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Alexandra Court Care Centre Requires improvement

The provider of this service changed - see old profile

Reports


Inspection carried out on 23 January 2020

During a routine inspection

About the service

Alexandra Court Care Centre is a residential care home providing personal and nursing care. The care home accommodates 72 people across three separate areas. The ground floor has 32 bedrooms for people with residential care needs. The first floor has 20 bedrooms for people who need nursing care and a separate wing with 20 bedrooms to care for people living with dementia. At the time of the inspection, there were 23 people receiving personal care, 11 receiving nursing care and 18 people living with dementia.

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

The provider and registered manager had made improvements in how the service was overseen and managed. These improvements were in areas such as staffing levels, risk management, accurate and up to date recording, and ensuring people received person-centred care. However, these improvements now needed to be sustained and more analysis was needed about medicines management. We have made a recommendation regarding this.

Although there had been improvements in some areas of medicines management, not everyone had received their medicines as prescribed, which could affect their treatment.

Staff knew how to safeguard people from the risk of harm and abuse. They completed training and followed risk assessments to help minimise accidents and incidents from occurring.

There were positive comments about the staff team and their approach when supporting people. They were described as kind and caring. Staff supported people to maintain their privacy and dignity. 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 had their needs assessed and care plans were developed. These described people’s needs and gave staff guidance in how to meet them in ways they preferred.

People’s health and nutritional needs were met. Staff ensured people saw health professionals in a timely way. The menus provided people with choices, alternatives and special diets when required.

Staff were recruited safely, and they received appropriate training, supervision and support.

The provider had a system to manage complaints. People were aware of how to complain and told us any concerns would be listened to and addressed.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 26 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 improvements had been made. However, the provider remains in breach of one regulation.

This service has been in Special Measures since 2 May 2019. During this inspection, the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a continued breach in regulations in relation to the management of medicines 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.

Inspection carried out on 2 May 2019

During a routine inspection

About the service: Alexandra Court Care Centre is a residential care home that can provide personal and nursing care to a maximum of 72 people. There were 61 people using the service at the time of the inspection, some of whom were living with dementia.

People’s experience of using this service: The provider took over the running of the service in February 2019. Until very recently there had been insufficient staff on duty; the new provider had used a care staffing tool which was not sufficiently accurate when calculating people’s complex health care needs. Staffing levels had been reduced and this had impacted on the delivery of care to some people and affected their health and welfare.

For example, people had not always received their medicines as prescribed, which affected their treatment. Risk had not always been managed to ensure people’s safety. This had impacted on their safe care, health and wellbeing. In one instance a person’s pain and distress had not been well-managed and another person had not been provided with the correct pressure relieving cushion.

People had not always had their needs met in ways they preferred, and in a timely way; this had resulted in one person being admitted to hospital for treatment that could have been provided in the service. The reduction in staffing numbers also impacted on the way the service was managed and the time available for the new registered manager to have oversight of the care of people with nursing needs.

There was a delay in the introduction of the new provider's own quality monitoring system. There was also a crossover regarding documentation, which left a newly registered manager and staff team managing different systems of recording. Records were not consistently accurate and up to date. The initial transition from previous provider to new provider could have been managed much more effectively. The provider’s audit system will need time to be fully carried out.

Complaints had been received about the levels of personal care and health care and treatment delivered to people; these had resulted in safeguarding investigations. Some of these were still being investigated by the local safeguarding team. In discussions, staff knew the different types of abuse and knew to report concerns to management.

There were positive comments about the care staff approach but there were also comments from relatives that this could be improved to be more caring and sensitive. Staff had not consistently gained consent before carrying out tasks such as placing clothes protectors on people. However, people were supported to have maximum choice and control of their lives were possible and staff supported them in the least restrictive way; the policies and systems in the service supported this practice.

People’s nutritional needs were met and menus provided them with choices for the main meals. Those people on textured meals such as pureed, due to swallowing difficulties, had limited choices for desserts.

Staff received training and supervision. There were gaps in training records when staff required courses or updates in training. However, these had been identified by the registered manager. A supervision and appraisal system had just been started following the new provider’s way of working. The provider had a safe system of staff recruitment.

Following the inspection, the registered manager and senior management had reflected on the concerns raised by relatives, the local authority contract monitoring team and the inspection findings. They told us they will produce an action plan and lessons learned document to share with staff and improve practice going forward.

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

Rating at last inspection: This was the first inspection of the service since the new provider was registered with the Care Quality Commission (CQC) in February 2019.

Why we inspected: We received information from the local autho