Alexandra Lodge Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Staff understood their duty to protect people from abuse. They understood to report concerns to the registered manager but not all staff understood about reporting concerns to external agencies including the Local Authority and CQC. The provider had updated their safeguarding policy to reflect current legislation and who to report concerns to including who to escalate concerns to. Safety risks to people were not always managed well. Assessments regarding specific risk issues for people had not been completed and issues regarding the safety of the environment were not always responded to promptly to protect people from risk of harm. Issues regarding the cleanliness of the home and fire safety had not been addressed in full. There were enough staff to meet people’s needs however, there were only 3 people receiving care and support at the start of our assessment process. In April, there were 2 people living at the home with 2 staff present but 1 person was still able to leave the home without staff support placing them at significant risk of harm. Staff had not all received relevant training to meet people’s needs and ensure their safety. The registered manager carried out checks when recruiting staff to support them to choose people who they deemed suitable and fit to be employed to support people at the service.

This service scored 38 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s relatives all told us they felt the home was clean and safe. However, people were found to continue to live in an environment that was not always safe. On previous visits the inspection team had advised the provider of concerns regarding risk assessments, fire safety and infection prevention and control which had not been responded to robustly. This meant people continued to be at risk due to the provider failing to adopt a learning culture and make improvements based on feedback received.

Staff were aware of the recent inspections and assessment but had limited insight into what was learnt from these processes. One staff member told us when asked about learning from these processes, “Yes, we have to keep things up to standard and do your job right.” The lack of shared understanding of issues and learning from when things go wrong means the team did not have a shared vision and direction to support with improvements to the service.

The provider did not have a proactive and positive culture in which concerns about safety were listened to and responded to promptly and robustly. There were no indicators of lessons learnt from previous inspection processes and embedding of good practice. For example: The provider had created a schedule for carrying out cleaning tasks further to concerns being communicated to them about poor infection prevention and control processes. However, although a schedule had been created the inspection team found that these were not being used.

Staff told us they had received safeguarding training and were able to show the inspection team where paper copies of the policies were located including Safeguarding and Whistleblowing policies. One staff member told us, “I would report it to the manager and take it further if I needed to.” Not all staff understood they could report concerns to the manager or external agencies, this meant not all staff knew what to do if they felt a person was a risk of abuse or harm.

We observed staff providing support and encouragement to people, we saw that they considered people’s safety and welfare to ensure that they were safeguarded from abuse or harm.

The provider had not submitted the appropriate documentation to the local authority which is required by law called a Deprivation of Liberty Safeguards (DoLS) application for people living at the home. DoLS is the procedure prescribed in law when it is necessary to deprive of their liberty a resident or patient who lacks capacity to consent to their care and treatment in order to keep them safe from harm. This meant people’s liberty and their rights were not legally restricted. The provider had appropriate policies in place for safeguarding which included information for people to report any safeguarding concerns to external agencies, for example: the CQC or the local authority. Policy and procedures had been updated since our previous visit to reflect current legislation and practice.

People felt their relatives were safe at the home. One relative told us, “[Relative] had a lot of falls previously but hasn’t had one since they have been here [Alexandra Lodge].” At the time of our assessment there were only 3 residents at the first visit and 2 at the second. This meant while people were safe with the current level of staffing, should more people move in people would not receive the same level of supervision and care and may not be safe.

Feedback from relatives was mixed regarding assessment and review. One relative told us they had been involved in the assessment process before their loved one moved into the home. Another relative said their loved one had a care plan from the home they were at previously. This meant that information about the person’s needs may not be current if the provider had failed to reassess them.

At our previous inspection we identified concerns regarding staff understanding of people being on modified diets. We observed that there was information available in the lounge and kitchen area on the International Dysphagia Diet Standardisation Initiative (IDDSI) Framework. The IDDSI Framework provides a common terminology for describing food textures and drink thicknesses to improve safety for individuals with swallowing difficulties. During the assessment the inspection team asked one of the catering staff about IDDSI and they were unclear about what this was. They were asked if they had been provided with any information for reference about modified diets and they said they had not. On the second assessment visit we found that staff were more knowledgeable about supporting people at risk of choking and the type of foods they could eat. Staff were not clear what IDDSI meant but understood how to prepare the persons food to reduce the risk of choking.

The registered manager told us there was an assessment of need carried out with people, their relatives, and staff when people were previously living in a supported setting, before people moved into the home.

People and their relatives were involved in providing information about people’s needs to support the development of care plans. However, risks to individuals were not always identified and assessed. We observed that one person was identified as being on a modified diet, but there was no choking risk assessment completed to support staff to keep the person safe. Assessment forms had not been completed in full and had some contradicting information in them. There was a lack of clear information regarding people’s care needs collected at assessment. This meant staff did not have access to information in clear care plans when people moved in to effectively, and safely, support them. On our second visit to the home as part of this assessment we noted that care plans had been typed up and contained clearer and more detailed information to support staff in providing safe care.

The provider had not taken adequate action to ensure that people were safe in the event of a fire. There was no regular fire evacuation practice, the fire risk assessment was inadequate and had failed to identify risk issues identified by the inspection team. People should have had a personal emergency evacuation plan (PEEP), in place however, these were not in place at the time of the assessment. We were advised PEEPs were being put in place but on review the content was not sufficient to guide staff or emergency workers to keep people safe in the event of a fire. Previously the inspection team identified concerns about hot water presenting a risk of scalding. Water temperatures were not being monitored and recorded and thermostatic mixed valves had been fitted to regulate the temperature to ensure it was safe.

The registered manager told us during our second visit as part of this assessment that the Fire and Rescue Service had visited the home and had identified areas for improvement in the environment. Not all staff we spoke with were clear about evacuation processes, including for people with mobility issues. Staff were not familiar with peoples Personal Emergency Evacuation Plans (PEEPs). This meant in the event of a fire staff would be unable to react appropriately and promptly to keep people safe.

We spoke with people’s relative who told us they had no concerns about the environment and felt their loved one was safe. However, the inspectors on site found concerns regarding fire safety and infection prevention and control management as well as issues of concern regarding people being able to access unsafe areas in the building, for example: the balcony area.

The home environment was not always safe. Wardrobes were not all secured to the wall which presented a risk of harm. We observed that fire doors to people’s bedrooms had inappropriate locks fitted which meant they were no longer effective as fire doors, one fire door did not fit properly into the frame meaning it would not be effective as a barrier to fire or smoke. We saw that a fire exit leading from one person’s room had been sealed shut. Doors opening onto the second-floor landing were not secured placing people at risk of falls. A gate put up to stop people accessing the top floor of the building was not adequate meaning people could access an area that was unsafe with windows that were not restricted in any way placing people at risk of a fall from height. On the second visit as part of this assessment we found that the provider had started to make improvements which included fitting window restrictors to all windows on the on the upper floor and fitting a keypad lock to the door to access this area of the building. The maintenance person for the home was on site during this visit and they were making repairs to holes that had been identified in doors and the ceiling which would affect fire safety in the event of a fire. These actions made the environment safer for people living at the home.

There were enough experienced staff on shift to ensure that people received effective support. Staff were observed as working together, with the registered manager, to provide safe care that met people’s needs. We saw that there were always staff present with people, they were attentive, and people were cared for appropriately.

At previous inspections we had highlighted the need for the registered manager to use a dependency tool to ensure they had appropriate staffing levels on shift to ensure people’s care and support needs could be safely met. During this assessment, on the second visit, there were only 2 people receiving care and the provider advised they had made the decision not to implement the use of a dependency tool at this time, but they would when the number of people receiving care increased. From the records it appeared that not all staff had completed training, but the manager confirmed that this was due to some staff being absent. Staff who had been recruited recently had a documented induction on file, but this was incomplete and there was an instance of a member of staff not having appropriate documentation on file. Staff files reviewed all had a Disclosure and Barring Service (DBS) check completed. A DBS check is a way for employers to check applicants criminal record to help them decide whether a person is suitable or not to work for them.

Staff told us they felt there were enough staff at the home, they received support, and were able to talk about matters at team meetings but not all staff told us they received regular supervision. One staff member told us, “I’ve come on leaps and bounds since working here.” Our findings at assessment were that there were infrequent team meetings to discuss issues.

People’s relatives felt that the home had safe and effective staffing. People felt there were enough staff at the home. One relative told us, “Staff know what they are doing, some of them have been there for years.”

Infection prevention and control was not always managed effectively. We observed that items stored in the fridge in the kitchen were not all labelled appropriately so it was unclear when these items should be disposed of. Fridge temperatures were not checked consistently to ensure food was stored at a safe temperature. We observed that one person’s room had an infestation of ants and there were surfaces and items throughout the home that were in poor repair and could not be kept hygienically clean which included a wooden framed commode chair with worn varnish surfaces. We noted that pressure relieving cushions were not labelled for individual use or identifiable and saw that one of the cushions was wet on the underside and smelt of urine which was pointed out to the registered manager at the time who confirmed pressure relieving cushions were for communal use.

People’s relatives told us the home was clean. One relative said, “Yes it’s very clean, everywhere was immaculate.” However, this was not the findings of the inspectors who identified concerns regarding infection prevention and control.

The provider had created a cleaning schedule, but this was not being completed which meant there was no tool in use to prompt cleaning, or evidence of what cleaning had been completed and when. There was no infection prevention and control audit completed or audit of pressure cushions to identify if they were clean, hygienic, and safe for people’s use. At our second visit we found that the cleaning schedules had been implemented and were being completed as staff carried out cleaning tasks. Pressure cushion and mattress audits were recorded as completed to check they were clean and appropriate for people to safely use. The NHS infection prevention and control team shared with us they visited the home on 21/3/24 and identified concerns regarding infection prevention and control processes which will be reviewed in 3 months.

We spoke with staff about infection prevention and control. We discussed cleaning schedules and whether there were domestic staff on site or not. One staff member told us, “We don’t have a set schedule to do things, if something needs doing, we just do it. There isn't a need for a domestic when we are not busy, we [care staff] do it”. As part of the second site assessment, we noted that cleaning schedules were in use. One staff member told us, “Yes there are [cleaning schedules]. We’re keeping the place clean, making sure everything is wiped down and kept clean daily.”

Relatives told us they had no concerns regarding the support their loved one received with medicines. One relative told us, “I’ve no concerns, I never have done .”

Medicines administration recording (MAR) charts were not always completed appropriately. We saw that one person had a signed MAR chart which would indicate medicines had been given. However, the registered manager explained the person had been declining this medicine which was unclear from the document as the appropriate code to show this on the MAR had not been used. We saw that an audit had been completed but the audit had not identified the issue with recording. An assessment had been completed to check if people were able to administer their own medicines. Updated documentation reflected people’s preferences regarding how their take their medicines, including a stock count record. Protocols had been put in place for people who received as required medicines.

Appropriate documentation for medicines were not always in place which was discussed with the registered manager. One specific person did not have a medicines care plan in place. The registered manger told us, "We have not completed a care plan or assessment yet this still needs to be done. We are getting to know them before we start planning and this will be done shortly.” During the second visit this was reviewed, and a care plan had been put in place.