Alexandra View Care Centre

Alexandra View Care Centre is a residential care home providing personal and nursing care to up to 68 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 45 people using the service.

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

People confirmed they felt safe living at the home. The provider assessed potential risks. There were enough staff deployed to meet people’s needs and new staff were recruited safely.

Staff followed good IPC practices and had completed IPC training. Incidents, accidents & safeguarding concerns were investigated, and action taken to help keep people safe.

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 and staff told us the registered manager was approachable and had improved the home since the last inspection. The provider had a structured approach to quality assurance which was focused on learning lessons.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 3 January 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Alexandra View Care Centre on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Alexandra view is a residential care home providing personal and nursing care to 52 people. The service can provide care for up to 68 people.

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

Prior to the inspection we received concerns linked to winter pressure beds beds operated within the home. The service had 20 beds designated for people being discharged from hospital. These were intended to be short-term (up to 6 weeks) until their longer care needs had been assessed.

Improvements were required to ensure people in these beds received the appropriate care. This was partly due to the process in place at the time for deciding which people should be referred to Alexandra View.

Health and social care professionals had acted to ensure appropriate referrals were made into the hospital contract beds.

The provider’s quality assurance processes had not proactively addressed issues with inaccurate care records and delays in developing personalised care plans.

Some people who were assessed as high risk did not have specific moving and assisting care plans in line with the provider’s guidance. Other risk assessments lacked detail about the measures needed to minimise risks to people's safety.

Relatives told us they felt their family members were safe living at the home.

Staff gave positive feedback about the registered manager. They said they felt supported and the registered manager was approachable.

There were regular opportunities for people and staff to give feedback.

Staff said they felt people were safe living at the home. They knew how to raise concerns and felt confident to do so.

Health and safety checks and environmental risk assessments were completed to help maintain safety. Incidents and accidents had been logged and investigated.

There were enough staff deployed to meet people’s needs. New staff were recruited safely.

Medicines were managed safely. The home was clean and staff used personal protective equipment (PPE) appropriately.

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 good (published 3 January 2020).

Why we inspected

We received concerns in relation to staffing levels, medicines management, poor communication with relatives, lack of information for people discharged from hospital into assessment beds, lack of care plans, poor cleanliness and dignity issues. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Alexandra View Care Centre on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

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

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Alexandra View Care Centre provides care and accommodation for up to 68 people with nursing care needs and people who are living with dementia. At the time of the inspection the service supported 49 people.

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

People felt safe and secure living in the home. People and their relatives were happy with the service and had good relationships with staff members. Comments included, “They are very caring” and “Kind. Very much so, they all have a lot of time for [family member].”

Staff safeguarded people from abuse and risks to people’s safety were assessed and managed. There were enough staff to meet people’s needs and safer recruitment procedures were in place. Medicines were administered and managed safely. The provider learned from previous accidents and incidents to reduce future risks. The premises were well maintained, clean and tidy.

Assessments of people’s needs were completed before they moved into Alexandra View Care Centre to ensure the service could effectively support them. Staff received regular training, supervisions and annual appraisals. People were supported with their nutritional needs and to access health care services to maintain their health. People were supported to have maximum choice and control of their lives, and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People were well cared for, respected and supported in a dignified manner. Staff promoted people’s independence by encouraging them to care for themselves, where possible. People’s personal information was kept secure and they were supported to access advocacy services, when needed.

People had person-centred care plans in place. Staff knew how to communicate with people effectively and communication needs were detailed in care records. People and relatives had no complaints about the service but knew how to raise concerns. Complaints were investigated and actioned. The service organised a wide range of activities for people to enjoy both inside the home and in the local community.

People and relatives were complimentary about the service and felt it was well managed. A relative said, “I think things have changed for the better.” An effective quality assurance process was in place. People and relatives were regularly consulted about the quality of the service via meetings and surveys. Staff were involved in the ongoing development and improvement of the service through regular meetings.

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 23 November 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question; is the service safe, to at least good.

During this inspection we noted improvements had been made. There was a visible staff presence with communal lounges supervised most of the time to maintain people’s safety. We also noted the provider monitored staffing levels to check they were appropriate for people’s needs and dependencies. However, we still continued to receive mixed views about staffing levels.

Alexandra View 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.

Alexandra View accommodates 68 people across three separate units, each of which have separate adapted facilities. One of the units specialises in providing care to people living with dementia. When we inspected 37 people were living at the home.

The registered manager left their employment at Alexandra View at the end of September 2018. An experienced manager had been recruited and was due to commence their employment on 29 October 2018. 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.

Medicines were not always managed safely. We noted some people had experienced delays in receiving their medicines. Although these issues had been resolved there was no evidence to confirm lessons had been identified and action taken to prevent future occurrences. The recording of medicines given only ‘when required' was inconsistent and ‘when required’ protocols required further detail relating to each person’s specific needs. We have made a recommendation about this.

People told us they received good care at Alexandra View. They told us staff were kind and treated them with dignity and respect. We observed many positive interactions between people and staff during our time at the home.

People, relatives and staff felt the home was a safe place. Staff had a good understanding of safeguarding and the whistle blowing procedure, including how to report concerns. Previous safeguarding concerns had been investigated thoroughly.

Staff were recruited safely with pre-employment checks completed to ensure new staff were suitable to work at the home.

Health and safety checks were up to date. The Fire Risk Assessment was being completed during our inspection. The provider supplied us with an action plan to address the findings from the risk assessment.

Incidents and accidents had been fully investigated. A new system had been implemented which allowed a more thorough analysis to be carried out to help ensure people remained safe and lessons were learnt.

Staff were well supported and received the training they needed for their role. Records confirmed supervisions, appraisals and training were up-to-date.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People gave us mostly good feedback about the meals provided at the home. People received the support they needed to ensure they had enough to eat and drink.

Staff supported people to access external health and social care services when required. Care records showed people had input from a range of health professionals in line with their needs such as GPs and specialist nurses.

People’s needs had been assessed and this was used as a baseline for developing their care plans. Most care plans contained the relevant information staff needed to support people effectively. This included information about people’s wishes and preferences. However, we noted care plans relating to mental health and wellbeing lacked information about the most effective strategies to support people when they were experiencing low mood or were agitated. Care plans were evaluated regularly to ensure they reflected people’s current needs.

People and relatives did not raise any complaints during our inspection but knew how to complain if needed. Previous complaints had been dealt with in line with the provider’s procedures. This included a full investigation and a written response to the complainant.

The provider had a comprehensive governance system. Audits and checks were completed consistently in line with the provider’s expected timescales. They had usually been effective in identifying and addressing issues. However, medicines audits needed to be more effective in addressing delays with people receiving their medicines. We also noted some supplementary records had not been completed in line with the provider’s expectations.

People and staff were happy with the management of the home. They also described the home as having a warm and friendly atmosphere. People and staff had regular opportunities to give feedback about the home.

At the last inspection in June 2016 the service was not meeting all of the legal requirements with regard to medicines management and record keeping. At this inspection we found improvements had been made and the service was no longer in breach of these requirements. However, we considered improvements were required with regard to other aspects of people's care.

Alexandra View Care Centre is registered to provide care and support for up to 68 older people, some of whom may be living with dementia or a dementia related condition. At the time of inspection 50 people were using the service.

A registered manager was not 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 said they felt safe and they could speak to staff as they were approachable. We had concerns however that there were not enough staff on duty to provide effective and individual care to people.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

Appropriate training was provided and staff were supervised and supported. Staff had an understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, the policies and systems in the service supported this practice.

Although people received a varied and balanced diet we had concerns due to staff deployment and staffing levels people did not all receive prompts and encouragement to eat and drink.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed.

Systems were in place for people to receive their medicines in a safe way. However, we have made a recommendation about the best interest decision making process when people did not have capacity to consent to their medicines.

Changes had been made to the environment. Some areas had been refurbished. However, not all areas of the home were clean and well maintained for the comfort of people who used the service. There were plans that the home would be designed to promote the orientation and independence of people who lived with dementia. We have made a recommendation that the environment should be designed according to best practice guidelines for people who live with dementia.

People said staff were kind and caring. However, we saw staff did not always have time to interact and talk with people. In some parts of the home there was an emphasis from staff on task centred care. We have made a recommendation that staff receive training about person centred care and personhood. Activities and entertainment were available to keep some people engaged and stimulated.

Staff knew the needs of the people they supported to provide individual care. Care was provided with kindness and people’s privacy and dignity were respected. Records were not all in place that reflected the care that staff provided.

A complaints procedure was available. People and relatives told us they would feel confident to speak to staff about any concerns if they needed to. People had the opportunity to give their views about the service. There was regular consultation with people and family members and their views were used to improve the service. People had access to an advocate if required.

The home had a quality assurance programme to check the quality of care provided. However, the systems used to assess the quality of the service had not identified the issues that we found during the inspection with regard to staffing levels, medicines management, nutrition, environmental design and record keeping.

You can see what action we told the provider to take at the back of the full version of the report. One breach with regard to regulation 18 was made because of staffing levels.

The service had a ‘Time to Think’ unit on the ground floor. This was a unit commissioned by the local authority with accommodation for 10 people. The unit was used mainly by people who needed more recovery time but were fit enough to leave hospital and this prevented a delayed discharge. Other people were on a short term placement to give their family carers a period of respite. It was also a unit where people could come and experience the care home before making a commitment to reside there on a permanent basis.

This inspection took place on 21 and 22 June 2016 and was unannounced. We last inspected this service in March 2014, at which time we found them to be compliant against all of the regulations that we inspected.

The manager of the service had been in post for one week and had begun the progress to become the registered manager. 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.

Medicines were not managed in line with safe working practices. We reviewed medicines in three treatment rooms and found issues with the storage and disposal of medicines. The temperature of the treatment rooms was not monitored and subsequently the room temperature was too hot meaning medicines and nutritional supplements were not being stored in line with the manufacturer’s guidelines. We also observed broken and disorganised storage facilities and flooring which needed replaced. Medicine administration records were found to be accurate and well maintained.

Checks on the safety of the home were routinely carried out by on-site maintenance staff as well as by external contractors where necessary. Action had not been taken to address potential risks with some electrical systems, although the provider gave assurances the systems were safe and the work was to be undertaken in August. Personal emergency evacuation plans were in place.

There were policies and procedures in place to ensure the smooth running of the service. These included a safeguarding policy which staff told us they understood along with their responsibilities towards protecting people from harm or improper treatment. Relatives of people living at Alexandra View Care Centre told us they thought they relations were safe. We found staff were following procedures which enabled them to provide safe, good quality care. We found some issues with regards to record keeping which we discussed with the manager and regional operations manager. For example, accidents, incidents and complaints were recorded but there was no evidence of thorough investigations, actions or outcomes.

Staff recruitment was safe, however we recommended that the service carry out additional annual checks or periodic checks with the Disclosure and Barring Service (DBS) in line with best practice to ensure long term employees remain suitable to care for vulnerable people.

There were no major concerns about staffing levels; staff working on the top floor told us they felt their team needed more staff. We observed care delivery at lunchtime on this floor and saw one person waited 25 minutes to be assisted to eat their meal.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. We found that mental capacity assessments had been carried out and the provider had applied to the local authority for DoLS applications. However decisions made in people’s best interests were not always made in line with the MCA principles. We have made a recommendation about this.

Staff received an induction into the company and were trained. The training plan was up to date with future training dates planned in advance. Formal staff supervisions and appraisals had taken place with the staff whose records we reviewed; however the records were not as detailed as they could have been.

Not everybody had a positive experience during mealtimes. The lack of a second hot trolley meant some people waited an excessive amount of time for their meal. People were supported by staff to maintain a well-balanced, healthy diet and the food looked appetising and nutritious.

People had been referred to external healthcare professionals to support their general health and social care needs.

We observed and heard staff offering people choices and they encouraged people to make decisions about daily life where appropriate. Staff treated people with respect and their privacy and dignity were maintained. Staff demonstrated kind and caring attitudes and treated people as individuals.

We saw people participated in a range of activities. Staff supported people to maintain links by welcoming family, friends and visitors into the home. The relatives we spoke with told us they knew how to complain and felt confident to do so if necessary. Complaints were briefly recorded; however investigatory notes and outcomes were not available for inspection. We were unable to ascertain whether complaints were managed well. ‘Residents and Relatives’ meetings were held but were poorly attended. The new manager had planned meetings for the year ahead and intended to encourage people to attend in order to gather their opinions and feedback on the service.

The provider carried out monthly quality assurance visits and had some oversight of the service. The provider audits had not been robust enough to identify that senior staff at the service were not satisfactorily completing daily, weekly and monthly checks on the safety and quality of the service.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which related to the management of medicines, safety of premises and good governance. You can see what action we told the provider to take at the back of the full version of the report.

We found staff with appropriate qualifications and experience were available during each working day to provide the required level of care and support to people using the service. On some occasions staffing levels had increased which ensured there were enough qualified, skilled and experienced staff to meet people's needs.

We had some concerns about there being not enough sufficient qualified, skilled and experienced staff to meet people's needs. There were systems for auditing and monitoring the service. For example audits, meeting with people using the service and their families and with staff. Surveys were also carried out. The records of these processes were up to date and gave the manager and staff members the information they needed to run the home effectively.

Care and treatment was planned and delivered in a way that ensured people's safety and welfare. Most people we spoke with made positive comments about their care they were being provided with. One person told us 'It is very nice here but I am looking forward to going home' a relative commented, 'I come to the home regularly and I watch the staff, they all seem to be genuinely caring people'.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. The people we spoke with told us they felt safe with their care workers and the care they were provided with. One relative commented, 'I think my mum is well cared for I haven't had any issues'.

There were enough qualified, skilled and experienced staff to meet people's needs. During the inspection we spoke with four people who used the service and one relative, all of whom thought that there was sufficient staff on duty to meet people's needs. One person said, "There always seem to be enough staff'." A relative commented, 'From what I have seen the staffing seems sufficient'.