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Alexandra Park Home Requires improvement

The provider of this service changed - see old profile

Reports


Inspection carried out on 3 December 2019

During a routine inspection

About the service

Alexandra Park Home is a residential care home for up to 13 older people who are living with dementia and mental health conditions. Care is provided across two floors with a communal area on the ground floor. At the time of the inspection 12 people were residing at the home.

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

The leadership, management and governance of the organisation did not ensure the delivery of high-quality and person-centred care. The management did not display an open and transparent culture when things went wrong and the systems for monitoring the safety and quality of the service were not effective.

People’s medicines were not always being managed safely. The systems in place to assess the risks to people’s safety were inconsistent, not always effective and ways to mitigate risks were not always clear.

The provider did not always ensure staff working at the home had the right mix of skills, competencies, qualifications, experience and knowledge, to meet people’s individual needs.

People were not always supported to express their views or be involved in making decisions about their care and treatment. People were not placed at the centre of their care provision. Care and support did not always reflect current evidence-based guidance, standards and best practice. Information about people’s needs, including their spiritual and religious needs was not always consistent.

The service did not always involve people in planning their meals, nor did it act on feedback received from people who use the service. Food was not always well presented.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

People liked the staff and felt safe with them.

The new provider had significantly improved the overall decoration of the home.

People took part in a range of activities at the home which had a positive effect on their well-being.

We have made three recommendations relating to food provision, the Mental Capacity Act (2005) and people's spiritual and religious needs.

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 20 July 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 we found sufficient improvements had not been made and the provider continued to be in breach of regulations.

Enforcement

We have identified breaches in relation to medicine management, risks to people’s safety, staffing, person-centred care and good governance at this inspection.

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

Why we inspected

The inspection was prompted in part due to serious concerns received from the local authority and local clinical commissioning group (CCG) about the safe care and treatment of people using the service. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Inspection carried out on 13 May 2019

During an inspection looking at part of the service

About the service:

Alexandra Park Home is a residential care home that was providing personal care to 13 people at the time of the inspection. Care is provided across two floors with a communal area on the ground floor. The service specialises in providing care to older people who are living with dementia and mental health conditions.

People’s experience of using this service:

Management oversight processes in place were ineffective and did not identify any of the issues we found as part of this inspection.

Policies and procedures were generic and had not been modified to be specific to this home.

Medicines management and administration was unsafe.

Risks associated with people’s individual health and care needs were not always assessed and guidance was not available to staff on how to minimise known risks to keep people safe.

Appropriate measures were not being taken to prevent or control the risk of infection.

People told us that they felt safe living at Alexandra Park Home.

People were generally positive about the home and the staff. One person told us the food, activities and interaction with staff could be better.

Staff demonstrated a good understanding of the needs of people using the service.

We identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around safe care and treatment and governance. Please see the ‘action we have told the provide to take’ section towards the end of the report.

Rating at last inspection:

At the last inspection the service was rated Good (the report was published on 13 June 2018). As a result of this inspection the overall rating has dropped to Requires Improvement.

Why we inspected:

This was a focused inspection where we looked at the key questions of Safe and Well Led. The inspection was prompted by information of concern.

Follow up:

The service is required to provide an action plan to us because there were two breaches of the regulations.

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.

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

Inspection carried out on 21 May 2018

During a routine inspection

The inspection took place on 21 May 2018 and was unannounced. The service first became registered on 26 April 2017. It was previously registered under another provider. This was the first inspection of the service with the new provider.

Alexandra Park 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.

Alexandra Park Home provides accommodation and care to up to 13 people. At the time of our inspection, 13 people were living in the home. Care is provided across two floors with a communal area on the ground floor. The service specialises in providing care to older people who

are living with dementia and mental health conditions.

There was a registered manager at this service. 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 and their relatives told us they felt safe with staff and there were enough staff to meet their needs. Staff were trained in safeguarding and knew how to safeguard people against harm and abuse. People’s risk assessments were completed, regularly reviewed and gave sufficient information to staff on how to provide safe care. Staff kept detailed records of accidents and incidents that took place. Staff wore appropriate protection equipment to prevent the risk of spread of infection. Thorough recruitment checks were completed to assess the suitability of the staff employed. Medicines were stored and administered safely. The home environment was clean.

Staff knew people’s individual needs and were provided training to meet those needs. Staff told us they felt supported by the registered manager and receiving regular supervision. People were supported to meet their dietary needs and told us they liked the food. Staff assisted and supported people to access ongoing healthcare services to maintain healthier lives. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. Staff understood people’s right to choices and asked their permission before providing care.

Staff we spoke with had a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). MCA and DoLS is a law protecting people who are unable to make decisions for themselves or whom the state has decided their liberty needs to be deprived in their own best interests. People who had capacity to consent to their care had indicated their consent by signing consent forms. However, where people lacked capacity to consent to their care the provider had not followed the principles of the Mental Capacity Act (MCA) 2005. We have made a recommendation about following the principles of the MCA.

People’s needs were assessed and met by staff in a personalised manner. Care plans were in place which included information about how to meet a person’s individual and assessed needs. People’s cultural and religious needs were respected when planning and delivering care. Most staff members showed that they respected people’s sexual orientation so that lesbian, gay, bisexual, and transgender people could feel accepted and welcomed in the service.

The service had a complaints procedure in place and we found that complaints were investigated and where possible resolved to the satisfaction of the complainant.

The service had an end of life policy for people who used the service. However, the service did not explore end of life wishes during the initial needs assessment and care planning. We have made a recommendation about supporting people with end of life wishes.

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