Alexandra - Oldham

We found the following examples of good practice.

There was a screening procedure in place for visitors to the home. This included taking people’s temperature and a health declaration.

The building was clean and well ventilated. Cleaning schedules had been enhanced to include more frequent cleaning of touch points such as the nurse call system and door knobs.

Information was displayed throughout the building to remind people to adhere to social distancing measures and to comply with government guidance around wearing PPE. There was an ample supply of PPE for staff and visitors to use. Hand sanitiser was available throughout the service. Staff had received training on the correct use of PPE and hand washing.

People who used the service, staff and visitors were tested for COVID-19 in line with current government guidance. Risk assessments had been completed to assess the impact of COVID- 19 on people and staff. The majority of staff and residents had been vaccinated against COVID-19.

Staff helped people using the service to maintain links with family and friends through the use of social media and phone and video calls. The home had recently re-introduced face to face visiting, in line with government guidance.

The registered manager worked closely with the local authority infection control and community nursing teams.

The Alexandra – Oldham is a residential care home providing personal and nursing care for up to 35 people. At the time of our inspection there were 27 people living at the home.

People’s experience of using this service and what we found

People told us, and we observed staff were kind and caring. People’s privacy and dignity were respected. People were supported to be as independent as possible.

There were systems in place to ensure only staff who were suitable to work with vulnerable people were recruited. Staff received the training, support and supervision they needed to carry out their roles effectively. Some staff had not completed first aid training. This has now been arranged. Nurses received clinical supervision and were competent at nursing procedures, such as wound care and catheterisation.

We received mixed views about staffing levels. However, we did not find any evidence during our inspection that there were not enough staff to provide the appropriate level of support to people.

The home was clean and generally well-maintained, although some parts of the corridors would benefit from being redecorated. There was an on-going redecoration programme. All servicing of equipment had been completed. Correct infection control practices were followed.

Medicines were managed and administered safely. However, the temperature of the medicines room was occasionally higher than recommended for the safe storage of medicines. The registered manager is currently seeking ways to reduce the room temperature.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

There were some opportunities for people to take part in activities to occupy their time and provide enjoyment and stimulation.

Risks to people’s health and safety had been assessed. People’s healthcare needs were being met. The home had referred people promptly to healthcare professionals when any issues or concerns had been noted, such as unplanned weight loss. Equipment was in place to support people to stay well, such as pressure relieving mattresses and cushions, for people at risk of skin breakdown.

People had person-centred care plans in place and staff were knowledgeable about people’s needs. The service provided end of life care. People’s end of life wishes were respected and staff supported the whole family during this difficult time.

People and staff were complimentary about the way the home was managed. Audits were in place to monitor the quality of the service and the environment.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (report published 1 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection on the 25, 26, 28 July and the 15 August 2016 we rated the service as ‘Inadequate' which meant the service was placed in ‘special measures.’ At that inspection we identified multiple regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014, affecting peoples’ safety, well-being and the quality of service provided to people living at the home.

Following the inspection the provider sent us information detailing how the identified breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

At this inspection we found significant improvements and the provider had taken action. As a result of the improvements the service is no longer rated “inadequate” and has moved out of special measures.

Alexandra Nursing Home is situated directly opposite Alexandra Park approximately half a mile from Oldham town centre. Accommodation is provided over three floors which are accessible via a passenger lift. The home has single and double rooms, with some rooms having en-suite facilities. The service is registered to provide the regulated activities, accommodation for persons who require nursing or personal care and the treatment of disease, disorder or injury, for up to 35 people. At the time of our inspection there were 23 people living at the home.

The service had a 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.

Staff had a good understanding of safeguarding procedures and what action they should take if they identified abuse. Recruitment checks had been carried out on all staff to ensure they were suitable to work with vulnerable people in a care setting.

The home was clean and well-maintained and staff had access to personal protective equipment (PPE) to help reduce the risk of cross infection. Environment checks on the building and equipment were up-to-date.

Medicines were safely stored and administered by people who received the appropriate training.

Staff had undertaken a variety of training to ensure they had the correct skills and knowledge required for their roles. Supervision of staff was carried out regularly. This enabled the registered manager to discuss any training and development needs and ensure staff were carrying out their duties safely and effectively.

People were complimentary about the caring nature of the staff and from our observations of staff interactions and conversations with people we saw staff had good relationships with the people they were caring for. A range of activities were available for people to take part in.

People were supported to maintain good health and where needed specialist healthcare professionals were involved with their care.

The service had a complaints procedure in place and people we spoke with felt that any complaints would be dealt with appropriately. People we spoke with made positive comments about the registered manager and about how the home was run.

People living at the home and their relatives were provided with an opportunity to comment on the service through an annual survey. Results of the February 2017 survey were all very positive.

A range of monthly audits were carried out to monitor the service and help maintain and improve the standard of care given at the home.

The Alexandra Nursing home was last inspected in August 2013 and was compliant with the regulations we assessed against at that time.

The service is registered to provide the regulated activities, accommodation for persons who require nursing or personal care and the treatment of disease, disorder or injury, for up to 35 people. At the time of this inspection there were 29 people living at the home.

The Alexandra Nursing home is located ½ mile from Oldham town centre, adjacent to a park and accessible by public transport. There is a secure car park at the rear of the property and maintained gardens to the front.

Accommodation is provided over 3 floors, which are accessible by a passenger lift. Single and double rooms are available, some with an en-suite washing facilities.

Our inspection was brought forward as a result of a Coroner’s regulation 28 report for avoidable deaths. Coroners have a legal power and duty to write a report following an inquest if it appears there is a risk of other deaths occurring in similar circumstances. This is known as a “Report under regulation 28” or “Preventing Future Deaths report”.

We found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, affecting people’s safety, well-being and the quality of service provided to service users. CQC is considering the appropriate regulatory response to resolve the problems we found. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. We may also take other enforcement action proportionate to the seriousness of any shortfalls and breaches at any time, including within the six month timescale of a revisit.

The service had a 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.

The service had a nominated individual. An organisation needs to have a nominated person who acts as the main point of contact for us.

We looked to see how the provider and registered manager had responded to concerns raised by the Coroner in the regulation 28 report issued in May 2016, in relation to staff responding appropriately to people's needs, the administration of medicines, seeking medical attention and the home's admission criteria for residential placements. The registered manager had on receipt of the report attended a safeguarding strategy meeting with the Local Authority to discuss the regulation 28 report. The nominated individual and registered manager confirmed that they had not completed an investigation in relation to the Coroner’s verdict and had not completed an appraisal as to the competencies, skills and fitness of staff to ensure the safe delivery of care. We found that the provider and registered manager had failed to implement all the necessary actions they had identified within the timeframes they had set out in their response to the regulation 28 report. Following the inspection CQC placed conditions on the provider’s registration, to which the provider co-operatively responded to. CQC is considering the appropriate regulatory response to address this concern.

Medicines were not safely managed. The provider did not have fully effective systems in place to ensure the safe disposal of medication. In addition we could not be sure that people using the service received their medicines as prescribed by their General Practitioner (GP).

Staff understood the different types of abuse and were confident in raising concerns with the registered manager. However, safeguarding incidents had not been investigated to ensure the on-going safety of the people involved. Nor had they been reported to the CQC.

Accidents and incidents were recorded but no analyse was being carried out by the provider or the manager.

We found that several people using the service did not have a Personal Emergency Evacuation Plan in place. A PEEP is a document, which advises of the support people need to leave the home in the event of an evacuation-taking place.

On review of staff files we found that some staff did not have adequate references in place to confirm their suitability for the job they had been employed to undertake at the home.

The principles of the Mental Capacity Act and conditions on authorisations to deprive a person of their liberty were not always met.

Following the inspection the provider placed a voluntary embargo on new admissions to the home, to focus on addressing concerns identified.

We found the home to be clean and tidy and relatives we spoke with confirmed this.

People who used the service said that they felt safe and staff were trained to provide them with appropriate support. However, we found that staff were not always appropriately supported and trained in relation to their responsibilities to provide safe care and treatment.

Staff did not always encourage people to make choices for themselves.

We observed some caring and patient interactions between staff and people who used the service.

Complaint and concerns raised by people who use the service and their relatives were recorded, investigated and action was taken in response.

Governance systems for the running of the home were not effective. We found that where issues had been identified, the registered manager had not ensured these were addressed in a timely manner.

At the time of our inspection a new manager had been in post for five weeks. A number of changes were being introduced to the way in which people's needs were assessed, to the planning and delivery of care, and to the environment. One person told us there had been "lots of change but for the better". A member of staff said "as long as it is in the best interests of the residents it's all good".

We found that a refurbishment programme was underway. Those areas which had been redecorated appeared fresh whilst those yet to be completed were tired. As part of the refurbishment new equipment had been purchased and several changes made to use of the available space.

A number of systems were in place to monitor quality of service and to identify and manage any health, welfare or safety risks to service users. The provider had a complaints procedure in place.