Archived: Alexander Heights Care Home

Updated 30 August 2017

‘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.’

This inspection took place on 31 May2017 and was unannounced.

Before the inspection, we reviewed all of the information we hold about the service, including previous inspection reports and notifications sent to us by the provider. Notifications are information about specific important events the service is legally required to send to us.

The inspection was carried out by one inspector and during the inspection we spoke with five people and two relatives about their views on the quality of the care. We spoke with the two staff and two activities coordinators, the registered manager and area regional manager.

We looked at documents that related to people's care and support and the management of the service. We reviewed a range of records which included three care records, staff training records, staff duty rosters, policies and procedures and quality monitoring documents. We looked around the premises and observed care practices for part of the day.

Updated 30 August 2017

Alexander Heights is a Care Home providing personal care for up to 28 people. At the time of this inspection there were 16 people living at the service. The home is situated in the grounds of Avon Park Retirement Village, where there are other care homes and independent living apartments and houses.

This inspection took place on 31 May 2017 and was unannounced.

At the last comprehensive inspection we found breaches of Regulations 11, 18 and 17. We took enforcement action for Regulation 17 and imposed conditions on the registration of this service. Following the inspection the provider developed a comprehensive action plan to meet the imposed condition of registration and to address requirements orders on Regulation 11 and 18.

A registered manager was 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.’

Some identified risks to people were assessed. Staff said risk assessments were developed on how to minimise potential risks to people. However, risk assessments were not in place for risks including choking A member of staff on duty acknowledged that two risk assessments were in need of reviewing. We asked to see copies of the risk assessments and were told they were not available.

Accidents and incidents were documented and an investigation was conducted following the event. The actions following the accident included observations for signs of head injury, arranging for GP visits and to review care plans and risk assessments were reviewed. However we found no documented evidence of this occurring after an incident or accident had taken place.

Staff signed the MAR charts when medicines were administered. A record of medicines that were no longer required had been maintained. Protocols for medicines prescribed to be administered when required (PRN) were missing, although the procedure in place stated one must be kept within the Medicine Administration Records (MAR) file. The staff on duty were not aware of the protocols or about their location. Directions on the use of thickeners were not provided to staff and the only information stated to administer “as directed”.

While the staff knew about enabling people to make day to day decisions we found gaps in their understanding of assessing people’s capacity to make decisions. The assessment records that related to people’s capacity t were inconsistent, which showed a lack of staff’s understanding regarding assessing people’s capacity to make decisions. Mental Capacity Assessments were not in place for specific decision such as restricting people access to their lighter and cigarettes. Where people lacked capacity to make decisions best interest decisions were not taken to show the decision was in the person’s best interest and the least restrictive.

Care plans were inconsistent and some were not always person centred. Care plans were not updated with people’s current needs. Staff said whilst they read the care plans, handovers were the main source of information about people’s changing needs”. They said care planning training was attended. Whilst they read the care plans, handovers were the main source of information about people’s changing needs. We were told that new care plan formats were to be introduced.

While people acknowledged attempts to improve the meals served had been made, some negative comments about the food were received. We were present during the lunchtime meals and we saw people eating the meals. Feedback about the quality of meals was variable but people said the quality had improved and the menus had changed. People told us the catering manager made regular visits to the home and their feedback was sought. Staff told us the catering manager visited daily to gain people’s feedback about the food. They also stated a complaints book was available in the dining room for people to give their feedback about the food,

The people we spoke with said they felt safe at the home and they received adequate levels of support from the staff. The rota showed there were three staff on duty. One senior or the unit manager and two carers were on duty. During the week the unit manager had a supernumerary day for administration tasks. One relative and people told us the consistency was better and they recognised the staff when they visited as staff faces were more familiar now.

The staff we spoke with said they had attended training in the safeguarding of people from abuse. They were aware of the different types of abuse and the action that must be taken where there were concerns of abuse.

A member of staff recently employed said their induction was excellent and prepared them for their role. The activities staff told us they had access to all mandatory training set by the provider. They said there were opportunities for personal development through one to one meetings with their line manager.

The training matrix showed staff attended mandatory training set by the provider and training which depended on the role of the staff. For example medicine training for senior carers. The staff we spoke with said the training provided was good.

Staff said their one to one meetings were regular and occurred every eight weeks. The supervision matrix in place showed all staff had regular one to one meetings with their line manager. We noted that all staff had a one to one session with their line manager in February 2017 and the meetings for June 2017 had been scheduled.

People told us they were able to join in group activities and one to one activities were available for people who preferred to spend most of their time in their bedrooms. An activities programme was on display and coordinators had documented the group and one to one activities undertaken. Activities coordinators knew people well and their likes in relation to one to one and group activities.

People told us they had made complaints in the past and their concerns were taken seriously and had been acted upon. The Complaints procedure on display needed reviewing as the name of the previous quality assurance manager was included for people to approach with their complaints.

Quality assurance systems were in place to monitor the quality of care provided. Visits on behalf of the provider were monthly and action plans developed where shortfalls were identified. Staff said the team worked well and stated the registered manager was approachable. People told us their views were gathered using surveys and during meetings. An agency worker told us they worked at the service regularly to provide continuity of care to people.