About the service:

Alexander Court (Sheffield) is a care home that provides accommodation for people who require personal or nursing care. The home can accommodate up to 60 people. At the time of this inspection there were 42 people using the service.

People’s experience of using this service:

The service had improved since the last inspection.

There were enough staff deployed to keep people safe and meet their needs. However, some staff recruitment records did not contain all the information required by regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; fit and proper persons employed.

Risks to people were assessed and kept under review. This supported people to remain safe. Staff were aware of their responsibility to safeguard people from the risk of abuse. People received their medicines as prescribed from trained and competent staff.

Staff were trained, supervised and supported by the management of the service. People told us they thought staff had the right skills to care for them. Staff supported people to meet their nutritional and hydration needs and they worked closely with health professionals to achieve good outcomes for people. We have made a recommendation about the support given to people at meal times.

Most staff knew people well and we observed staff interacted with people in a positive, friendly and respectful manner. People’s care records were person-centred and supported staff to provide personalised care to people. Most people told us staff were kind and caring. Relatives raised no concerns about how their family member was treated.

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 involved in reviews of their care so their choices and preferences could be recorded and acted upon.

People and their relatives knew how to complain. Complaints had been appropriately recorded and acted upon.

A range of activities were on offer to people, however people told us they would like more to choose from. We have made a recommendation about the involvement of care staff with the activity provision in the service.

A new manager had recently started working at the service. Without exception we received positive feedback about the manager and the way the service was run. People, relatives and staff all told us the service had made improvements since the last inspection and we found this to be the case.

The provider, manager and senior staff completed a range of audits and checks on the quality of the service. A home improvement plan was reviewed and updated weekly to ensure the service continued to improve. However, we found further improvements were required to the provider’s systems and processes to ensure compliance with all regulations.

More information is in the full report.

Rating at last inspection:

At the last inspection the service was rated requires improvement (published 21 September 2018). We identified the service was in breach of six regulations: regulation 10, dignity and respect; regulation 11, need for consent; regulation 12, safe care and treatment; regulation 14, meeting nutritional and hydration needs; regulation 17, good governance; and regulation 18, staffing.

Following the last inspection, we asked the provider to send us an action plan to show what they would do and by when to improve the rating to at least good. At this inspection, we checked whether the provider had complied with their action plan. We found improvements had been made to the service and it was no longer in breach of the six regulations identified at the last inspection. We identified a new breach of regulation 19; fit and proper persons employed.

Why we inspected:

This was a planned inspection based on the rating awarded at the last inspection.

Enforcement:

Please see the 'action we have told the pro

We carried out this inspection on 21 June and 3 July 2018. The inspection was unannounced, which meant the people living at Alexander Court and the staff working there didn’t know we were visiting.

Our last inspection at Alexander Court took place in December 2015. At that inspection, we found a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Staffing. This was because the staff did not have regular supervision in line with the registered providers own policy.

The registered provider sent an action plan detailing how they were going to make improvements. At this inspection, we checked improvements the registered provider had made.

We found sufficient improvements had been made to meet the requirement of this Regulation. However, we had received concerns about this service prior to this inspection. We identified the service had declined at this inspection. The registered manager had left and there had been a period with a turnaround manager until the registered provider had recruited another manager. The registered provider had identified the concerns and was taking action to ensure improvements were made.

Alexander Court (Sheffield) is a care home providing nursing and personal care for up to 56 adults. It is within easy distance of the local amenities and on the bus route making it easy for people to access. At the time of our inspection there were 43 people living at Alexander Court.

The service had a registered manager. 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 we spoke with gave mixed views about whether they were safely cared for in the home on the first day of the inspection, however people were feeling more positive about the level of safety on the second day.

People we spoke with gave us mixed opinions about how the registered manager handled their concerns. Some people did not feel listened to, but others felt their concerns had been dealt with satisfactorily. We found changes within the management team had impacted on the performance of the team.

The registered provider had safe recruitment procedures in place which helped to keep people safe.

Not all care records showed that risks to specific to people’s health and wellbeing had been assessed and planned for so that staff had information needed about how best to support the person to help reduce or eliminate such risks.

People are not supported to have maximum choice and control of their lives and staff do not support them in the least restrictive way possible; the policies and systems in the service do no support this practice.

People told us they were not happy with the quality, quantity and variety of meals offered. Some people required a fortified diet to ensure they received adequate nutrition. There was little evidence to show this need had been fulfilled and systems to monitor people’s nutritional intake were ineffective.

Not all care records showed that risks to people’s health and wellbeing had been assessed and planned for so that staff had the information they needed about how best to support the person to help reduce or eliminate the risk.

Staff had received supervision and training and an ongoing programme was being developed. Staff training completion rates were found to be high.

Staff had a good understanding of safeguarding and whistleblowing procedures.

Staff worked with healthcare professionals to ensure people received appropriate care and treatment.

There were safe and effective systems in place for managing medicines at the service.

People were provided with activities and opportunities to help promote their community presence as well as develop and maintain their independen

We carried out this inspection on 17 December 2015. The inspection was unannounced, which meant the people living at Alexander Court and the staff working there didn’t know we were visiting.

Alexander Court (Sheffield) is a care home providing nursing and personal care for up to 60 adults. It is within easy distance of the local amenities and on the bus route making it easy for people to access. At the time of our inspection there were 56 people living at Alexander Court.

At the last inspection on 5 and 6 November 2014 we found the provider to be non-compliant with four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These were regulations 12; Safe care and treatment, 9; Care and welfare of people who use services, and 17, good governance. We followed up on these breaches during our inspection and found improvements had been made in all areas.

It is a condition of registration with the Care Quality Commission that there is a registered manager in place. 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. There was a manager present during our inspection who told us they were in the process of registering with the Care Quality Commission. We have checked our records to confirm that this is the case.

People told us they like living at Alexander Court, one person said, “I love it me, everything is done for me,” and another person told us, “It’s smashing here.”

We saw people’s medicines were stored securely and procedures were followed to ensure that people were given their medication safely.

The care records we looked at included risk assessments, which identified any risks associated with people’s care and had been developed to help minimise and monitor the risks. For example one the care records we looked at contained good guidance for staff regarding how the person expressed pain or discomfort, so they could respond appropriately.

Staff we spoke with had a clear understanding of safeguarding people and they were confident management would act appropriately to safeguard people from abuse.

During our inspection we observed the number of staff on duty and looked at how quickly people were able to summon assistance. We saw, and we were told by people living at Alexander Court and the staff who worked there, that there were enough staff to keep people safe, but that staff often did not have time to spend engaging with people in a more meaningful way because they were so busy.

Staff told us the training they completed provided them with the skills and knowledge they needed to do their jobs. We saw that supervisions and appraisals were not always provided in line with the provider’s policy. The meant that not all staff were receiving all the support required to carry out their jobs.

Care staff had an understanding of the Mental Capacity Act and the need for people to consent to their care and treatment. The manager understood Deprivation of Liberty Safeguards (DoLS) and was in the process of applying for authorisations.

The service now employs two part time activities co-ordinators and we saw some activities take place. However, the activities available did not suit everybody’s needs particularly those people living with dementia.

People living at Alexander Court and those working there, told us they found the manager approachable and responsive.

People felt able to tell staff if there was something they were not happy with. We saw that information on how to complain was clearly displayed.

There were now systems in place to monitor and improve the quality of the service provided. Checks and audits were undertaken to make sure full and safe procedures were adhered to, however we saw that they didn’t happen as regularly as they should. Some policies and procedures were out of date. These needed to be reviewed to ensure they reflected current practice.

The provider has made progress since our last inspection to improve the service for people living at Alexander Court.

We found this service was not informaing us of the notifiable incidents according to regulation 18 of the CQC (Registration) Regulation 2009.

We wrote to the provider and they rectified this by ensuring that they notified us of the incidents and accidents.

We visited the home on 09/12/2013 to check this outcome and found them to be compliant.

We spoke with seven people who used the service, four relatives and most staff on duty.

People and their relatives said they were encouraged to make choices in aspects of care, treatment and support. Staff told us they offered people choices and involved them when making decisions about care and treatment.

Care was planned and managed by staff with the help of regular reviews of people’s needs. One person said, “Staff showed me the folder where they keep all the information about me. I know I can read it if I want.”

People said they were able to choose what they wanted from the menu. Two people said although they chose the meals, they often forgot what they had ordered when the meal arrived.

Staff said they worked as a team with partner agencies such as community health workers. A relative said staff had co-ordinated with external agencies to make sure their family member received appropriate services.

Two people who lived at the home said their bedrooms were cleaned most days. One person said, “I like my room. The girls empty my bins and keep it clean and tidy for me.”

The manager had followed their company policy when recruiting staff.

Qualified, skilled and experienced staff were employed to meet people’s needs.

People who lived at the home told us they were able to raise any concerns with staff. The relatives said they were confident that staff would help their family members to make a complaint to the manager if they wanted to.

Our inspection of 24 September 2012 found there was a lack of staff on duty to meet the needs of the people. As a result people were at risk of not receiving the care and treatment they required in a timely manner.

The provider wrote to us and told us that they would review the staffing levels and make changes so that more staff were available at the peak times so people received the appropriate care and support promptly.

We carried out an unannounced inspection around tea time on 27 November 2012. We spoke to people who used the service, visitors to the service and staff.

There were enough qualified, skilled and experienced staff on duty to meet people’s needs. People said staff were hard workers and strived to do their best. Two people said they had noticed more staff were around at meal times. One relative said, “Most days there seems to be reasonable number of staff around.”

We carried out an unannounced inspection of Alexander Court on 26 April 2012. At the inspection we found the provider was not compliant in three outcome areas. We therefore issued three compliance actions which required the provider to address their non-compliance. An unannounced visit to the premise was made on 24 September 2012 to check compliance with the three outcome areas.

We spoke with seven people and four visiting relatives. People told us they liked living at Alexander Court. They made positive remarks about the manager saying that she was caring and the staff worked hard. They also said staff treated them with respect. They told us staff were friendly and did their best. However, there were some negative comments made by three relatives and four people about the lack of available staff during the day to care for the needs of the people. One person said, “Most people here need a lot of care and care takes time. These girls don't have the time to give the care properly." Another person suggested that we should do our best to increase the staffing levels on days.

To address these comments we looked at the staffing levels at the service and we have reported our findings under staffing.

People told us they liked living at Alexander Court. They made positive remarks about the staff who worked there. They said they were well cared for and treated with respect by staff working at the service. They told us staff were friendly and they were not worried for their safety whilst living at the service.

People who lived at the service said they were offered a variety of activities and they were looking forward to better weather so that they could go out. Two people said, in summertime they had trips out and that they could not wait for the days out.

A further two people said they saw their GP on a regular basis and were able to access the optician, chiropodist and hairdresser when they wanted.

This inspection took place on 5 and 6 November 2014. The first day of the inspection was unannounced. We informed the registered manager that we would be returning on the following day to complete the inspection.

The last scheduled inspection took place on 11 October 2013 where we found the service to be in breach of Regulation 18 of the Care Quality Commission (Registration) Regulation 2009. This was because the provider did not notify the Commission about incidents that affected the health, safety and welfare of people who used the service. The provider notified us of the action they took and when we returned to the service on 29 November 2013 we found the service was no longer in breach of this regulation.

Alexander Court (Sheffield) is a care home providing nursing and personal care for up to 60 adults. The home is divided into three floors. The lower ground floor is used by staff only. This area houses the laundry, staff rooms, handyman’s office and stock rooms. On the ground floor and the first floor there are bedrooms and communal areas accessed by people who used the service.

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.

We found the provider had not made the necessary arrangements to ensure people’s medical and nursing records were securely stored at the service. The nurses’ stations on both floors were left open and unattended for long periods. People’s care records and sensitive documents were kept on the shelves and were accessible to anyone at the service

We observed that nurses were not always following the correct procedure when handling medicines. We received information through our website ‘Share your experience’ about relatives finding tablets on the bedroom floor and in the chairs where people were seated. They had raised their concerns with the staff and the manager. During our inspection two relatives raised further, similar concerns.

Staff had received training on safeguarding people. They were able to describe how they would recognise any signs of abuse and protect people.

We received a mixed response when we looked into the effectiveness of the service. Although some comments were positive, some relatives raised concerns about the skill and ability of staff. .

We saw that staff gave choices and did not rush people when they needed to make decisions. Staff understood the principles of the Mental Capacity Act 2005 (MCA). We found that people were cared for in an environment which took into account people’s mental capacity, their human rights and their right to liberty.

People were not always supported to eat and drink enough to meet their nutrition and hydration needs. Two people said they did not mind as they knew staff would come to help as soon as they could. However, the present arrangement did not make sure all the people received their meals at the correct temperature and that some people had to wait with their meals placed in front of them for staff to become available to assist them with eating.

We observed staff making efforts to engage with people and gain their response. A person was sitting quietly in the lounge and looked lonely; a staff member went up to them and knelt next to them held their hand and chatted. The person smiled and stroked the care staff’s face. This showed a positive interaction between the person and the staff member.

We received comments from some family members that they did not feel they were involved when changes were made about the care. But most people we spoke with and some other relatives told us that they were kept informed by the nurses and they were involved. However the documentation did not always support that relatives had been involved. Therefore the present arrangement did not demonstrate that all the people who lived at the service and/or their representatives have been involved.

Staff had a good understanding of confidentiality. People told us that they trusted staff not to divulge any personal information to others.

The registered manager told us that they had appointed an activities co-ordinator and in the interim they were organising social activities for people. During our inspection we found there was a lack of meaningful activities for people.

As part of this inspection we contacted the commissioners of the service, the local CCG team and the community professionals such as the tissue viability staff member and requested their view of the service. The comments we received were encouraging and informed us that the service had made improvements during the last year and that the registered manger and the nurses did not hesitate to seek help when they needed.

Staff told us that they had regular staff meetings. We saw a copy of the minutes with action points with time scales.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.