The inspection took place on 8 and 16 October 2018 and was unannounced. We last inspected the home between 10 and 15 August 2017 and found the provider had breached the regulation relating to staffing. We rated the home as Requires Improvement. This was because insufficient staff were deployed to enable people’s needs to be met in a timely way.

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 key question; is the service safe, to at least good.

During this inspection we noted improvements had been made. There was a visible staff presence with communal lounges supervised most of the time to maintain people’s safety. We also noted the provider monitored staffing levels to check they were appropriate for people’s needs and dependencies. However, we still continued to receive mixed views about staffing levels.

Alexandra View 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 View accommodates 68 people across three separate units, each of which have separate adapted facilities. One of the units specialises in providing care to people living with dementia. When we inspected 37 people were living at the home.

The registered manager left their employment at Alexandra View at the end of September 2018. An experienced manager had been recruited and was due to commence their employment on 29 October 2018. 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.

Medicines were not always managed safely. We noted some people had experienced delays in receiving their medicines. Although these issues had been resolved there was no evidence to confirm lessons had been identified and action taken to prevent future occurrences. The recording of medicines given only ‘when required' was inconsistent and ‘when required’ protocols required further detail relating to each person’s specific needs. We have made a recommendation about this.

People told us they received good care at Alexandra View. They told us staff were kind and treated them with dignity and respect. We observed many positive interactions between people and staff during our time at the home.

People, relatives and staff felt the home was a safe place. Staff had a good understanding of safeguarding and the whistle blowing procedure, including how to report concerns. Previous safeguarding concerns had been investigated thoroughly.

Staff were recruited safely with pre-employment checks completed to ensure new staff were suitable to work at the home.

Health and safety checks were up to date. The Fire Risk Assessment was being completed during our inspection. The provider supplied us with an action plan to address the findings from the risk assessment.

Incidents and accidents had been fully investigated. A new system had been implemented which allowed a more thorough analysis to be carried out to help ensure people remained safe and lessons were learnt.

Staff were well supported and received the training they needed for their role. Records confirmed supervisions, appraisals and training were up-to-date.

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 gave us mostly good feedback about the meals provided at the home. People received the support they needed to ensure they had enough to eat and drink.

Staff supported people to access external he

This was an unannounced inspection which took place on 10 August 2017 and 15 August 2017.

At the last inspection in June 2016 the service was not meeting all of the legal requirements with regard to medicines management and record keeping. At this inspection we found improvements had been made and the service was no longer in breach of these requirements. However, we considered improvements were required with regard to other aspects of people's care.

Alexandra View Care Centre is registered to provide care and support for up to 68 older people, some of whom may be living with dementia or a dementia related condition. At the time of inspection 50 people were using the service.

A registered manager was not 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.

People said they felt safe and they could speak to staff as they were approachable. We had concerns however that there were not enough staff on duty to provide effective and individual care to people.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

Appropriate training was provided and staff were supervised and supported. Staff had an understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves. 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.

Although people received a varied and balanced diet we had concerns due to staff deployment and staffing levels people did not all receive prompts and encouragement to eat and drink.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed.

Systems were in place for people to receive their medicines in a safe way. However, we have made a recommendation about the best interest decision making process when people did not have capacity to consent to their medicines.

Changes had been made to the environment. Some areas had been refurbished. However, not all areas of the home were clean and well maintained for the comfort of people who used the service. There were plans that the home would be designed to promote the orientation and independence of people who lived with dementia. We have made a recommendation that the environment should be designed according to best practice guidelines for people who live with dementia.

People said staff were kind and caring. However, we saw staff did not always have time to interact and talk with people. In some parts of the home there was an emphasis from staff on task centred care. We have made a recommendation that staff receive training about person centred care and personhood. Activities and entertainment were available to keep some people engaged and stimulated.

Staff knew the needs of the people they supported to provide individual care. Care was provided with kindness and people’s privacy and dignity were respected. Records were not all in place that reflected the care that staff provided.

A complaints procedure was available. People and relatives told us they would feel confident to speak to staff about any concerns if they needed to. People had the opportunity to give their views about the service. There was regular consultation with people and family members and their views were used to improve the service

Alexandra View is owned and operated by Roseberry Care Centres GB Ltd. It is a large three storey residential care home situated in the Southwick area of Sunderland. The service is able to provide accommodation, nursing care and support to 62 older people, most of whom have physical and/or mental health conditions, including people who live with a form of dementia. At the time of our inspection 58 people used the service.

The service had a ‘Time to Think’ unit on the ground floor. This was a unit commissioned by the local authority with accommodation for 10 people. The unit was used mainly by people who needed more recovery time but were fit enough to leave hospital and this prevented a delayed discharge. Other people were on a short term placement to give their family carers a period of respite. It was also a unit where people could come and experience the care home before making a commitment to reside there on a permanent basis.

This inspection took place on 21 and 22 June 2016 and was unannounced. We last inspected this service in March 2014, at which time we found them to be compliant against all of the regulations that we inspected.

The manager of the service had been in post for one week and had begun the progress to become the 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.

Medicines were not managed in line with safe working practices. We reviewed medicines in three treatment rooms and found issues with the storage and disposal of medicines. The temperature of the treatment rooms was not monitored and subsequently the room temperature was too hot meaning medicines and nutritional supplements were not being stored in line with the manufacturer’s guidelines. We also observed broken and disorganised storage facilities and flooring which needed replaced. Medicine administration records were found to be accurate and well maintained.

Checks on the safety of the home were routinely carried out by on-site maintenance staff as well as by external contractors where necessary. Action had not been taken to address potential risks with some electrical systems, although the provider gave assurances the systems were safe and the work was to be undertaken in August. Personal emergency evacuation plans were in place.

There were policies and procedures in place to ensure the smooth running of the service. These included a safeguarding policy which staff told us they understood along with their responsibilities towards protecting people from harm or improper treatment. Relatives of people living at Alexandra View Care Centre told us they thought they relations were safe. We found staff were following procedures which enabled them to provide safe, good quality care. We found some issues with regards to record keeping which we discussed with the manager and regional operations manager. For example, accidents, incidents and complaints were recorded but there was no evidence of thorough investigations, actions or outcomes.

Staff recruitment was safe, however we recommended that the service carry out additional annual checks or periodic checks with the Disclosure and Barring Service (DBS) in line with best practice to ensure long term employees remain suitable to care for vulnerable people.

There were no major concerns about staffing levels; staff working on the top floor told us they felt their team needed more staff. We observed care delivery at lunchtime on this floor and saw one person waited 25 minutes to be assisted to eat their meal.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on wha

The reason for this visit was to check if improvements had been made in areas of staffing skill mix following a previous inspection to the home in December 2013. We spoke with some people who received care but, due to their needs, some were unable to communicate with us.

We found staff with appropriate qualifications and experience were available during each working day to provide the required level of care and support to people using the service. On some occasions staffing levels had increased which ensured there were enough qualified, skilled and experienced staff to meet people's needs.

We spoke with a number of people and visiting relatives throughout the day. People we spoke with told us they were happy with the service provided by the staff. Another said “The staff are what makes this home, they are lovely and really pleasant and supportive". Staff members were seen to interact well with people and knew them by their first name. We saw how the privacy and dignity of residents was respected as we observed care interventions being carried out. Staff spoke to people in a pleasant and respected manner. People had been individually assessed to see if they could make their own decisions. Care records had enough information so staff would be able to know how to support each person in the right way.

We had some concerns about there being not enough sufficient qualified, skilled and experienced staff to meet people’s needs. There were systems for auditing and monitoring the service. For example audits, meeting with people using the service and their families and with staff. Surveys were also carried out. The records of these processes were up to date and gave the manager and staff members the information they needed to run the home effectively.

We spoke to the people who were using the service. One person commented, “The staff are very caring” and another person commented, “I like the staff all the same”. One relative told us that their family member would let them know if they were unhappy with the care at the home.

Care and treatment was planned and delivered in a way that ensured people's safety and welfare. Most people we spoke with made positive comments about their care they were being provided with. One person told us “It is very nice here but I am looking forward to going home” a relative commented, “I come to the home regularly and I watch the staff, they all seem to be genuinely caring people”.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. The people we spoke with told us they felt safe with their care workers and the care they were provided with. One relative commented, “I think my mum is well cared for I haven’t had any issues”.

There were enough qualified, skilled and experienced staff to meet people's needs. During the inspection we spoke with four people who used the service and one relative, all of whom thought that there was sufficient staff on duty to meet people's needs. One person said, "There always seem to be enough staff”." A relative commented, “From what I have seen the staffing seems sufficient”.