All inspections: Alexander Court Care Centre

This was an unannounced inspection, carried out over three days on 28, 29 May and 5 June 2015. At the previous inspection of this service in April 2014 the provider was not meeting the legal requirement in relation to safety and suitability of premises, care and welfare of people, safeguarding people from abuse, infection control, nutritional needs, and respecting and involving people.

Alexander court care Centre provides 24 hour care, including personal care for up to 82 older people. This includes nursing care for people with dementia and those with physical needs. The service is a large purpose built property. The accommodation is arranged across five units over three levels. There are three units for people living with dementia and one unit for young people with physical disabilities, all providing nursing care. There is also a residential unit for older people. There were 70 people living at the service at the time of our inspection. During our last inspection of Alexander Court Care Centre on 28 April 2014 we found six breaches of regulations. The provider was not meeting the legal requirements in relation to cleanliness and infection control, safeguarding people from abuse, safety and suitability of the premises, respecting and involving people, meeting nutritional needs and care and welfare of people using the service.

People were not kept safe at the service. There were poor arrangements for the infection control and we had concerns about the safety and suitability of the premises. There were not enough staff available to meet people’s needs.

The service had a safeguarding procedure in place and staff were aware of their responsibility with regard to safeguarding adults.

People received nutrition which was compatible with their specific dietary requirements.

Staff received regular supervision or appraisals and there was a clear line management structure for staff. Training records showed that some staff had not received up to date mandatory training.

Senior staff demonstrated they had an awareness of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, which meant they could support people to make choices and decisions where people did not have capacity.

People told us they did not always feel cared for by some staff. The staff knew peoples likes and dislikes. We saw staff speaking with people in a way that promoted their independence.

Some people told us they did not feel there were enough activities at the home. The service had two activities co-ordinators who provided support with activities during weekdays. There was no weekend activity program.

Each person had a care plan which set out their individual and assessed needs. However some preferences were not always evident. People had access to health care professionals. People had opportunities to attend residents meetings.

The service was not always well led. During the inspection we identified failings in a number of areas. These included managing risks, infection control, safety and suitability of premises, staffing levels and training. Records relating to peoples care were not always fully completed.

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

Alexander Court Care Centre is registered to provide 24 hour care, including personal care, for up to 82 people and is comprised of five units. This includes nursing care for people with dementia and those with physical needs. There is a registered manager for the service.

We found that the service was not always safe for people. People were not protected against identifiable risks of acquiring an infection. Electrical equipment in the main fire escape route presented a fire safety hazard. However, most people and their visitors told us people felt safe.

There were some aspects of care that were not effective. People were not protected from the risks of inadequate nutrition and dehydration. Some people’s care records were not stored securely. However, people’s capacity, needs, preferences and choices for care, treatment and support were assessed.

Most people and their visitors told us that staff were caring and kind. However, we were told that some people were not listened to. We were told of and observed some poor interactions between staff and people.

The care provided was not always responsive to people’s needs or delivered in a timely manner. A complaints system was in place. However, it was not in a format to meet some people’s needs and some people were not provided with support to make a complaint. People, those significant to them and professionals were consulted and involved in decisions about people’s care. An activities programme met some people’s needs.

Staff and relatives told us that the registered manager was approachable. Regular audits were made of the service and accidents, incidents and complaints were monitored. Effective staff recruitment, training and support for staff was in place. Most people’s views of the service were sought.

The provider was not fully meeting the requirements of the Deprivation of Liberty Safeguards as some restrictions were being placed on people’s movements without obtaining the necessary approvals. People’s human rights were therefore not being properly recognised, respected and promoted.

We found six breaches of The Health and Social Care Act Regulations. You can see what action we told the provider to take at the back of the full version of the report.

People expressed their views and were involved in making decisions about their care and treatment. People told us they were treated with dignity and respect and they were able to make choices. Comments included "they (staff) ask if I like this or that" and "we get two (meal) choices everyday." This meant people were able to make choices about their daily lives.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People said they were satisfied with the care and treatment they received. Comments included "they're very kind" and "they're helpful." A relative said "the care is very good."

People who used 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. People and their relatives said they felt the service kept people safe.

People's health and welfare needs were met by staff who were fit, appropriately skilled and qualified. There were effective recruitment and selection processes in place. Appropriate checks were undertaken before staff began work.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately. Comments included "Gladys (the manager) is good. Any complaints would go straight to her" and "the main thing is you can go to Gladys and she'll sort anything out."

People's care and welfare needs were being met. Overall people were happy with the quality of care they received and how they were treated by the staff team. One person told us 'if you are not well they look after you.' Another said 'I am very happy here. I am well looked after.' A visiting medical practitioner told us 'things are so much better here now and the nurses know people well.' We saw an email from a specialist nurse which said 'I am impressed with the improvements made in tracheostomy (a tube to assist breathing) care.'

We found that staffing levels had improved and there were sufficient staff on duty to meet people's needs. Overall staff spoken to felt that there were sufficient staff on duty to meet people's needs. This was supported by the fact that the quality of care had improved. Minutes of a recent relatives meeting indicated that relatives said the standard of care had improved a lot and that they were quite happy with it.

We also found that each person had a care plan and associated risk assessments and that these had been reviewed regularly and updated when needed. Staff therefore had current information about people's needs and how to meet these safely. Other records, such as medication and daily notes were accurate and up to date and indicated the care and support that people had received. People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

We were not able to speak with people who use the service on this occasion and were only able to have limited discussions with staff. This was because we carried out the visit in the early hours of the morning. Most people were asleep and fewer staff were available during this period of time.

We found that people received their prescribed medication appropriately. .Medication was stored safely and disposed of appropriately. However people's records were not always accurate or up to date and did not indicate the care and support people had received. This placed people at risk of receiving unsafe or inappropriate care.

Serious concerns were raised about the care of people who use this service. As a result of the concerns we visited the service and other agencies visited at the same time. This included the local authority and the local Primary Care Trust (PCT). The PCT informed us that following the review of people with complex care needs they found no concerns.

We spoke with people who used the service and their relatives about the quality of care that was provided at Alexander Court. Generally people were satisfied with the care provided but they did express concerns about staffing levels. One person who used the service told us, 'They treat me well and are all very kind. The give me choices about things and treat me like an ordinary human being.' Another said, 'Generally speaking it's a nice home and I am not treated badly. I feel quite safe when they are assisting me. Two people do it when there is enough staff but one when not.' Staff also raised concerns about low staffing levels and the potential negative impact of this on the people that used the service. They also felt that they were often not able to have breaks due to the pressure of being understaffed.

Archived: Alexander Court Care Centre

All Inspections

28, 29 May & 5 June 2015

During a routine inspection

28 April 2014

During a routine inspection

20 November 2013

During a routine inspection

20, 21 March 2013

During an inspection looking at part of the service

7 December 2012

During an inspection in response to concerns

7, 8 June 2012

During an inspection in response to concerns