Archived: Alexandra Lodge Care Centre

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.

The previous inspection took place in August 2014 when we found a breach of one regulation. This was because the hot water system was not working properly. We received an action plan in September 2014 which stated that new taps had been installed and a new water pump was being obtained. At this inspection we checked that the hot water was working properly, which it was.

Alexandra Lodge Care Centre is a care home which provides residential and nursing care. It is registered to provide accommodation for up to 37 people. At the date of this inspection there were 34 people living in the home. Of these 14 were receiving nursing care and 20 were receiving ‘residential’ care.

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. There is a nurses’ office next to the main lounge.

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. Alexandra Lodge Care Centre had a registered manager. They had been in post since May 2014 and had become registered in April 2015. At the date of the inspection they were taking extended leave of around two months, which the provider had notified us about. The clinical lead was the acting manager.

Most people told us they felt safe. Staff were trained in safeguarding. We found that an allegation about bruises had been made and not reported as a safeguarding incident to the local authority. This was a breach of the regulation about safeguarding. We also found two incidents had not been reported as safeguarding incidents to the CQC. This was a breach of the regulation requiring allegations of abuse to be reported to the CQC.

The arrangement for storing controlled drugs was not satisfactory. Medicines were administered in a safe manner, except that we saw they were recorded in a batch rather than individually, which risked errors. These two issues were a breach of the regulation relating to the safe administration of medicines.

There were sufficient numbers of staff on duty to meet people’s needs, although fewer in the early evening. There had been a high turnover of staff which meant agency staff were used. Staff and relatives raised concerns about agency staff not knowing people as well as regular staff did. Because of staff availability some staff, including the acting manager, were working excessive hours per week. This was a breach of the regulation relating to having sufficient numbers of staff available.

At its last infection control inspection Alexandra Lodge had scored highly. Most areas of the building were clean. We noted some stains on the walls in one dining room, and some food debris on a radiator. This was cleaned during the inspection but there were still some stains.

Alexandra Lodge followed good practice in recruitment to ensure that all staff were suitable to work in the home. The home was well maintained and precautions were taken against fire.

People had access to healthcare services outside the home. However we found one example of someone who had been waiting three months for an appointment to be made for a new hearing aid. This was a breach of the regulation relating to providing appropriate care.

Alexandra Lodge was complying with the requirements of the Mental Capacity Act 2005, although staff did not always explicitly ask for consent when carrying out care tasks. Authorisation under the Deprivation of Liberty Safeguards was applied for when needed.

There was a good range of training. Staff were supported with regular supervision.

People said they enjoyed the food. The cook was able to cater for special dietary needs.

The building was comfortable and homely. We have made a recommendation about improving the environment for people living with dementia.

People living in the home and relatives were enthusiastic about the quality of care. However, district nurses told us that continence needs were not always met and people were not always kept clean and dry. This was a breach of the regulation relating to meeting people’s needs.

We saw some other examples where staff were not putting first the needs of people living in the home. However, at other times staff were treating people respectfully.

The home had a good working relationship with a local GP practice. The home was experienced in caring for people who were nearing the end of life and enabled people to stay in the home till the end if they wished. Several relatives had commended the home for the quality of its end of life care provision.

Thorough assessments were completed before people moved into the home. Care plans were detailed and tailored to the needs of the individual. More personal history of each person would enhance the person-centred care. Care plans were updated regularly.

There was a newly-appointed activities organiser who was developing a range of activities. There were links with the community and people could go out shopping with the activities organiser. Residents’ meetings took place.

There was a complaints policy and procedure, but no complaints had been received within the last 12 months.

Feedback from relatives about the quality of the management was mainly positive. However, the high turnover of staff had affected staff morale and contributed to some of the failings identified in this report.

The Statement of Purpose was out of date, but policies and procedures were up to date.

Staff meetings were held, and meetings for nurses. Some staff felt that the meetings did not make a lasting difference.

Audits were conducted to monitor and improve the quality of the service. The manager’s office was untidy, which made finding documents difficult, but a new filing cabinet was on order which would help with organising the office.

We found breaches of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one regulation of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the end of the full version of the report.

Was the service safe?

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, safeguarding, whistleblowing and investigations. The registered manager audited any incidents and used the information to improve the service. Three people we spoke with felt safe and did not have any complaints. A visiting professional (Advanced Nurse Practitioner) said, "I have never seen any adverse issues with patient's here and would report to safeguarding if I had to". A whistle blower and a person who shared their experience with us had raised some concerns. We investigated the concerns and found the new manager had raised most of the issues with staff at various meetings prior to them being raised and was taking action to rectify what he saw as poor practice. Staff commented, "I have only seen staff treating people with respect and dignity. If I saw any instances of abuse I would report it. We have a whistle blowing policy. All staff have to read it. Including staff on induction", "I have never seen or heard anybody being abusive and would report it if I saw or heard anything" and "I have never heard anyone being abusive. I would bypass everyone and go straight to the manager if I saw or heard anything I did not like". Staff were aware of their responsibilities to protect vulnerable adults.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made and how to submit one.

We conducted a tour of the home and found it was clean, warm and free of any offensive odours. There were dedicated domestic staff to clean the home. Staff had been trained in infection control. Two people said the home was clean and another commented, "It is warm, clean and the food is good".

We saw that the electrical and gas equipment had been maintained. The fire system was checked regularly. We were told repairs were carried out promptly to ensure it was in good working order. However, there have been on-going problems with the temperature of water to baths and sinks. We have asked for an action plan to tell us how and when this will be fixed. Staff told us water had been a problem but they thought it was all right. One person who used the service thought it was too cold.

At the last inspection the recording of medication did not meet the standard expected. The manager had changed the system for the recording of medication, including creams and conducted medication audits to ensure it was safe.

Was the service effective?

People's health and care needs were assessed with them if possible, and they were involved in writing their plans of care. We looked at three plans of care and found them to be individual to people's needs and kept up to date. Three people who used the service said, "The staff here are kind and look after me", "They care for me very well. I think the care is good" and "I am happy here". A visiting professional told us, "Staff will contact us if they have any problems with our patients. Patients are well looked after. All the people we have placed here have been well cared for".

Specialist dietary, mobility, skin care and community support needs had been identified in care plans where required. Specialist equipment was provided such as pressure relieving devices or mobility aids. People had access to healthcare professionals and specialists for treatment and advice.

The manager and other key staff audited the effectiveness of the systems they used. This included medication, the environment, infection control and plans of care. The information was used to improve the service.

Staff were trained in key topics such as health and safety, infection control, fire awareness, food hygiene, medication administration, first aid, mental capacity, deprivation of liberties and moving and handling. There were other training opportunities in dementia care. Staff were encouraged to take a nationally recognised qualification in health and social care.

Was the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. There was a friendly atmosphere within the home and we observed that staff interacted and chatted to people

who used the service. Two people who used the service told us, "Staff are lovely" and "The staff are very nice. They are never rude and are friendly".

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People who used the service were encouraged to provide as much information about their past lives and what they liked or did not. This information gave staff the knowledge to treat people as individuals.

People lived in a comfortable environment and were able to personalise their rooms to make them feel more at home. People who used the service told us, "I have a lovely room with a good view", "My room is nice and I have some of my own things. We don't share here which is good" and "I like my room and can stay here to watch my television". Two people thought to mention that the beds were comfortable.

Was the service responsive?

People completed a range of activities in and outside the service regularly. Each person had their known hobbies and interests recorded. Activities were suitable for the people accommodated at the home.

The registered manager held regular meetings with people who used the service and staff. Each day staff attended a 'handover' meeting to ensure they were up to date with people's needs. Staff were able to voice their opinions at meetings and supervision sessions.

Was 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. There was a system for providing information to other providers in an emergency.

Records we looked at were up to date and policies and procedures had been reviewed by the manager. The records were stored securely and readily available for inspection.

The service had good quality assurance systems. The registered manager undertook regular audits of the service. Records seen by us showed that identified shortfalls were addressed promptly and as a result the quality of the service was continually improving.

Some people did comment that the activities programme had reduced since the dedicated activities co-ordinator had recently left; as one person stated: "There's room for more activities; we had a very good activities worker." One person did have a few comments about how the home could be improved which we passed on to the manager of the home.

We saw that the home was meeting essential standards in relation to care and welfare, co-operating with other services, staff training and supervision, and complaints. We have asked for improvements on the management of medicines and care records.

One member of staff told us: 'Care staff get along with people ok.' They also said: 'The residents all get on they don't fall out.'

We saw that people were provided with physical, emotional, and social support to meet their needs. People told us: 'I love it here, I really do! We do all sorts but I prefer watching television though.' And: 'They called the doctor because of my legs; they're very good like that.'

We saw that people were provided with nutritious meals that met their cultural and health needs. People who used the service were mostly positive about the food and told us: 'The food is very nice.'

We saw there were sufficient staff on duty that were skilled at meeting people's needs and liked by the people who used the service. We were told: 'The staff are very helpful.'

We found that Alexandra care centre met the individual needs of people and promoted their physical, emotional, and social wellbeing and development. We saw that people using the service were supported to achieve a good lifestyle and so their sense of self worth and personal values were promoted.