Archived: Alexander Court Care Home

Below is a summary of what we found. The summary describes what people using the service, their relatives and staff told us, what we observed and the records we looked at.

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

Is the service safe?

A lack of clear and up to date information in care plans and a lack of knowledge and understanding of some staff placed people at risk of unsafe or inappropriate care.

Recruitment processes were poor. The record of staff interviews undertaken was lacking in detail and did not explore areas of concern raised by previous employers or checks carried out through the disclosure and barring service (DBS). The documents we saw have given us concern about the level of scrutiny the provider took in determining people's identity and their suitability to work with vulnerable people.

Owing to the serious shortfall identified at the inspection and the inability of the service to attract high calibre nursing staff we took immediate action to prevent the home from providing nursing care.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to safely manage them.

We checked the medicine administration records (MAR) together with receipt records and these showed us that people were not always receiving their medicines correctly. For three people we found more of the medicine was remaining than the administration records indicated, meaning that some doses of medicine recorded as given either had not been given, or were given at an incorrect dose

The provider failed to ensure appropriate maintenance of the building and utility services this placed people who use the service, staff and visitors at potential risk of harm.

Is the service effective?

We looked at care plans and found inconsistencies in the quality of information available to explain how each person needed to be safely supported by the staff. We saw evidence that staff failed to check care plans and carry out interventions to provide the correct care.

People were not always consulted before they received any care or treatment and the provider did not take into account their wishes.

Is the service caring?

We saw written from one relative who described staff as being 'friendly' and 'brilliant despite not always being able to understand the language'. During our inspection relatives variously described staff to us as "wonderful" and "amazing." However, although we saw some positive interactions between staff and people who lived at the service we also saw other interactions which caused us continuing concern. We observed for example, that some staff demonstrated a lack of insight into the complex needs of people living with dementia and we saw instances where appropriate and timely support was not provided by either qualified nurses or care staff to alleviate people's anxiety and distress. We also had to intervene to make sure some people were given the appropriate support and assistance at mealtimes.

Is the service responsive?

We saw examples where staff failed to recognise to urgent situations for example one person who suffered two nosebleeds that necessitated an ambulance being called on each occasion. Health care professionals from other agencies also in the home at the time assisted the ambulance crew and instructed staff on what they had to do to make sure protective aprons and gloves were brought to the room.

We observed a people having difficulties eating their meals. Staff failed to respond and support people appropriately.

Is the service well-led?

Effective management systems were not in place to promote people's safety and welfare. This meant that the managers and staff could not monitor and learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations.

The registered manager had failed to anticipate and understand the possible outcomes of their decisions and actions on people's lives and take appropriate action.

At our previous inspections in March 2014 and July 2014 the provider was not meeting the requirements of the law in relation to the management of medication, staff recruitment, and how the quality of the service was monitored.

As a result of these findings, and the provider's inability to attract high calibre nursing staff, we used urgent enforcement powers to prevent the home from providing nursing care services.

During this visit, we spoke with the acting manager, care staff and the chef. We reviewed records and observed the lunchtime experience. We were accompanied by a Specialist Advisor whose area of expertise was in meeting nutritional needs.

Alexander Court Care Home provides accommodation and care for up to 85 people. At this inspection there were 27 people living at the home, 15 of whom had dementia care needs. We found shortfalls in both areas that we checked; that is, how well medicines were managed and arrangements for people to receive adequate nutrition and dehydration.

We found that people's nutrition and health care needs were not planned or delivered consistently. In some cases, this put people at risk or meant they were not having their individual support needs met. We also found that people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to safely manage them.

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

Is the service safe?

The service was not safe. People who used the service were being put at risk because their medicines were not managed safely.

We saw that essential information relating to people's nutritional and care needs was not always accurately recorded placing people at risk of receiving inappropriate care and support.

Is the service effective?

People enjoyed the care home's food and had a choice about what they had to eat. However, we found people's care files were incomplete and confusing for staff to understand. We saw for example, that nutritional assessments and weights were not always documented. This meant that staff were not able to consistently follow the care plans to ensure that people's nutritional care needs were met so their needs were not effectively met.

Is the service caring?

We observed a calm atmosphere at lunch, but this was not supported by other findings. Staff had received no training for the different types of diets that people living in the home required and they were unsure about what a soft diet or puree diet should look like and the food to include.

Is the service responsive?

The service was not responsive to people's needs. Care plans did not always show the most up-to-date information on people's needs, preferences and risks to their care in relation to their dietary needs or medication needs.

Is the service well led?

The service was not well led. People were put at risk because systems for monitoring quality and bring about needed improvements were not effective.

People were not always consulted before they received any care or treatment and the provider did not take into account their wishes.

We had concerns about the health and safety of people living at the home and took immediate steps to ensure people were safe. The provider has agreed to suspend admissions until we are satisfied that the service has made the required improvements.

Information contained in people's care records was inconsistent; which increased the risk of people receiving care which did not met their needs and wishes.

Inconsistent recruitment processes and staffing arrangements placed people at risk of receiving unsafe care, particularly for those requiring nursing care.

Poor auditing and monitoring meant that people's health and safety was being placed at unnecessary risk of harm.

We spoke with a relative who said 'Overall I am quite happy with everything."

We spoke with two people living at the home who made the following comments: 'The staff are all right they are very helpful' and 'There have been a lot of staff changes recently.'

Because of concerns about people's care and welfare needs we made a further unannounced visit on 15/05/2014. We found a similar level of concern that people were not receiving safe and appropriate care to meet their needs.

We saw staff and people using the service had positive relationships and people appeared relaxed and comfortable with with staff and the activities they were engaged in. We saw that staff spoke appropriately with people and engaged with them in a calm and patient way. One person said 'I like it here.' Another said 'They look after me very well. The staff are very kind.'

There were systems in place to ensure the home was kept clean. Staff had access to protective equipment and there were sufficient hand washing facilities available. However improved monitoring of some equipment in the home would reduce the risk of cross infection.

We saw that medicines were kept safely and that appropriate arrangements were in place in relation to the recording and administration of medicines.

There were sufficient staff available. We saw people being assisted promptly and we saw that staff had time to spend socialising and engaging with people.

There was a complaints procedure available. Complaints were investigated and taken seriously; information from complaints was used to improve the service patients received.

We could not speak to some of the people who lived in the home because of their complex care needs, however we reviewed their care records and we saw that where necessary their care had been discussed and agreed by their relatives or their care managers. We also observed that people looked clean, tidy and well cared for.

We observed the lunch and tea time meals being served. People were offered choices and support and appeared to be enjoying their meals.

People who lived at Alexander Court Care Home were cared for in safe accessible surroundings which promoted their well being.

We observed the care staff were a visible presence and were able to answer call bells in a timely way. Staff told us they felt there were sufficient numbers on duty to care for people effectively.

The provider had systems in place to effectively monitor the quality of care provision so that people's health, safety and well being could be protected.