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Keychange Charity Alexander House Care Home Good

Reports


Inspection carried out on 25 April 2018

During a routine inspection

Keychange Alexander House 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. The home can accommodate up to 20 people and there were 19 people using the service at the time of our visits.

At the last inspection in March 2017, the service was rated Requires Improvement. We found two breaches of Regulations relating to medicines management and quality assurance. After the inspection, the provider wrote to us to say what they would do to meet the legal requirements.

At this inspection we found the provider had made the necessary improvements to meet the Regulations and had improved to an overall rating of Good.

Why the service is rated Good.

People felt safe living at Keychange Alexander House and spoke positively about the care provided to them. Staff knew people well and treated them with kindness, dignity and respect. Relatives and other visitors were welcomed and people were supported to maintain relationships with those who matter to them. People and their relatives spoke about the friendly staff and the relaxed and homely atmosphere. This was evident on both days we visited.

There were enough staff to meet people’s needs. Some relatives told us they would welcome more permanent staff on duty with the home using less agency staff. Recruitment was on-going at the time of our inspection.

Individual care and support needs were fully assessed, documented and reviewed at regular intervals. A new electronic system for care planning provided an effective tool for staff to do this.

Staff had received training around safeguarding vulnerable people and knew what action to take if they had or received a concern. They were confident that any concerns raised would be taken seriously by senior staff and acted upon.

The service understood and complied with the requirements of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). Staff understood the importance of gaining people’s consent before assisting them. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

There was a system in place for dealing effectively with people’s concerns and complaints.

An experienced acting manager had been in post since November 2017 and acknowledged the service was undergoing a period of change. This included some changes of staff, procedures and job roles. Care staff spoken with were positive about the improvements made.

There were now effective systems in place to help ensure the safety and quality of the service provided.

Inspection carried out on 10 March 2017

During a routine inspection

This service was previously inspected in August 2015 when we found five breaches of legislation, relating to premises and equipment, safe care and treatment, safeguarding people from abuse, good governance and staff training and support. We were so concerned about the service and the people living at the home that we imposed a condition which prevented them from admitting new people until such time as the service had improved.

We returned in March 2016 and found that although there had been some improvements, the service continued to breach legislation which related to good governance and staff support. We issued two warning notices) that required the provider to make the relevant improvements within a set time period and maintained the condition the service could not admit any new people into the home.

In August 2016, we carried out a focused inspection and found the service had improved sufficiently to meet the remaining two breaches of legislation and we therefore removed the condition which had previously restricted new residents. The services’ rating remained at ‘requires improvement’ as we needed to see consistent progress over time.

This inspection took place on the 10 March 2017 and was unannounced. Alexander House is a care home that provides personal care for up to 20 older people, some of whom maybe living with dementia. At the time of the inspection, there were 16 people living at the home and one person was temporarily receiving respite care at the home.

The service did not have a registered manager in post, although it is legally required to do so. 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 regional manager told us the registered manager had recently resigned and the provider was seeking to recruit a new manager as soon as possible. At the time of the inspection the deputy manager was acting up as the manager.

At this inspection we found areas of concern, namely in respect of the storage and the recording of medicines. With regard to the storage, the provider had identified the issue and was awaiting a new metal cabinet but in the meantime, medicines were not stored as securely as they should have been. The recording of medicines was generally satisfactory; however, we noted a number of omissions over a one week period for a person using the service.

The second issue of concern was regarding the general recording of information about people who used the service. We found some areas where records were not complete and contemporaneous, such as an injury to someone who used the service which had not been appropriately recorded. In addition, the lack of a complaints log meant the provider could not easily identify what action had been taken or if there were any patterns or trends.

We identified two breaches of the Health and Social Care (Regulated Activities) Regulations 2014 during our inspection. You can see what action we told the provider to take at the back of the full version of this report.

People told us they felt safe. The provider had completed pre-employment checks, including criminal records checks, to make sure only suitable staff were employed. Staff were knowledgeable about what they needed to do if they considered anyone was at risk of harm.

People received care from staff that were well trained and supported to undertake their roles and responsibilities. There were sufficient staff on duty to meet people’s needs.

Staff were kind and compassionate. They knew people well and could deliver care in line with the person’s wishes. People could participate in a range of activities dependent upon their wishes and were encouraged to maintain contact with friends and relatives.

The provider supp

Inspection carried out on 26 August 2016

During an inspection to make sure that the improvements required had been made

This inspection took place on 26 August 2016 and was unannounced. At the last inspection on 2 March 2016 we found the provider was continuing to breach the regulations in relation to medicines management, good governance and staff training and supervision. We served warning notices in relation to the regulations about good governance and staffing. We also kept in place a condition we had imposed on the provider’s registration after the previous inspection on 26 August 2015 that they were legally required to take into account when providing a service. The condition prevented the provider from admitting and providing personal care to any new people at the service from 5 January 2016.

We carried out this focused inspection to check whether the provider had complied with the warning notices and rectified the legal requirements they were previously breaching. This report only covers our findings in relation to these requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Keychange Charity Alexander House Care Home on our website at www.cqc.org.uk.

This service provides accommodation and personal care for up to 20 people, some of whom may be living with dementia. At the time of our visit there were 15 people using the service. There was a registered manager in post. 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.

At this inspection we found the provider had taken the necessary action to improve medicines management and risks to people from unsafe medicines practices were reduced. People were happy with how they received their medicines. Medicines were stored, administered and recorded safely. There was a variety of safeguards in place to check that medicines were administered and signed for as required. Each person who took medicines had a medicines care plan in place and, where relevant, personalised protocols for taking ‘as required’ (PRN) medicines so staff could support them safely with these. There was a homely remedies policy in place.

The provider had made improvements to the support that staff received to do their jobs. Staff received regular individual and group supervision, including extra sessions when required to address any concerns that were raised. Staff had annual appraisals to assess and discuss their development. There was a training programme in place, covering the knowledge and skills staff needed to work with people currently using the service.

People and staff gave us positive feedback about the registered manager and improvements they had made since our last inspection. There was a range of systems in place to assess, monitor and continually improve the quality of the service. The provider used audits and checks to quickly identify and effectively address shortfalls in the quality of the service. Audits of medicines and other care records allowed the provider to make significant improvements in the quality of record keeping.

The above shows that the provider had made the necessary improvements to meet legal requirements they were previously breaching. As a result we have made a decision to remove the condition we had placed on the provider about not admitting any new people to the home. We have however not changed the rating of the key questions and of the location from ‘Requires improvement’ to ‘Good’, because to do so would require consistent and sustainable improvements at the service over time.

Inspection carried out on 2 March 2016

During a routine inspection

We undertook this inspection on 2 March 2016. At our previous inspection on 26 August 2015 the service was in breach of five regulations, relating to; premises and equipment, safe care and treatment, safeguarding people from abuse, good governance and staffing. We had serious concerns regarding the provider’s failure to meet legal requirements in relation to the safe care and treatment of people and in response to this we imposed a condition on the provider’s registration that they were legally required to take into account when providing a service. The condition prevents the provider from admitting and providing personal care to any new people at the service from 5 January 2016. After the inspection, the provider wrote to us to say what they would do to meet the legal requirements. As part of this inspection we checked that they now met legal requirements.

Keychange Charity Alexander House provides accommodation for older people who require support with their personal care, some of whom also have dementia. The service can accommodate up to 20 people. At the time of our inspection 17 people were using the service. The majority of people using the service funded their own care.

At our previous inspection the service did not have a manager in post. A new manager was appointed in September 2015 and was in the process of becoming the service’s registered manager. 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.

Systems and processes in place to review, monitor and improve the quality of service provision were not sufficiently robust. Audits and reviews had been undertaken which had identified improvements were required to improve the quality of care provision. However, sufficient action had not been taken to address the concerns identified, particularly in regards to medicines management and care records.

Accurate care records were not maintained. Care records were missing some key documents, provided conflicting information about people’s support needs and were not updated in response to incidents that occurred and changes in people’s support needs.

The provider’s system for reviewing training provision had identified that many staff had either not completed the required training that the provider considered mandatory for their role or had not completed refresher training. This meant there were risks that staff’s skills and knowledge were not up to date and in-line with good practice. The provider’s systems to formally support staff were not consistently implemented. There were inconsistencies in supervision arrangements and staff had not received an appraisal.

Safe medicines management processes had not been maintained. There were some discrepancies in stock balances, there were no protocols in place to instruct staff when to administer “when required” medicines, and the homely remedies protocol had not been updated to include everyone at the service.

We saw that improvements had been made to ensure a safe and secure environment was provided. All windows had the appropriate restrictions in place, and fire exit doors had been linked to the fire safety system. Equipment had been maintained and serviced to ensure it was in safe working order. Processes were in place to review health and safety in relation to the environment and equipment used.

Staff were aware of their responsibilities to safeguard people from harm. All concerns were reported to the manager, who liaised with the local authority safeguarding team to ensure appropriate management and protection plans were in place to minimise the risk of harm to people.

People were involved in decisions about their care and consented to the support provided. Staff adhered to the princ

Inspection carried out on 26/08/2015

During a routine inspection

We carried out an unannounced inspection of this service on 26 August 2015. At the last inspection on 3 July 2015 we found the provider did not have effective arrangements to manage risks relating to the premises and people using the service. In addition, the provider had not ensured that items of equipment were being appropriately serviced and maintained to make sure people and others were protected against risks associated with equipment and the premises. We found the service to be in breach of the regulations regarding the safety of the premises and safe care and treatment. We served a warning notice in relation to safe care and treatment which contained requirements for the provider to meet by 26 July 2015. At this inspection we checked whether the provider was now meeting the requirements of the warning notice as well as other legal requirements providers have to meet. We did not fully inspect the requirement relating to safety of the premises because timescales to be compliant as per their action plan had not been met. We will inspect fully against this requirement at our next inspection.

Keychange Charity Alexander House is a care home for up to 20 older people, some of whom have dementia. There were 19 people using the service at the time of our inspection.

There was no registered manager in post at the time of the inspection. They had left the service in May 2015. The Deputy Manager was managing the service with the support of the area manager. The deputy manager told us a new manager had been recruited and was due to start in September 2015. 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.

At this inspection we found the provider had not met the requirements of the warning notice. The action the provider had taken to keep people safe was insufficient and people remained at risk from harm due to leaving the home via unsecured fire doors. In addition people were still at risk of falling from a height due to inappropriate window restrictors being fitted on some windows.

Risk assessments and risk action plans were not always robust. Some risk assessment action plans, such as those for pressure ulcers and malnutrition, did not contain sufficient detail about how identified risks would be mitigated by staff. However, while risk assessments did not fully address the support people required with the risks of malnutrition we found people received the right support when staff were concerned they were at risk of malnutrition.

Staff understood the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them. However, the service was not meeting their requirements to keep people safe under DoLS because they had not identified that a person had restrictions on them which could have amounted to them being deprived of their liberty. As the provider had not recognised this they had not applied for authorisation to deprive them legally. Previously, the provider had applied for DoLS for other people using the service in the correct way.

People felt safe and staff understood the signs people may be being abused and the action to take when they were concerned as they had received training in this. However, the provider did not always take the necessary action to keep people safe when alleged abuse between people using the service occurred. In addition accidents and incidents were not always clearly recorded to evidence people received the right support or to look for patterns and trends so action could be taken to prevent reoccurrence.

The provider did not have effective governance systems because they had not been able to make the improvements necessary to meet the requirements of the warning notice. Audits to assess, monitor and improve the quality of the service were not always adequate as they had not identified the breaches of legal requirements we found during this inspection.

There were not always enough staff deployed to meet people’s needs in keeping them safe in the home and in meeting other needs.

The service recruited staff robustly as they checked staff were safe to work with people. Staff received sufficient support through supervision and appraisal to ensure they could do their jobs appropriately. There was a training programme in place and staff received the right training to carry out their roles effectively.

People had choice in the food and drink they ate. People also received the right support from staff to maintain their health with access to the various healthcare services they needed.

People were treated with kindness, dignity and respect and staff knew the people they were caring for. Information about people’s life stories and preferences was gathered by the provider so staff could refer to this in understanding and supporting them in the ways they wanted. People were supported to maintain relationships with those that mattered to them as relatives and visitors were welcomed and encouraged. People were supported to take part in activities they were interested in and their spiritual and religious needs were catered for.

The provider kept people, their relatives and staff up to date with information about the service. However, the service did not always actively gather feedback from these parties as part of monitoring and improving the service. People knew how to complain and a suitable complaints system was in place.

At this inspection we identified four breaches of regulations. In relation to the breaches of regulations for safeguarding people, staffing and good governance, you can see what action we told the provider to take at the back of the full version of the report. Because of our serious concerns in relation to the breach of regulation about the safe care and treatment of people we took enforcement action which you can also read about on the back of the full version of the report.

Inspection carried out on 03/07/2015

During an inspection to make sure that the improvements required had been made

We carried out an unannounced focused inspection of this service on 3 July 2015. At the last inspection on 11 July 2014 we found the service to be meeting the regulations we inspected.

We undertook this focused inspection to check whether the service had appropriate systems to manage risks to help ensure the safety of people, staff and visitors following a serious incident the provider notified us of. This report only covers our findings in relation to this. You can read the inspection reports from our previous inspections, by selecting the 'all reports' link for Keychange Charity Alexander House on our website at www.cqc.org.uk

Keychange Charity Alexander House is a care home for up to 20 older people, some of whom have dementia. There were 19 people using the service at the time of our inspection.

There was not a registered manager in post at the time of the Inspection. They had left a few weeks prior to us visiting the home. The Deputy Manager was managing the service with the support of the area manager while a new manager was being recruited. 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.

During the inspection we found the provider had not taken sufficient action to keep people who required supervision outside the home safe from leaving by themselves and coming to harm. We also found risks relating to the premises were not always well managed. In addition, the provider had not ensured that items of equipment were being appropriately serviced and maintained to make sure people and others were protected against risks associated with equipment and the premises. These issues were breaches of regulations and you can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 16 July 2014

During an inspection to make sure that the improvements required had been made

During our last inspection of the service on 24 April 2014, we identified the provider had not taken proper steps to ensure that each person who used the service was protected against the risks of receiving care that was inappropriate or unsafe. We found people's health and care needs were not always assessed properly and documented accurately in their care plans and risk assessments. We also found people and staff were not protected from unsafe moving and handling systems.

Following that inspection we asked the provider to take action to achieve compliance with the appropriate regulation. The provider sent us an action plan on 4 July 2014 setting out the steps they had taken to do this. During this visit we checked these actions had been completed.

This visit was carried out by a single inspector who helped answer two of our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, from looking at records and from speaking with the team leader on duty. We also spoke with two carers and a member of the domestic staff team. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found at this visit the provider had taken appropriate steps to protect people from the risks of unsafe or inappropriate care. Staff had received appropriate training to protect people from unsafe moving and handling practices. Staff had also received training in supporting people whose behaviours may be challenging and could put them at risk.

Risk assessments had been reviewed and there was appropriate guidance and support plans in place for staff. This helped to ensure people were protected from risks to their health, safety and welfare.

Is the service effective?

People's health and care needs had been reassessed and documented and we saw where people�s needs had changed, senior staff took appropriate action to ensure the home could effectively meet the needs of people using the service.

Inspection carried out on 24 April 2014

During a routine inspection

This inspection was carried out by an Inspector who helped answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with eight people using the service, four of their relatives, the manager and deputy manager, thirteen staff including 9 care workers and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

There was a Deprivation of Liberty Safeguard in place for one person using the service at the time of the inspection. We saw that this had been made in the best interests of the person, and at the right level, by the local authority. Relevant staff had been trained to understand when an application should be made, and how to submit one. This meant that systems were in place to safeguard people.

Systems were not always in place to make sure that staff learned from events, such as incidents of behaviours which challenged the service. People�s needs, for example relating to moving and handling, were not always managed effectively. This meant that people using the service and staff were not protected from unsafe moving and handling systems.

We found the home to be clean, however, most staff we spoke with told us that there had been difficulties in keeping the home clean on weekends since around August 2013. There had also been difficulties recruiting to the weekend domestic role. However, we saw that the manager had recently taken action to improve the situation, such as employing agency cleaners.

Is the service effective?

People told us that they liked the food, and we saw that they received nutrition and hydration to meet their needs. People�s health and care needs were not always assessed properly and documented accurately in care plans and risk assessments. There were therefore risks that people might not get the care they needed because comprehensive care plans were not available to support staff consistently to meet people�s needs, particularly if they were bank or new staff working at the home.

Is the service caring?

Regular staff knew the needs of people who used the service well. People who used the service made positive comments about the staff, as did the family members we spoke to. People who used the service told us that they liked living here. One relative told us, �It�s marvellous here, they look after [my relative] well.� We saw staff responding to people in a respectful way and respecting people�s privacy.

Is the service responsive?

The manager had responded well to a fire enforcement notice, and within four months of receiving it had met all the requirements. The operations manager visited the home regularly to assess quality within the care home. The manager told us how improvements were made and where weaknesses were highlighted from these reports.

Is the service well-led?

We found that the manager had appropriate arrangements in place to respond to complaints and where people had complained, the provider had taken action to resolve complaints appropriately. The service had systems in place to seek the views of staff about the care of people using the service. However, five staff we spoke with did not feel that the providers did not have sufficient regard to their views and experiences.

Inspection carried out on 3 July 2013

During a routine inspection

We spoke with five people using the service. One person told us, �They treat me very well. They are kind.� Another person told us, �I have no complaints really. They look after me very well.�

We also spoke with five visitors who spoke positively about the care provided at Alexander House. One visitor said, �I think it�s absolutely wonderful.� Another visitor told us, �The manager and the staff are very helpful. I always feel welcome and I am involved in whatever is going on.�

We found that people using the service, or people acting on their behalf, were involved in the planning of care and treatment. Care and treatment was planned and delivered in line with their individual care plans.

We found that there were appropriate arrangements in place for the management of medicines and a satisfactory procedure for dealing with complaints. We noted improvements in training and supervision of staff.

Inspection carried out on 13 February 2013

During a routine inspection

During our visit we spoke with seven people and overall they expressed satisfaction with the care and treatment provided.

They made positive comments about their life at Alexander House. People said to us, �I�m perfectly happy, I like it here.� and, �It�s really nice here. I don�t have to do anything, they do it all for me.� A regular visitor said, �The home is marvellous, it really is.�

We observed staff talking to people in a friendly and inclusive manner. We saw that staff respected people's privacy and dignity.

However, although most people said they were happy with the care and support at Alexander House we found that the provider did not have adequate systems in place to ensure that staff were appropriately trained.