We undertook this unannounced inspection to Queen Alexandra Cottage Homes on 3, 5 and 6 April 2018. At our previous inspection in November 2015 we rated the service good. However, we found people’s records did not always reflect the care and support they needed. We asked the provider to make improvements in relation to this. At this inspection we found improvements were still required to ensure people’s records reflected their care and support needs.Queen Alexandra Cottage Homes is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Queen Alexandra Cottage Homes accommodates up to 28 older people in one adapted building. At the time of the inspection there were 24 people living there. People were living with a range of complex health care needs which included diabetes and Parkinson’s disease. Queen Alexandra Cottage Homes is a nursing home run by a charity. Accommodation was provided over two floors with two passengers lifts that provide level access to all parts of the home. The home was part of a complex, which includes independent living flats and bungalows, however these are not regulated or inspected by CQC.
There was a registered manager at the service, who was known as Matron. 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.
Improvements were needed to ensure people’s care plans reflected the care and support they needed. Although staff knew people really well the lack of detailed care plans for some people meant they were at risk of inconsistent care. The registered manager was well thought of by people, visitors and staff. She was supportive to staff and had a high profile in the service. However, improvements were needed to ensure the culture was positive between staff and the provider. These issues had been identified and action was being taken to address them.
Quality assurance systems were in place. These identified where improvements were needed across the service. Actions plans were in place to demonstrate what was needed to address the shortfalls.
People were protected from the risks of harm, abuse or discrimination because appropriate safeguarding procedures were in place. Staff knew what steps to take to ensure people were protected from the risks They were aware of their individual responsibilities in relation to reporting concerns.
There were enough staff, who had been safely recruited, to meet people’s needs. Staffing levels were reviewed regularly. There were systems in place to ensure medicines were ordered, stored administered and disposed of safely. Individual and environmental risk assessments were in place. Staff had a good understanding of people’s needs and the risks associated with supporting them. They knew what action to take keep people safe.
People are 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. There was a complaints policy in place and people and visitors told us they would raise any concerns with staff.
Staff had received the training they needed to support people and deliver care in a way that responded to people's changing needs. They received regular supervision and appraisal.
People were provided with a choice of food and drink throughout the day and were supported to maintain their nutritional and hydration needs. Their health was monitored and staff responded when health needs changed. People's individual needs were met by the adaptation of the premises.
People’s privacy and dignity were respected. Staff knew people well. They had a good understanding of them as individuals, their needs and their choices. People were and treated with kindness, understanding and patience. Staff cared about the people they looked after and supported them to make their own decisions and choices.
Staff knew people really well and people received care that was person centred and met their individual needs. People were able to take part in a variety of activities each day. They told us they were never bored and had enough to do each day. Activities were meaningful and reflected people’s interests and hobbies.
There was a genuine commitment by all staff to ensure people received excellent care and support during their final days. This was supported through the Gold Standard Framework.