infections. One stairway was visibly unclean and 2 sets of double doors on 1 community required repainting. One leather sofa had a ripped seat and ripped arm rest. A torn sofa and chipped paintwork and exposed wood can harbour bacteria. This placed people at risk of avoidable harm as a dirty environment significantly increases the risk of infections due to the presence of bacteria and viruses. The registered manager took action that included disposal of the sofa.

At the time of our assessment visit, 1 community was experiencing an infection outbreak. There were safeguards to restrict the spread of infection. However, we observed when staff were delivering breakfasts to people in their rooms, they had seven uncovered meals on a trolley in areas where infections were present. Meals left out for too long may develop harmful bacteria due to a drop in food temperature.

The provider was in the process of recruiting a new head of housekeeping. The registered manager took immediate action and reviewed and updated the cleaning schedules.

The Alexandra Nursing Home had a food hygiene rating of 4 out of 5. This meant hygiene standards in the kitchen were good. Staff had access to personal protective equipment, and we observed staff using this appropriately.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

People did not always receive their medicines as prescribed. For people on medicines with a variable dose we found they did not always receive the correct dose. People prescribed time critical medicines did not always have these administered at the prescribed time and for two people we found the recommended 4-hour time interval between paracetamol doses had not been observed. We could not be assured people in the service received their medicines as prescribed.

Medicines were not always stored in line with the services policy. We found medicines waiting to be destroyed were not always stored appropriately.

Peoples care plans did not always contain the information needed for staff to manage someone’s condition. We found for one person prescribed two laxatives there was not enough information for staff to know when to administer. This meant we could not be assured medicines were given appropriately.

For people who had their medicines administered covertly hidden in food and drink there were plans from a healthcare professional which would aid staff to give medicines in this way safely. However, staff told us they did not always follow these plans so we could not be assured medicines given in this way were given safely.

The service provided information that showed not all staff had completed training for their role in managing medicines, although all had their competency assessed. For people prescribed medicine patches there was a record kept of where this was applied to the body. However, staff did not always follow the manufacturer’s instructions on where to place or rotate the patch. This meant people may be at risk of side effects from their medicine or the medicine not being absorbed correctly. The registered manager and nominated individual took immediate action to address these concerns.

Controlled drugs were stored, recorded, administered and disposed of safely. There was effective oversight of their handling in line with current legislation and guidance.