Archived: Alexandra Care Home

There was a manager in post who had registered with the Care Quality Commission (CQC). 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 and associated Regulations about how the service is run.

People were supported to take their medicines by trained staff. However these medicines were not consistently dispensed safely. Medicine audits had not identified the issues found. However the registered manager took immediate action.

People felt safe at Alexandra Care Home. Staff had received training in how to safeguard people from abuse and knew how to report concerns, both internally and externally.

Safe recruitment practices were followed to help ensure that all staff were suitably qualified and experienced. Arrangements were in place to ensure there were sufficient numbers of suitable staff available at all times to meet people’s needs.

Where potential risks were identified there was involvement of other professionals to help ensure people were safe.

Staff received training and refresher updates relevant to their roles and had regular supervision meetings to discuss and review their development and performance.

People were supported to maintain good health and had access to health and social care professionals when necessary. People were provided with a healthy balanced diet that met their individual needs.

Staff obtained people’s consent before providing personal care and support, which they did in a kind and compassionate way. Staff had developed positive and caring relationships with the people they cared for.

People were involved in the planning, delivery and reviews of the care and support provided. Confidentiality of information held about people’s medical and personal histories was securely maintained throughout the home.

People received personalised care and support that met their needs and took account of their preferences. Staff were knowledgeable about people’s background histories, preferences, routines and personal circumstances.

People were supported to take part in meaningful activities relevant to their needs.

Complaints were recorded and responded to in line with the service policy. People, relatives and staff were complimentary about the registered manager and how the home was run and operated.

Below is a summary of what we found based on the evidence gathered during our inspection carried out on 27 May 2014. This included speaking with people who used the service, their relatives and members of staff who supported them. We looked at people's care records.

Is it safe?

We noted that call bells were within people's reach so they were able to request help and support if they needed it.

People told us that they were happy at the home and that staff were kind and attentive. People said that they felt able to raise their concerns. One person told us, "Yes I feel safe here now. The new manager has brought in new staff and they are really kind and supportive."

Staff we spoke with were able to demonstrate their awareness, through discussion, of the signs of abuse, and told us how they would report their concerns. Staff had received training in relation to safeguarding adults from abuse.

Is the service effective?

We saw that assessments had been completed and reviewed in relation to a wide range of issues relevant to people's care needs. These included assessments which related to the management of people's medicines, skin integrity and risks associated with pressure care, nutrition and hydration, mobility and falls.

During our inspection we did not see that any meaningful activity took place for people who used the service.

Where people displayed challenging behaviour there was no effective care planning to address how this was to be managed.

People's weight and nutritional needs were regularly assessed. Where a person was at risk of malnutrition or dehydration staff members took appropriate action.

We found that there was enough experienced staff available to support people's needs. Care was provided in a timely manner and call bells were answered promptly.

The manager had recently implemented a new system to encourage people who lived with dementia to choose a meal. They were shown a choice of two meals to assist them just prior to the meal being served. This helped to ensure that people were aware of their menu choices.

However people were not always provided with food that was in line with the recommendations of a dietician.

Is the service caring?

During our inspection we saw that people who lived at the home were treated with care and respect.

We observed the breakfast and lunchtime meals and saw that staff members provided appropriate levels of support to help people to eat and drink in a calm, patient and dignified manner. This promoted their independence.

We observed that staff interacted with people with warmth and respect. For example, we watched as a staff member assisted a person to transfer from their wheelchair to an armchair. We noted they provided continuous re-assurance to the person, maintained their dignity at all times, and ensured they were comfortable and secure.

Staff members we spoke with were able to demonstrate a comprehensive understanding of people's needs.

Is the service responsive?

We saw that people's views, experiences and choices were considered in the way that care, support and treatment was delivered. The provider had collated people's views and experiences through surveys and meetings. These included people who used the service, and their relatives. We noted that people were generally satisfied with the care that they received.

Where people were at risk of dehydration or malnutrition, they were referred appropriately for specialist support from health professionals such as doctors or dieticians. We saw the recommendations were then followed, and regular checks of people's weight, nutrition, fluid intake, skin integrity and general wellbeing were carried out.

Where people were at risk of developing pressure ulcers, staff members ensured the appropriate pressure relieving devices were used, such as mattresses and cushions.

Is the service well led?

We saw that people had access to relevant health care professionals where necessary including GPs, dieticians and occupational therapists.

Records we looked at showed that the home took account of accidents, incidents and near misses and investigated them thoroughly.

Effective systems were in place to assess and monitor the quality of services provided. Systems were also in place to identify, assess and manage risks posed to the health, welfare and safety of people who lived at the home.

At our most recent inspection, we found the provider had made all the required improvements and were found to be meeting all the regulation outcomes we tested. People who used the service told us that things in the home had improved over the past six months. We asked people what had improved. People told us there were more staff on duty and they were able to spend more 'quality time' with people. Food and menu's had been reviewed and people and their relatives had contributed to the process. The home had undergone major refurbishment and looked much better. One person said 'the environment is so much better'. Another said they enjoyed the interaction with staff.

We noted that the home had a different 'feel' to it. We observed people who used the service having 'positive interactions with staff. Staff appeared to be much more relaxed and we observed them chatting happily with people. There were activities going on in two of the lounges. People were being supported with drinks and snacks. People looked well cared for and told us the staff were great.

We observed that people's dignity and privacy was respected in most cases and people were involved in planning their care, when possible. Although we noted that there had been improvements in the care and welfare of people, we found that further improvements were required as people did not always have their needs met appropriately and in accordance with their care plans. People's safety and well-being was better than it had been on the previous visit, but we observed that people were still at risk because staff did not always have the skills, knowledge and or experience to protect people from risks associated with inadequate care, treatment and support.

We found that many staff were either newly recruited or were from an "agency" and were unfamiliar with the people who lived at Alexandra care home or the processes within the home. This meant that staff were "unfamiliar" with their responsibilities and were reliant on the more experienced staff to direct them.

Quality monitoring arrangements had improved and were much more robust. Likewise, complaints had been recorded and investigated in line with the home's complaints policy and procedures.

Our initial observations were that the home smelt strongly of urine. Almost all the bedroom doors were left open, which meant that people's dignity was compromised. We observed that some people were not appropriately dressed. Most people in one unit had 'crash mats' on the floor and had low profile beds. Bathrooms were dirty and out of use and some had no lock on the door.

Staff told us they felt demotivated and undervalued. They said that they were always very busy and that there were frequent changes of staff, which meant there were many new starters leading to inconsistency of the staff on duty. We found that care plans were difficult to follow and the records were inconsistent.

People who used the service told us the staff were very good but they were always very busy. People said that there was not much to do and organised activities were very sparse. People told us they did not like the food and said it was of poor quality.

We shared our concerns with Hertfordshire County Council and they visited the home on the day of our inspection to assess and evaluate some of the concerns we had raised.

We observed that there were continuing improvements being made to the decoration of the home. We saw that some parts of the home remained under used at present although changes were planned. We saw that new equipment was still being purchased for the benefit of people who use the service. We noted in discussion with the manager and the senior staff that the home is getting better.