14 May 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection of Alexandra House took place on 12 and 13 April 2016 and was announced. We gave the provider 48 hours’ notice so people would be available to speak with us at our visit.
The inspection was conducted by one inspector.
We reviewed the information we held about the service. We looked at the statutory notifications the service had sent us. A statutory notification is information about important events which the provider is required to send to us by law.
We spoke with commissioners about Alexandra House. Commissioners are people who work to find appropriate care and support services which are paid for by the local authority. We did not receive any information of concern.
Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We used this information as part of our inspection planning. We found that information provided within the PIR did not consistently reflect our inspection findings. For example the provider told us all safeguarding incidents were reported to the local authority and statutory notifications sent to ourselves. We found this was inconsistently carried out.
During our visit we spoke with the registered manager, the new manager and three support workers. We spoke with eight people who used the service and one relative. We reviewed three people’s care plans and daily records, to see how their care and support was planned and delivered.
We looked at other records related to people’s care and how the service operated including, medication records, staff recruitment file, the provider’s quality assurance audits and records of complaints.
14 May 2016
This inspection took place on 12 and 13 April 2016 and was announced. We gave the provider 48 hours’ notice so people would be available to speak with us at our visit.
Alexandra House provides an extra care service of personal care and support to people within a complex of 40 apartments. Staff provide care at pre-arranged times and people have access to call bells for staff to respond whenever additional help is required. The complex is spread over three floors with a lift and stairs to each floor. People have access to communal lounges and a dining room where they can have a lunchtime meal.
At the time of our visit 29 people were receiving personal care support. The provider does not own the property and people have tenancies with a landlord. This was the first time the service had been inspected.
The service had a registered manager. 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.
At the time of our visit there was a new manager in post, who was in the process of registering with us. We refer to them as the new manager in this report. They were being supported by the current registered manager who is also the locality manager for other of the provider’s locations in the area.
People received varying levels of support from staff, depending on their needs. Some people only required a ‘wellbeing’ check or minimal assistance with personal care. Other people required assistance with taking medicines, continence care, nutritional support and with mobility.
People told us they felt safe with the staff who delivered their care. Staff were aware of the action they needed to take if they had any concerns about people’s safety, or health and wellbeing. However, we found that safeguarding concerns were not consistently reported correctly to the local safeguarding team so that investigations could take place if required.
The staff allocation sheets showed us there were sufficient staff to cover the scheduled calls to people. People told us they received their care on time and staff stayed the allocated time to complete tasks. New staff had been recruited and were awaiting the outcome of checks to ensure they were safe to work with people before starting work at the service. The provider had reduced the use of agency staff, so that people received care and support from consistent staff that knew them.
Staff received a detailed induction and training when they started working at Alexandra House. Some training was out of date, but there were plans to ensure all staff completed the required training to ensure their work reflected good practice. Staff received supervision and support and told us the new manager was approachable and had made significant improvements since taking up their position.
Care plans did not always include important information about risks to people’s health, but staff were able to talk confidently about how they managed those risks, as they knew people well. Care plans were written in a ‘person-centred’ way that supported staff in delivering care and assistance that met people’s individual needs.
People were happy with the care they received and said staff were caring and friendly. Staff respected people’s privacy and maintained people’s dignity when providing care. The manager and staff understood the principles of the Mental Capacity Act (MCA) and gained people’s consent before they provided personal care.
All the people we spoke with clearly recognised that due to the support and care provided by staff, they were able to enjoy living relatively independently in their own homes.
There were processes to monitor quality of the service provided through feedback from people and a programme of checks and audits.
However the provider had not sent us statutory notifications in order for us to monitor the quality of the service being provided.
We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of the Care Quality Commission (Registration) Regulations 2009.
You can see what action we told the provider to take at the back of the full version of the report.