Alexandra Park

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last inspection we rated this key question requires improvement. At this assessment the rating has remained the same. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

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.

Whilst relatives did not raise any specific concerns regarding this area, we identified shortfalls with the assessment of medicines, mental capacity, people’s moods, environmental safety at night and nutrition and hydration. These shortfalls posed a risk to people’s health and wellbeing.

Whilst management staff explained that people’s needs were assessed, we identified shortfalls in relation to this area. Staff told us 1 person had lost weight. Timely advice from a health professional had not been sought. Following our feedback, the manager stated that a GP review of their weight was being arranged.

Most health and social care professionals told us that communication with the service was poor. This posed a risk to joint working and the assessment of people’s needs.

An effective system was not in place to ensure people’s needs were assessed in line with best practice guidance and the regulations.

A person’s care plan did not demonstrate that advice from the speech and language therapist about the texture of food had been followed. A second person’s care plan stated they had previously become ill when they drank too much. Details of the maximum amount of fluid the person could have, were not recorded.

Some care plans stated staff should complete a mood assessment before supporting people to access the local community to ensure their safety. These assessments were not recorded, so it was not clear whether they had been carried out to ensure people’s safety.

Staff raised concerns about the safety of 1 person at night. An assessment was not in place to document the actions taken to mitigate the risks. Care records relating to a person picking up/chewing or swallowing cigarette butts were contradictory about the measures in place to reduce the risk of harm.

We identified shortfalls regarding assessments relating to mental capacity. Records relating to whether a deprivation of liberty was in place were not accurate.

At our previous inspection we found the monitoring of people's weights was sometimes inconsistent, and a recognised nutritional risk assessment tool was not used. At this assessment staff told us a person had lost weight, but a recognised nutritional risk assessment was still not in place to ensure timely action could be taken.

This is the third consecutive time shortfalls have been identified with the assessment of people’s needs.

Some relatives raised concerns that people were not always able to access the community. They also said that people did not always have the same core team of staff.

We also identified shortfalls in relation to the delivery of evidence-based care and support in relation to medicines management, mental capacity, supporting people who displayed distressed behaviours, nutrition and hydration, meeting a person’s social needs and promoting independence. These shortfalls posed a risk to people’s health and wellbeing.

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

An effective system was not fully in place to ensure records evidenced that care was delivered in line with standards, guidance and the law.

Records did not always evidence that staff delivered care in line with best practice guidance. We identified shortfalls in relation to medicines management, supporting people who displayed distressed behaviours, nutrition and hydration and meeting 1 person’s social needs.

At our previous inspection, we recommended that the provider followed best practice guidance in relation to the assessment of malnutrition. We found the monitoring of people’s weights was inconsistent and a recognised assessment tool was not in place. During this assessment, we identified ongoing issues in relation to this area.

Records did not always demonstrate how staff promoted 1 person’s independence. Their care plan stated that staff should prompt the person with home skills to reduce the risk of ‘deskilling’ them. Daily records did not evidence how staff delivered this support.

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

Several people’s care plans required staff to have undertaken specific training to help them support people with their distressed behaviours and ensure staff followed and delivered best practice guidance. However, training records and management staff, confirmed that not all staff had completed this training. A staff member had raised concerns in a person’s daily records that another staff member had been restrictive in their practices whilst they were supporting the person in the community. This staff member had not undertaken the training specified in the person’s care plan.

Relatives told us communication with management and staff teams was not always good. This posed a risk to people’s wellbeing.

Some staff also told us communication with management staff was not always effective. They explained that management staff were not always approachable or visible. They said management ‘walkarounds’ were often carried out by staff themselves as there was a lack of team leaders.

Management staff told us a new manager had been appointed together with 2 deputy managers and team leaders to ensure there was effective oversight and management of the service.

Most external agencies and health and social care professionals raised concerns about communication at the service. This posed a risk to effective team working and collaboration.

An effective system to ensure staff, teams and services worked together well was not fully in place.

Handover records and accident and incident records did not always evidence management oversight. In addition, management walkarounds were often not signed so it was not clear who had completed these. This meant there was a lack of evidence to demonstrate that management staff were aware of any workforce issues or concerns around people’s care so timely action could be taken.

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.

Staff provided us with examples of when timely action hadn’t been taken to seek relevant professional support and advice. Staff told us a person had lost weight. Advice from a health professional had not been sought. Following our feedback, the manager stated that a GP review of their weight was being arranged. 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.

Most health and social care professionals raised concerns about communication at the service. This posed a risk to people’s health and wellbeing.

An effective system was not fully in place to evidence how people were supported to live healthier lives. Records did not always evidence that advice from relevant professionals had been sought. When relevant professional had provided advice and guidance, this had not always been followed. These issues posed a risk to people’s health and wellbeing.

Some relatives raised concerns that people were not always able to access the community and people did not always have the same core team of staff. They also told us the management team did not ensure the service was effectively managed to make sure people achieved positive outcomes.

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

An effective system was not fully in place to ensure people’s health, safety and wellbeing was monitored to ensure they achieved positive outcomes.

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 this was being carried out. A health and social care professional told us another person was moving to a different service since being at Alexandra Park was, “No longer positively beneficial” for them.

Records did not always demonstrate how staff promoted 1 person’s independence. Their care plan stated that staff should prompt the person with home skills to reduce the risk of ‘deskilling’ them. Daily records did not evidence how staff delivered this support. Records also did not always show how the person’s social needs were met. These issues posed a risk to the person’s health and wellbeing.

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

We found that records relating to whether a deprivation of liberty was in place were not always accurate. This posed a risk that people’s rights may not be upheld.

Management staff had not identified the shortfalls regarding records relating to the Mental Capacity Act 2005 (MCA) or that CQC had not been notified about the outcome of a Deprivation of Liberty Safeguards application.

Management staff told us there had been delays by the local authorities in relation to community deprivation of liberty applications and authorisations. This was ongoing at the time of the assessment.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty had the appropriate legal authority and were being met.

Records relating to whether a deprivation of liberty was in place were not always accurate. In addition, CQC had not been notified of the outcome of a Deprivation of Liberty Safeguards application. This omission was not in line with legal requirements and had been identified at our last inspection.

MCA assessments and best interests’ decisions documented staff who had been involved in the decisions; however, they did not demonstrate other individuals who had been involved such as advocates or relatives.

This is the second time the provider has been in breach of the regulations in relation to mental capacity and consent.