Archived: Alexander House Private Nursing Home

Updated 20 April 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was completed by two inspectors.

Service and service type

Alexander House Private Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Alexander House Private Nursing Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post. The provider was also the registered manager.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We sought feedback from the Local Authority who work with the service. We used all of this information to plan our inspection.

During the inspection

We spoke with 7 people about their experience of the care provided. We spoke with the deputy manager, a senior member of staff, 3 care staff and the services chef during the inspection. We also spoke with the provider, in their role as both provider and the registered manager. We spoke with 1 healthcare professional.

We reviewed a range of records relating to people using the service. This included 8 people's care records and risk assessments, medication administration records and people’s financial records. We reviewed staff training and supervision data. We looked at some of the provider's auditing arrangements.

Updated 20 April 2023

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Alexander House Private Nursing Home is registered to provide accommodation for persons who require nursing or personal care and treatment of disease, disorder or injury for up to a maximum of 25 people. At this inspection 8 people were using the service, some of whom were living with dementia, had a mental health condition, were autistic and had a learning disability.

People’s experience of using this service and what we found

The provider was not able to demonstrate how they were meeting the underpinning principles of ‘Right support, right care, right culture’.

Right Support:

• The registered manager and staff team did not support people to have choice, control and independence or focus on people’s strengths and abilities.

• There were not enough staff to fully support people to have a fulfilling and meaningful everyday life.

• The registered manager and staff did not support people to take part in activities and pursue their interests within their local area.

• Suitable arrangements were in place to ensure the proper and safe use of medicines.

Right Care:

• Staff were observed to deliver task-based care and support.

• Not all people’s nutritional needs were being met in line with their care needs or care plan.

• Recommendations and advice by healthcare professionals were not always implemented or followed up.

• The registered manager and staff did not protect people from poor care and abuse.

• People did not routinely take part in activities or pursue interests that were tailored to them.

Right Culture:

• The leadership, management and governance arrangements did not provide assurance that the service was well-led, that people were safe, and their care and support needs could be met.

• The registered manager and staff team did not help people lead inclusive and empowered lives.

• The registered manager and staff team did not ensure people are always put first. People did not receive care that was person centred or protected and promoted people’s rights.

• A ‘closed culture’ had been developed at Alexander House Private Nursing Home, whereby there was a risk of harm for people living there.

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 inadequate [published December 2021]. The provider did not complete an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended that the provider seek guidance to ensure the premises were suitable to meet people’s needs. At this inspection we found the provider had not fully acted on this recommendation and only minor improvements had been made.

Why we inspected

The inspection was prompted in part due to continued concerns received about people living at Alexander House Private Nursing Home not having access to professionals and stakeholders. involved in their care. The provider was continuing to not allow professionals and stakeholders to access the service to carry out their statutory obligations to ensure people’s safety and wellbeing. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to person-centred care, consent, risk management, safeguarding, meeting people’s nutritional needs, governance and staffing at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.