Alexander Court

Updated 7 March 2019

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 unannounced comprehensive inspection took place on 22 and 23 January 2019. On the first day, the inspection team consisted of two inspectors. On the second day there was one inspector.

Before our inspection we looked at information that had been sent to us by the registered manager. We also reviewed our previous inspection report, and the Provider Information Return (PIR) that the registered manager had completed. The PIR is a form that asks the provider to give some key information about the service, what the service does well and what improvements they plan to make.

We spoke with seven people who used the service and four relatives. We also spoke with the registered manager, the deputy manager, team leader, head of house-keeping, the chef, three members of care staff, one visiting health professional and a manager with the local authority.

We observed how staff cared for people and looked at care records of six people who lived at the service, how the service was staffed to meet people’s assessed needs, three staff recruitment files, the dependency scores and training records. We reviewed how people were supported with their dietary requirements and prescribed medicines. We also checked the recorded complaints and compliments received by the service and audits of care.

Updated 7 March 2019

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

The service provides personal care and accommodation for up to 47 older people. There are two floors and people with more complex needs or living with dementia live on the top floor. At the time of our unannounced inspection there were 46 people living at the service. Each person had their own bedroom and had access to communal lounges, dining rooms and a secluded garden.

The service had a registered manager. ‘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.’

At our last inspection of 19 October 2017, the service was rated as requires improvement. At that inspection we found that staff training was not being renewed in line with the provider’s own expectations. The staff were not provided with regular formal supervision to monitor and develop their practice. We found a variable approach in promoting people’s rights in accordance with the Mental Capacity Act 2005 (MCA) and restrictions imposed upon one person with regard to the associated Deprivation of Liberty Safeguard. Some information in people’s care plan was missing which meant that staff lacked guidance about mitigating risks to people’s safety especially regarding their mobility. The leadership and management of the service had not addressed issues identified in the providers own quality assurance reports. Left unattended these issues could have an impact on peoples well-being.

At this inspection of 22 and 23 January 2019 we found the service had improved and there were no breaches of the Health and Social Care Act 2008 and we have rated the service good. This is because the staff have received regular supervision and training. Peoples consent was sought and recorded regarding the care they received. The care plans were clear regarding how to support people with their mobility and falls were recorded and monitored to determine how the service could support the person.

The new registered manager having come into post in October 2018 had begun to address the quality assurance of the service through audits and actions plans derived from the audits. These were not as yet fully effective. The current audits in place had not identified that robust checks were in place with regard to the employment of new staff. We found a cupboard containing substances which could have been harmful to people were not locked and tilling in a bathroom had not been completed. Hence the bathroom at that time was out of use. A care plan of a person recently admitted to the service was not fully clear with regard to why they were not taking prescribed medicines. Although the staff knew the people well in their care, kitchen records for example regarding the number of people with diabetes was not clear. During our inspection action was taken on all the above to resolve the issues.

The staff had been trained in how to safeguard people. Staffing levels were appropriate to support people meet their assessed needs.

Staff had received training in the control of infections and the service was clean throughout.

The registered manager, along with the senior staff held meetings to determine how the service could learn from events and improve.

People were provided with sufficient amounts of nutrition and fluids and a variety of meals. The staff ensured that people were referred to professionals when they were unwell. Professional staff visiting the service each day informed us they had a positive working relationship with the service staff.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

Care was delivered in an understanding and empathic way to meet people’s needs. People were supported by staff to make day to day decisions about their care. The staff respected people’s dignity and privacy.

Each person had a care plan which was based on an individual needs assessment and took into account people’s preferences. The care plans were reviewed monthly to ensure they remained accurate and up to date. We did find one care plan which required some further information to be accurate but were aware that a meeting to discuss the person’s care had been planned but not documented in the care plan.

People were encouraged to engage with a variety of activities which had been developed from listening to the views of the people. People and their relatives were aware of how to make a complaint and spoke positively about the service. The service had consulted with people and their relatives as appropriate to discuss plans of they wished to receive care should they become unwell.

People and relatives reported the service was run by knowledgeable and responsive staff with an open culture to listen to their views.

Further information is in the detailed findings below.