Alexandra Lodge Care Home

Alexandra Lodge is a residential care home providing personal care to up to 19 people. People are supported in 1 adapted building. On the day of our inspection, there were no people using the service. This is because we had suspended the registration of the service.

What we found

Our last inspection resulted in the registration of the service being suspended. This means the provider is able to remain registered but is not able to support any people. A suspension of a provider's registration is time limited, so we returned to the service to assess if the provider had made improvements to the service since our last inspection. Our inspection was targeted to only look at the areas of concern at our last inspection.

We found that most of environmental risks at the service had been resolved. We found the main boiler was not working however action had been taken to ensure this was fixed, the provider did not plan on admitting new people to the service until the boiler was fixed. Action had been taken to restrict water temperatures to ensure people would no longer be at risk of scalding. Water maintenance to prevent the buildup of legionella bacteria had been completed. A risk assessment by a qualified contractor had been completed.

All staff including kitchen staff had completed training in the management of choking. Best practice guidance was available in both the dining room and kitchen to ensure staff had the correct information in regards to safe food preparation.

The home was clean and tidy. New cleaning schedules had been created and implemented to monitor cleaning processes.

The manager had reviewed staffing numbers and implemented a new dependency tool to calculate the number of staff required. Policies relating to the management of the service had been updated to ensure staff had clear guidance in order to provide safe care.

Rating at last inspection and update

The last rating for this service was inadequate (published 28 July 2023). We carried out a further targeted inspection on 2 August 2023.

Why we inspected

After the last inspection, we suspended the providers registration. We returned to the service to see if any changes had been made. This is to ensure safety for people using the service in the future.

We completed a targeted inspection. This does not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Enforcement

The last focused inspection identified 5 breaches of regulation. This was due to concerns with safety, staffing levels, recruitment, safeguarding from abuse and governance. At the time of this inspection, there were no people living at Alexandra Lodge. We were therefore unable assess if the service was still in breach of legislation. This means that these breaches of regulation remain and will be reassessed if suitable at a future inspection of the service.

Follow up

At the time of our inspection, the service had a time limited suspension. This prevented them from supporting people at the service. The suspension ended following this inspection meaning the service was able to carry out the registered regulated activity and support people in line with their imposed legal conditions. We are still considering any further regulatory action and full details of this will be added once any appeals are concluded. In the interim, we will continue to monitor information we receive about the service, which will help inform when we next inspect.

Alexandra Lodge is a residential care home providing personal care to up to 19 people. People are supported in 1 adapted building. On the day of our inspection, there were no people using the service. This is because we have suspended the registration of the service.

What we found

Our last inspection resulted in the registration of the service being suspended. This means the provider is able to remain registered, but is not able to support any people. A suspension of a provider’s registration is time limited, so we returned to the service to assess if the provider had made improvements to the service since our last inspection. Our inspection was targeted to only look at the areas of concern at our last inspection.

During the inspection, we found that environmental risks remained at the service. There was hot water which could risk scalding. Fire doors did not close, which risks the spread of fire through the building. Windows were not restricted, which meant people could fall out of windows.

We found that some policies had been updated. However, these were not always good enough to guide staff.

Staff had updated DBS checks, to ensure they were still safe to work with people. However, the policy had not been updated to ensure that regular DBS checks would occur in the future.

At the last inspection, people were at risk of choking. At this inspection, kitchen staff had not received training and updated guidance on how to manage swallowing needs and suitable food preparation going forward. Therefore, the risk of people choking if they used the service remained.

Water maintenance was not completed. This lack of maintenance risked the build up of legionella bacteria in the water system. This bacterial build up can cause a respiratory illness and serious ill health.

At the last inspection we found there were not enough staff. The manager told us that they do not intend to increase staffing levels if people returned to the service. The manager had a tool to calculate how many staff were needed, however this was not fit for purpose.

Staff had now received training in how to give medicines safely. However, there were still unclear processes for how medicines would be managed and monitored at the service.

The cleanliness of the home had improved, however there was still a room that was malodourous and had dirty light pull cords. So, we were not assured that cleaning processes were fully embedded at the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 28 July 2023).

Why we inspected

After the last inspection, we suspended the providers registration. We returned to the service to see if any changes had been made. This is to ensure safety for people using the service in the future.

We completed a targeted inspection. This does not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Enforcement

The last inspection identified 5 breaches of regulation. This was due to concerns with safety, staffing levels, recruitment, safeguarding from abuse and governance.

At the time of this inspection, there were no people living at Alexandra Lodge. We were therefore unable assess if the service was still in breach of legislation. This means that these breaches of regulation remain and will be reassessed if suitable at a future inspection of the service.

Follow up

At the time of our inspection, the service had a time limited suspension. This prevented them from supporting people at the service. We are still considering our regulatory action and full details of this will be added once any appeals are concluded.

In the interim, we will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

At the last inspection, the overall rating for this service was ‘Inadequate. This meant the service remained in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Due to the targeted focus of the inspection, we have been unable to assess all key questions. Therefore, this service remains in special measures.

Alexandra Lodge is a residential care home providing personal care to up to 19 people. People are supported in 1 adapted building. The service supports older people, some of whom are living with dementia and mobility needs. On the day of our inspection, there were 8 people using the service.

People’s experience of using this service and what we found

The premises and environment were poorly maintained, and staff training and competency was poor, this put people at risk of significant harm. Action identified in previous urgent enforcement action had not been taken and further risk was identified. The provider failed to take action to mitigate significant risk to people. This meant the environment and risk management was ineffective, which placed people at risk of harm and therefore, following this inspection, people were transferred to alternative care homes.

The home was not safe. Environmental risks were not managed. The provider had not been carrying out health and safety checks where they should, to ensure risks relating to windows, hot surfaces, and infection control were safely and appropriately managed.

The service failed to protect people from poor care and abuse. The provider had failed to have systems and processes in place to monitor and review incidents and the quality of the care provided to people. This resulted in poor care and no action taken to prevent reoccurrence of incidents.

Medicines were not managed safely. The provider failed to appropriately stock check medicines. Multiple medicines could not be accounted for meaning people were at risk of under or over administration of medicines.

People received poor quality care, due to staff not having the required skills and abilities to meet people’s needs. Staffing levels were consistently low, some staff were expected to fulfil dual roles, which meant people received inconsistent care from staff due to insufficient time to meet people’s needs.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

There was a poor culture at this home. Staff told us the home was not safe and the provider did not listen when they raised concerns. This meant there was no focus on continued improvement and assessment of the quality of care at this home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 28 June 2023)

At this inspection we found the provider remained in breach of regulations.

This service has been in Special Measures since 28 June 2023. During this inspection the provider did not demonstrate improvements have been made. The service remains rated as inadequate overall. Therefore, this service remains in Special Measures.

Why we inspected

The inspection was prompted in part due to previous urgent enforcement action resulting in conditions added to the registration. Concerns were received these conditions were not being met in regards of risk oversight and governance improvements, additionally concerns with the environment, infection control, staffing and leadership. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service remains inadequate. This is based on the findings at this inspection. We found evidence the provider needs to make significant improvements. Please see the safe and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Alexandra Lodge on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to risk management, staffing, safeguarding people from risk of abuse and good governance at this inspection.

Following the inspection we suspended the providers registration. This means the provider cannot support any people for a period of time.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Alexandra Lodge is a residential care home providing personal care to up to 19 people. People are supported in 1 adapted building. The service supports older people, some of whom are living with dementia and mobility needs. On the first day of our inspection, there were 10 people using the service.

People’s experience of using this service and what we found

The home was not safe. Environmental risks were not well managed. For example, we found the provider had not been carrying out fire safety checks when they should, to ensure fire related risks were managed. People were at increased risk of developing pressure ulcers. The provider did not ensure risks relating to people who could experience falls were well managed. Lessons had not always been learnt following incidents and accidents. People were not always protected from the risk of abuse and improper treatment. Staff were not recruited safely. Protocols for medicines used as required were not always in place. However, medicines were stored safely.

Records showed staff had not received up-to-date training. Staff did not receive regular supervisions from the provider. People's care plans were not always reflective of their current needs. People did not have access to regularly planned activities. The provider had not always made referrals to external health professionals where people required additional support relating to falls and times when they could experience emotional distress. However, people's nutrition and hydration needs were met.

Where people lacked the mental capacity to make specific decisions, best interests decisions were not documented. This meant; people were not supported to have maximum choice and control of their lives, and staff did not have the information they needed to support them in the least restrictive way possible and in their best interests; there were no policies and systems in the service to support this practice.

The home was not well led. The provider had no established policies in place for recruitment, accidents and incidents and falls. This meant there were no set standards and clear expectations for ensuring quality and safety in these areas. Environmental, care plan and medicines audits carried out by the provider were not always completed accurately, which increased safety risks to people. The provider and a relative told us opportunities for social activities, such as parties, needed to be improved. However, relatives told us they were kept up to date.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 22 June 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from good to inadequate based on the findings of this inspection. We found evidence the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Alexandra Lodge Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safety, safeguarding people from the risk of abuse, staffing, person centred care, ensuring people’s consent to the care they receive and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The service did not have a registered manager as this is not required as they are the sole provider. 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.

People told us they felt safe and staff knew how to recognise and report potential abuse. Risks to people and the environment were identified and managed in a way to keep people safe. There were enough staff available to meet people’s needs and the provider ensured their suitability to work within the home. Medicines were managed in a way to protect people from the risks associated to them. There were infection control procedures in place and these were implemented throughout the home.

When people were able to consent, capacity assessments had been completed and decisions had been made and recorded in people’s best interests. When people were being unlawfully restricted, this had been considered and application to the local authority had been made.

People were offered a choice of food and drinks and enjoyed what was available. When needed people had access to input from health professionals. People and relatives were happy with the staff. They were able to make choices about their day and encouraged to be as independent as possible. People enjoyed the activities offered. Friend and families were free to visit when they chose. Staff knew people well including their likes and dislikes and people received care in their preferred way. People’s cultural needs had been considered.

Quality monitoring checks were completed to bring about improvements. The provider sought the opinion of people and relatives to bring about positive changes. People knew who the manager was and felt they were approachable. If people wanted to complain they were confident this would be dealt with. The provider had a system in place to ensure that when things went wrong, lessons were learnt. They also understood their registration responsibilities and notified us of any significant events that occurred within the home.