Alexander Court

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.

This is the first assessment for this service under a new provider. This key question has been rated requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

We found care plans which had contrasting information to support people with their health. For example, people’s diabetes care plans said staff are to check the MAR before administering insulin. This differentiated with the care plan reviews and what staff told us, which was the District Nurse team supported people with administering their insulin. People’s care plans were not being regularly reviewed, meaning any changes to people’s needs was not reflected in the care plans. We found staff had a clear understanding of people’s needs which reduced the impact of poor documentation leading to people’s needs not being met. The leadership team were implementing a new electronic care planning system, which went live during our inspection. The new system enabled the leadership team to have oversight of care documentation to reduce the risk of people’s care not being updated when required.

The Service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. The provider used recognised risk assessment tools to help assess people’s needs and make changes, if necessary. These included Waterlow for assessing people’s risk of developing pressure ulcers and Malnutrition Universal Screening Tool to assess people’s risk of malnutrition. However, the tools were not regularly reviewed to identify peoples risk change, for example, people’s Waterlow score assessment had not been reviewed for prolonged time periods. This potentially put people at risk. We found no harm had come to people. The new electronic care plan system enabled the leadership team to have oversight of care documentation to reduce the risk of people’s care not being reviewed in the future.

The provider worked well across teams and services to support people. Records showed people were supported to access external health professionals, including when people needed to attend hospital appointments.

We found handovers took place at the service to ensure staff were updated of people’s needs. Staff told us that they attend handovers at the start of their shifts. One staff told us, ‘Handovers happen twice, from day staff to night staff and night staff to day staff.’

During our inspection we observed people being visited by the district nurse who supported people with their insulin administration.

Relatives told us that they were happy with the support people received from their GP. One relative told us, ‘They have a doctor that goes in weekly which is brilliant.’

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

When we spoke with staff, they were aware of people’s preferences and dietary needs. One staff member told us, ’We have to know what a person needs are so we can support them with the right food, if we don’t know we always check and ask a senior.’

Relatives told us that the service ensures people’s dietary needs are met.

One relative told us, ‘[person] is a plain eater, but they always have a selection, and they will rustle something up if [person] doesn’t like what is on offer.’

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and

consistent, or that they met both clinical expectations and the expectations of people themselves. We could not be assured that the service always effectively reviewed and monitored care constantly to ensure positive outcomes. For example, we found some people who required repositioning every 2 hours to reduce the risk of skin damage, were not being repositioned for longer periods than 2 hours. This put people at risk. We found no harm had come to people.

When we informed the leadership team, they were proactive in reviewing all people at risk and ensured that regular oversight was made.

Where a person did not have capacity to make their own decisions, or had fluctuating capacity, the provider had not consistently completed Mental Capacity Act assessments. This meant the service had not acted in line with the Mental Capacity Act (MCA) (2005) code of practice.

The leadership team was proactive on acting on our findings and Mental Capacity Assessments were completed as required.

Staff had received training in the MCA and understood what consent was. One staff member told us, ‘Always ask people what they want.’

We observed staff consistently offering people choices and seeking consent before any care or support was delivered.