Alexandra House - Harlow

Alexandra House - Harlow is a care home providing personal and nursing care to up to 106 people some of whom may be living with dementia. At the time of our inspection there were 97 people using the service. The service is set across 3 floors in 1 adapted building.

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

People told us they felt safe. Risks to people's safety had been assessed and there was guidance in place for staff to mitigate the risks. Accidents and incidents had been recorded and analysed to identify patterns and trends; action had been taken to reduce the risk of them happening again. Staff were aware of safeguarding processes. Medicines were managed safely. There were enough staff to meet people’s needs.

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's needs were assessed before they moved into the service to ensure they could receive the care they required. Staff had the skills and experience to provide care and support to people. Staff provided support to people with health monitoring and referred people to healthcare services when required. People were supported to eat and drink enough to ensure they maintained a balanced diet.

People were supported to follow their interests and participate in social activities. Care plans detailed how people wished and needed to be cared for. People and relatives felt included in the planning of care and knew who to complain to if they needed to do so. People, their relatives and staff told us there was a positive atmosphere at the service.

There were systems in place to monitor the quality of the care provided. Regular audits were undertaken, and any actions identified completed. The registered manager and regional operations director took immediate action in response to any minor concerns found during the inspection.

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 5 September 2020). 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 and the provider was no longer in breach of regulations.

At a previous comprehensive inspection in 2019 we recommended the provider seeks best practice from a reputable source about how to identify people's protected characteristics and ensure care is planned around them. At this inspection we found the provider had acted on the recommendation.

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.

Follow up

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

Alexandra House - Harlow provides accommodation with personal and or nursing care for up to 106 people some of whom may be living with dementia. At the time of the inspection 89 people were receiving support. People living on the ground and first floor of the service received residential care and those living on the third floor received nursing care.

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

Staff told us there were not enough staff to meet people’s preferences. Whilst we found staff very responsive during our visit, they told us some people particularly on the nursing floor could not always get up when they wanted to as there were not enough staff available to do this or supervise people. Care plans did not always state clearly people’s preferences and needs in relation to being supported to get up. We have requested a full review of people being cared for in bed on the nursing floor and the reasons for this.

At the previous inspection the provider was in breach of regulation 9 HSCA RA Regulations 2014 Person centred care as people did not always have access to meaningful activities. This area continued to require improvement.

The service design was suitable for the needs of people, and people were protected against the risk of infection. A new visitor’s protocol had been developed by the provider to minimise the risk of people acquiring an infection. However, we were not asked to complete this until senior staff arrived later.

The systems in place to assess, monitor and improve the quality and the safety of the service were ineffective in practice. Which meant governance systems were not robust or effective as they did not identify the shortfalls we found.

The local authority had identified several issues at Alexandra House. The service had been open and honest about this and was working closely with the local authority to put improvements in place.

People were protected from the risk of abuse by staff who had up to date training. People told us they felt safe living at the service. Staff we spoke with knew people well.

People's risks were assessed, and measures were in place to reduce risk. Medicines were administered and managed safely.

The provider had appointed a new manager who was aware of their responsibility to take action when shortfalls were identified.

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 requires improvement (published 15 May 2019). The service remains rated requires improvement

At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We undertook this initially as a targeted inspection to check on concerns identified by the local authority safeguarding team and concerns raised to us in relation to staffing. We widened the inspection to a focused inspection to assess whether there were any additional risks to people using the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

Enforcement

We have identified continued breaches in relation to good governance and person-centred care.

We have found evidence that the provider needs to make improvements. Please see the safe and well led relevant key question sections of this full report.

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

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Alexandra House – Harlow is a residential and nursing home providing care to up to 106 people, across three floors, in one purpose built building. Two floors provide residential care and one floor supports people with nursing needs. At the time of this inspection there were 104 people living at the service including older people, people with physical disabilities, people with long term medical conditions and people living with dementia.

People’s experience of using this service:

People told us that they felt safe but we found recorded guidance about how to keep people safe was inconsistent. Care records sometimes lacked detail about people’s needs and preferences, including information about their healthcare needs. Information about people’s background, culture and identity was not always clearly captured and recorded.

People told us they did not always have access to meaningful activities and our findings supported this. We found the providers systems to check and audit the service were not always picking up or addressing the shortfalls that we found during this inspection. We found information to calculate and monitor staffing levels was not always accurate, but people told us there were enough staff and our observations supported this.

People received their medicines safely and where nursing care was required, this was delivered competently by trained staff. The service had developed links with local health services and had a clear process for assessment and admission that was followed. There were links with the local community that had led to fundraising initiatives including for activities and development of the home environment. The home environment was suited to people’s needs with clear signage and areas for people living with dementia to engage with.

People told us that staff were well trained and kind and caring. We observed pleasant interactions between people and staff and that people were supported in a way that they could be independent. Staff told us they felt supported by management and records showed they received training and support suited to their roles. Recruitment checks had been carried out to assess the suitability of staff for their roles, but one piece of information had to be provided after our visit due to inaccurate record keeping.

People said they liked the food that was prepared for them and information about their dietary needs and food preferences were recorded. People had regular meetings and told us they felt any issues they raised would be addressed. There was a complaints policy in place and any concerns that had been raised were investigated and responded to by management. The service regularly sought the views of people and relatives to identify improvements.

Rating at last inspection: Good (Published 14 June 2016)

Why we inspected: This was a planned comprehensive inspection.

Enforcement: Please refer to the action we told the provider to take at the end of the full report

Follow up: We will ask for an action plan from the provider and continue to monitor the service closely. We will return in line with our policy to check that improvements have been made and sustained.

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

A registered manager was in post at 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.

The Care Quality Commission (CQC) monitors the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) which apply to care homes. We found the provider had followed the MCA code of practice in relation to DoLS.

People were safe because the management team and staff understood their responsibilities in managing risk and identifying abuse. People received safe care that met their assessed needs.

There were sufficient staff who had been recruited safely and who had the skills and knowledge to provide care and support in ways that people preferred.

The provider had systems in place to manage medicines and people were supported to take their prescribed medicines safely.

People's nutritional needs were assessed and monitored by staff. Their preferences and special dietary needs were known and were catered for. Staff encouraged and assisted people to eat and drink, where necessary. Advice from relevant health care professionals was sought to ensure that people's nutritional needs were met.

Families and friends were welcome to visit the home. People were encouraged to maintain relationships important to them.

Staff respected people’s choices and took their preferences into account when providing support. People were encouraged to enjoy pastimes and interests of their choice and were supported to maintain relationships with friends and family so that they were not socially isolated.

There was an open culture in the home and people, relatives and staff were comfortable to speak with the manager if they had a concern.

The provider and manager had arrangements in place to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

We saw that the service had a complaints policy and people were made aware of the complaints system. We looked at the records of five of the complaints that had been received in the six months prior to our inspection. We saw that a full investigation had been carried out in each case.

We saw that there was an effective system in place to notify the Care Quality Commission about the death of a person who lived at the home.

We looked at the copies of the notifications of incidents, other than the death of a person who lived at the home, that had been sent to CQC in the six months prior to our inspection. We noted that there was an effective system in place to notify the Care Quality Commission about incidents that affect the health, safety and welfare of people who lived at the home.

We looked at the care records of 10 people who lived at the home. We noted that whilst these were of a generic nature each had been personalised to the individual. We saw that the home worked closely with other health and social care providers to ensure that people received the care and treatment that they needed.

On the day of our inspection the home looked clean and smelled fresh. We saw that all the bedrooms were thoroughly cleaned on a daily basis and were clean and dust free. We noted that the home's infection control policy had been updated in January 2013.

Records showed that the staff members had started work only after a full and satisfactory criminal records check had been received. We saw that people had completed a medical questionnaire and signed a declaration that they were fit to undertake the work of the post.

We saw that there were regular meetings with people who lived at the home. We also saw the report from a monthly compliance visit that took place on 12 June 2013, the action plan that arose from this and that staff had been made aware of the content of it.

During our inspection on 17 January 2013 we spoke with six people and four relatives who were visiting the home. People told us that calls were responded to quickly. One person said, "If I want anything they come quickly." We saw that when someone used their call bell to call for assistance this was answered within five minutes.

The second floor accommodated a total of 38 people with one nurse, one senior care worker and five care workers available to support and care for people during the day. Sixteen people needed assistance to eat their meals. Both the acting manager and deputy manager assisted people to eat at meal times. People told us that they could have what they wanted to eat when they wanted it. We saw that one person who had asked for boiled eggs with their mid morning cup of tea was given them. We saw that each unit had a kitchen area that contained breakfast cereal, biscuits and bread for toasting.