Archived: Alexandra Court Care Centre

Updated 19 May 2018

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 site visit commenced on 27 March 2018 and was unannounced. Due to an unforeseen incident, the inspection was halted on the first day. The second day of the inspection took place on 10 April 2018. On the first day, the inspection team consisted of two adult social care inspectors, a new inspector under induction, a specialist professional adviser in end of life care and an expert-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert-by-experience had expertise in caring for an older relative who lived with dementia.

The provider had completed a Provider Information Return (PIR) prior to the inspection. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We checked the PIR and also our systems for any notifications that had been sent in as these would tell us how the provider managed incidents and accidents that affected the welfare of people who used the service.

Prior to the inspection, we spoke with local authority safeguarding, contracts and commissioning teams, and also health commissioners about their views of the service.

During the inspection, we observed how staff interacted with people who used the service throughout the day and at lunchtime. We spoke with eight people who used the service, 11 people who were visiting their relatives and a volunteer. We spoke with the registered manager, a nurse, three senior care workers and six care workers. We also spoke with an activity coordinator, a cook, a laundry assistant, an administrator and maintenance personnel. We received information from three health care professionals.

We looked at five care files which belonged to people who used the service. We also looked at other important documentation relating to them such as medication administration records (MARs) for 22 people and monitoring charts for food, fluid intake, weights and pressure relief. We looked at how the service used the Mental Capacity Act 2005. This was to ensure that when people were assessed as lacking capacity to make their own decisions, best interest meetings were held in order to make important decisions on their behalf.

We looked at a selection of documentation relating to the management and running of the service. These included five staff recruitment files, training records, the staff rota, minutes of meetings with staff and people who used the service, quality assurance audits, complaints management and maintenance of equipment records. We completed a tour of the environment.

Updated 19 May 2018

This inspection took place on 27 March and 10 April 2018 and was unannounced on the first day. At the last inspection in April 2017, the provider was in breach of three regulations. These related to consent in the key question effective, person-centred care in responsive and governance in well-led. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve these key questions to at least good. We checked to see that the action plan had been completed and found progress in some areas but further improvements were required in others.

Alexandra Court Care Centre is registered to provide care for up to 84 people who need nursing care and who may be living with dementia. The building is purpose built, over three floors accessed by passenger lift and stairs. All the bedrooms are for single occupancy and all of them have an en-suite shower, sink and toilet. Recent changes had taken place; the provider decided to close the top floor and use it for storage. People who required nursing care were now located on the first floor and those that required residential care were on the ground floor.

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

The service had a registered manager in post. A registered manager is a person who has registered with the CQC 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.

We had concerns with how some people’s specific health conditions were managed so that they received timely oversight from professionals involved in their care.

Although improvements had been made in the quality monitoring system and more effective audits were carried out, there remained an issue with audit of records; some records were not up to date and had gaps which made it difficult to check if the care had been delivered. Management of the service was described as open and approachable. However, the move of people to different bedrooms to assist in the restructuring of the service was hurried and could have been managed more effectively.

We also had concerns about shortfalls in staff training, updated skills and supervision to ensure they were knowledgeable about how to manage people’s specific health care needs.

These issues were breaches of Regulation 12 Safe care and treatment, Regulation 17 Good governance and Regulation 18 Staffing, of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. You can see what action we have told the provider to take regarding these issues at the back of the full version of this report.

The provider had policies to guide staff in safeguarding people from the risk of harm and abuse. Staff knew how to raise safeguarding alerts if they had concerns. People had risk assessments and these were kept under review.

People received their medicines as prescribed. There had been some administration errors in the past, but when these occurred, staff acknowledged them, sought medical advice and informed the person and their relatives. Staff who administered medicines had received updated competency checks.

People were supported to make their own decisions and choices. The registered manager and staff had a much improved understanding of mental capacity legislation. People had assessments of capacity and best interest decisions made on their behalf if they lacked capacity; documentation regarding best interest decisions had been completed. Appropriate applications had been made to the local authority when people’s liberty was deprived due to their lack of capacity and need for continual supervision.

People liked the meals provided to them. The menus gave people choices and alternatives and specialist meals were provided for people’s diverse needs. We discussed with the regional manager how mealtimes could be held over two sittings to ensure people who required full support were assisted more effectively. They assured us this would be addressed.

There were mixed comments about the number of care staff deployed and whether this was sufficient. There had been a very recent staff rota change and the closure of six beds on one floor; staffing levels were to be monitored by the registered manager and regional manager to see if this impacted on the comments received from people.

People who used the service and their relatives we spoke with all had very positive comments about the caring approach of staff. They confirmed staff respected their privacy and dignity, delivered care which was person-centred and treated them as individuals.

People could remain in the service to receive end of life care. This had improved since a concern was raised last year. Staff attended meetings with other professionals to discuss people’s needs at the end of their life and to make sure the right equipment and medicines were in place.

There were lots of activities for people to participate it within the service. There were also trips arranged to local venues and visits from entertainers and primary school children to help people feel part of the community.

The provider had a complaints procedure which was displayed in the service. People told us they felt able to raise concerns and these would be addressed.

The environment was safe and clean. Staff used personal, protective equipment to help prevent the spread of infection. Equipment used in the service was checked and maintained to ensure it was safe.