Archived: Alexandra Care Home

The service was registered to provide accommodation for up to 40 people. People who used the service had physical health needs and some were living with dementia. At the time of our inspection 35 people were using the service.

There was a registered manager in post. 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.

The provider determined the staffing levels on the number of people living in the home and the level of support they required. Staff had received training in dementia which they told us had increased enhanced the support they were able to offer and increased their knowledge. Other training was on-going and offered as directed from audits or through staff requests. Relatives had told us they felt people who used the service were safe and staff understood their role in ensuring people were protected from abuse or poor practice.

We saw that the provider and manager understood their responsibilities in complying with the requirements of the Mental Capacity Act 2005 (MCA). Where people lacked capacity to make certain decisions, appropriate assessments had been completed and recorded how w how people were supported to make those decisions. Where people were being restricted of their liberty in their best interests, the appropriate authorisations had been applied for.

. Everyone we spoke with felt the changes being made at the home were positive and had improved people’s experience of care. We saw that people were responded to in a kind and friendly manner and staff respected their decisions. Risk assessments were in place to ensure people’s safety was maintained.

Medicines were managed safely and in accordance with good practice. People received food and drink that met their nutritional needs and had a choice of the foods they liked. Staff made referrals to healthcare professionals in a timely manner to maintain people’s health and wellbeing.

Staff were caring in their approach and they created a warm homely environment which people told us they liked and enjoyed. People felt confident they could raise any concerns with the provider and manager. There were processes in place for people to express their views and opinions about the home. The provider and manager had systems in place to monitor and improve the quality of the service.

We also used observation to understand people's experience, as some people had communication needs and were unable to tell us their views and experiences.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask. This is a summary of what we found:

Is the service safe?

People told us that they felt safe living at Alexandra House and that they were treated well. One person explained: 'I feel very safe, I have no complaints of that sort.' Another person told us: 'You can always find fault, but I've been very happy here.'

We talked to staff to see whether there were enough staff on duty to meet the needs of those in their care. We received various responses. Comments received included: 'On the whole it is adequate, but it would be nice to have time to spend with people, it is very busy in the morning.' And: 'I think we need more staff.' And: 'I feel the current staffing levels are sufficient.' We were told that staffing levels were monitored regularly to ensure that enough staff were on duty. This ensured that there were appropriate numbers of staff on duty to meet the needs of the people in their care.

The manager completed a pre-assessment before people moved in to the service to make sure people's assessed needs could be met. Review systems were in place to ensure care plans and risk assessments were up to date and kept people safe.

Records kept to monitor how much food and drink people had consumed during each day were up to date. This showed us that people were protected from the risk of malnutrition and dehydration.

Staff spoken with knew what to do if they suspected that someone was being abused. One staff member explained: 'I would report anything to the manager, and would go higher if necessary, we have the phone number to take things higher.'

On checking the medication records we found that on a number of occasions, the registered nurse had failed to sign to say that they had dispensed people's medicine.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Relevant policies and procedures were in place and the manager on duty at the time of our visit understood when an application should be made. The majority of staff spoken with understood what it meant to deprive someone of their liberty and why this might happen.

Personal protective equipment was available for staff to use including disposable aprons and gloves. This ensured that care and support was provided safely and in line with the services infection control policy.

On entering the service we evidenced a strong unpleasant odour. We discussed this with the area manager and were informed that all attempts to address this issue by the regular cleaning of the carpets had failed. Therefore, the carpets in the hallway and the dining room were due to be replaced within the next three weeks.

Is the service effective?

We spoke with people who used the service and they told us that they were satisfied with the care and support they received. One person told us: 'I didn't like it to begin with but now, I think it's good.'

Relatives spoken with told us that, on the whole, they were happy with the care and support their relative received. One person explained: 'I would say that he looks cared for though sometimes they shave, and sometimes they don't.' Another person told us: 'I have no complaints about the care.'

Care plans provided staff with information about people's care and support needs. It was clear from our observations and from speaking with staff, that they understood the needs of the people they supported. This ensured that people's needs were met.

The provider had systems in place that demonstrated they co-operated with other health and social care professionals. This meant people received a person centred and coordinated approach to their health, safety and welfare needs.

Consent to the care and support that people received was obtained and this was reviewed on a regular basis. This ensured that people remained happy and in agreement with the support they received.

Is the service caring?

We observed staff going about their work. They treated the people they were supporting in a kind and gentle way and people looked relaxed and comfortable in the presence of staff.

Everyone spoken with told us that, on the whole, staff were caring and attentive. One person explained: The staff are mostly very good, you get the odd one, but they listen to you.' Visitors told us: 'We are 80% happy with the care, for some it's a job, for others it's a vocation. Some take great care, some occasionally, do not, like ensuring my relative is neat and tidy." And 'The care is very good.'

Is the service responsive?

People's needs had been assessed before they moved into the home and they and their relatives had been involved in the care planning process whenever possible. One relative explained: 'They came to the hospital to do an assessment.' This ensured that their care and support needs could be met.

People told us that staff treated them with respect and involved them in their day to day care. One person explained: 'They give me choices and they discuss things with me.'

Relevant professionals had been involved in people's care, and records showed that visits were arranged when necessary. This included visits from their doctor, the optician, the dentist and the local speech and language team. This ensured that people who used the service received the care and treatment they required.

A complaints procedure was in place and a copy of this was displayed. This provided people with the information needed, should they wish to make a complaint about the service they received.

Is the service well-led?

A robust quality assurance system was in place and the management team regularly assessed the service provided. This ensured that people received the care and support they needed, in a safe and effective way.

Care plans and risk assessments were reviewed at regular times to monitor people's needs and where changes in people's health and welfare had been identified; these had been updated to reflect this.

Regular meetings had been held, both for people who used the service and their relatives, and the staff who worked there. This provided the opportunity for people to have a say on how the service was run.

Relatives shared their concerns with regard to the lack of communal space at the service. They explained that the conservatory leading off from the main lounge had been blocked off for some months and this impacted on their relatives comfort and well-being. We discussed this with the area manager who acknowledged these concerns. They informed us that planning permission had recently been granted for the intended improvement works to this area. The provider may wish to note that by keeping the people who used the service and their relatives, regularly updated on issues relating to the service, any concerns or worries people had would be allayed.

Staff on the whole felt supported by the management team and told us that they felt able to talk to someone should they have a concern of any kind. One member of staff explained: 'You can talk to the nurses or the managers.'

One person living at the home told us 'care workers explain everything'. Another person told us they were treated well and staff listened to them. We observed people's care and support during the visit and saw care workers were available to support them.

People told us they enjoyed the variety and quality of meals available. Comments included, 'the food's very nice' and 'I enjoy the meals'.

Some of the people we spoke to were able to confirm they had suitable equipment to meet their needs and support them in maintaining their independence.

Two people told us they were happy to live at the home and had no complaints. They said they would speak to the manager if they had any concerns. Representative's of people who spoke with us told us they were happy to use the systems in place. They told us they would be able to raise a concern and would expect it to be dealt with to their satisfaction.

Representatives of people at the service told us staff at the home were able to provide support to their relative. We saw staffing numbers had been greatly improved and created a good working atmosphere for staff to work in. Staff happily showed us how they were already using parts of the new style care plan to help them write about the care they provided. They were willing to show us how they used and understood aspects of the restyled care plan. The visiting manager told us she was happy to stay and take charge of the service and to lead by example.

One relative told us, 'my relative needs to have their fluids but since the manager has gone there does not seem to be any monitoring of the care provided and there is an over reliance on the use of agency staff'.

One relative told us staff at the home would try to cover up when an incident had happened as staff could not explain how it had happened. However, another relative told us staff worked hard and were responsive to the needs of their relative. They thought staff were helpful and would protect their relative.

Three relatives expressed their concern as there was no permanent manager in post and they were beginning to see the impact that this was having on care.

We saw a potting shed was used to grow plants and food. We saw one person using the outdoor facilities.

One relative commented, 'I think upstairs smells because they do not have enough staff to either keep the place clean or not enough care staff to keep people clean".

Three relatives told us, 'standards have started to slip we had a relative's meeting to discuss how we felt, we are looking for improvements'.