Archived: Alexandra Lodge Care Centre

Alexandra Lodge Care Centre is a care home registered to provide accommodation with nursing and personal care. The home can accommodate up to 38 people in a large, adapted house. At the time of our inspection there were 34 people living at the service.

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

Following our last inspection, the provider has made improvements around managing medicines safely. However, we continued to identify concerns in this area. For example, there were occasions where people did not receive their medications as they were out of stock. There was a lack of guidance around supporting people with diabetes.

Necessary improvements to the environment had not been completed in a timely way. The home requires further refurbishment works, due to the wear of some of the carpets and the water damage caused by leaks.

There were appropriate risk assessments in place for people using the service. People were supported to eat and drink in line with their abilities. Staff received appropriate training to meet the needs of the people living at the home.

Staff knew people well. We observed kind and caring exchanges between staff and people living at Alexandra Lodge Care Centre. People gave positive feedback about staff at the home. People were supported with dignity and respect.

Staff regularly engaged people in activities which they enjoyed. Staff supported people in activities, within groups and on a one to one basis. People knew how to make a complaint and any complaints received were appropriately responded to by the registered manager. Person centred care plans had been developed for people living at the service. Care plans included people’s preferences relating to their care, food and activities they engaged in. Staff knew people well and were able to communicate effectively with people.

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. The registered manager maintained an accurate log of people who had a deprivation of liberties safeguarding in place.

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 of this service was requires improvement (published 5 August 2021) and there were breaches of the regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection, although some improvements had been made, the provider remained in breach of regulation. This service has been rated requires improvement on the last three consecutive inspections under this provider.

Why we inspected

This inspection was carried out in response to the concerns previously identified and to review if improvements had been made, to assist with capacity in the local area. We also followed up on action we told the provider to take at the last inspection. Following the previous focused inspection, this comprehensive inspection was carried out to see if there had been an improvement to change the overall rating of the 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. This included checking the provider was meeting COVID-19 vaccination requirements.

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 and will take further action if needed.

We have identified breaches in safe care and treatment and good governance. Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 request an action plan from the provider to understand what they will do to improve the service.

We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Alexandra Lodge Care Centre provides accommodation, nursing and personal care for up to 37 adults living with age-related health problems or dementia. At the time of our inspection, Alexandra Lodge Care Centre accommodated 33 people over three floors, each of which had separate adapted facilities.

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

Although the provider had made some improvements to medicines management since our last inspection, people did not always receive their medicines safely. The provider had systems and processes in place to record care given in real time but staff did not always follow them.

People received the care and support they needed to keep them safe and well. Staff used risk assessments and care plans to support people with their individual care needs. The home had a full staff team who knew people well. The care home had good standards of cleanliness and hygiene.

People looked well. The home offered them a good choice of healthy food and drink. They received the healthcare they needed from other professionals such as GPs, dieticians, speech and language therapists and district nurses. Staff received the appropriate training and supervision to help them support people effectively.

People received support that gave them maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff showed a strong commitment to keeping people safe and well. People and their visitors gave positive feedback about their experiences. They spoke highly of the staff describing them as dedicated, caring and attentive. Managers used a range of governance systems, tools and processes to assess the quality of the service and identify areas that needed attention.

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 6 December 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 some improvements had been made but the provider was still in breach of some regulations. The service remains rated Requires Improvement. This service has been rated Requires Improvement for the last two consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 14-15 October 2019. We found breaches of legal requirements. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance. We carried out this focused inspection to follow up on action we told the provider to take at the last inspection and check they had followed their action plan.

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.

This report only covers our findings in relation to the Key Questions Safe and Well-Led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection.

The overall rating for the service remains Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Alexandra Lodge 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to medicines management and good governance. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider after this report is published to discuss how they will make changes to ensure they improve their rating to at least Good. 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 Lodge Care Centre is a care home providing personal and nursing care for up to 37 older people and younger adults. At the time of inspection, there were 33 people living at the home.

Alexandra Lodge Care Centre is a large detached house. There are three floors with 35 bedrooms. Two bedrooms are shared rooms with single occupancy. There is a passenger lift to enable access to each floor.

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

The management of medicines was not always safe. Further work was needed ensure staff were administering medicines competently. Food and fluid thickener was left in the communal areas. People who received medicines via a tube into their stomach, did not have clear guidance for staff to administer medicines. The lifting equipment had not received a thorough examination for over two years by a competent person. People had the risks they presented assessed and reviewed. Staff were aware of how to report any safeguarding concerns.

Audits to monitor and improve the service had not identified the concerns found with medicines and the missing checks on the lifting equipment. Although there was a new provider, there had been failings to improve the service to at least good over the last three inspections. Staff told us, they had seen some improvements since the new provider took over, including redecoration of the home.

We observed some caring interactions, however staff had little time to spend with people. We observed a nurse made little communication when administering medicines to someone who could not speak English. Staff told us they didn’t have the time to spend with people.

People were left for long periods of time without stimulation. The activities coordinator was off sick and assistance had been sought to support people, one afternoon per week. Care plans were not always updated when there was a change, staff needed to read through the reviews to be aware of the change. People were supported to remain at the home, should that be their wish, at the end of their life.

People were supported to eat a healthy and nutritious diet. However, one person who required a particular amount of fluid, didn’t have the amount totalled and the records were not reviewed. People received support from health and social care professionals when they required it. The provider had began a period of redecoration to improve the décor of the home.

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.

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 14 March 2018). Since this rating was awarded the registered provider of the service has changed. We have used the previous rating and enforcement action taken to inform our planning and decisions about the rating at this inspection.

The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This was a planned inspection based on the new providers registration.

Follow up

We will request an action plan and meet with 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.