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Archived: Alexandra Care Home Good

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Reports


Inspection carried out on 16 May 2016

During a routine inspection

This inspection was unannounced and took place on 16 May 2016. At our last inspection on 20 and 21 April 2015 we asked the provider to make improvements to ensure there were enough staff to meet people’s needs. . The provider sent us a report explaining the actions they would take to improve. At this inspection, we found improvements had been made. We also asked the provider to make some improvements in other areas of their service. These covered medicine management, the meal experience for people, the responsiveness of staff to support people’s needs, the stimulation on offer to people and staff support and the quality monitoring systems in place. At this inspection we saw that improvements had been made in all these areas of concern.

The service was registered to provide accommodation for up to 40 people. People who used the service had physical health needs and some were living with dementia. At the time of our inspection 35 people were 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.

The provider determined the staffing levels on the number of people living in the home and the level of support they required. Staff had received training in dementia which they told us had increased enhanced the support they were able to offer and increased their knowledge. Other training was on-going and offered as directed from audits or through staff requests. Relatives had told us they felt people who used the service were safe and staff understood their role in ensuring people were protected from abuse or poor practice.

We saw that the provider and manager understood their responsibilities in complying with the requirements of the Mental Capacity Act 2005 (MCA). Where people lacked capacity to make certain decisions, appropriate assessments had been completed and recorded how w how people were supported to make those decisions. Where people were being restricted of their liberty in their best interests, the appropriate authorisations had been applied for.

. Everyone we spoke with felt the changes being made at the home were positive and had improved people’s experience of care. We saw that people were responded to in a kind and friendly manner and staff respected their decisions. Risk assessments were in place to ensure people’s safety was maintained.

Medicines were managed safely and in accordance with good practice. People received food and drink that met their nutritional needs and had a choice of the foods they liked. Staff made referrals to healthcare professionals in a timely manner to maintain people’s health and wellbeing.

Staff were caring in their approach and they created a warm homely environment which people told us they liked and enjoyed. People felt confident they could raise any concerns with the provider and manager. There were processes in place for people to express their views and opinions about the home. The provider and manager had systems in place to monitor and improve the quality of the service.

Inspection carried out on 20 and 21 April 2015

During a routine inspection

This inspection took place on the 20 and 21 April 2015 and was unannounced.

At our last inspection carried out on 14 May 2014, the provider was not meeting the requirements of the law in relation to the management of medicines. Following that inspection the provider sent us an action plan to tell us the improvements they were going to make.

During this inspection we looked to see if these improvements had been made. We found that they had.

Alexandra Nursing Home - Nottingham is registered to provide accommodation, personal care and nursing care for up to 39 older people. The accommodation is provided on two floors which are accessible via a passenger lift. There were 38 people living at the service when we visited.

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.

People told us they felt safe living at Alexandra Nursing Home and felt safe with the staff who looked after them. Their relatives agreed.

An appropriate recruitment process had been followed when new staff had been employed. This included the collection of references to check that they were suitable to work at the service. Staff had received training relevant to their role and on going support through supervision sessions and team meetings had been provided.

Staff had received training on how to keep people safe from abuse however, we observed practices that didn’t always keep people safe from harm. This included one person being transferred in a wheelchair without the use footplates.

People told us there were not always enough staff around to meet people’s needs and staff members agreed. This was confirmed during observations carried out during our visit and the checking of people’s records.

People had been involved in making day to day decisions about their care and support and staff understood their responsibilities with regard to gaining people’s consent.

Throughout our visit we identified concerns regarding the lack of interaction between the people who used the service and the staff working there. Some staff were very good at interacting with people, others not so. We saw a number of occasions where care workers were in attendance in the lounges but there was little or no communication between them and the people who used the service. Staff focussed their time on completing paperwork instead.

People received their medicines as prescribed by their doctor. Their medicines were being handled in line with national guidance and the required records were being kept. On the first day of our visit we did note that the morning medicines round took an excessive amount of time (medicines were still being given out at midday) which then impacted on the rest of the days medicine rounds.

People’s needs had been assessed before they moved into the service and plans of care had been developed from the assessment. People’s likes and dislikes had been identified to assist the staff in providing the care and support that people preferred.

People’s nutritional and dietary requirements had been assessed and a nutritionally balanced diet was being provided. For people assessed to be at risk of not getting the food and fluids they needed to keep them well, appropriate records had been kept showing their food and fluid intake.

People felt that overall, the service was appropriately managed and the management team were available to talk with when needed. Some of the staff we spoke with felt supported by the management team but others felt less supported.

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

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.”

Inspection carried out on 4 September 2013

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

Not everyone we spoke with was able to converse with us. We saw family visitors who we had met before continued to visit and continued to help where they could. This was helpful to staff as they could ask about any consent issues arising from care provided by them to the family member. Family representatives told us they understood their relatives care plan and had agreed to help provide information to support their needs.

One person living at the home told us “care workers explain everything”. Another person told us they were treated well and staff listened to them. We observed people's care and support during the visit and saw care workers were available to support them.

Inspection carried out on 16, 17 April 2013

During a routine inspection

Two people that we spoke with were able to tell us that they were happy with the care and support provided to them. We also found most of the representative’s of people living at the service told us, staff usually asked them for their help or advice. This included being invited to contribute and to attend reviews about their relative’s care. When visiting the home, two representative’s explained how staff sometimes missed an opportunity to allow them to contribute to their relative’s care needs. They had expected staff to include them wherever possible.

People told us they enjoyed the variety and quality of meals available. Comments included, “the food’s very nice” and “I enjoy the meals”.

Some of the people we spoke to were able to confirm they had suitable equipment to meet their needs and support them in maintaining their independence.

Two people told us they were happy to live at the home and had no complaints. They said they would speak to the manager if they had any concerns. Representative’s of people who spoke with us told us they were happy to use the systems in place. They told us they would be able to raise a concern and would expect it to be dealt with to their satisfaction.

Inspection carried out on 7 January 2013

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

We spoke with one person who was able to express their views and told us they were listened to. We saw meetings for relative’s were held at the home and a review of care needs for people living at the service was provided. Representatives told us they could see improvements at the service. They also told us there was still the issue of the environment being noisy and not relaxing for their relative's to sit in for long periods of time. They told us there was a reduction in the number of new faces on duty which they liked better as agency was used less often. They told us they thought staff seemed to be responsive to people’s needs.

Representatives of people at the service told us staff at the home were able to provide support to their relative. We saw staffing numbers had been greatly improved and created a good working atmosphere for staff to work in. Staff happily showed us how they were already using parts of the new style care plan to help them write about the care they provided. They were willing to show us how they used and understood aspects of the restyled care plan. The visiting manager told us she was happy to stay and take charge of the service and to lead by example.

Inspection carried out on 31 August 2012

During a routine inspection

We spoke with one person who was able to express their views and told us they would expect it to be listened to. We saw meetings for relatives were held at the home and a review of care needs for people living at the service was provided. We saw that not everyone had the benefit of being involved in life at the home and their day could be lonely.

One relative told us, ”my relative needs to have their fluids but since the manager has gone there does not seem to be any monitoring of the care provided and there is an over reliance on the use of agency staff”.

One relative told us staff at the home would try to cover up when an incident had happened as staff could not explain how it had happened. However, another relative told us staff worked hard and were responsive to the needs of their relative. They thought staff were helpful and would protect their relative.

Three relatives expressed their concern as there was no permanent manager in post and they were beginning to see the impact that this was having on care.

We saw a potting shed was used to grow plants and food. We saw one person using the outdoor facilities.

One relative commented, “I think upstairs smells because they do not have enough staff to either keep the place clean or not enough care staff to keep people clean".

Three relatives told us, “standards have started to slip we had a relative’s meeting to discuss how we felt, we are looking for improvements”.

Reports under our old system of regulation (including those from before CQC was created)