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

The service provides personal care and accommodation for up to 47 older people. There are two floors and people with more complex needs or living with dementia live on the top floor. At the time of our unannounced inspection there were 46 people living at the service. Each person had their own bedroom and had access to communal lounges, dining rooms and a secluded garden.

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.’

At our last inspection of 19 October 2017, the service was rated as requires improvement. At that inspection we found that staff training was not being renewed in line with the provider’s own expectations. The staff were not provided with regular formal supervision to monitor and develop their practice. We found a variable approach in promoting people’s rights in accordance with the Mental Capacity Act 2005 (MCA) and restrictions imposed upon one person with regard to the associated Deprivation of Liberty Safeguard. Some information in people’s care plan was missing which meant that staff lacked guidance about mitigating risks to people’s safety especially regarding their mobility. The leadership and management of the service had not addressed issues identified in the providers own quality assurance reports. Left unattended these issues could have an impact on peoples well-being.

At this inspection of 22 and 23 January 2019 we found the service had improved and there were no breaches of the Health and Social Care Act 2008 and we have rated the service good. This is because the staff have received regular supervision and training. Peoples consent was sought and recorded regarding the care they received. The care plans were clear regarding how to support people with their mobility and falls were recorded and monitored to determine how the service could support the person.

The new registered manager having come into post in October 2018 had begun to address the quality assurance of the service through audits and actions plans derived from the audits. These were not as yet fully effective. The current audits in place had not identified that robust checks were in place with regard to the employment of new staff. We found a cupboard containing substances which could have been harmful to people were not locked and tilling in a bathroom had not been completed. Hence the bathroom at that time was out of use. A care plan of a person recently admitted to the service was not fully clear with regard to why they were not taking prescribed medicines. Although the staff knew the people well in their care, kitchen records for example regarding the number of people with diabetes was not clear. During our inspection action was taken on all the above to resolve the issues.

The staff had been trained in how to safeguard people. Staffing levels were appropriate to support people meet their assessed needs.

Staff had received training in the control of infections and the service was clean throughout.

The registered manager, along with the senior staff held meetings to determine how the service could learn from events and improve.

People were provided with sufficient amounts of nutrition and fluids and a variety of meals. The staff ensured that people were referred to professionals when they were unwell. Professional staff visiting the service each day informed us they had a positive working relationship with the service s

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

The home provides accommodation and support for a maximum of 47 older people. People who are living with dementia are accommodated on the first floor. Each floor has adapted facilities for bathing or showering as well as sitting and dining areas. There is a lift for people to move between floors and a secure and accessible garden at the front of 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.

The inspection took place on 19 October and 1 November 2017. The first day of the inspection was unannounced. At the time of our inspection, there were 42 people living at Alexander Court.

At our last inspection in January 2017, we found that the service required improvement overall. There was one breach of Regulation 14 of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014 meaning the service was not as effective as it should be. This was in respect of people’s nutrition and hydration and making sure people had enough to eat and drink. After that inspection, we asked the provider for an action plan to show what they would do to meet the regulation.

At this inspection, we found that there was no longer a breach of regulation 14. People had enough to eat and drink to meet their needs and keep them well. However, other aspects of the effectiveness of the service had declined and remained in need of improvement. Staff were not renewing their training promptly in line with the provider’s own expectations. They lacked regular, formal supervision in line with the provider’s expected frequency, to monitor their performance and development needs. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014 for staffing arrangements.

We also found variable practice in promoting people’s rights in accordance with the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguards (DoLS). Some care was planned well to consider people’s capacity to make specific informed decisions. Other people’s care records did not show proper consideration of the MCA. We were concerned that restrictions imposed upon one person were not properly considered in line with the code of practice for DoLS. This was a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014 for consent.

The service was no longer as safe as it should be in all areas, representing a decline since our last inspection when the safety of the service was rated as good. Assessments of risk, including those associated with falls and mobility, were sometimes conflicting. Some information was missing so staff lacked guidance about mitigating risks to people’s safety. There was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014 for providing safe care and treatment.

Some aspects of the leadership and management of the service had not improved since our last inspection. They remained in need of improvement. The registered manager had not addressed issues highlighted in the provider’s own quality assurance reports consistently or promptly. Neither the provider’s systems for monitoring quality and safety, nor internal checks by the management team, identified the issues our inspection team found. The history of the service showed that the registered persons had not always sustained previous im

The inspection took place on 24 January 2017 and was unannounced.

Alexander Court provides accommodation and support for a maximum of 47 older people, some of whom may be living with dementia. The ground floor is divided into two 'wings'. People living with dementia are predominantly accommodated on the first floor. Each floor has their own communal areas. There is a secure garden area outside the main entrance. At the time of our inspection there were 44 people living in the home.

There was a registered manager in place who has been at the home since 2012. 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 provider of the service has changed their name since the last time we inspected.

At our last inspection, in November 2015, there was a breach of regulations for the safety of systems for managing people's medicines. At this inspection, we found that action had been taken to improve. People's medicines were stored and administered safely and as the prescriber intended. The management team had improved the way that they checked the way medicines were managed and that staff were competent to support people in this area.

There were enough staff working in the home to promote people's safety. Where there were unexpected shortages due to staff sickness, staff cooperated well, with support from the deputy manager, to ensure people's needs were met in a timely way. Staff were recruited in a way that ensured proper checks were made and helped protect people from the employment of staff who may not be suitable to work in care services. Staff were aware of the importance of reporting any concerns or suspicions that people were at risk of harm or abuse and the registered manager understood their role in addressing any issues.

There were some gaps in the way that risks to people's safety were recorded and reviewed, and in producing written guidance for staff about managing these. This included risks of developing pressure ulcers. However, staff were clear about their role in addressing risks and working with health professionals to promote people's welfare and safety. Staff took prompt action to seek professional advice and to act upon it where there were concerns about people's health and wellbeing.

People had a choice of food and drink although this was not always as well promoted as it could be. There was a lack of consistent guidance for staff to promote people's welfare when people lost weight or did not drink enough. The provider's recent audit of service quality also identified that plans of care to support people effectively in this area, needed to improve.

Staff were trained and competent to meet people's needs. There was a core of long-standing staff members who understood people's backgrounds and preferences and could support newer staff to work with people effectively. They responded flexibly to people's needs, preferred routines and interests. However, supervision, to monitor staff performance and development needs, was not always being used effectively, particularly to monitor new staff properly during their probationary period.

Staff understood the importance of helping people to make choices about their care and seeking consent from people to provide support. Staff were aware of the importance of acting in people's best interests to protect their rights if they could not make some decisions. The registered manager had taken action to ensure the rights of people who did not understand risks to their safety and welfare were protected.

Staff had developed warm and compassionate relationships with people and treated them with respect for their privacy and dignity. They acted promptly to offer reassurance when people became distress

The inspection took place on 25 November 2015 and was unannounced.

Alexander Court provides accommodation and care for up to 47 older people. At the time of our inspection there were seven vacancies in rooms on the first floor for people who may be living with dementia. There were 40 people living in the home.

There was a registered manager 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 of this service in April 2015, we found that improvement was needed in all areas. The service was in breach of regulations for staffing, planning and delivering care to meet people’s individual needs, and for notifying CQC about events taking place in the home. We found that action had been taken to ensure the regulations were met and for improving in other areas.

Staffing levels had improved so that people’s needs could be attended to more promptly. The manager undertook to review arrangements on the first floor for the late afternoon and early evening to see if further improvements could be made. Staff deployment took into account the numbers of people using the service and their dependency. There was a designated staff member to support people with their interests and hobbies. This represented an improvement in the way that people’s social and recreational needs were being met.

Improvements had also been made to staff training. Staff better understood how to protect the rights of people who may be unable to make informed decisions for themselves.

The manager had taken action to ensure that they told CQC about events and incidents happening within the service and to comply with that regulation.

However, there was a breach of one regulation where we found concerns about people’s safety in relation to the management of risks associated with medicines administration. Medicines audits had not identified the issues we found at this inspection. You can see what action we told the provider to take at the back of the full version of the report.

Staff understood how to recognise and report concerns that anyone may be being abused or harmed. Recruitment practices also contributed to protecting people from unsuitable staff being appointed. There were regular checks on the safety of the premises and equipment to help protect people from risks that these were unsafe.

People had enough to eat and drink to ensure their welfare. Staff took action to ensure concerns about people’s physical or mental health were responded to promptly and to seek advice from relevant health professionals.

Staff responded to people in a kind, caring and respectful manner. They took prompt action to offer reassurance to people who were distressed or anxious. People’s privacy was promoted and there were only isolated examples of this being compromised when staff walked into their rooms without knocking if their doors were open.

People, with support from their relatives if necessary, had opportunities to express their views about their care and about improvements they thought could be made to the service. They were confident that their complaints or concerns would be addressed if they had any.

Improvements had been made to the way that the quality of the service was checked and monitored. Action to improve the service in response to visitors and people’s suggestions was taken more promptly than was the case at our last inspection. However, some staff still expressed frustration that suggestions they felt would make improvements easily were not always responded to promptly.

The inspection took place on 9 April 2015 and was unannounced.

Alexander Court is a service that provides accommodation for up to 47 people. It offers residential care and support for older people some of whom are living with dementia.

There was a registered manager in post. They had been seconded elsewhere during 2014 and returned to being in day-to-day charge of the home in January 2015. 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.

Staff knew the importance of recognising and responding to any indications which might indicate a person had been abused or harmed in some way. People’s medicines were managed safely. However, staffing was not always maintained or deployed in a way that meant staff could intervene promptly to support people who became distressed or agitated.

CQC is responsible for the monitoring the implementation of the Mental Capacity Act (MCA) 2005 and the associated Deprivation of Liberty Safeguards (DoLS). Staff understood the importance of supporting people to make decisions and choices about their care. Where people had difficulties making decisions they were able to tell us how they would encourage the person to understand what was needed. However, there was some inconsistency in the way people’s abilities to make specific and informed decisions were assessed in accordance with the MCA. The manager understood when an application to deprive someone of their liberty under the MCA and DoLS should be made.

People had access to enough to eat and drink but they and their family members did not consistently feel that the variety of food and interval between tea and breakfast was as good as it should be.

People were referred to their doctor or other professionals when this was necessary, to help them maintain their health.

Staff responded to people in a calm and kind and respectful manner when they were distressed. However, there were isolated occasions when people did not receive a prompt, compassionate and respectful response.

Staff recognised how they should support people with their personal care and people knew how to raise a complaint about any concerns they may have. However, people’s needs for support and encouragement with social and recreational activity and stimulation were not well addressed. This had not been properly recognised within the provider’s systems for assessing the quality of the service to drive improvement in this area. People were asked for their views about the quality of the service but improvements were not always made promptly. Shortfalls identified as needed within the provider’s audits and checks were identified with an action plan for improving the quality of the service.

We found that the provider was in breach of three regulations. There were not always enough staff deployed to support people safely and people’s needs and preferences for their hobbies and interests were not properly assessed and met. The provider had not notified the Care Quality Commission of an incident in the home affecting people’s welfare and potentially, their safety.

You can see the action we told the provider to take at the back of the full version of the report.

We spoke with people who lived at the home and relatives who told us that staff consulted them and respected and acted on the decisions they made about the care and support they agreed to.

Our observations showed us that people were given the support and attention they needed and had a positive experience of being included in conversations and decision making. However, people also told us that more in-house daily activities were needed.

We found that plans of care contained the information staff members needed to ensure that the health and safety of people was promoted.

Relatives told us that people received the care and support they needed and that staff were very kind.

Medication was administered, recorded and stored accurately and safely.

Staff members were trained and were supported to provide an appropriate standard of care and support through increased supervision and staff team meetings.

People told us their complaints were listened to and resolved. We found that there was a complaints system in place that met the needs of people living in and visiting the home but the complaints log was incomplete.

We spoke with people who used the service and their relatives who told us that staff consulted them and respected and acted on the decisions they made about the care and support they agreed to.

Our observations showed us that people were given the support and attention they needed and had a positive experience of being included in conversations, decision making and activities.

The plans of care contained the information staff members needed to ensure that the health and safety of people was promoted.

People who used the service and their relatives told us that people received the care and support they needed and that staff were very kind but busy.

Staff were trained but were not fully supported to provide an appropriate standard of care and support. This was because regular supervision, staff meetings and appraisal had not been carried out with all staff members.

There were effective quality assurance systems in place that monitored and reviewed the standard and quality of the service provided. People who used the service, their representatives and staff were asked for their views about the care and support provided and suggestions for improvements were acted on.