Archived: Alexandra House - Eastwood

About the service

Alexandra House is a care home providing personal and nursing care for 25 people, some of whom were living with dementia, at the time of the inspection. The service can support up to 38 people in one adapted building across two floors. At this inspection we found improvements had been made and the home was no longer in breach of regulations.

People's experience of using this service and what we found.

Robust systems were in place to ensure people received their medicines when they required them, this included time specific medicines.

Risk assessments contained detailed information to keep people safe. Falls management was monitored and analysed to note themes, trends and when other professional involvement was required.

We were assured the provider was following infection control guidelines.

Systems were in place to ensure staff were deployed for people to receive effective care and treatment. However, we had mixed comments from people and staff with regards to the level of staff at busy times.

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.

The management team showed leadership and were clear about their roles. They were open and honest and we received positive feedback on the management of the service.

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

Rating at last inspection and update

The last rating for this service was Requires improvement (25 August 2022) with three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We last inspected the service in August 2022 and at that time we had concerns regarding storage of medicines, infection control, managing risks to people, staffing levels and governance of the home. Alexandra House was rated required improvement overall.

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Alexandra House Eastwood on our website at www.cqc.org.uk.

Follow up

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

Alexandra House is a care home providing personal and nursing care for 26 people, some of whom were living with dementia, at the time of the inspection. The service can support up to 38 people in one adapted building across two floors.

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

Medicines were delivered correctly on the day of our inspection; however, systems and storage were not always safely managed. Some people did not receive their medicines in a timely manner. Risk management was not always effective. The care plan reviews system did not always reflect people’s needs. Temperatures checks were not accurate and people were at risk of scolding. We were not always assured Infection control policy and procedures were accurate and up to date. Staff were not always following current guidelines for wearing personal protective equipment (PPE). Staffing had increased, but we were not assured staff were deployed effectively. Systems were in place to protect people from abuse and harm. The provider was not always working in the principles of the mental capacity act and did not always record it correctly.

People were not always supported to have maximum choice and control of their lives. Staff did not always support people in the least restrictive way possible and in their best interests.

There was lack of management oversight. General Data Protection Regulation (GDPR) was not always adhered too, as people’s personal information was not stored safely and correct. Incident and accidents were regularly monitored. Staff knew people well. The new manager was supported by senior management to implement an action plan to drive improvement.

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

Rating at last inspection and update

The last rating for this service was good (published 22 April 2021)

Why we inspected

We undertook this focused inspection because we received concerns in relation to staffing levels, medicine management, training, good governance and similar concerns raised by the local authority. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Alexandra House Eastwood on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, staffing and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

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

Alexandra House is a care home providing personal and nursing care for 26 people, some of whom were living with dementia, at the time of the inspection. The service can support up to 38 people in one adapted building across two floors. At the time of the inspection, parts of the home were under refurbishment.

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

People told us they felt safe. Staff had training in safeguarding and were aware of how to deal with any concerns. Staff were recruited safely. Staffing levels were sufficient to meet the needs of the people who used the service on the day of the inspection.

People’s prescribed medicines were managed safely, and appropriate protocols and guidance were in place. The home was undertaking refurbishment works and some areas of the home were affected however these had been risk assessed and measures were in place to ensure people remained safe.

People and relatives, we spoke with, felt supported by the manager. Audits and quality checks were carried out and any issues addressed appropriately. Staff supervisions and meetings were held regularly. The home engaged and worked with healthcare professionals to ensure people received appropriate care.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 24 October 2019) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We received concerns in relation to infection control and managing people’s nursing needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection. We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe section of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Alexandra House - Eastwood on our website at www.cqc.org.uk.

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.

Alexandra House is a residential care home providing personal and nursing care to 28 people at the time of the inspection. The service is registered to accommodate a maximum of 38 people, however the operational manager told us they would only accommodate 34 people.

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

Actions were not always taken to mitigate risks present in the environment and to protect people from the risks of infection. When risks had been identified in audits, prompt and timely action had not always been taken in response to mitigate risks. Audits were not always effective at identifying shortfalls in the service.

Staff were trained, however staff were not always seen to be competent when assisting people to mobilse with equipment.

Refurbishment plans were in place to improve the decoration and flooring. Areas that had been refurbished had been designed to meet people’s needs. However, areas still waiting for refurbishment were not always supportive to people living with dementia.

Risks associated with people’s healthcare conditions were assessed and monitored and medicines were managed safely. The provider had taken actions to help prevent the abuse of people using the service. There were enough staff to meet people’s needs and staff recruitment processes checked on staffs’ suitability for the role.

Assessment processes were in place to cover people’s health, care and well-being needs. People received food and drink to meet their needs; improvements had been made to how people’s fluid intake was monitored and managed. The service worked in partnership with other healthcare professionals to ensure effective care.

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.

Staff were caring and respectful to people. People’s choices were promoted and their views and preferences for their care and treatment were known and informed care plans. People told us staff respected their privacy and promoted their independence.

Staff understood people’s life histories and interests. People told us they enjoyed a variety of activities, including connections with their local community. People’s communication needs were assessed and met. Where people required care at the end of their lives, procedures were in place to ensure this would meet people’s wishes.

The service was run with an open and approachable management team. People’s views were gathered and used when developments or changes in the service were considered.

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 Requires Improvement (published 19 July 2018).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report. We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will continue to monitor information we receive about the service. We will request an action plan and meet with the provider. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Alexandra House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of the inspection there were 29 people using the service.

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.

Alexandra House was last inspected on 25 February 2016 and the service was rated as Good On this inspection the service has been rated as Requires Improvement. Providers should be aiming to achieve and sustain a rating of ‘Good’ or ‘Outstanding’. Good care is the minimum that people receiving services should expect and deserve to receive and we found systems in place to ensure improvements were made and sustained were not effective.

This is the first time the service has been rated Requires Improvement. This was because there was not enough staff to meet people’s needs in a timely manner. This lack of sufficient staffing impacted on all aspects of the service. It meant people had to wait too long for their needs to be met. Staff employed to provide activities had to provide care when staff were very busy. When they rang their call bell, staff checked if they were safe and if they were came back later to attend to them. This could be up to 20 minutes later. People were left unattended at busy times due to pressure on staff.

Risk was recognised and managed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Staff were aware of the Mental Capacity Act and people’s rights under this.

Staff were aware of their duty of care to keep people safe. They understood what abuse was and how to respond appropriately should they be concerned about people’s safety or welfare.

People’s medicines were administered as prescribed and stored appropriately. Staff were trained to care for the people they supported.

People were not always happy with the food. However people’s dietary needs were recognised and met.

Staff were seen to be kind and caring in their interactions with people. However, some staff did not always acknowledge people when they were in the communal rooms.

Floor covering was worn and broken in some areas, this meant staff could not always clean it effectively. The environment was not well maintained and some areas showed signs of neglect.

People maintained important relationships, as relatives and friends could visit at any time. People were able to regularly review their care to ensure it was still relevant for them. People enjoyed a varied programme of entertainment and support with their hobbies to prevent them from becoming socially isolated, however this could be interrupted due to staff shortages. People knew who to speak with if they wanted to discuss a concern or complaint.

People received support from health care professionals where they needed this to keep well. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs. People felt the registered manager was approachable and keen to listen to their views and they were able to share their views about how the service was managed.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Accommodation for up to 38 people is provided in the home over two floors. The service is designed to meet the needs of older people. There were 27 people using the service at the time of our inspection.

At the previous inspection on 25 and 26 March 2015, we asked the provider to take action to make improvements to the areas of person-centred care, dignity and respect, need for consent, safe care and treatment, premises and equipment and good governance. We received an action plan in which the provider told us the actions they had taken to meet the relevant legal requirements. At this inspection we found that improvements had been made in all areas, however, more work was required in the area of safe care and treatment.

There is a registered manager and she was available during the inspection. 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.

Safe infection control and medicines practices were not followed by one staff member. Incident forms were not always fully completed.

People felt safe in the home and staff knew how to identify potential signs of abuse. Systems were in place for staff to identify and manage risks and respond to accidents and incidents. The premises were managed to keep people safe. Sufficient staff were on duty to meet people’s needs and they were recruited through safe recruitment practices.

Staff received appropriate induction, training, supervision and appraisal. People’s rights were protected under the Mental Capacity Act 2005. People received sufficient to eat and drink. External professionals were involved in people’s care as appropriate. People’s needs were met by the adaptation, design and decoration of the service.

Staff were caring and treated people with dignity and respect. People and their relatives were involved in decisions about their care. Advocacy information was made available to people.

People received personalised care that was responsive to their needs. Care records contained information to support staff to meet people’s individual needs. A complaints process was in place and staff knew how to respond to complaints.

People and their relatives were involved or had opportunities to be involved in the development of the service. Staff told us they would be confident raising any concerns with the registered manager and that they would take action. There were systems in place to monitor and improve the quality of the service provided, however, statutory notifications had not always been sent to the CQC.

We spoke with three people using the service. All of the people we spoke with indicated they felt staff were respectful and treated them with dignity and respect. They were also happy with the care provided by the service.

People told us they received sufficient to eat and drink and that the premises were clean. They told us they would raise any matters of concern or suggestions with the manager and they would be listened to.

We found that people's dignity was respected and they experienced care, treatment and support that met their needs. We found that people were supported to be able to eat and drink sufficient amounts to meet their needs and effective infection control practices were being followed. We found that the provider had an effective system to regularly assess and monitor the quality of service that people receive.

We spoke with seven people who were using the service. All of the people we spoke with indicated they felt staff were respectful and treated them with dignity and respect. They were also happy with the care provided by the service.

People told us they received enough to eat and drink and that the premises were clean and safe. They were aware of the ways in which they could provide their opinion about the quality of the service, including the complaints procedure. They also did not raise any concerns about the security or content of their personal records.

We found that people's dignity was still not always respected and they did not always experience care, treatment and support that met their needs. We found that people were not always supported to be able to eat and drink sufficient amounts to meet their needs and effective infection control practices were not always being followed. We also found that the provider did not have an effective system to regularly assess and monitor the quality of service that people receive.

However, we also found that people using the service were protected against the risks of unsafe or unsuitable premises. We found that the provider responded to complaints appropriately and that records were fit for purpose and kept securely.