Archived: Alexandra Care Home

Alexandra Care Home is a residential care home providing personal and nursing care to up to 48 people. The service provides support to older people over two floors, fully accessible to all. At the time of our inspection there were 32 people using the service.

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

Medicines were managed safely across the home. People told us they felt safe living at Alexandra Care Home. Clear procedures were in place for the reporting of incidents, accidents and safeguarding concerns to prevent further occurrences. Where a significant incident had taken place, detailed investigations took place and any improvement actions identified were implemented.

People spoke positively about the support they received from the staff team and said they were treated with dignity and respect. Effective procedures were in place for the safe recruitment of staff.

Risks to people's health and wellbeing had been assessed and guidance was available for staff to support people safely. Regular checks and maintenance of the service took place to provide a safe environment for people to live.

Governance systems were in place to monitor and assess the quality of care people were provided with. Through these systems, the registered manager had identified areas of improvement needed in the content and level of information needed in records and care planning documentation.

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.

Staff felt supported in their role and regular meetings took place to share information about the service. The registered manager worked in partnership with other external agencies and professionals to promote and meet the needs of people living at the service.

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

Rating at last inspection

The last rating for this service was good (published 5 September 2018).

Why we inspected

This inspection was prompted in part by information received from the coroner following investigations into the death of a person. As a result, we carried out this inspection to review changes made by the provider following their investigation.

We found evidence during this inspection that systems and procedures had been reviewed and changes implemented following the providers investigation.

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.

The overall rating for the service remains good.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full 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.

Recommendations

We have recommended that the provider considers current guidance and continually reviews the quality and detail of records and takes action to update their practice accordingly.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice:

People were able to see their loved ones in different ways, including video calls and window visits. At the time of the inspection, the home had introduced procedures to allow a nominated visitor.

Staff did not move between the ground and first floor units to reduce the risk of cross-infection.

There were designated areas in the home for personal protective equipment (PPE) to be put on and removed safely and in line with guidance. We saw staff wearing PPE correctly and maintaining social distancing where possible.

Clinical waste was managed safely and in line with the national guidance. Staff also carried out additional cleaning in the areas through which clinical waste was removed from the building.

The home had a regular testing programme in place for staff and residents. A vaccination programme was also underway.

Cleaning schedules at the home had been reviewed and enhanced. This included regular cleaning of frequently touched surfaces throughout the day.

Further information is in the detailed findings below.

At the last inspection on 9 February 2016, the service was rated ‘Good’. We found during this inspection that the service remained ‘Good.’

Alexandra Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Alexandra Care home is registered with CQC to provide the following regulated activities; accommodation for people who require nursing and personal care, treatment of disease disorder or injury, and diagnostic and screening procedures.

Alexandra Care Home is a two-storey building, situated in Newton le Willows.

At the time of our inspection there were 44 people living at the home.

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 and associated Regulations about how the service is run.

Rotas showed there was enough staff at the home to support people safely. However, some staff raised that due to a recent staffing reduction on the ground floor, they sometimes felt there was not enough of them to be able to spend more time with people or take them out. A dependency tool was in place to determine people’s level of need, and this was being utilised, however, some staff still felt there was not always enough of them on duty. We discussed this at the time with the registered manager who informed is they would raise this with the registered provider.

Some of the information relating to the recording of environmental checks was confusing and duplicated. We raised this at the time of our inspection with the registered manager for further consideration. This was actioned straight away.

Practices relating to medication storage and administration were safe. We found some bottles of medicine were not dated when opened, however the registered manager rectified this straight away.

Staff were able to describe the course of action they would take if they felt anyone was at risk of harm or abuse this included ‘whistleblowing’ to external organisations. The registered manager had systems and processes in place to ensure that staff who worked at the service were recruited safely. Risks were well assessed and information was updated as and when required.

All newly appointed staff were enrolled on a work based induction when they took up post at the home. Records showed that all staff training was in date. There was a supervision schedule in place, all staff had received up to date supervision and most had undergone an annual appraisal. Those due were booked in to take place.

We saw that where people could consent to decisions regarding their care and support this had been documented. Where people lacked capacity, the appropriate best interest processes had been followed. The service was working in accordance with the Mental Capacity and DoLS (Deprivation of Liberty) and associated principles. We checked the status of peoples DoLs and any conditions on their authorisation. The registered provider had a system in place to ensure this was monitored.

The environment was pleasant and homely. There was an ongoing programme of refurbishment and we saw some people's bedrooms would benefit from this.

People we spoke with were complimentary about the staff, the registered manager and the service in general. People and relatives told us they liked the staff who supported them. We observed staff treating people with kindness and dignity throughout the day. Staff were able to give us examples of how they preserved dignity and privacy when providing care.

There had been three complaints received. The complaints process was well managed and documented in accordance with the provider’s complaints policy.

Care plans contained information about people’s likes, dislikes, preferences, backgrounds and personalities. People's diverse needs were respected. We saw that there was limited accessible information in place for people to help support their understanding, which we discussed at the time of our inspection with the registered manager.

Regular audits took place for different aspects of service delivery. Quality assurance systems were effective and measured service provision. Action plans were drawn up when areas of improvement were identified.

Staff meetings and resident meetings took place. Feedback/ questionnaires were sent out

Further information is in the detailed findings below.

Alexandra House provides nursing care and support for up to 48 people in the Newton-Le-Willows area. The service has two floors, the ground floor offering residential care, and the first floor providing nursing care. There is an outdoor area which has a seating where people are able to sit. At the time of the inspection there were 43 people living within the service.

There is a registered manager in post within the service. 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.

People were protected from the risk of abuse. Staff had received safeguarding training and they were able to identify the signs and indicators associated with abuse. Staff were also familiar with how to report their concerns. Safeguarding incidents were reported to the local authority by the registered manager as and when they occurred.

People’s care records were personalised and contained information around how they should be supported. People told us that care staff provided appropriate support that was in line with their preferences.

Recruitment processes were robust, and ensured that people were of suitable character to work with vulnerable adults. New staff were required to produce two references, one of which needed to be from their most recent employer. They were also subject to a check from the disclosure and barring service (DBS). A DBS check ensures that people are suitable to work with vulnerable people.

People were supported to take their medication as prescribed. Medicines were stored securely, and there were systems in place to monitor the quantities of medications kept, and to ensure that it had been administered appropriately.

Deprivation of liberty safeguards (DoLS) were in place for people who needed them. Staff had received training in the Mental Capacity Act 2005, and knew the basic principles of the Act. Staff also identified when a DoLS may be required for a person.

People’s nutritional and hydration needs were met. People told us that they enjoyed the food and that there were different options available. People with special dietary requirements were supported to take their nutrition in line guidance from professionals. People were offered a choice of drinks through the day, which included tea, coffee and juice.

Staff were kind and caring in their approach to people, and there was a positive atmosphere throughout the service. People told us that staff were respectful and that their dignity was maintained. Staff had received training in a variety of areas such as manual handling and infection control. There was an induction process in place for new staff which included a period of training, and shadowing more experienced members of staff.

People told us that there was a variety of activities available to them which they enjoyed. There was an activities co-ordinator in place who spent time doing group activities, or one-to-one sessions with people. This helped meet people social needs and protected them from the risk of social isolation.

People and their relatives were familiar with the complaints process, and told us that they found the registered manager to be approachable and responsive to their concerns. A record of comments and complaints was kept which outlined actions that had been taken in response to concerns that had been raised.

We drew the registered manager’s attention to some areas of the environment that needed addressing, for example there were dirty mop heads in one of the cleaning cupboards and the lock to one of the sluice rooms was not working properly. We also found linen being stored on the floor in one cupboard. These issues were dealt with straight away. Other areas of the environment, such as the communal areas and bathrooms presented as clean and tidy.

There were systems in place to monitor the quality of the service by both the registered manager and the registered provider. These looked at areas such as accidents and incidents, pressure areas, care records and the environment. Information gathered from these processes was used to generate improvement by identifying trends and putting in measures to help prevent them from happening in the future.

People living in the home told us, "I am very happy living here, they are lovely, the food is good, my room is warm and the staff are pleasant', 'Staff are excellent', "There is always enough staff available, I never wait long for anything", 'They are really good and helpful' and "I have seen my care plan, they talk to my family and me about it".

We spoke with relatives of people who lived in the home they told us that they were 'Very happy' with the care and support that they received. All the relatives spoken with told us that they felt that their relatives were safe in the home. They told us that they were always welcomed into the home, there was enough staff available and the home never had an unpleasant smell.

Records showed that peoples' individual rights were supported and the care plans were written in a manner that highlighted people's individual needs and how staff were to support them. We saw that monitoring of care were available in peoples bedrooms in order to support them to access their records as needed. Other records available showed that risks were identified by the service and action taken to reduce any potential risks.

Care records were well organised and included detailed assessments of need, risk assessments and strategies to manage those risks. We spoke with the home's activity co-ordinator who showed us the schedule of activities arranged. She also told us that she spent time with people on an individual basis and kept a record of their interests and preferences.

The home had systems in place for the safe administration of medication. We observed staff support people to take their medication in a safe and timely manner. We checked a number of medication administration records (MAR charts) and they were accurate, signed and dated appropriately.

The home had systems in place to support staff to be suitably skilled to meet people's needs. The manager told us and staff confirmed that there was an induction programme in place to support new staff during their first three months.

We saw examples of the complaints received in the last six months and found that they were responded to in a timely manner and that actions had been taken as a result of the complaints.