We undertook this unannounced inspection to Queen Alexandra Cottage Homes on 3, 5 and 6 April 2018. At our previous inspection in November 2015 we rated the service good. However, we found people’s records did not always reflect the care and support they needed. We asked the provider to make improvements in relation to this. At this inspection we found improvements were still required to ensure people’s records reflected their care and support needs.

Queen Alexandra Cottage Homes 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.

Queen Alexandra Cottage Homes accommodates up to 28 older people in one adapted building. At the time of the inspection there were 24 people living there. People were living with a range of complex health care needs which included diabetes and Parkinson’s disease. Queen Alexandra Cottage Homes is a nursing home run by a charity. Accommodation was provided over two floors with two passengers lifts that provide level access to all parts of the home. The home was part of a complex, which includes independent living flats and bungalows, however these are not regulated or inspected by CQC.

There was a registered manager at the service, who was known as Matron. 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.

Improvements were needed to ensure people’s care plans reflected the care and support they needed. Although staff knew people really well the lack of detailed care plans for some people meant they were at risk of inconsistent care. The registered manager was well thought of by people, visitors and staff. She was supportive to staff and had a high profile in the service. However, improvements were needed to ensure the culture was positive between staff and the provider. These issues had been identified and action was being taken to address them.

Quality assurance systems were in place. These identified where improvements were needed across the service. Actions plans were in place to demonstrate what was needed to address the shortfalls.

People were protected from the risks of harm, abuse or discrimination because appropriate safeguarding procedures were in place. Staff knew what steps to take to ensure people were protected from the risks They were aware of their individual responsibilities in relation to reporting concerns.

There were enough staff, who had been safely recruited, to meet people’s needs. Staffing levels were reviewed regularly. There were systems in place to ensure medicines were ordered, stored administered and disposed of safely. Individual and environmental risk assessments were in place. Staff had a good understanding of people’s needs and the risks associated with supporting them. They knew what action to take keep people safe.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. There was a complaints policy in place and people and visitors told us they would raise any concerns with staff.

Staff had received the training they needed to support people and deliver care in a way that responded to people's changing needs. They received regular supervision and appraisal.

People were provided with a choice of food and drink throughout the day and were supported to maintain their nutritional and hydration needs. Their health was monitored and staff responded when health needs changed. People's individual needs were met by the adaptation of the premises.

People’s

At our previous inspection we found that care and support had not been planned and delivered in a way that ensured people's safety and welfare. Following our inspection the provider sent us an action plan that informed us they were making changes to ensure these issues were being addressed. Evidence gathered at this inspection showed that the provider had achieved compliance.

People we spoke with told us they were well looked after at the home. One person told us, “I am looked after ever so well, they’re very good.” Another person told us, “I’m really happy here, I can do what I like.” People told us that they enjoyed the activities and were able to choose what they took part in. We were told, “I like to stay in my room but if there’s something I want to join in with I can.”

There were 24 people living at Queen Alexandra Cottage Homes at the time of this inspection visit. We spoke with ten people and observed interaction between them and the staff. We spoke with three care workers, the chef, activity person, housekeeping and laundry staff, the catering manager, two nurses, the manager and deputy manager.

We saw that staff asked for people's consent before they provided any care or treatment. One person said, "The staff ask me if I need any help. I can usually manage but sometimes I need help." People told us that staff were very kind and understood their needs.

We examined four care plans. We found that there were inconsistencies in the information recorded, which impacted on the care and support provided by the staff.

We looked at the policies and procedures for medicine management and how the service ensured people were safe.

We reviewed the staff rotas and staffing levels. We found that the shift patterns and number of care workers, nurses and supporting staff on each shift were flexible, to meet people's needs.

A complaints procedure was in place. People were aware of this and told us they did not have any complaints at the time of the inspection

We used a number of different methods to help us understand the experiences of people using the service, because some of the people had complex needs which meant that they were not always able to tell us their experiences. We observed staff supporting people living in Queen Alexandra Cottages, we looked at documents and spoke to visitors, the care staff, manager and deputy manager.

We visited the home and spoke with eight people who used the service. People who spoke with us said the staff were very good and one person said, “I have everything I want.”

We spoke with one visitor and they told us the staff provided the support that people needed. They said people who used the service were involved in decisions about their care and, “the staff always talk to me about what they are doing, they are very good.”

We examined three care plans, for people who had a dementia type illness. We found evidence that the people who used the service, and their relatives were fully involved in making decisions about the care provided.

We looked at the staff rota and spoke with two care workers. They said that there were enough staff working in the home, and they felt able to offer the support and care that people needed and wanted.

We found the home clean and the people we spoke with said they were very comfortable. We saw that appropriate infection control systems were in place.

We looked at the services offered by the home by talking to people who received them, the staff who provided the care and the supporting documentation.

People who used the service said that the support they received was “very good.” The told us that the staff treated them with respect and that they were involved in decisions about the care they received.

People told us that they were happy with the care and support they received and that their needs were being met. They said that the staff treated them with respect, listened to them and supported them to raise any concerns they had about their care.

People living within the service had many positive comments about the quality of care. One said “I’m very happy here. Staff are friendly, they are very good and spend time chatting to you. I have no complaints” Another said “I can do what I like. I love the garden….. Feel happy to complain, no issues”.

Some people who use the service were unable to communicate and tell us what they thought of the quality of the care due to their communication difficulties. However through observation during the site visit we were able to observe staff supporting people who use the service in a respectful way and saw that staff took time to explain the options available and supported them to make choices.

Queen Alexandra Cottage Homes provides nursing and personal care for up to 28 people. There were 25 people living at the home at the time of the inspection who had a range of complex health care needs which included people who have stroke, diabetes and Parkinson’s disease. Some people required help and support from two members of staff in relation to their mobility and personal care needs.

Queen Alexandra Cottage Homes is a nursing home run by a charity. Accommodation was provided over two floors with two passengers lifts that provide level access to all parts of the home. The home was part of a complex which includes sheltered housing flats and bungalows.

There is a registered manager at the home. 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.

This was an unannounced inspection which meant the provider and staff did not know we were coming. It took place on 23 and 24 November 2015.

The registered manager had identified a number of changes were required to ensure people received the care and support they required. Some areas had been addressed for example staff had received training and updates to ensure they had the appropriate knowledge and skills to look after people. Other areas, particularly in relation to record keeping were still being addressed.

People and their visitors spoke very highly of the caring and kind nature of the staff and said that there was a lot of respect for their dignity. Staff knew people well and treated them as individuals; they were able to tell us about their choices, personal histories and interests however people’s care plans were not personalised and did not always reflect the care and support people received.

Staff had a good understanding of mental capacity assessments (MCA) and Deprivation of Liberty Safeguards (DoLS) and people were supported to make their own decisions. People were involved in decisions about their day to day care and support and were able to decide what care and support they required. Staff cared for people with kindness and patience. They were supported to take part in a range of activities maintain their own friendships and relationships.

There were enough staff who had the appropriate knowledge and skills and had been safely recruited to look after people at the home.

People were protected against risks including the risk of abuse, malnutrition and pressure area damage because staff had identified where these risks may be and measures put in place to reduce their likelihood. However, people told us they were not restricted and able to take individual risks which enabled them to remain independent.

People were given choice about what they wanted to eat and drink and received food that they enjoyed. They had access to a varied menu and if they did not like what was on offer alternatives were available.

People were supported to have access to healthcare services and maintain good health. People and their visitors said that they would have no hesitation in raising concerns or complaints and that staff were very approachable and would help to resolve any issues.