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Cuerden Developments Limited - Alexandra Grange Good

Inspection Summary


Overall summary & rating

Good

Updated 9 June 2017

We carried out an unannounced inspection of Alexandra Grange on 17 May 2017. We last inspected the service on 29 March 2016 when we found three breaches of regulations. These were in relation to person-centred care, safe care and treatment and good governance.

The service sent us an action plan identifying the actions they intended to take to address the breaches of regulations identified. At this inspection we found improvements had been made and the service was now meeting all regulatory requirements.

There was a registered manager in place. 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.

People who used the service, their relatives and professionals we contacted, told us they felt the service was safe. There were appropriate risk assessments in place with guidance on how to minimise highlighted risks. Safeguarding policies were in place and staff had an understanding of the types of abuse and procedures for reporting concerns..

The environment was effective for people living with dementia and provided stimulation. There was signage to aid people’s orientation and help them to be as independent as possible.

The home worked within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff had a good understanding of DoLS and the MCA, the importance of consent to care and treatment and how to act in peoples best interests.

People who used the service and their relatives told us the staff were caring and kind. We observed care in the home throughout the day. Staff interacted with people who used the service in a kind and considerate manner, ensuring people’s dignity and privacy were respected.. Relationships between people who used the service and staff members were warm. Conversations were of a friendly nature and staff’s attitude to people was polite and respectful using their chosen names, to which people responded positively.

There was an appropriate complaints procedure in place. Complaints were followed up appropriately and people who used the service and their relatives knew how to make a complaint.

A number of audits were carried out by the service, issues were identified and action plans put into place. Medication policies were appropriate and medicines were administered, stored, ordered and disposed of safely.

People’s care plans showed evidence of effective partnership working and we saw information in peoples care files that showed the involvement of relatives where appropriate.

People’s nutrition and hydration needs were met appropriately and they were given choices with regard to food and drinks. Care plans included appropriate personal and health information and were up to date.

We observed the lunchtime meal. There was a relaxed unrushed atmosphere and we saw that staff interacted with people in a respectful and dignified manner, recognising people as individuals’ and encouraging their engagement. There was a four week, seasonal menu cycle in use which was nutritionally balanced and offered a varied selection.

The home had a Service User Guide and this was given to each person who used the service in addition to the Statement of Purpose, which is a document that includes a specific set of information about a service.

The home had an End of Life Care Policy in place and people’s wishes regarding end of life were recorded in their care files, including any updates.

There was evidence of multi-disciplinary team reviews in people’s care files and evidence of best-interest decisions and discussions.

We saw that prior to any new admission a pre-assessment was carried out with the person and their relative(s).

People’s spiritual needs were met through th

Inspection areas

Safe

Good

Updated 9 June 2017

The service was safe.

People we spoke with and their relatives told us they felt safe.

There were robust systems in place for the safe management of medicines.

There was evidence of robust recruitment procedures in place.

The home was adequately maintained, including the servicing and maintenance of equipment used within the home.

Effective

Good

Updated 9 June 2017

The service was effective.

People’s care plans showed evidence of effective partnership working and the involvement of relatives where appropriate.

Staff provided assistance to people who required it as identified in their care plan.

There was a four week, seasonal menu cycle in use which was nutritionally balanced and offered a good range of choices.

There were adaptations to the environment which made it dementia friendly.

Caring

Good

Updated 9 June 2017

The service was caring.

People who used the service told us staff were caring.

Relationships between people who used the service and staff members were very warm and staff demonstrated a good understanding of the people they supported.

The home had an End of Life Care Policy in place and people’s wishes regarding end of life were recorded in their care files, including any updates.

Responsive

Good

Updated 9 June 2017

The service was responsive.

There was evidence of multi-disciplinary team reviews in people’s care files.

There were regular visits by different supporting professionals such as chiropodists and opticians.

Well-led

Good

Updated 9 June 2017

The service was well-led.

There was a registered manager in post which is a condition of Alexandra Grange’s registration with CQC.

People we spoke with and their relatives told us they thought the service was well-led.

There was a range of monthly audits in place.