Archived: Alexandra Lodge Care Centre

Updated 14 March 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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 inspection took place on 08, 09 and 16 January 2018. The first day was unannounced which

meant the provider did not know we were inspecting on this day. The second day was by arrangement. We returned for a third day of inspection on16 January 2018 specifically to look at the safe management of medicines.

The inspection team consisted of one adult social care inspector, a CQC pharmacist inspector and an expert by experience. An expert by experience is someone who has personal experience of using or caring for someone who uses this type of care service. On this occasion the expert by experience had personal experience of supporting older people living with dementia in a residential, community and acute care setting.

Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed the information in the PIR, along with other information that we held about the service including previous inspection reports and notifications. A notification is information about important events which the service is required to send us under the regulations.

During the inspection we looked around the building and observed mealtimes and interaction between staff and people living in the home.

We spoke with 11 people using the service, two visiting relatives, six members of staff, and two visiting professionals. We also spoke with the registered manager and the provider.

We looked at six care records in detail, medicine administration records for 16 people, five staff files, and staff rotas for four weeks. Following the inspection the registered manager sent us a number of documents at our request, including their business renovation plan, service user guide and statement of purpose.

Updated 14 March 2018

This unannounced comprehensive inspection took place on 08 and 09 January 2018 and was completed on 16 January 2018 when a medicines inspector from CQC carried out an unannounced comprehensive inspection of medicines. At our previous inspection on 24 and 25 May 2016 the service was given an overall rating of requires improvement and we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, safeguarding, staffing, person-centred care (two parts) and good governance.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the overall rating of the service. At this inspection we found although the provider had taken action to improve the rating of some domains inspected, further improvements were still necessary in order to fully meet all regulatory requirements.

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

Alexandra Lodge Care Centre provides nursing and residential care. The home is a detached property in its' own grounds and there is a designated car park. The home is located on a main residential road in Chorlton and is well positioned for local amenities and public transport to Manchester City Centre.

There are seven bedrooms on the ground floor, six of which are en-suite. The remaining 28 bedrooms are on the first floor, 14 of them being en-suite. Two of those can be shared by two people. Downstairs there are two lounges and two dining rooms. There is an enclosed garden and a nurses' office next to the main lounge.

The care home is registered with CQC to provide care and accommodation for up to 37 people and at the time of inspection 31 people were living at the home.

There was a registered manager in post. 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 living at Alexandra Lodge Care Centre told us they felt safe and said staff were kind and caring. The staff we spoke with told us they had completed training in safeguarding and were able to describe the different types of abuse that could occur.

There were policies and procedures to guide staff about how to safeguard people from the risk of abuse or harm. Staff had access to a wide range of policies and procedures regarding all aspects of the service.

Staff received appropriate induction, training, supervision and appraisal and there was a staff training matrix in place. Staff told us they had sufficient induction and training and this enabled them to feel confident when supporting people.

We saw there were individualised risk assessments in place to identify specific areas of concern. The care plans were person-centred and covered essential elements of people’s needs and preferences. Staff sought consent from people before providing support. People’s health needs were managed effectively and there was evidence of professional’s involvement. Information on how to thicken drinks was not always available in people's care files but was in the kitchen and one staff member gave the wrong amount of thickener.

Equipment used by the home was maintained and serviced at regular intervals. The home was clean throughout and there were no malodours. The environment was suitable for people's needs.

We looked at five staff personnel files and there was evidence of robust and safe recruitment procedures.

Accidents and incidents were recorded and audited monthly to identify any trends or re-occurrences. The home had been responsive in referring people to other services when there were concerns about their health.

People told us the food at the home was good. There was a four week seasonal menu in use and this was displayed on the wall in the dining room. We found people's nutritional needs were monitored and met.

People told us staff treated them well and respected their privacy and dignity. We observed positive interactions between staff and people who used the service.

When people had undertaken an activity this was recorded in their care file information and there was a range of activities available for people to choose from.

The service aimed to embed equality and human rights though good person-centred care planning and people were provided with a range of useful information about the home and other supporting organisations.

Personal evacuation plans were in place but would benefit from more added detail about each person.

The service was supported by other relevant professionals when providing end of life care and feedback received from a visiting health care professional about end of life care was very positive. The home had a good working relationship with a local GP practice and was experienced in caring for people who were nearing the end of life which enabled people to stay in the home if they wished. Several relatives had commended the home for the quality of its end of life care provision.

There was a complaints policy and procedure in place. This clearly explained the process people could follow if they were unhappy with aspects of their care. There was a service user guide and statement of purpose in place.

The home had received a high number of compliments since the date of the last inspection. Formal feedback from staff, people who used the service and their relatives was sought through annual quality assurance surveys.

Regular audits were carried out in a number of areas but had not always been effective in identifying and resolving some of the issues we found with medicines and drink thickeners, which was a breach of regulations.

The service worked in partnership with other professionals and agencies in order to meet people's care needs.

There was an up to date certificate of registration with CQC and insurance certificates on display as required. We saw the last CQC report was also displayed in the premises as per legal requirements. Shortly after the date of the inspection the registered manager contacted us to identify their website had been removed.