Alexandra Nursing Home - Poulton-le-Fylde

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to the governance at the service.

This service scored 57 (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 had introduced new processes seeking to embed a positive culture to ensure the service was well led. They had previously been unable to maintain a good rating in this key question. The provider showed they now had a shared vision, strategy, culture and an understanding of the challenges and needs of people they supported.

The management team were working to change the culture of the service. This included organisational changes, the introduction of new systems and processes, addressing poor practice and driving improvements. Since our last visit there had been a new registered manager and nominated individual. A staff member commented, “[Registered manager] she's what the home needed. [Registered manager] has made positive changes.”

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively.

All the staff we spoke with felt supported by the management team and directors. They felt the community managers were visible within the home and modelled positive, nurturing behaviours.One staff member told us, “There is good teamwork, lovely staff who are supportive and the community manager, says things in a supportive manner.”

The provider sought to foster a positive culture where people felt they could speak up and their voice would be heard.

Staff were aware of their right to speak up and most were confident community managers would listen if they did so. However, some staff did not believe management would always act when they shared concerns about staffing levels. One staff member told us they would share any

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The provider had policies and procedures around equality, diversity and inclusion. Staff felt the management team considered their equality, diversity and inclusion and treated people equally and fairly.

The provider failed to have clear systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes.

The providers systems to monitor medications had not identified the concerns we found related to variable dose medicines, administration of time-based medicines, lack of information about the administration of thickened fluids and the administration of topical creams. Medicines audits had not identified when covert medicines had been wrongly administered. This indicated the provider did not have effective processes established to provide oversight on the management and administration of prescribed medicines.

The provider carried out environmental audits which demonstrated equipment and environments were safe, but not whether staff had the training to use equipment available in the event of a fire. The providers system to ensuring care plans were regular updated and reflected people’s current needs had not identified the concerns we found at this inspection. They failed to identify some staff responsible for the management of medicines had not received training.

Management had clear responsibilities, roles, systems of accountability . New quality assurance systems were in place and were being assessed and modified when required to give greater oversight of the service. This was a work in progress.

To improve processes the quality and compliance manager now met with managers from all the providers homes weekly. They spoke about how inter-organisational learning could be supportive to each other and drive improvements in people’s experiences. They spoke about the importance of celebrating success and recognising staff contribution.

Audits and checks were carried out to ensure the environment was safe. Fire, gas, electrical and water safety checks were carried out in line with guidance and issues identified were resolved. Audits and checks carried out on equipment used to support people with their care were effective. concerns with the senior carer or the community manager.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

Management and staff worked closely with relatives, health and social care agencies, the local authorities and us (CQC) to drive improvement and meet people’s needs. Records we viewed and our experience of transparent conversations with the management team and information sharing confirmed this.

The provider focused on continuous learning and innovation across the organisation. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They did not always embed safe effective practices shared from regulatory feedback.

We have found repeated concerns at consecutive assessments. However, the current management team understood how to make improvements happen. When we have shared concerns found at this assessment, the registered manager and nominated individual have acted responsively implementing action plans to address the concerns.

The provider was waiting on the installation of smart lamps in some bedrooms to monitor people’s safety and wellbeing. The lamps can alert staff if people get out of bed or fall and the motion sensor lighting can prevent disorientation, trips and falls. The registered manager told us they were looking forward to the lamps being installed and hoped to see a significant reduction in falls.