Princess Alexandra Home For The Blind

Princess Alexandra Home for the Blind is a residential care home providing accommodation for persons who require nursing or personal care to up to 40 people. The service provides support to older people who may have a sensory impairment or learning disabilities or autistic spectrum disorder. At the time of our inspection there were 32 people using the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice. When people lacked capacity to make specific decisions, we found the service was following the best interest's principle. Relevant authorisations had been granted where people’s liberties were deprived.

People’s needs were assessed, and care plans were developed to promote positive risk taking. People’s bedrooms and decor was personalised and reflected their personalities, showing their choices and decisions had been respected. Staff had been employed following robust recruitment procedures and were trained in the safe storage and administration of medicines. Staff were knowledgeable on what actions to take should they witness any safeguarding concerns or hear any allegations of abuse.

Right Care:

The service had enough staff to meet people’s needs and keep them safe. Staff knew the people they were supporting well, including their health and wellbeing needs. Staff were trained and skilled to offer support and guidance to quickly lessen or minimise people’s distress. Staff and visitors had access to protective personal equipment to limit the risk of infection.

Right Culture:

People and staff told us they could raise concerns with managers and feel safe and supported. People were comfortable and relaxed in the company of staff. People and staff had a friendly rapport and people had a positive relationship with the management team. The provider carried out regular audits and could evidence lessons were learnt when things went wrong. The management team worked alongside staff to keep people safe.

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 28 January 2019).

Why we inspected

We received concerns in relation to the management of risk and personal care. As a result, we undertook a focused inspection to review the key questions of safe 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 remained the same based on the findings of this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. 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 inspection reports and timeline’ link for Princess Alexandra Home for the Blind on our website at www.cqc.org.uk.

Follow up

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

At the last inspection on 01 June 2016, the service was rated good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

During this inspection visit, we observed staffing levels were sufficient to meet people’s different needs. When we discussed this with those who lived and visited the home, they confirmed adequate staff meant they felt safe. One person said, “When I’ve used my call bell, staff came and helped me quickly, I feel safer now than when I did in my flat.”

Princess Alexandra had implemented respite support for individuals with a learning disability in addition to caring for people with a sensory impairment. We discussed with those who lived at the home how this was implemented and their sense of community living and received positive comments. A staff member told us, “They feel they can help [each other], it’s beneficial for us all.”

Personnel files evidenced the management team used the same safe recruitment procedures we found at our last inspection. Staff records showed personnel received good levels of training.

Staff administered medication with a calm and patient approach. We found storage areas were clean and secure and staff told us they received relevant training to enhance their skills. The registered manager completed regular audits to assess the continued safety of procedures.

The registered manager adopted good systems to maintain a safe environment. Control measures in care records guided staff about mitigating the risks of inappropriate or unsafe care. Staff showed a good awareness about protecting people from and reporting abuse or poor practice.

When we discussed nutrition with people who lived at the home, we received positive comments. We observed staff supported them with their meals, where required, with a respectful approach.

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 supported this practice. We found evidence people or their representatives had documented their consent to care.

Staff were consistently kind and patient when they supported people. Relatives we spoke with told us they were encouraged to visit to maintain their important relationships with their family members. One relative said, “I visit often and I’m always made to feel welcome.” People and their relatives commented staff were keen to include them in their support planning.

Princess Alexandra had a wealth of activities and events to maximise people’s social stimulation and wellbeing. One person commented, “There are activities every day and the staff are wonderful. They can’t do enough for me.”

Care records we saw were of a good standard, detailed and personalised to the person’s needs. There was clear evidence of a multi-disciplinary approach to create holistic assessments and support plans.

We found the registered manager sought and acted on people’s opinions to enhance care delivery. Various quality audits had been completed to assess everyone’s safety and wellbeing.

Further information is in the detailed findings below.

Princess Alexandra provides care and support for a maximum of 40 older people who live with sensory impairment. At the time of our inspection there were 35 people living at the home. Princess Alexandra is situated in a residential area of Blackpool close to the promenade. All bedrooms offer single room accommodation with en suite facilities. There are communal lounges, dining areas and gardens for people’s use.

A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission (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.

At the last inspection on 29 November 2013, we asked the provider to take action to make improvements to people’s care and welfare. We requested they reviewed procedures related to the management of people’s medicines to ensure this was safe. At the follow-up inspection on 07 April 2014, the provider completed improvements and had met the requirements of the regulations.

During this inspection, we found staff had received safeguarding training to protect people from harm or injury. Environmental and support risk assessments were in place to minimise the risk of receiving unsafe care. People told us they felt safe whilst living at the home.

People and their relatives were supported to maintain their important relationships. They told us staff were kind and respectful. The registered manager had guided staff to assist individuals with dignity in care. One person said staff were, “Marvellous. I’d give them 11 out of 10.”

The provider had sufficient staffing levels to meet people’s requirements. One staff member told us, “We have time to do the little jobs, like chatting with residents and checking with them that their clothes are labelled.” We found the registered manager supported staff with a range of training to underpin their skills and knowledge. The management team followed safe recruitment processes in the employment of suitable staff.

We observed staff were supported to focus on one person at a time to ensure the safe management of their medication. Medicines were stored in a secure area and there was a clear audit trail of when they were ordered, delivered, administered and disposed.

Staff documented and updated risk assessments to protect people from the risks of malnutrition. We discussed nutrition with individuals who lived at the home, who said they could choose a variety of meals and portion sizes. One person told us the food was, “Lovely, if you don't like one thing they’ll give you something else.”

Staff had a good awareness of the Mental Capacity Act (MCA) and associated Deprivation of Liberty Safeguards (DoLS). We observed people were not deprived of their liberty and care records contained their consent to care and support.

Care planning was personalised to people’s requirements and the management team reviewed this to ensure support continued to meet their needs. Records held evidence to demonstrate individuals who lived at the home were involved in care planning processes. People said they were supported to maintain their social needs and stated there were activities available to keep them occupied. A relative said, “I’m taking [my relative] out for a cup of tea and a cake this afternoon.”

People and their representatives were supported to give feedback in a variety of ways, including surveys and ‘resident’ meetings. They told us the home was managed well. Staff said the registered manager had a ‘hands on’ approach and was supportive and accessible. The management team had suitable arrangements to assess the quality and safety of people’s care.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. 'I have been here for some time now. I feel a lot more secure here than being on my own'.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made and in how to submit one. This meant that people would be safeguarded as required.

Is the service effective?

Specialist dietary, mobility and equipment needs had been identified in care plans where required.

People's needs were taken into account with specific adaptations for people who were visually impaired including signage and the layout of the service. This enabled people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people who were visually impaired.

People we spoke with told us the service was flexible to meet their individual needs. 'I get up and go to be when I choose. It's not a problem at all, they are very accommodating'.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, 'The staff are all wonderful. Very kind and caring'. Also, 'Staff are very patient, they never rush you and it can take some time for me to move around'.

People using the home, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. The results had been measured and shared with staff and residents. The results are used to inform the development and quality of the service. Any issues highlighted were looked at and responded to in order to ensure the home was meeting quality standards.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly. We saw evidence of daily activities in place and delivered by various staff. External activities were available for those who wanted to use them. A resource centre on site was also available to people living at the home.

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Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. The service has a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times

We found there were processes in place to record people's consent to their care plan. However, we observed one person was asked to sign their care plan when it was not clear the content of this plan had been discussed or agreed with them

We looked at the care files for four people who used the service. We found care plans contained limited information about how people wished their care to be delivered. Care plans had also not been updated to reflect people's changing needs. This meant there was a risk of people receiving unsafe or inappropriate care.

We found there were insufficient arrangements in place to ensure the safe handling of medicines in the home.

We saw evidence there were effective recruitment procedures in place. These should help to ensure people who used the service were protected from inappropriate staff.

We found suitable arrangements were in place to manage an effective process for identifying, receiving and handling complaints for people living at Princess Alexandra Home for the Blind.

Comments received included:

"You couldn't be better looked after than we are here. Not even at home."

"I had the option of going back home, but I chose to stay here. It is really a good place."

"I looked on the website at the Care Quality Commission report and this home ticked all the boxes for my Mum. It has lived up to my expectations. I have not been disappointed at all."

During our inspection we assessed standards relating to people's care and welfare and how the home addressed their care needs. We also looked at how the home went about safeguarding people from abuse. Standards relating to training and monitoring the quality of service provided were also inspected. We found the home to be compliant in all areas we assessed.