We carried out a review of the data available to us about Alexandras Community Care Penryn on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Alexandras Community Care Penryn, you can give feedback on this service.
Alexandras Community Care is a domiciliary care service providing personal to people in their own homes. When we inspected the service was providing the regulated activity, personal care, to 51 people living around the Penryn area in Cornwall.
People’s experience of using this service and what we found.
Since the last inspection improvements had been made to how safeguarding allegations were recorded, investigated and reported. Improvements had also been made in the way identified risks relating to people’s behaviour were recorded, assessed and monitored. Staff knew how to keep people safe from harm.
Some people were supported, by staff, to take their prescribed medicines. Medicine Administration Records (MAR) were completed by staff when medicines had been taken. Improvements had been made to the information provided for staff when medicines were provided in blister packs by the pharmacy. Care plans now contained details of each medicine and what support the person may need from staff.
There were sufficient numbers of staff to cover scheduled visits. People told us staff mostly arrived at the expected time and stayed for the agreed period. Staff were recruited safely.
Staff told us they had time to meet people’s needs and did not need to rush. They were given adequate travel time to get to each visit.
Staff felt well supported by the management team and were happy working for the service. Staff were provided with training to help ensure people’s needs were met.
Care plans were individualised, and detailed people’s needs and preferences.
Any changes in people’s health were escalated to the relevant professional and relatives were kept informed.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
The infection control policy and procedure had been updated in line with Covid-19 guidance to help staff to protect people they visited, from the risk of infection.
People, their relatives, staff and health and social care professionals were regularly asked for feedback on the service’s performance. Feedback from surveys was positive. Comments included, “I’m as pleased as punch with them, I would recommend them to anyone. We are all very happy with them” and “If I need to make any changes to my care, I ring the office, for example if I have a hospital appointment; they will change my visits around for me without any problem. They do what I ask them to do when they come. I’d like to thank them all for their care.”
There was a stable staff team who knew people well and worked together to help ensure people received a good service.
People, their relatives and staff told us the management were approachable and listened when any concerns or ideas were raised.
The registered manager and the provider carried out regular audits to monitor the service provided.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement. (Report published 2 October 2019) There was a breach of the regulations.
At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating.
We undertook this focused inspection to check on the improvements they had made and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Alexandras Community Care on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Alexandras Community Care is a domiciliary care service that provides personal care and support to people living in their own homes in the community. When we inspected the service was providing the regulated activity, personal care, to 40 people in and around the Penryn area in Cornwall.
People’s experience of using this service and what we found
People and their relatives told us care was delivered in a safe way and they had confidence in staff’s abilities. Identified risks related to people’s behaviour were not always clearly recorded, assessed and monitored. When allegations had been made these had not been appropriately recorded and reported.
Other risks had been assessed and guidance provided to enable staff to mitigate the risk.
Some people were supported with medicines. Medicine Administration Records (MAR) were completed appropriately to indicate when medicines had been taken. When medicines had been provided in blister packs neither the care plans or MARs individually listed each medicine or the support people would need to take them. This was not in line with national guidelines. We have made a recommendation about this in the report.
There were enough staff to cover all visits. People told us staff were usually punctual and stayed for the allotted time. Staff were able to complete personal care tasks and spend time with people talking and checking on their well-being.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. The importance of providing care in line with people’s preferences and offering meaningful choices was a recurrent theme in our conversations with staff.
Staff told us they enjoyed their jobs and were committed to providing a caring service. They were keen to support people to maintain active lives and retain their independence as much as possible. Staff told us they were well supported by the registered manager and acting deputy manager.
People and their families were asked for their views of the service. They told us they were involved in care plan reviews and had opportunities to express their views of the service. People said they would be confident raising a complaint if necessary.
The registered manager and senior management team carried out various audits to monitor the service. These had failed to identify the shortcomings identified in the safe section of this report. We have made a recommendation about this in the report.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was Good (report published 7 March 2017)
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified a breach in relation to the systems to record and report allegations of abuse.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
At the last inspection in April 2015, the service was rated Good for all five of our key questions. At this inspection we found the service remained Good.
The service followed safe and robust recruitment procedures. Staff had received safeguarding training and understood their role in protecting people from avoidable harm.
People told us they were safe and cared for by staff who they knew and got on with well. People’s comments about their care staff included, “They are very good, very helpful” and “I do get on well with every one of them.” While relatives said, “The staff are very good, I think they are excellent” and “I have been very impressed with them.” Staff were well motivated and told us they found their role “very fulfilling.”
There were sufficient staff available to provide all of the service’s planned care visits. Records showed that care visits were normally provided on time and that staff stayed for the allocated time.. People told us, They are pretty well on time. Sometimes five minutes late but never more than that” and “They do have enough time, they don’t rush.” The service’s visit schedules were well organised and staff and people who used the service were provided with copies of their visit schedules each Friday. Staff told us the schedules were accurate and that they had enough time to travel between calls. People told us they had not experienced missed care visits and records showed the service had acted appropriately to ensure people’s safety when a planned care visit had been missed.
Managers visited people at home either prior to the first care visit or during the first week of care provision, to assess risks and identify the individual’s specific needs. This information was used to develop people’s care plans. These documents were accurate, informative and provided staff with enough detailed guidance to enable them to meet people’s care needs. The documents were regularly reviewed by managers who visited people at home to discuss their experience and identify any areas of improvement.
Staff were well trained. There were systems in place to manage staff training needs. All new staff completed formal training and shadowed experienced carers before being permitted to provide care independently. Staff told us, “I had a lot of training at the beginning before I started”, “I did I think nine courses before I started work” and We are always training.” Relative told us, “They do come and shadow before they do the visit on their own.”
Managers and staff understood the requirements of the Mental Capacity Act and recognised the importance of supporting people to make decisions. Care plans included guidance for staff on how to support people to make decisions and people said staff respected their choices. People told us, “They do what I want them to do” and “Certainly yes, they do treat me with respect.”
The service had experienced significant management changes since our last inspection. Although there was a registered manager in place this staff member had other responsibilities that meant they were not routinely present in the office. A new manager had recently been appointed and was leading the service effectively. This manager was based in the service full time and staff told us, “I have noticed a big change, it has improved since the change of manager” and “The new manager is lovely and communicates well.” Records showed staff meetings were held regularly and that staff had received formal supervision.
The service had appropriate quality assurance systems in place and was proactive in seeking people’s feedback about it’s performance. Where issues had been identified managers had worked collaboratively with staff to ensure these were addressed and resolved. People understood the service complaints procedure and one person told us, “I have no problems, if you speak up and ask them something they will sort it out.”
This inspection took place on 21 to 23 April 2015 and was announced 48 hours in advance in accordance with the Care Quality Commission’s current procedures for inspecting domiciliary care services. The inspection team consisted of one inspector and one expert by experience. The service was previously inspected in September 2013 when it was found to be fully compliant with the regulations.
Westcountry Home Care, trading as Alexandra’s, provides personal care to people who live in their own homes in south and west Cornwall. At the time of our inspection the service was providing care and support to approximately 200 predominantly older people.
The organisation was led by a registered manager who works part of each week in each of the service’s offices. 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 and associated Regulations about how the service is run.
People were pleased with the support they received and told us; “I can honestly say that the care is terrific, all of them, their care is second to none”, “Overall I would say they are excellent” and, “I have been flabbergasted, in a good way, at the dignity and respect that they treat me with.”
Recruitment procedures were robust. Staff had received appropriate training and knew how to respond if they had any concerns about a person’s welfare. When accidents or incidents occurred these were appropriately investigated.
The agency employed enough staff to meet people’s planned care needs. Staff received regular training, support and supervision. People told us their care staff were well trained and knew how to meet their care needs.
The service used a call monitoring system to track staff arrival and departure times from individual care visits to ensure people received the planned care. We found staff normally arrived on time and stayed for the full planned care visit. People told us, “They (care staff) are normally on time, never more than 15 minutes late”, ‘I have never been missed, they are very good.’ Staff said: “We definitely do all our visits”. During our inspection we identified two occasions where a care visit had been missed. Both incidents had been fully investigated by the service and where appropriate, changes made to further reduce the possibility of similar incidents occurring in future.
People received care from consistent groups of staff who they knew well. People and their relatives told us they enjoyed their care visits and said their staff took time to chat and laugh with the person they supported during care visits.
People told us their care plans were up to date and we found they were sufficiently detailed to enable staff to provide individualised care. The care plans included information about people’s life history and interests as well as clear guidance on the care each person required. Daily care records completed by staff at the end of each visit were detailed and informative.
People’s feedback was valued by the service. Complaints had been appropriately investigated and resolved to people’s satisfaction. A recent survey found people were happy with the care and support they received.
Staff were well motivated and told us, “The manager is amazing”. Staff were encouraged to visit the service’s office and regular team meetings and team building events were used to ensure office staff and carers worked effectively together as a team.