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Cuerden Developments Limited - Alexandra Court Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 10 May 2018

Alexandra Court is a 40 bed intermediate care centre providing a time limited period of assessment and rehabilitation for people being discharged from hospital. People access this service because they are not ready to return home safely or to have physical therapy and rehabilitation.

In response to concerns about a specific incident, we carried out an unannounced comprehensive inspection of Alexandra Court on 8 and 9 January 2018.

The service had received a coroner's Regulation 28: Report to prevent future deaths. A person using the service had slipped from a standing hoist on three occasions, the coroner found this had contributed to the persons death. The coroner also found staff were not adequately trained and had failed to keep proper records of the events. We found the service had responded effectively to this and addressed the concerns raised about training in moving and handling and record keeping. Further improvements had also been made in relation to communication between the health and social care staff.

The service was last inspected in June 2016 when it was rated as good overall with a breach of Regulation 12 of the HSCA 2008, safe management of medicines.

At this inspection we found the service had made improvements in the management of medicines but there remained some risks in relation to the storage of medication for people who were self-medicating. The service addressed this immediately following the inspection and installed lockable cabinets in the bedrooms. We also found there were some anomalies and gaps in the records for medication and topical creams.

This was a continued breach of HSCA (2008) Regulation 12(2)(g) the proper and safe management of medicines. You can see what action we asked the service to take at the end of this report.

The people we spoke with reported feeling safe. There was a safeguarding policy in place and staff were familiar with what might be a safeguarding concern and how to report this. There was a whistleblowing policy displayed in communal areas, the staff we spoke with reported knowing how to raise concerns. People who used the service and visitors also had access to this information.

Risk assessments and plans to manage identified risks were completed for people using the service. We saw that these were reviewed and updated at regular intervals.

Assessments of health and social care needs were completed on admission and we could see that people were closely involved in these. Discharge and goal planning was completed within 48 hours and people using the service told us they had felt supported to get back home and kept informed of progress.

Staff had received appropriate training and records showed that they were up to date with refresher training. Staff were also encouraged to suggest areas of interest for training sessions to develop their knowledge further. Staff reported that they had received good training and felt confident that their practice had improved as a result of this.

The staff were knowledgeable about the Mental Capacity Act 2005 and their obligations under it. Staff were clear about seeking consent from people using the service. The provider was aware of their obligations under the Deprivation of Liberty Safeguards though at the time of inspection there was nobody who was subject to this.

People using the service said that the food was fine and they had plenty to eat and drink. Support was provided for people needing help to manage their food and drink intake. The records were not always completed by the staff. There had not been any harm identified, such as dehydration which indicated that this was a record keeping error.

This was a breach of Reg. 17 good governance, as accurate records had not been maintained for each person. You can see what action we asked the service to take at the end of this report.

The building was clean and well decorated. The furniture was in good condition and there were a few communal areas for pe

Inspection areas

Safe

Requires improvement

Updated 10 May 2018

The service was not consistently safe in relation to the management of medication. Medication was not always stored safely. Medication records were not consistently completed.

People using the service said they felt safe, especially when being supported to mobilise.

People were protected from the risk of harm and abuse. Staff recognised what might be a safeguarding matter and knew how to follow the service's policies to report this.

Risks relating to the people using the service were assessed and management plans developed to mitigate these.

The building, utilities and equipment were maintained and serviced when required.

Effective

Good

Updated 10 May 2018

The service was effective

People's needs were comprehensively assessed and support plans developed to meet them.

The service had an effective training system in place including, induction for new staff, refresher training for existing staff and 'pop up' training sessions around areas of interest suggested by the staff. People using the service felt the staff had the right skills to support them.

The staff received supervision regularly in line with the service's policy.

The staff were aware of the principles of the Mental Capacity Act 2005 and understood the importance of consent. People using the service said that staff asked them before providing care.

Caring

Good

Updated 10 May 2018

The service was caring.

People using the service and their relatives praised the caring attitude of the staff.

We observed staff behaved in caring and kind ways when supporting people.

People were closely involved in developing their goals and independence.

People using the service felt their dignity and respect was valued.

Responsive

Good

Updated 10 May 2018

The service was responsive.

People received care that was personalised and responsive to their needs.

People's care plans included information about what was important to them, their interests and previous experiences.

There were clear systems in place to ensure the safe transition of people between different services, for example, hospital or returning home with support.

People were protected against discrimination.

There was a complaints policy which all people were given access to when they arrived.

End of Life care is not provided routinely because the service is for 'intermediate care' Staff had however, had training should they need to provide this service.

Well-led

Requires improvement

Updated 10 May 2018

The service was not consistently well led.

Audits of records had not always picked up on some areas of concern identified in this inspection.

People using the service and their relatives felt that the home was well run.

Staff working at the service felt that the service was well managed and found the registered manager and management team were approachable and clear about expectations.