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Alexandra Court Care Centre Requires improvement

The provider of this service changed - see old profile


Inspection carried out on 27 March 2018

During a routine inspection

This inspection took place on 27 March and 10 April 2018 and was unannounced on the first day. At the last inspection in April 2017, the provider was in breach of three regulations. These related to consent in the key question effective, person-centred care in responsive and governance in well-led. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve these key questions to at least good. We checked to see that the action plan had been completed and found progress in some areas but further improvements were required in others.

Alexandra Court Care Centre is registered to provide care for up to 84 people who need nursing care and who may be living with dementia. The building is purpose built, over three floors accessed by passenger lift and stairs. All the bedrooms are for single occupancy and all of them have an en-suite shower, sink and toilet. Recent changes had taken place; the provider decided to close the top floor and use it for storage. People who required nursing care were now located on the first floor and those that required residential care were on the ground floor.

Alexandra Court Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a registered manager in post. A registered manager is a person who has registered with the 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.

We had concerns with how some people’s specific health conditions were managed so that they received timely oversight from professionals involved in their care.

Although improvements had been made in the quality monitoring system and more effective audits were carried out, there remained an issue with audit of records; some records were not up to date and had gaps which made it difficult to check if the care had been delivered. Management of the service was described as open and approachable. However, the move of people to different bedrooms to assist in the restructuring of the service was hurried and could have been managed more effectively.

We also had concerns about shortfalls in staff training, updated skills and supervision to ensure they were knowledgeable about how to manage people’s specific health care needs.

These issues were breaches of Regulation 12 Safe care and treatment, Regulation 17 Good governance and Regulation 18 Staffing, of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. You can see what action we have told the provider to take regarding these issues at the back of the full version of this report.

The provider had policies to guide staff in safeguarding people from the risk of harm and abuse. Staff knew how to raise safeguarding alerts if they had concerns. People had risk assessments and these were kept under review.

People received their medicines as prescribed. There had been some administration errors in the past, but when these occurred, staff acknowledged them, sought medical advice and informed the person and their relatives. Staff who administered medicines had received updated competency checks.

People were supported to make their own decisions and choices. The registered manager and staff had a much improved understanding of mental capacity legislation. People had assessments of capacity and best interest decisions made on their behalf if they lacked capacity; documentation regarding best interest decisions had been completed. Appropriate applications had been made to the local authority when people’s liberty was deprived due to their lack of capacity and need for continual supervision.

People liked the meals provided to them. The menus gave people choices and alternatives and specialist meals were provided for people’s diverse needs. We discussed with the regional manager how mealtimes could be held over two sittings to ensure people who required full support were assisted more effectively. They assured us this would be addressed.

There were mixed comments about the number of care staff deployed and whether this was sufficient. There had been a very recent staff rota change and the closure of six beds on one floor; staffing levels were to be monitored by the registered manager and regional manager to see if this impacted on the comments received from people.

People who used the service and their relatives we spoke with all had very positive comments about the caring approach of staff. They confirmed staff respected their privacy and dignity, delivered care which was person-centred and treated them as individuals.

People could remain in the service to receive end of life care. This had improved since a concern was raised last year. Staff attended meetings with other professionals to discuss people’s needs at the end of their life and to make sure the right equipment and medicines were in place.

There were lots of activities for people to participate it within the service. There were also trips arranged to local venues and visits from entertainers and primary school children to help people feel part of the community.

The provider had a complaints procedure which was displayed in the service. People told us they felt able to raise concerns and these would be addressed.

The environment was safe and clean. Staff used personal, protective equipment to help prevent the spread of infection. Equipment used in the service was checked and maintained to ensure it was safe.

Inspection carried out on 25 April 2017

During a routine inspection

The inspection took place on 25 April 2017 and was unannounced. This is the new registered provider’s first inspection since they registered with the Care Quality Commission in October 2015. At the time of the inspection, there were 77 people using the service.

Alexandra Court provides nursing and personal care for a maximum of 84 people. It is situated in a residential area in East Hull close to local amenities and has good access to public transport. The service has 84 single bedrooms which are located over three floors; each bedroom has an en suite which consists of a shower, a sink and a toilet. There are rooms for communal use on each floor such as sitting rooms, dining rooms, bathrooms and additional shower rooms and toilets. There is also a hairdresser’s salon on the ground floor. There are two lifts and stairs for access to the upper floors and a large enclosed, landscaped garden and patio, which provides a secure area for people to enjoy the outdoor space.

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.

During the inspection, we found some concerns regarding quality monitoring which had resulted in shortfalls being missed when audits were completed. Examples included gaps in care plans, supplementary charts for recording food and fluid intake and accident analysis.

There was some inconsistency with the application of mental capacity legislation. Some people had assessments of capacity and records in place when restrictions were in place, but this was not consistent throughout the service. We found some people may meet the criteria for a deprivation of liberty safeguard but this had not been completed.

People had care plans in place, however, we found these were not always person-centred and missed important information regarding how staff were to care for them. This meant that important care could be missed.

You can see what action we told the provider to take regarding the above three areas at the back of the full version of the report.

We observed staff demonstrated a kind and caring approach when supporting people who used the service. They were attentive and patient throughout the day and in discussions, they gave examples of how they would promote values such as privacy, dignity, confidentiality and choice. People who used the service and their relatives confirmed staff were caring and compassionate.

We found staff knew how to protect people from the risk of harm and abuse. They had policies and procedures to follow and had received safeguarding training so knew what to do if they witnessed any concerns. Risk assessments were completed to ensure staff had information about how to minimise risk.

Staff were recruited safely and there were sufficient staff on duty to meet people’s needs. There was a concern about the deployment of staff in the residential unit in the early evening. However, the registered manager told us they had received confirmation from the registered provider of an additional member of staff between 6 and 10pm, which would resolve the issue.

Medicines were managed safely and people who used the service received them as prescribed. People told us their medicines were administered to them in a timely way.

People who used the service had their health care need met either from the nurses on duty or from access to community health care professionals. Staff made referrals to health care professionals in a timely way and knew how to recognise when people’s health was deteriorating.

We saw the menus provided people with a choice of nutritious meals. People told us they liked the meals provided to them and staff were flexible if they wanted an alternative to the main menu choices each day. We observed drinks and snacks were served between meals. Staff completed assessments of people’s nutritional needs and monitored their weight. They referred people to dieticians when required.

Records evidenced that staff received appropriate induction, training, supervision and support, which enabled them to feel skilled and confident when supporting people who used the service.

Staff, people who used the service and their relatives, told us the registered manager had an open-door policy and was available to speak with them when required. There was a complaints procedure on display in the service and it was included in information given to people. Staff knew how to manage complaints and people spoken with felt able to raise concerns.

We found the environment was clean and safe, and equipment used was serviced regularly and maintained on a day to day basis. Checks were completed in important areas such as fire safety equipment, bed rails, window restrictors, hot water outlets and the nurse call. There was a policy on infection prevention and control and staff had access to personal and protective equipment such as gloves, hand sanitiser and aprons. There was a business continuity plan which gave staff guidance in what action to take in emergencies such as floods or a failure in utilities.