Background to this inspection
Updated
4 August 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection team consisted of three inspectors 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.
Service and service type
Alexandra Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Alexandra Care Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with six people who used the service and eight relatives about their experience of the care provided. We spoke with ten members of staff including the operations manager from the provider organisation, registered manager, deputy manager, nurses and care staff.
We reviewed a range of records. This included seven people's care records and multiple medication records. We looked at two staff files in relation to recruitment.
A wide variety of records relating to the management of the service, including audits and monitoring
records, feedback, the ‘home development plan’ and meeting minutes were also reviewed.
Updated
4 August 2022
About the service
Alexandra Care Home is a care home registered to provide accommodation and nursing care to up to 76 people. The service provides support to adults who require personal and/or nursing care, who may be living with physical disability, sensory impairment or dementia. At the time of our inspection there were 63 people were living at the service.
People’s experience of using this service and what we found
People experienced delays in their care. There were insufficient staff deployed to meet the needs of people at key times. People, relatives, staff and visiting professionals shared concerns regarding the staffing level at the service, which our observations confirmed.
Risks to people were not consistently managed. Records regarding incidents, accidents and untoward events were not consistent in their completion or consistent with entries made in people’s care records. We were not assured that all incidences of concern were investigated or reported to appropriate authorities, when needed. This included relevant statutory notifications to the Care Quality Commission (CQC).
Quality assurance processes failed to identify the impact of the staffing level on people. Actions required following audits, checks and reviews were included in the ‘home development plan’ however, some actions were marked as completed when issues remained.
Staff were recruited safely.Staff were aware of their responsibilities regarding safeguarding people and the concerns to raise, should they have any. Medicines were managed safely with robust infection prevention and control measures in place.
People, relatives and staff found the registered manager approachable and supportive. Relatives reported an improvement in communication with the service and receiving up-to-date information regarding their family member’s care.
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 requires improvement (published 29 April 2022).
The provider completed an action plan after the last inspection to show what they would do and by when to improve.
The provider told us the improvements required would be completed by 30 June 2022. This inspection was carried out before this date.
At this inspection we found the provider in breach of further regulations.
Why we inspected
We received concerns in relation to staffing and risks to people’s health and wellbeing. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
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.
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 remained the same based on the findings of this inspection.
We have found evidence that the provider needs to make improvements. Please see the safe section of this report.
You can see what action we have asked the provider to take at the end of this report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Alexandra Care Home on our website at www.cqc.org.uk
Enforcement
We have identified breaches in relation to staffing, the management of risks and the submission of notifications at this inspection.
Please see the action we have told the provider to take at the end of this report.
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.