About the service:

Alexander Court Care Centre is a care home that registered to accommodate up to 82 people across five separate units, each of which have separate adapted facilities. Three of the wings specialise in providing care to people living with dementia. The home provided personal and nursing care to 76 people, aged 65 and over, at the time of the inspection.

People’s experience of using this service:

The provider had made improvements since our last two inspections. The home provided more person-centred care to people and people’s consent to care was now being obtained. People were provided their medicines as prescribed. There were safer systems in place for the storage, administration and management of medicines. There were more effective governance systems to ensure the home was being managed to a good standard.

People spoke positively about the care and support they received. They felt safe using the service. Staff had a good understanding of what constituted abuse and how to report any concerns to keep people safe.

Risks associated with people’s care and support had been assessed and there was guidance in place to keep them safe. Accidents and incidents in the home were reviewed to learn from any lessons. However, we have made a recommendation around supporting people with behaviour that may challenge because records did not always indicate how staff supported them following incidents, to minimise re-occurrence.

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.

People were supported with their nutritional needs and had choices with meals. People had access to health care professionals such as GPs, when required.

People received care from staff who were kind and compassionate. Staff treated people with dignity and respected their privacy. People's independence was promoted.

Staff understood people's needs, preferences, and what was important to them. Staff had developed positive relationships with the people they supported.

People were supported to engage in meaningful activities and pursue their interests, where they were able.

Care plans were person-centred and detailed people's support needs.

A complaints procedure was in place. People and relatives were supported with complaints they wished to make and the registered manager investigated them.

Staff were recruited safely and were supported with the necessary training and development to increase their skills. Staff felt supported by the management team and told us there was a positive culture.

There was a system in place to monitor the home and ensure consistent and good quality care was provided to people. The registered manager and provider demonstrated they were able to run the home effectively and were committed to making continual improvements to the home where required.

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

Rating at last inspection:

At the last comprehensive inspection on 28 February 2018 and 6 March 2018 the service was rated Requires Improvement (published 9 May 2018).

We carried out a focused inspection on 1 November 2018 (report published 18 December 2018) to follow up on specific breaches of regulations; safe care and treatment and good governance. We found improvements in the service but did not change our overall rating.

Previous breaches:

At the last comprehensive inspection, the service was in breach of two other regulations in relation to obtaining consent to care and providing person-centred care to people. We asked the provider to complete an action plan to show what they would do and by when, to improve. At this inspection, we found improvements had been made and the provider is no longer in breach of regulations.

Why we inspected:

This inspection was carried out to follow up action we told the provider to take a

At our last comprehensive inspection of this service on 27 February and 6 March 2018, breaches of legal requirements were found in relation to the safe care and treatment of people and the overall management of the service by the provider. We rated the service as ‘Requires Improvement’. We sent the provider a Warning Notice for them to be compliant with legal requirements by June 2018. After the comprehensive inspection, the provider wrote to us to say what they would do to meet these legal requirements.

We undertook this unannounced focused inspection on 1 and 2 November 2018, to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to those requirements. At this inspection, we found these requirements were met.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk

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

Alexander Court Care Centre is registered to accommodate up to 82 people across five separate units, each of which have separate adapted facilities. There are three units for people living with dementia and one unit for young people with physical disabilities. There is also a residential unit for older people. At the time of our inspection, 78 people were living in the home.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the home. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the legal requirements in the Health and Social Care Act 2008 and the associated regulations on how the home is run.

The registered manager was committed to improving the service and had demonstrated the work they had carried out since the last inspection. We saw that improvements had been made in ensuring people were safer.

Medicines were being managed safely. Nursing staff and trained senior care staff administered medicines to people. They signed medicines administration record (MAR) charts to evidence that medicines were given as prescribed and at the correct times. All staff received medicines administration training and were assessed as competent before being allowed to administer medicines.

Risks to people were assessed and guidance was in place for staff to follow to help minimise these risks.

The provider's quality assurance systems and processes had improved to assess, monitor and improve the quality and safety of people in the home.

However, further time and work was needed to ensure these changes were fully embedded and that the home was well managed and safe. For example care plan audits had not identified that some had not been updated and the recording of prescribed creams for people was not always effective.

Staff were recruited appropriately and the necessary background checks were undertaken to ensure they were persons of good character and suitable to support people. There were enough staff in the home across each of the units.

People were protected from abuse and staff understood safeguarding procedures.

The premises was safe and equipment was serviced and checked according to the manufacturer guidelines.

Infection control procedures were followed to protect people from contamination.

Staff ensured there was learning from accidents and incidents to prevent reoccurrence.

The registered manager ensured feedback was received from people and relatives to check they were satisfied with the home.

Staff told us they were supported by the management team and could approach them with any concerns.

We were assured that the registered manager an

This unannounced inspection took place took place on 27 February 2018 and 06 March 2018. This was the first inspection since the home transferred to a new provider in July 2017. At our last inspection of the home on 8 June 2017, we found the provider at the time did not meet legal requirements to ensure the service was consistently safe, caring and well-led. We therefore attached conditions to the new provider’s registration because of these concerns. The provider was required to submit information to us monthly to let us know what action they were taking to meet legal requirements and how they were ensuring these actions were being completed and monitored.

Alexander Court 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.

Alexander Court Care Centre accommodates 82 people across five named separate units, each of which have separate adapted facilities. There are three units for people living with dementia and one unit for young people with physical disabilities. There is also a residential unit for older people. At the time of our inspection, 76 people were living in the home.

The home has a newly appointed 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. The previous registered manager had left their position a few weeks before our inspection. The deputy manager was managing the service at the time of our inspection and completed their registration as manager shortly after our inspection.

Each unit in the home was managed by a registered nurse who was supported by the newly registered manager and a new deputy manager.

At our inspection, we found breaches of health and social care regulations. This was because people did not always receive safe care. They did not always receive their medicines as prescribed and when needed. Risks to people, such as diabetes and other conditions, were not always adequately assessed or identified to ensure they remained safe. This meant that the provider did not always assess, monitor and mitigate risks associated with the service to ensure people received safe care.

The provider’s systems to support people who lacked capacity to make decisions for themselves were not effective. Staff received training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). However, 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; the policies and systems in the service do not support this practice.

The provider did not always ensure people had access to appropriate healthcare when needed because their appointments with health care professionals were not always followed up. This meant people’s health needs were not being managed effectively to ensure they remained in the best of health and their wellbeing was maintained.

Most people told us they were treated with dignity and their choices were acted upon. However people were not always treated with respect. They were not always involved in their care planning. We have made a recommendation for the provider to look into establishing a more caring and sensitive environment.

People did not receive care and support to ensure their individual needs were met. Care plans were not person centred and did not contain sufficient information on people’s backgrounds and preferences. Complete, accurate and contemporaneous records were not being kept for each person.

The registered manager was committed to developing the service, al