Archived: Alexandria's Residential Care Home

Updated 5 September 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Since the last inspection the local authority had informed us they had placed an embargo on the provider which meant that the local authority would not be placing any new people at the service. The provider had written to people and their relatives on 14 May 2018 to tell them they planned to close the service. The provider had detailed in the letter to people and their relatives that they could not guarantee people’s safety. We brought forward our planned comprehensive inspection to check that people were receiving safe care. The local authority had sent in a team of care managers and health and social care professionals to reassess people’s care and support needs. The local authority commissioners had met with people and their relatives on 22 May 2018 to explain processes for helping them find new care services to meet their needs because the provider was closing the service.

This inspection took place on 23 May 2018 and was unannounced. The inspection was carried out by two inspectors.

Before the inspection, we reviewed the information we held about the service including previous inspection reports. We looked at notifications which had been submitted. A notification is information about important events which the provider is required to tell us about by law. We also reviewed information of concern that we had received.

We spent time speaking with four people who lived at Alexandria's Residential Care Home. We observed care and support in communal areas.

We contacted health and social care professionals including the local authority commissioners and safeguarding coordinators and Healthwatch to obtain feedback about their experience of the service. There is a local Healthwatch in every area of England. They are independent organisations who listen to people’s views and share them with those with the power to make local services better.

We spoke with eight staff; including a housekeeper, cook, care staff, senior care staff and one of the provider’s.

We looked at four people’s personal records, care plans and medicines records, risk assessments, staff rotas, staff schedules, three staff recruitment records, meeting minutes, policies and procedures.

We asked the provider to send us additional information after the inspection. We asked for confirmation that the staffing rota had been covered, confirmation that servicing and repairs had been completed, one staff members file and the answers to queries we had raised before the inspection about a person’s death. We did not receive all the information in a timely manner.

Updated 5 September 2018

The inspection took place on 23 May 2018, it was unannounced.

At the last inspection on 11 January 2018 we rated the service Requires Improvement overall. The service remained rated as Inadequate in well led, which meant the service remained in special measures. We found breaches of Regulations 12, 15, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of section 33 of the Health and Social Care Act 2008. The provider had failed to operate effective recruitment procedures.

The provider needed to make further improvements to ensure the premises and equipment were suitably maintained, appropriately located and clean. The provider had failed to ensure that medicines were suitably stored according to the manufacturer’s instructions. The provider had failed to provide training and support for staff relating to people's needs. The provider had failed to operate effective quality monitoring systems. The service did not have a registered manager. The provider had failed to apply to register with CQC the manager they had employed.

We served the provider a warning notice for the breach of Regulation 12 and told the provider to meet this Regulation by 20 March 2018. We also served the provider a warning notice for the breach of Regulation 15 and told the provider to meet this by 03 April 2018. We served the provider a fixed penalty notice for having no registered manager in post. We imposed a condition of registration in relation to the breach of Regulation 17 and served the provider requirement actions relating to the breaches of Regulations 18 and 19. We also made recommendations. We recommended that the provider reviewed systems and processes to evidence that staffing levels met people’s assessed needs. We recommended that the provider reviewed and amended practice at meals times to ensure that reasonable adjustments were made to meet people’s nutritional needs and preferences taking into account people’s communication preferences. We recommended that the provider reviewed practice to ensure that people received the care and support according to their wishes and preferences. We recommended that that provider sought guidance from a reputable source to review and amend policies, procedures and documentation to ensure people’s equality diversity and human rights (EDHR) needs were met. We also recommended that the provider reviewed the complaints information to ensure that it was in an accessible format to meet the needs of people living in the service.

The provider did not submit an action plan within agreed timescales and was formally chased for this by letter. The provider submitted documentation to detail that they had met the warning notices. Following the last inspection, we met with one of the providers to discuss our concerns about the ongoing non-compliance with regulations and to ask the provider to complete an action plan to show what they would do and by when to meet the regulations under each of the five. An action plan was received eventually on 25 April 2018.

Alexandria's Residential Care Home 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. The service was not registered to provide nursing care. Any nursing care was provided by community nurses.

At the time of our inspection 10 people lived at the service. There was a through floor lift fitted in the home to enable people to use the first floor. There were a small number of bedrooms on the second floor which were accessible using a stair lift, these rooms were not in use. The service accommodated up to 18 older people. Some people lived with dementia.

The service did not have 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 provider was in breach of their registration by not having a registered manager in post.

Medicines had not been managed effectively. Medicines records were not complete; stock had not always been counted and recorded appropriately. Medicines were securely stored. Some storage areas had not been temperature checked the ensure that medicines were being stored at safe temperatures. We reported this to the local authority.

There were enough staff deployed on shift to meet people's care and support needs. The provider had reduced staffing levels. One staff member had been removed from the morning shift and one staff member had been removed from the afternoon shift. The housekeeper’s hours had also been cut back. The provider had not carried out an assessment of people’s care and support needs when reviewing staffing levels.

The provider did not follow safe recruitment practices. Essential documentation was not available for all staff employed. Gaps in employment history had not been explored to check staff suitability for their role.

Risks to people's safety and wellbeing were not always managed effectively to make sure they were protected from harm. Risk assessments had not always been reviewed and updated when people's health needs changed. The provider had failed to take action when accidents and incidents had occurred. Lessons had not been learnt from accidents and incidents to prevent further concerns and to strive for improvement.

Staff had a good understanding of what their roles and responsibilities were in preventing abuse.

Several areas of the home smelt of stale urine. The home was dirty and required redecoration and maintenance. Fire drills had not taken place within six months as detailed in the provider’s policy. The emergency evacuation chair was not easy to get to as the medicines trolley was fixed the wall in front of it.

Decoration of the home did not follow good practice guidelines for supporting people who lived with dementia.

Staff had not received all the training, support and supervision they needed to meet people’s assessed needs. The provider had not followed good practice guidance to ensure that new staff received a comprehensive induction.

People’s healthcare needs had been met in a timely manner. People who were at risk from developing pressure areas had been referred to community nurses and were supported to reposition regularly. Barrier creams and sprays had consistently been used to protect people’s skin.

The provider did not have good systems in place to monitor the quality and safety of the service provided. The provider had no evidence to show they had undertaken quality audits. Accurate records were not kept to ensure good communication and the safety of people being supported.

The provider did not offer staff the support and help they required. Staff meetings had not been held.

The provider had failed to notify CQC of important events such as deaths and safeguarding allegations.

People were treated with dignity and respect by the staff. Staff respected people's privacy. Staff were kind and caring towards people and offered plenty of reassurance. However, the provider had failed to treat people in a kind and caring manner and had failed to treat people with dignity and respect.

People were not provided with sufficient, meaningful activities to promote their wellbeing.

People’s care plans detailed their care and support needs. Staff knew people well and provided personalised care. Some people had not had baths or showers for some time.

People had not had opportunities to voice their views and opinions about the service through surveys and through meetings.

The provider's complaints procedure did not give people all the information about who they could raise concerns with. There was no accessible and easy to understand complaints information in place. The provider had not followed their complaints policy.

People had choices of food at each meal time. People were offered more food if they wanted it. Food choice was restricted to chicken or pork/gammon. Food stocks were low and staff were purchasing food to ensure people had choices.

There were procedures in place and guidance was clear in relation to the Mental Capacity Act 2005 (MCA) that included steps that staff should take to comply with legal requirements. Staff had a good understanding of the MCA 2005 to enable them to protect people’s rights.

The provider did not have an understanding of when people’s Deprivation of Liberty Safeguards (DoLS) authorisations had expired, no action had been taken to reapply to legally deprive people of their liberty.

Staff working in the kitchen were unable to follow ‘Safer Food Better Business’ guidance provided by the Food Standards Agency. We reported this to the Food Standards Agency.

People were supported to maintain their relationships with people who mattered to them. Relatives and visitors were welcomed at the service at any reasonable time.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a number of breaches of the Care Quality Commission (Registration) Regulations 2009 . You can see what action we told the provider to take at the back of the full version of this report.

The overall rating for this service is ‘Inadequate’ and therefore the service remains in ‘Special measures’. This is the third consecutive time the service has been in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose 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 im