Archived: Alexandra Care Home

Updated 5 October 2019

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

One inspector, an assistant inspector, a specialist and expert by experience.

An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. A specialist advisor is a professional who has expertise in a specific area.

Service and service type

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

The service had a manager who was in the process of registering with the Care Quality Commission. However, in the absence of their registration, the provider is legally responsible for how the service is run and for the quality and safety of the care provided. The service was also supported by other managers from the providers locations.

Notice of inspection

This inspection was unannounced on both dates we attended the service.

What we did before the inspection

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. However, we had received monthly monitoring from the service which we have used to plan for the inspection. We also liaised with the local authority and the local health care practitioners. We used all of this information to plan our inspection.

During the inspection-

We spoke with four people who used the service and seven relatives, who were visiting. We spoke with three nurses, three domestic staff, two kitchen staff and five members of care staff. We also spoke with the current manager, the supporting manager and the providers regional quality manager and regional director who support the home.

We reviewed a range of records. This included six people’s care records and multiple medication records. We looked at four staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records, which the provider shared with us. We spoke with two professionals who regularly visited the service.

Updated 5 October 2019

About the service

Alexandra Care Home is a nursing home providing personal and nursing care to 29 people aged 65 and over at the time of the inspection. The service can support up to 40 people.

The accommodation is provided over two floors. The upper floor has its own communal space, bedrooms toileting and bathing facilities. The downstairs also has bedrooms and toilet and bathing facilities with the addition of two large communal spaces. These are used for dining, relaxing and activities. The garden was well maintained and provided an accessible space which was safe for people to use.

People’s experience of using this service and what we found

A range of audits and systems were used to monitor the service; however, these had not always identified changes, or the changes implemented had not been effective. Staff had received training in many areas and it was effective in supporting their role. However, we have made a recommendation the provider ensured staff received the training required to support people with behaviours that challenge.

Daily records had not always been completed or cross referenced with incidents and so we could not be sure these had been responded to as required. Risk assessment had not always identified the required support people needed and some areas of care had not been monitored consistently. There were some medicine errors in relation to recording and stock.

People’s health needs were monitored, and referrals made to a range of health professionals. Partnerships had been established with some of these, however further developments were required to provide ongoing clinical support.

Staff had established positive relationships with people and this enabled people to spend time each day as they wished. We observed respect for people’s dignity and personal needs being responded to. People were able to follow their spiritual beliefs and consideration was made to individuals’ preferences.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People were encouraged to make choices and their independence was encouraged.

There was a relaxed atmosphere in the home and people enjoyed the lunchtime experience. Assistance was provided if required and there were many choices to promote people’s dietary needs. People had the opportunity to enjoy entertainment or follow areas of interest. A partnership had been established with a local school for a joint exercise session.

The care plans were detailed, and person centred. It covered all aspects of the persons care requirements and people and those important to them had been included in this process. The plans included their wishes to be considered for their end of life needs.

There was a complaints policy which had been followed when any concerns had been raised. The provider had displayed their rating on their website and at the home. People and relatives were consulted and informed about the care and any changes.

There was a new manager at the home and staff felt supported by them. There were sufficient staff to support people’s needs and additional support for the nurses had been introduced. All staff had received the required recruitment checks.

The environment had been enhanced by many changes to the layout and the decoration. Additional sensory features were now in place and signage or objects of reference had been used to help orientate people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: The last rating for this service was requires improvement (Published March 2019 and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection improvements had not been made, however the provider was still in breach of some regulations.

Why we inspected: This was a planned inspection based on the rating at the last inspection which was Requires Improvement with Inadequate in Well-led.

Enforcement: At our last inspection we placed positive conditions on the provider in relation to this location. These required the provider to send us a monthly report on all the areas of concern reflected in the last inspection. Although improvements had been made, this did not reflect a sustained approach and we felt it to be appropriate for the conditions to remain at the location until our next inspection.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of the report.

Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals are added to reports after representations and appeals have been concluded.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

You can see what action we have asked the provider to take at the end of this full report.