Alexandra Park

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

At our last inspection we rated this key question requires improvement. At this assessment the rating has remained the same. This meant people did not always feel well-supported, cared for or treated with dignity and respect.

The provider was in breach of the legal regulation in relation to governance.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Due to the concerns identified during the assessment, we could not be assured people received a high quality, compassionate and caring service.

Whilst relatives raised concerns about the management of the service, they generally spoke positively about the caring nature of care and support staff.

Staff talked positively about the people they supported. We spoke with a member of staff who had worked with a person for many years. They knew the person well and how best to support them.

Due to the concerns and feedback given by health and social care professionals we were not assured people were receiving a high quality and compassionate service people deserved.

Most of our observations between staff and people were positive. However, we provided feedback to management that staff had not fully promoted 2 people’s dignity during our visits to their homes. A person was undressed when we visited. Staff had not informed us prior to our visit to ensure their dignity was promoted. Another person sat on the toilet when we visited; whilst they did not use the toilet, we requested to leave for their dignity, however, the staff member told us we could stay.

The environment did not always promote people’s dignity. We visited a person and noticed they did not have a toilet seat. There was disused equipment and a toilet seat in their garden. They also had no curtains or blinds fitted because of the risk of ingestion. There were black bags covering the outside of another person’s windows which we had also observed at our last inspection.

Management staff explained that due to the nature of the person’s condition, they often broke their toilet seat and a specialist toilet seat was going to be fitted. They also told us they were obtaining quotes for special integrated internal blinds which people could not access and ingest.

Several relatives said that people did not always have the same core team. They also said people were not always able to access the community because there were not always enough staff who could drive which affected people’s wellbeing and individuality.

We identified shortfalls around supporting a person with their social needs and promoting their independence which posed a risk to the person’s health and wellbeing.

We read and heard examples and reviewed photos which the management team provided of how being at the service had improved people’s wellbeing.

We received feedback from several health and social care professionals that the care provided did not always meet people’s individual needs. In addition, the service remained in organisational safeguarding processes because insufficient action had been taken to improve and make sure people achieved positive outcomes which met their individual needs.

Most of our observations between staff and people were positive. A person had arrived back from the cinema and had enjoyed their visit with staff. Another person went out for a walk with staff; we observed the staff member place a reassuring hand on their shoulder at times.

An effective system was not in place to ensure records evidenced that individualised person centred care was provided.

A person’s care plan stated staff needed to ensure the person had access to new activities and try out new experiences to ensure they achieved a good quality of life. Records did not demonstrate that this was being carried out.

We provided feedback to management staff that 1 person’s daily records were detailed and evidenced how staff treated the person as an individual. However other people’s records we reviewed were much less detailed which meant there was a risk that people did not receive individualised care and support.

Several relatives said that people did not always have the same core team. They also said people were not always able to access the community because there were not always enough staff who could drive which affected people’s wellbeing. 3 relatives told us they were not involved in aspects of their relative’s care, including choosing the staff who supported their family member.

Staff spoke positively about the people they supported. We read and heard examples and reviewed photos which the management team provided of how being at the service had improved people’s wellbeing.

We visited a person in their bungalow. Staff supported them to make a drink and get a snack.

An effective system was not in place to ensure records evidenced how staff promoted people’s independence, choice and control.

We provided feedback to management staff that 1 person’s daily records were detailed and evidenced how staff supported the person’s independence, choice and control. However, other people’s records were not always detailed and did not always demonstrate how staff promoted people’s independence or supported their social needs.

Gaps in training provision, records and feedback received did not assure us that people had optimum support to remain as independent as they could or have the choice and control of their daily lives they were entitled to.

Management staff explained that further updates and training had/were being provided to staff regarding record keeping.

A person met the criteria for an advocacy referral in relation to a specific decision regarding their support at night. Management staff said that an advocacy referral had not been made. This meant processes were not fully in place to support the person’s choices and independence. Following our feedback, management staff stated that a referral had since been made.

We identified shortfalls regarding responding to people’s immediate needs in relation to medicines management, the assessment of people’s moods, environmental safety at night, meeting 1 person’s social needs and nutrition and hydration. These shortfalls posed a risk to people’s health and wellbeing.

Some staff told us that due to staffing and the availability of staff who could drive, it was sometimes difficult to support people to access the local community. Management staff told us that there had been an increase in staff who could drive since our last inspection.

Several staff told us they had not completed specific training in relation to supporting people who sometimes exhibited distressed behaviour. This training helps staff support people with their distressed behaviours and helps ensure staff follow non-abusive psychological and physical interventions.

A person met the criteria for an advocacy referral in relation to a specific decision regarding their support at night. Management staff said that an advocacy referral had not been made. Following our feedback, management staff stated that a referral had since been made.

Staff explained a person’s regular medicine had been changed to ‘when required’ at the request of their relative. However, this change had not been authorised by the prescriber of this medicine. Another person was prescribed a medicine to be taken in the morning before food and another medicine to be taken after food, however, staff explained because the medicines were in one blister compartment, these medicines were administered altogether. These issues posed a risk to people’s health and wellbeing.

During our site visits, people were involved in a variety of activities, they accessed the local community and the resource centre at the service which was used for social activities.

Some staff told us that they did not always feel supported or enabled at work. Staff explained management staff were not always visible

Management staff told us not all staff had accepted the changes they were making to ensure improvements were made. This was an area they needed to address.

An effective system was not fully in place to ensure staff felt supported and enabled at work.

Records did not evidence that staff were supported to have a debrief following a serious incident. In addition, accident and incident records, management walkaround records and handover records did not always evidence management oversight to help identify whether any further support was required for staff.