We carried out a review of the data available to us about Hallmark Alexandra Grange Luxury Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Hallmark Alexandra Grange Luxury Care Home, you can give feedback on this service.
We found the following examples of good practice:
The registered manager and deputy manager were knowledgeable, skilled and experienced in managing infection prevention and control. They were passionate about the safety of people at the service.
There were sufficient supplies of personal protective equipment.
All areas of the building were extremely clean. Daily walk arounds by the management team checked the cleanliness of each area in the service.
Hand hygiene points in bathrooms and along corridors were clean, accessible and fully stocked.
The service ensured that visitors had their COVID-19 vaccination status and lateral flow test checked before entry to the main building. This ensured people’s protection from the risk of infection.
The service worked closely with the local authority and clinical commissioning group to keep people safe. They also kept up to date with best practice initiatives and shared information with other locations within the provider’s group of care homes.
Audits were completed to scrutinise infection prevention and control. The findings were taken seriously, and the management team acted promptly to respond to any areas for improvement.
Records regarding staff vaccinations were detailed, accurate, easy to interpret and showed only those eligible to work at the service were employed.
Essential caregivers were promoted to be part of people’s lives. Appropriate risk assessments and testing were in place. We met an essential caregiver who praised the staff’s efforts of ensuring people’s safety.
About the service:
Alexandra Grange is a residential care home for older people some of whom have some degree of dementia. The home is arranged over three floors with the middle floor dedicated to people who have a diagnosis of dementia. It can provide accommodation and personal care for up to 58 people at any one time. On the day of the inspection 50 people were using the service.
People’s experience of using this service:
¿The registered manager did not always ensure they maintained clear and consistent records when people had injuries and the Duty of Candour was applied. This means providers must act in an open and transparent way with people who use services and other ‘relevant persons’ (people acting lawfully on their behalf) in relation to care and treatment.
¿We made a recommendation to explore relevant guidance on how to ensure environments used by people with dementia were more dementia friendly.
¿We have made a recommendation about seeking guidance from a reputable source to ensure principles of the Accessible Information Standard are met.
¿There was an activities programme and some people were involved in activities. The registered manager took action to ensure all people had opportunities for social engagement and meaningful activities according to their interests to avoid isolation.
¿People felt safe living at the service. Relatives felt their family members were kept safe.
¿Staff understood their responsibilities to raise concerns and report incidents or allegations of abuse. They felt confident issues would be addressed appropriately.
¿Recruitment processes were in place to make sure, as far as possible, that people were protected from staff being employed who were not suitable.
¿People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
¿We observed kind and friendly interactions between staff and people. People and relatives made positive comments about the staff and the care they provided.
¿People told us staff were available when they needed them and staff knew how they liked things done most of the time. The registered manager reviewed and improved staffing numbers to ensure enough qualified and knowledgeable staff were available to meet people's needs at all times.
¿Staff training records indicated which training was considered mandatory by the provider. The registered manager had planned and booked training to ensure staff had appropriate knowledge to support people. Staff said they felt supported to do their job and could ask for help when needed.
¿There were contingency plans in place to respond to emergencies. The premises and equipment were cleaned and well maintained. The dedicated staff team followed procedures and practice to control the spread of infection and keep the service clean.
¿People had sufficient to eat and drink to meet their nutrition and hydration needs. Hot and cold drinks and snacks were available between meals.
¿People had their healthcare needs identified and were able to access healthcare professionals such as their GP. The service worked well with other health and social care professionals to provide effective care for people.
¿People received their prescribed medicine safely and on time. Storage and handling of medicine was managed appropriately.
¿People confirmed staff respected their privacy and dignity. The registered manager was working with the staff team to ensure caring and kind support was consistent.
¿We observed people were treated with care and kindness. People and their families were involved in the planning of their care.
¿The service carried out risk assessments and had drawn up care plans to ensure people's safety and wellbeing. Staff recognised and responded to changes in risks to people who use the service and ensured a timely response and appropriate action was taken.
¿The registered manager held residents and relatives' meetings as well as staff meetings to ensure consistency in action to be taken. The staff team had handovers and daily meetings to discuss matters relating to the service and people’s care.
¿Staff felt the management was open with them and communicated what was happening at the service and with the people living there.
¿People and relatives felt the service was managed well and that they could approach management and staff with any concerns.
¿The management and staff team had reviewed, assessed and monitored the quality of care. They encouraged feedback from people and families, which they used to make improvements to the service. The provider was taking steps proactively as part of the quality assurance to ensure people were protected against the risks of receiving unsafe and inappropriate care and treatment.
Rating at last inspection: At the last inspection the service was rated Good in all the domains (Report was published 02 September 2016).
Why we inspected: This was a planned comprehensive inspection based on the rating at the last inspection.
Follow up: We will continue to monitor all information we receive about this service. This informs our ongoing assessment of their risks and ensures we are able to schedule the next inspection accordingly.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
At the time of the inspection there was 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 provider completed thorough recruitment checks on potential members of staff. Maintenance and checks of the property and equipment were carried out promptly and within required timescales. Checks on fire alarms and emergency lighting had been completed in accordance with the provider’s policy and manufacturer’s instructions.
There was a system to ensure people received their medicines safely and appropriately. The quality of the service was monitored by the registered manager and the provider through gaining regular feedback from people and their representatives and auditing of the service. The provider had plans in place to deal with emergencies that may arise.
People who use the service were able to give their views about the quality of the care provided. Relatives, community professionals and commissioners told us they were very happy with the service they received from Alexandra Grange and felt that people were safe using the service. The service had systems in place to manage risks to both people and staff. Staff had good awareness of how to keep people safe by reporting concerns promptly through procedures they understood well. Information and guidance was available for them to use if they had any concerns.
People were treated with kindness, dignity and respect. They were involved in decisions about their care as far as they were able and relatives/representatives told us they had been asked for their views on the service for particular individuals. People’s care and support needs were reviewed regularly. The registered manager ensured that up to date information was communicated promptly to staff through regular meetings.
Staff felt very well supported by the registered manager and care manager (deputy manager) and said they were listened to if they raised concerns and action was taken without delay. We found an open culture in the service and staff were comfortable to approach the registered manager or any member of the management team for advice and guidance.
Staff understood their responsibilities in relation to gaining consent before providing support and care. People’s right to make decisions was protected. New staff received an induction and training in core topics.
We carried out an unannounced comprehensive inspection of this service on 13 and 14 January 2015. Breaches of three legal requirements were found. We issued warning notices for breaches in relation to the provider maintaining accurate and secure records, and ensuring consent to care was sought in accordance with the principles of the Mental Capacity Act (MCA) 2005. We issued a compliance action for a breach relating to safe administration and disposal of medicines.
The provider was required to meet the regulations relating to the warning notices by 6 April 2015. They told us they would address the breach relating to medicines by 31 March 2015.
This report only covers our findings in relation to these areas. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Alexandra Grange’ on our website at ‘www.cqc.org.uk’.
Alexandra Grange provides residential care for up to 58 older people without nursing needs, but with other care needs, including dementia care. At the time of our inspection 40 people were living in the home.
Since our inspection in January 2015, a new manager had submitted their application as the home’s registered manager. They had been in place as the manager of this home for ten days at the time of our inspection. They were being supported through their induction by the provider’s managerial and regional staff, including the person who was managing this home at our inspection in January 2015. 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 and associated Regulations about how the service is run.
At our focused inspection on 28 May 2015, we found that the provider had taken action to ensure the requirements of the Regulations had been met.
People’s medicines were stored, administered and disposed of safely. The provider had put systems and checks in place to ensure issues, omissions and errors were identified promptly, and actions demonstrated that learning occurred to address these issues and reduce the risk of repetition.
People’s consent to care was documented. When people declined specific areas of care, this was recorded, and their decisions were supported. Where people were unable to sign their consent, records documented how the person had indicated their wishes. If staff were unsure of a person’s capacity to consent, an assessment of their mental capacity was documented, and a decision was made and recorded on their behalf by those appropriate and with the person’s best interests at heart, such as family, staff or health professionals. Relatives had been supported by the provider to understand the principles of the MCA 2005, including the role and limitations of power of attorney.
Where people had been identified at risk of harm from malnutrition, dehydration or pressure sores, staff completed charts in full to record the support provided to people over each 24 hour period. This ensured people received the care and support they required to protect them from identified risks.
Records were stored in staff offices that were kept locked when unattended. Staff understood and implemented the provider’s policy regarding records security. Managers conducted daily checks to ensure confidential information was maintained securely.
The provider had taken sufficient action to meet the requirements of the warning notices and compliance action in relation to maintaining accurate and secure records, ensuring lawful consent to care was obtained and documented, and the safe administration and disposal of medicines.
The inspection took place on 13 and 14 January 2015 and was unannounced.
Alexandra Grange provides residential care for up to 58 older people including people living with dementia. At the time of our inspection 39 people were living in the home.
The home consisted of three floors. There were individual en-suite bedrooms and shared bath or wet rooms on all floors. The Peacock top floor cared for people with residential needs. The Monarch first floor catered for people living with dementia. The Grayling ground floor accommodated people with personal care needs and people living with the earlier stages of dementia. Communal lounges and dining rooms were available for people on all floors. Stairs and a lift provided access between floors. A range of communal areas, including a hairdressing salon, and a café open 24 hours daily, were available for people’s use. The doors to Monarch were secured with a keypad, to ensure people were protected from dangers that could affect their safety. People able to independently leave the home or floor safely knew the codes to do so, otherwise they were supported to leave as they wished.
A registered manager was not in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 confirmed that a person had been appointed to this role shortly after our inspection, and would be applying with CQC to take up the post of registered manager.
During this inspection we checked whether the provider had taken action to address the nine regulatory breaches we found during our inspections in May 2014 and July 2014. The provider told us that they would have completed their action plan by end of November 2014.
We found the provider was working towards improving the service. The provider had implemented a system of quality and risk checks to support the manager to monitor the service and drive improvement. It was too early to assess the effectiveness of these systems in promoting sustained improvement in the quality of the service people received. Though improvements had been made, we found ongoing concerns relating to the practices of record keeping, medicine management and gaining people’s consent.
People’s care records were not always kept securely. Daily care records did not reflect the care delivered to people to ensure they stayed healthy and safe. These incomplete records did not enable the manager to tell whether people’s care had been delivered effectively.
Though our previous concerns about medicine management had been addressed we found new evidence of unsafe medicine administration and disposal. The provider had identified similar concerns and was working with the community pharmacist to improve practice.
Where people lacked capacity to make decisions about their care, decisions had not been made lawfully in line with the principles of the Mental Capacity Act 2005 (MCA). The provider had not taken sufficient actions to protect people’s rights.
The provider had improved their learning from safety incidents. When safety incidents occurred these had been investigated, analysed and preventative action taken to keep people safe.
The provider employed sufficient staff and the recruitment process was robust to ensure people were supported by appropriate staff. Staff support and supervisions had improved. This was confirmed by the staff we spoke with. Where staff performance had fallen below an appropriate standard the provider had taken action to address shortfalls.
People were cared for by staff who were kind and respectful of their needs and wishes. Their dignity was promoted by thoughtful consideration. People were involved in decision-making in the home, both with their own care planning and in areas such as staff recruitment. The complaints process ensured people’s concerns were addressed appropriately.
People, relatives and staff acknowledged progress towards a stable management team in the home, and spoke with confidence about the manager in post at the time of our inspection.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.
In this report the name of a registered manager appears who was not in post or managing the regulatory activities at this location at the time of the inspection. We have written to the provider to ensure actions are taken to remove the name of the registered manager who is no longer in post.
The service did not have a manager in post who was registered with the CQC at the time of our inspection. This is a requirement for registration with the Care Quality Commission (CQC). The regional manager told us the application process for becoming a registered manager with the CQC would commence following the appointment of a new manager at the service. An acting general manager, with support from the regional manager, was managing the service during our inspection.
At our last inspection we found evidence that confirmed the provider had failed to comply with the condition of their registration. That is, the provider must not provide nursing care at Alexandra Grange. We found nursing care had been carried out by a senior staff member at Alexandra Grange. Failure to comply with the condition of their registration meant the provider had not ensured that people were protected against the risks of unsafe or inappropriate care and treatment. We issued a formal warning to the provider to make urgent improvements.
During this inspection we found the manager had taken action to address these concerns and gain compliance with the condition of their registration. Examples of actions taken included, a memorandum to staff informing them that they were not permitted to perform nursing procedures at the service. We saw staff had signed these to confirm they had read and understood the information in the memorandum. We saw notes of a senior staff 'Ten at Ten' meeting dated 12 June 2014. This recorded a discussion that staff had been instructed not to carry out nursing procedures at the service. The role of clinical care manager had been changed to care manager. The manager told us a person had been appointed to this role. We noted there was no reference made to performing any nursing procedures at the service in the job description. We saw a folder of nursing procedures in the staff room and reference to nursing on the provider's signage outside the service. When we told the manager about these concerns they took immediate action. The folder was removed from the staff room and placed in the manager's office. The word 'nursing' on the provider's signage was covered. However, we have not been able to test that this compliance has been sustained.
People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. The service manager had reviewed the service's reporting in relation to safeguarding and had taken appropriate steps to ensure that relevant authorities were informed of allegations of abuse.
A system of staff supervision and appraisal had recently been re-instated to support staff. Six out of 34 staff had recently received a supervision meeting. The last supervisions recorded prior to that were October 2013. This meant staff had not received support through supervision to enable them to deliver care and treatment to people safely and to an appropriate standard.
One person who uses the service said 'Staff have the right skills.' However, a review of the staff training records for 34 staff showed 30 staff had not received all of the mandatory training to meet the needs of the people safely and to an appropriate standard.
The provider did not have an effective recruitment process in place. We found all of the required pre-employment checks had not been completed for seven staff members. There was a risk that people would be cared for by staff who were not suitable for the role.
The provider had not ensured that, at all times, there were sufficient numbers of suitably qualified, skilled and experienced staff working at the service to provide care and support to meet the needs of the people living there.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to recruiting new staff, supporting staff and ensuring there are sufficient numbers of suitably qualified, skilled and experienced staff working at the service at all times.
We considered our inspection findings to answer questions we always ask;
' Is the service safe?
' Is the service effective?
' Is the service caring?
' Is the service responsive?
' Is the service well-led?
This is a summary of what we found.
Is the service safe?
Relatives of people who use the service were complimentary about people's safety being maintained by the provider. One relative told us 'They (staff) look after X. We have no concerns about X's safety.' Personal evacuation plans were in place for each person to ensure their safety in the event of a fire at the service.
People were protected from unsafe or unsuitable equipment. Equipment was well maintained and serviced regularly to ensure people were not put at unnecessary risk.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to this type of service. While no applications have needed to be submitted for the people using the service, proper policies and procedures were in place. Relevant staff were trained to understand when an application should be made, and how to submit one.
People had been cared for in an environment that was safe, clean and hygienic. One person told us "the home is lovely and clean." However, people were not always protected from the risk of infection because some protocols based on current Department of Health guidelines had not been followed. People were not always protected against the risks associated with medicines because staff did not follow the provider's policy and procedures in relation to the recording, safe keeping and safe administration of medicines. We have asked the provider to tell us what they are going to do to ensure they have effective processes in place to manage the prevention and control of infection and ensure the safe management of medicines. This is a requirement to meet the Regulations.
We found people's records could be located promptly but were not securely kept. People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not always maintained. For example, we found a risk assessment for pressure sore development and guidance for the management of a urine infection were missing from one person's care plan documentation. We have asked the provider to tell us what they are going to do to ensure the accuracy and secure storage of people's records. This is a requirement to meet the Regulations.
There was no system for monitoring and learning from incidents relating to the welfare and safety of people who use the service. This meant people were at risk of unsafe care, because the provider could not identify possible trends that may require additional actions, such as risk assessments and the implementation of appropriate actions to minimise the risk of occurrences to people and others who use the service. We have asked the provider to tell us what they are going to do to ensure that learning from incidents and events that affect people's safety takes place. This is a requirement to meet the Regulations.
We found evidence that confirmed the provider had failed to comply with the condition of their registration. That is, the provider must not provide nursing care at Alexandra Grange. We found nursing care had been carried out by a senior staff member at Alexandra Grange. Failure to comply with the condition of their registration meant the provider had not ensured that people were protected against the risks of unsafe or inappropriate care and treatment. We have issued a formal warning to the provider to make urgent improvements.
Is the service effective?
During our visit we saw people were asked for their consent before they received any care, and staff acted in accordance with their wishes. However, the provider did not ensure that processes for formally obtaining the consent of people living at the home regarding their care and treatment were followed. This meant staff asked relatives to sign for or provide consent, on behalf of a person using the service, without ensuring the relatives were lawfully able to do so.
People's health and care needs were assessed with them and their relatives when appropriate. Their views about the type of care they wanted had been sought. Relatives of people who use the service confirmed their involvement in the development of their family member's care plan. They told us the care plans were up to date and reflected their family member's needs. However we found not all of the staff had a good understanding of people's care and support needs, for example, in relation to pressure sore prevention, moving and handling and assistance with eating.
We spoke with six people who use the service and three relatives of other people. They were complimentary about the care received. One person we spoke with said 'I like it here. I have no concerns. If I did I would ask to leave here.'
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to gaining lawful consent to care and treatment on other people's behalf and to ensure care is always delivered in a way that ensures people's safety and welfare.
Is the service caring?
People were supported by kind and supportive staff. One person told us 'Staff are very kind to me.' A relative said 'This is a very pleasant home.' All interactions we observed between the staff and people were open, respectful and courteous. We saw that care workers gave encouragement when supporting people. People were able to do things at their own pace and were not rushed.
People using the service had the opportunity to complete an annual satisfaction survey. The last one was completed in October 2013. Where shortfalls or concerns were raised these were addressed.
Is the service responsive?
People's needs were assessed before they use the service. Records confirmed people's preferences and diverse needs had been recorded. Staff provided examples of care and support being provided in accordance with people's wishes, for example, in relation to where they received their meals. Following the recruitment of a new activities coordinator we noted people had access to activities that were important to them and had been supported to take part in these.
People and their relatives knew how to make a complaint if they were unhappy. Two relatives said that they had made a complaint and were satisfied with the outcome.
Is the service well-led?
The provider had systems in place to regularly assess and monitor the quality of service that people received. The provider carried out monthly quality audits of the service. The home manager told us a survey went out to staff, people and their relatives annually. This survey asked people what they thought about the quality of support provided. We saw records that showed people were complimentary about the service. Any identified shortfalls were addressed promptly. Relatives we spoke with confirmed they had been listened to and provided examples of improvements made to the service following their feedback. One relative told us 'We are very pleased with the standard of care here. We are very impressed with the carers (staff). We are comfortable with what they are doing.'
Existing staff recruitment files were reviewed to ensure they recorded satisfactory explanations for any gaps in employment histories and health checks had been completed. This was to ensure that people who use the service were not placed at risk of being cared for by staff who were not suitable to provide their care and treatment.
The provider had put measures in place to ensure staff received appropriate training and professional development. This was to enable them to deliver care and treatment to people safely and to an appropriate standard. A system of staff supervision and appraisal was in place to support workers.
Care was planned with the involvement of the people who use the service and their relatives. Their views had been sought about the type of care they wanted. However, the daily notes were not always detailed enough to show care and treatment delivered always met all of the people's specific needs as identified in their individual care plans.
Appropriate checks were not always undertaken by the provider before staff began work. Missing documentation included full employment histories and health checks.
A system of staff supervision and appraisal was in place to support workers. However, staff did not always receive appropriate training and professional development to enable them to deliver care and treatment to service users safely and to an appropriate standard.
There were processes in place for recording, investigating and resolving complaints from people who use the service and their relatives. The people we spoke with were aware of who they would speak to if they had any complaints.
During our inspection we observed a clean environment throughout the home. People living in the home and relatives we spoke with told us the home was always kept clean and tidy. People were protected from the risk of infection because protocols based on current Department of Health guidelines had been followed. We found there were systems in place to manage and monitor the prevention and control of infection.
The home appointed a new manager in January 2013 and restructuring of the staff team was taking place. We spoke with staff, looked at staff training records and shift patterns worked by staff. We found the majority of staff had attended training and future dates were booked for those that had not. All staff had received an induction prior to commencing their role independently.The staff rota showed there were enough staff to meet people's needs and identified additional domestic staff employed to promote a clean and hygienic environment. People living in the home told us they were happy with the staff team and services provided. One person said 'staff are very good. All my needs are being met.'
The people who lived at the home were highly complimentary about the quality of accommodation, the choice of food and the attitude of the staff team. They told us the staff were "lovely, couldn't be better", "they always help me when I need them" and "I've absolutely no complaints, the staff are kind and friendly", "it's just like home". Relatives said "staff are genuinely caring" and "staff are lovely, very caring and kind". However, relatives did also comment "the staff do seem a little pushed at times and maybe a little overworked" and "the staff are always busy".
Some people and visitors told us that there were not enough staff to meet the changing needs of people.
One person told us they were now able to manage their own medicines, which was an improvement, but we found that people had not always had their medicines managed appropriately.
Recently there had been changes to the management of the home and people did not feel that they had been kept fully informed about them.
Two people commented on the change in the service recently. One person said 'Since last week I cannot fault it'. Another said that they had, in the last few days, been asked a lot of questions about their care needs. People and their relatives that we spoke to said that they had not seen their plan of care.
One visitor told us that they had been told that their husband could not keep his GP when he moved to Alexandra Grange, despite the GP practice being quite local. We spoke to the manager about this at the time of our visit.
One person who needed to use a hoist to move safely said that they felt safe whilst staff were hoisting them but said that they found it uncomfortable. They said that they wanted to become more mobile again and we saw an appointment that had been arranged for them to consult with a physiotherapist.
One resident said that she looked around before the home opened and said that her needs had been assessed. A relative said that she believed her husband's needs had been assessed before he moved in but said that she had not been involved in the process