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Archived: Alexandra Care Home Good

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Inspection report

Date of Inspection: 14 May 2014
Date of Publication: 11 June 2014
Inspection Report published 11 June 2014 PDF | 88.45 KB

Overview

Inspection carried out on 14 May 2014

During a routine inspection

As part of this inspection we spoke with three people who used the service, seven relatives, twelve members of the staff team and the clinical services manager. The area manager and regional support manager were also at the service at the time of our visit. We looked at a number of records including people's personal records, medication records and records kept in relation to the management of the service.

We also used observation to understand people’s experience, as some people had communication needs and were unable to tell us their views and experiences.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask. This is a summary of what we found:

Is the service safe?

People told us that they felt safe living at Alexandra House and that they were treated well. One person explained: “I feel very safe, I have no complaints of that sort.” Another person told us: “You can always find fault, but I’ve been very happy here.”

We talked to staff to see whether there were enough staff on duty to meet the needs of those in their care. We received various responses. Comments received included: “On the whole it is adequate, but it would be nice to have time to spend with people, it is very busy in the morning.” And: “I think we need more staff.” And: “I feel the current staffing levels are sufficient.” We were told that staffing levels were monitored regularly to ensure that enough staff were on duty. This ensured that there were appropriate numbers of staff on duty to meet the needs of the people in their care.

The manager completed a pre-assessment before people moved in to the service to make sure people’s assessed needs could be met. Review systems were in place to ensure care plans and risk assessments were up to date and kept people safe.

Records kept to monitor how much food and drink people had consumed during each day were up to date. This showed us that people were protected from the risk of malnutrition and dehydration.

Staff spoken with knew what to do if they suspected that someone was being abused. One staff member explained: “I would report anything to the manager, and would go higher if necessary, we have the phone number to take things higher.”

On checking the medication records we found that on a number of occasions, the registered nurse had failed to sign to say that they had dispensed people’s medicine.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Relevant policies and procedures were in place and the manager on duty at the time of our visit understood when an application should be made. The majority of staff spoken with understood what it meant to deprive someone of their liberty and why this might happen.

Personal protective equipment was available for staff to use including disposable aprons and gloves. This ensured that care and support was provided safely and in line with the services infection control policy.

On entering the service we evidenced a strong unpleasant odour. We discussed this with the area manager and were informed that all attempts to address this issue by the regular cleaning of the carpets had failed. Therefore, the carpets in the hallway and the dining room were due to be replaced within the next three weeks.

Is the service effective?

We spoke with people who used the service and they told us that they were satisfied with the care and support they received. One person told us: “I didn’t like it to begin with but now, I think it’s good.”

Relatives spoken with told us that, on the whole, they were happy with the care and support their relative received. One person explained: “I would say that he looks cared for though sometimes they shave, and sometimes they don’t.” Another person told us: “I have no complaints about the care.”

Care plans provided staff with information about people’s care and support needs. It was clear from our observations and from speaking with staff, that they understood the needs of the people they supported. This ensured that people’s needs were met.

The provider had systems in place that demonstrated they co-operated with other health and social care professionals. This meant people received a person centred and coordinated approach to their health, safety and welfare needs.

Consent to the care and support that people received was obtained and this was reviewed on a regular basis. This ensured that people remained happy and in agreement with the support they received.

Is the service caring?

We observed staff going about their work. They treated the people they were supporting in a kind and gentle way and people looked relaxed and comfortable in the presence of staff.

Everyone spoken with told us that, on the whole, staff were caring and attentive. One person explained: The staff are mostly very good, you get the odd one, but they listen to you.” Visitors told us: “We are 80% happy with the care, for some it’s a job, for others it’s a vocation. Some take great care, some occasionally, do not, like ensuring my relative is neat and tidy." And “The care is very good.”

Is the service responsive?

People’s needs had been assessed before they moved into the home and they and their relatives had been involved in the care planning process whenever possible. One relative explained: “They came to the hospital to do an assessment.” This ensured that their care and support needs could be met.

People told us that staff treated them with respect and involved them in their day to day care. One person explained: “They give me choices and they discuss things with me.”

Relevant professionals had been involved in people’s care, and records showed that visits were arranged when necessary. This included visits from their doctor, the optician, the dentist and the local speech and language team. This ensured that people who used the service received the care and treatment they required.

A complaints procedure was in place and a copy of this was displayed. This provided people with the information needed, should they wish to make a complaint about the service they received.

Is the service well-led?

A robust quality assurance system was in place and the management team regularly assessed the service provided. This ensured that people received the care and support they needed, in a safe and effective way.

Care plans and risk assessments were reviewed at regular times to monitor people’s needs and where changes in people’s health and welfare had been identified; these had been updated to reflect this.

Regular meetings had been held, both for people who used the service and their relatives, and the staff who worked there. This provided the opportunity for people to have a say on how the service was run.

Relatives shared their concerns with regard to the lack of communal space at the service. They explained that the conservatory leading off from the main lounge had been blocked off for some months and this impacted on their relatives comfort and well-being. We discussed this with the area manager who acknowledged these concerns. They informed us that planning permission had recently been granted for the intended improvement works to this area. The provider may wish to note that by keeping the people who used the service and their relatives, regularly updated on issues relating to the service, any concerns or worries people had would be allayed.

Staff on the whole felt supported by the management team and told us that they felt able to talk to someone should they have a concern of any kind. One member of staff explained: “You can talk to the nurses or the managers.”