Alexandra Care Home

About the service

Alexandra Care Home is a care home registered to provide accommodation and nursing care to up to 76 people. The service provides support to adults who require personal and/or nursing care, who may be living with physical disability, sensory impairment or dementia. At the time of our inspection there were 63 people were living at the service.

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

People experienced delays in their care. There were insufficient staff deployed to meet the needs of people at key times. People, relatives, staff and visiting professionals shared concerns regarding the staffing level at the service, which our observations confirmed.

Risks to people were not consistently managed. Records regarding incidents, accidents and untoward events were not consistent in their completion or consistent with entries made in people’s care records. We were not assured that all incidences of concern were investigated or reported to appropriate authorities, when needed. This included relevant statutory notifications to the Care Quality Commission (CQC).

Quality assurance processes failed to identify the impact of the staffing level on people. Actions required following audits, checks and reviews were included in the ‘home development plan’ however, some actions were marked as completed when issues remained.

Staff were recruited safely.Staff were aware of their responsibilities regarding safeguarding people and the concerns to raise, should they have any. Medicines were managed safely with robust infection prevention and control measures in place.

People, relatives and staff found the registered manager approachable and supportive. Relatives reported an improvement in communication with the service and receiving up-to-date information regarding their family member’s care.

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 29 April 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

The provider told us the improvements required would be completed by 30 June 2022. This inspection was carried out before this date.

At this inspection we found the provider in breach of further regulations.

Why we inspected

We received concerns in relation to staffing and risks to people’s health and wellbeing. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 remained the same based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe section of this report.

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

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

Enforcement

We have identified breaches in relation to staffing, the management of risks and the submission of notifications at this inspection.

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

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Alexandra Care Home is registered to provide accommodation and nursing care for up to 76 people, some of whom may be living with dementia. At the time of our inspection there were 67 people were living at the service.

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

There was a system of audits and checks to monitor the service. The service had a ‘home development plan’ in place which was used to record and take action to address any issues arising. However, the management team had not identified the impact on people that the staffing level presented. Audits completed by the management team had also not identified the issues we found with risk assessments, capacity assessments and care plans.

There was a marked difference in the quality of care plans and records across the three units in the service. The provider had a series of templates and assessments tools which formed people’s care plans and records. Some documents contained inconsistencies, whilst others lacked information.

People and their relatives told us that the care provided at the service met people’s physical needs and was safe, but some felt there was a lack of staff. This impacted on staff’s ability to provide personalised care to people, offer companionship and support with people’s wellbeing and provide support and information to relatives in some areas of the service. The staffing level also had an impact of staff’s ability to promote people’s privacy and dignity. We received consistent feedback from people and relatives that there were limited opportunities for people to be supported to maintain hobbies and interests or to keep active.

We received mixed responses from people, relatives and staff regarding their engagement with the service and the opportunities afforded to them to provide feedback. However, all confirmed they felt involved in assessments, planning of care and decision making.

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 support this practice.

People told us that staff were caring and respectful. Staff received training, regular supervision and competency checks.

The service worked well with partner agencies to ensure people’s health needs were met, with referrals made to healthcare professionals when needed. Medicines were managed safely and there were strong infection prevention and control measures in place.

The provider had systems in place to ensure that safeguarding referrals were made, and any incident or accident was reviewed. There was a complaints system 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

This service was registered with us on 31 July 2020 and this is the first inspection.

The last rating for the service under the previous provider was good, published on 18 August 2017.

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. 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 a breach in relation to 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 request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.