Archived: Alexander Heights Care Home

This inspection took place on 31 May 2017 and was unannounced.

At the last comprehensive inspection we found breaches of Regulations 11, 18 and 17. We took enforcement action for Regulation 17 and imposed conditions on the registration of this service. Following the inspection the provider developed a comprehensive action plan to meet the imposed condition of registration and to address requirements orders on Regulation 11 and 18.

A registered manager was 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.’

Some identified risks to people were assessed. Staff said risk assessments were developed on how to minimise potential risks to people. However, risk assessments were not in place for risks including choking A member of staff on duty acknowledged that two risk assessments were in need of reviewing. We asked to see copies of the risk assessments and were told they were not available.

Accidents and incidents were documented and an investigation was conducted following the event. The actions following the accident included observations for signs of head injury, arranging for GP visits and to review care plans and risk assessments were reviewed. However we found no documented evidence of this occurring after an incident or accident had taken place.

Staff signed the MAR charts when medicines were administered. A record of medicines that were no longer required had been maintained. Protocols for medicines prescribed to be administered when required (PRN) were missing, although the procedure in place stated one must be kept within the Medicine Administration Records (MAR) file. The staff on duty were not aware of the protocols or about their location. Directions on the use of thickeners were not provided to staff and the only information stated to administer “as directed”.

While the staff knew about enabling people to make day to day decisions we found gaps in their understanding of assessing people’s capacity to make decisions. The assessment records that related to people’s capacity t were inconsistent, which showed a lack of staff’s understanding regarding assessing people’s capacity to make decisions. Mental Capacity Assessments were not in place for specific decision such as restricting people access to their lighter and cigarettes. Where people lacked capacity to make decisions best interest decisions were not taken to show the decision was in the person’s best interest and the least restrictive.

Care plans were inconsistent and some were not always person centred. Care plans were not updated with people’s current needs. Staff said whilst they read the care plans, handovers were the main source of information about people’s changing needs”. They said care planning training was attended. Whilst they read the care plans, handovers were the main source of information about people’s changing needs. We were told that new care plan formats were to be introduced.

While people acknowledged attempts to improve the meals served had been made, some negative comments about the food were received. We were present during the lunchtime meals and we saw people eating the meals. Feedback about the quality of meals was variable but people said the quality had improved and the menus had changed. People told us the catering manager made regular visits to the home and their feedback was sought. Staff told us the catering manager visited daily to gain people’s feedback about the food. They also stated a complaints book was available in the dining room for people to give their feedback about the food,

The people we spoke with said they felt safe at the home and they received adequate levels of support from the staff. The rota showed there were three staff on duty. One senior or the unit manager and two carers were on duty. During the week the unit manager had a supernumerary day for administration tasks. One relative and people told us the consistency was better and they recognised the staff when they visited as staff faces were more familiar now.

The staff we spoke with said they had attended training in the safeguarding of people from abuse. They were aware of the different types of abuse and the action that must be taken where there were concerns of abuse.

A member of staff recently employed said their induction was excellent and prepared them for their role. The activities staff told us they had access to all mandatory training set by the provider. They said there were opportunities for personal development through one to one meetings with their line manager.

The training matrix showed staff attended mandatory training set by the provider and training which depended on the role of the staff. For example medicine training for senior carers. The staff we spoke with said the training provided was good.

Staff said their one to one meetings were regular and occurred every eight weeks. The supervision matrix in place showed all staff had regular one to one meetings with their line manager. We noted that all staff had a one to one session with their line manager in February 2017 and the meetings for June 2017 had been scheduled.

People told us they were able to join in group activities and one to one activities were available for people who preferred to spend most of their time in their bedrooms. An activities programme was on display and coordinators had documented the group and one to one activities undertaken. Activities coordinators knew people well and their likes in relation to one to one and group activities.

People told us they had made complaints in the past and their concerns were taken seriously and had been acted upon. The Complaints procedure on display needed reviewing as the name of the previous quality assurance manager was included for people to approach with their complaints.

Quality assurance systems were in place to monitor the quality of care provided. Visits on behalf of the provider were monthly and action plans developed where shortfalls were identified. Staff said the team worked well and stated the registered manager was approachable. People told us their views were gathered using surveys and during meetings. An agency worker told us they worked at the service regularly to provide continuity of care to people.

We carried out this inspection in response to concerns raised relating to the quality of care and support people were receiving. These concerns related to all three locations, Hillcrest Care home, Alexander Heights Care Home and Fountain Place Nursing Home which are all located in Avonpark Village. Due to this we inspected all three locations. The inspection took place on the 18, 19 and 23 May 2016 and was unannounced.

The service had 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 registered manager was not present during our inspection. We found the service was not well led.

People were protected from the risk of harm and from the risk of abuse. Processes and procedures in place ensured members of staff knew how to identify abuse and they knew the expectations placed on them to report abuse.

Risks were managed appropriately. Where risks were identified action was taken to lower the levels of risk. Care plans were reviewed by staff but did not evidence involvement from people.

Safe systems of medicine management were in place.

The arrangements for staffing levels did not ensure there were sufficient staff on duty during peak periods.

Staff knew people well and supported them with maintaining their independence. People and their relatives told us staff treated them or their relative with kindness and respected their privacy and dignity.

People were supported to have sufficient to eat and drink to maintain good health. People told us the quality of the food was poor.

Suitable arrangements were in place for people to receive on-going support from healthcare professionals.

Mental Capacity Act (MCA) 2005 procedures were not clear for staff to follow. Records were not maintained to show the process followed by the staff to assess people's capacity and making best interest decisions. Staff did not always know who should be the decision maker in best interest decisions.

Problems with the service and required improvements were not always identified. We did not always see evidence of actions taken where concerns had been highlighted. Not all staff felt they were supported by management to raise concerns or question practice. They did not feel that concerns raised had been acted on and responded to appropriately.

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

A team of four inspectors carried out the inspections across the three locations. On the day of our inspection of Alexander Heights there were nine people living at the home.

This location was inspected by one Adult Social Care Inspector. We spoke with four people who use the service, two visitors, three care staff, and the activities co-ordinator. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found which describes what we observed, what the staff told us, and the records we looked at.

Is the service safe?

The environment looked clean in the areas we viewed. However, the systems in place to support the process of minimising infection control risks were not safe. Specifically there was no lead person to promote good practice in infection control. Guidance and information were not readily available to support staff to minimise infection risks. Information was held electronically but the staff we spoke were not aware of where or how to locate it.

At our last inspection on 9 January 2014 we had found there were not enough qualified, skilled and experienced staff at all times to meet people's needs. At this inspection there were nine people living in the home. At this inspection we found there were enough experienced staff on duty to meet the needs of the nine people living there.

Is the service effective?

The service was effective at providing support so that peoples health care needs were met. Staff were knowledgeable about the care that people needed. People were able to see visiting healthcare professionals when needed.

Is the service caring?

People who used the service were treated in a polite way by the staff who were attentive to their needs when they assisted them. Staff showed respect for peoples privacy and they also engaged them in friendly and social conversation.

People were assisted with their needs by staff who were attentive in their manner towards them. For example, staff asked people how they were feeling. Staff asked people what sort of assistance they required. People were also asked what meal choices they wanted for breakfast and lunch.

People who used the service and relatives had generally positive views of the staff who assisted them with their needs. Examples of comments made included, 'the carers do their best' and 'there have been so many changes of staff', 'the two senior staff are both caring'.

Is the service responsive?

Care plans varied in the detail they contained .Some of the care plans were not clear and lacked detail. They did now fully show how to provide the person with the support and assistance they required.

Is the service well-led?

The registered manager had recently left. We were told that until the new manager starts employment in October 2014, staff were being supported by two senior managers. However the lack of a permanent registered manager in post has impacted on the overall leadership in the home. This has further impacted on the overall quality of service.

There was a quality checking system in place to monitor infection control in the home. However audits had failed to identify where the systems in place to minimise infection risks were not being effective.

People told us their care was delivered by staff in the way they liked but they were not involved in the planning of their care. The care plans in place contained people's essential information but needed to be more focused on the person. For example people's likes, dislikes, preferred routines and their abilities to meet part of their assessed needs were not included in their care plans. The manager told us care planning was to be reviewed and changes were to be made to the care planning process.

One person told us they self-administered their medicines while two other people told us their medicines were administered by the staff. One person said 'I like the staff giving me my medicines.' The second person told us 'the staff do my medicines it saves me worrying that I have taken the right medicine.'

The people we spoke with and two relatives told us there were staff shortages. One person said 'there is a lot of agency staff. It would be nice for us to know the staff and them to know us. It's not good because they (agency staff) are from different agencies.' A relative of a person who lived in the home said 'there is no one to discuss things with.' Our observations of the staff on duty on the day of the inspection and the rotas in place showed to maintain staffing levels there was a heavy reliance on agency staff. While actions was to be taken improve staffing people were not receiving consistency of care from staff that knew them and knew their needs.