Alexander Court Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

During our assessment of this key question, we found shortfalls in the management of risk and the management of medicines. People's care plans contained inconsistent, contradictory, and missing information, and further improvement was required to ensure they fully reflected people's physical and emotional needs. People's medicines were not always managed safely. Staff did not always receive competency checks on their performance and abilities to ensure they carried out their roles and responsibilities safely. We discussed this with the manager, and they took immediate action to address the concern. People were mostly 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. We found records relating to consent and capacity needed improvement. We have reported this under the consent to care quality statement. However, people were safeguarded from abuse and harm. Staff received safeguarding training and demonstrated a clear understanding about how to recognise and report abuse and poor care. The manager understood their responsibility to refer any safeguarding matters to the appropriate agencies. The service had systems in place for infection control and prevention

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider acknowledged the service had received concerns from the local authority, relatives, and staff. They had taken action to address these concerns. The management team at the home completed accidents, incidents, and safeguarding analysis in order to learn from events. However, the analysis needed to be more robust and consistently implemented. Staff knew how to identify and respond to any incidents of concern. There was evidence that learning from incidents and investigations took place, and appropriate changes were implemented.

Staff told us they had experienced noticeable improvements since the new provider took over and the current manager came in to post. One staff member said, “This last month we have had a bit of a breakthrough and things have definitely got better.”

People and relatives told us since the new provider had taken over, there was an overall feeling of change for the better.One family member said," The new providers have made a massive difference here. They are so approachable, and they seem to genuinely care about the people here and the care they provide.” People said the provider and the management team were 'open and honest'. People and staff were encouraged to raise concerns.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People appeared very relaxed and comfortable with staff. People indicated they liked living at the home and raised no concerns. The provider and staff were very open and welcomingand we observed them chatting and laughing with people.

Staff were able to recognise possible signs of abuse and knew how to report such concerns promptly. There was a commitment to taking immediate action to keep people safe from abuse and neglect. This included working with partners in a collaborative way.

People told us they felt safe at Alexander Court. People using the service told us that care and treatment was planned and delivered in a way that ensured people's safety and welfare and that they were involved in their care. Comments included, “I feel safe, there’s always someone about” and “We are safe, if you fall or are not well there’s always someone about to help you.” One relative told us, " I feel [relative] is so safe. When I first walked through the door here it felt so warm and it is clean, no smells.”

The provider had effective systems, processes, and practices in place to make sure people were protected from abuse and neglect. Staff received training in safeguarding people from the risk of abuse. The home manager kept a detailed log of any incidents that may indicate a person was at risk of abuse. Records showed safeguarding issues had been investigated and action taken to mitigate future risk. People can only be deprived of their liberty when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). Some people living at the service were deprived of their liberty in order to support them to remain safe. Where this was the case, we found the appropriate legal authorisations were not always in place. Records relating to consent and capacity need improvement. For example, records did not always demonstrate that people or their legal representatives had consented to their care. Despite the issues with records, we saw no indication people's rights were restricted.We have reported on this in the consent to care key question.

Overall, we observed there were positive interactions between staff and people and staff knew people well. People’s walking aids were left within reach. Staff reminded people who needed walking aids to use them if they forgot, to support their safety. Where people chose to spend more time in their rooms, we observed staff went in to check on them regularly. Staff were present in the communal areas to be on hand if people.While we observed positive interactions between staff and people our assessment found elements of care did not meet the expected standard.

While the people we spoke to expressed that they were generally happy with their care, our assessment found elements of care did not meet expected standards. People were involved in the assessment of their needs and the management of their risks where able.Relatives told us staff supported their loved ones to meet their needs. This included supporting people's mobility and sharing any concerns with other health professionals. One relative commented, “My relative needs turning in the night, and they complain, but the staff have cleared the pressure ulcer they had.”While the people we spoke to said they were generally happy with their care our assessment found elements of care did not meet the expected standard.

Staff had a good awareness of people's needs and how best to support them. People’s care plans were regularly reviewed and in response to any change in needs.Staff felt informed about people's risks and told us how information about people’s individual risks and changes were communicated. This included through care plans and handover sessions. While staff had a good awareness of peoples needs and how best to support them our assessment found elements of care did not meet the expected standard.

Risks to people's safety were assessed and recorded. However, risk assessments had not always been updated when changes occurred, and some care plans contained contradictory information. We identified issues in relation to records relating to the monitoring of identified risks. Some people required regular repositioning due to the risks associated with poor skin conditions. Records were not always completed to show that repositioning had taken place in line with their care plans. Where people needed their food and drink intake to be monitored due to the risks associated with poor diet and fluid intake, records were not consistently kept showing what and how much food and drink had been offered and/or consumed.This was a breach of the legal regulations.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff felt well supported in their role and received relevant training. Staff told us there were safe staffing levels at the service. Staff we spoke to felt supported and told us they had a good induction and support where this was relevant. Staff told us how things had improved since the new provider had taken over. One person commented, “I like the new provider; we get support now, whereas before we got left to our own devices

We observed calm, unhurried support. Staff were patient, caring, and had time to spend with people. Interactions were friendly and person-centred. Staff knew people really well and responded to their needs and preferences. Staff were on hand throughout the day to attend to people when they needed it. People were not left waiting for help, and call bells were responded to quickly.

There was enough staff to provide support to people. The provider used a dependency tool to help them assess how many staff hours they needed to provide support to people. This was then reflected in the rota. Staff had the skills and knowledge they needed to provide safe support to people. Staff had completed the training they needed to undertake the role.Staff were recruited safely. For example, Disclosure and Barring Service (DBS) checks were undertaken. DBS checks provide information, including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

People provided mixed views about staffing levels and the consistency of staff at Alexander Court. Comments included, "There’s not enough staff, they are short of carers, but usually there’s someone when I want one [staff member]” and “I’m well looked after, the staff are busy but always there.”

The systems used by the provider to monitor infection, prevention and control practice were effective in practice and ensured people were protected from the risk of infection.

Staff had ensured people were protected from the risk of infection because premises and equipment were kept clean and hygienic.Staff had completed infection control and food hygiene training.

People and relatives did not share any concerns about infection control. People were able to receive visitors in line with best practise guidance.

We observed people were protected from the risk of infection because premises and equipment were kept clean and hygienic. We found there were effective laundry management and clinical waste management systems in place. Staff had access to enough personal protective equipment (PPE) which they used appropriately. We saw evidence that environmental and equipment checks had been completed. Equipment was available in different areas of the service for staff to access easily.

Medicines were not always managed safely.This was a breach of legal regulations.Staff competency assessments had not been completed prior to staff administering medicines to ensure their practice was safe. After the assessment, the provider ensured the appropriate staff were trained and assessed as competent to support people with their medicines. Records were not always completed to show topical preparations such as creams were being applied; therefore, we were not assured people's skin was cared for properly. We were also not assured topical preparations were stored safely. This meant there was an increased fire risk because some creams can contain oil, which can make it easier for clothing, dressings, and fabric to catch fire. We found some people were prescribed pain relief in the form of a patch applied to their skin. However, there was poor record keeping, demonstrating these had been applied properly.

Staff told us they received training to safely administer medicines.While staff gave us positive feedback about medicines management our assessment found elements of care did not meet the expected standard.

One relative told us their biggest concern was people not having access to their medicines when they needed them.