CQC report explained · a nursing home
What the CQC found at Poulton-le-Fylde
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, January 2024
Alexandra Nursing Home - Poulton-le-Fylde was rated Good overall; inspectors found improved safety and caring staff, but well-led was Requires Improvement.
This was an unannounced focused inspection on 9 and 13 November 2023. Inspectors looked only at Safe and Well-led, partly because of concerns about pressure care and wound management. They spoke with people, relatives and staff, observed care, checked medicines and reviewed care and management records.
Inspectors found improvements since the previous inspection. Risks, pressure care, wound care, nutrition records and medicines management were generally handled safely. Staff were described as caring and person-centred. The home was clean and infection control arrangements were satisfactory.
The overall rating improved from Requires Improvement to Good because the home was no longer in breach of regulations. However, Well-led remained Requires Improvement. A new management team was still putting quality systems in place, there was no registered manager, staffing arrangements were still being reviewed, and some records needed further improvement.
Improved risk management
Inspectors found that individual risks were assessed more thoroughly and that measures were in place to reduce them.
“At this inspection we found staff had assessed risks thoroughly and put measures in place to reduce those risks to improve safety.” from the report
Pressure and wound care
Pressure care and wound care were managed safely. Staff reviewed skin risks, used care records and sought professional advice when needed.
“Risks related to pressure care and wound care were managed safely.” from the report
Improvements since the last inspection
Risk assessments, care plans and several records had improved. The provider was no longer in breach of the regulations identified at the previous inspection.
“At this inspection we found improvements had been made and the provider was no longer in breach of regulations.” from the report
No registered manager
needs fixingThe home had a registration condition requiring a registered manager, but there was no registered manager in post. The report says an application had not been submitted within a reasonable timescale.
“The location has a condition of registration that it must have a registered manager, but it does not have one, and satisfactory steps had not been taken to submit an application to register with us within a reasonable timescale.” from the report
Staffing arrangements still changing
needs fixingOn the first inspection day, one area did not have enough staff to cover breaks effectively. A new staffing system had not been fully followed or implemented, although staffing was increased after inspectors raised the issue.
“In one area of the home, on the first day of our inspection, there were not enough staff to cover breaks effectively.” from the report
One-to-one care records
needs fixingRecords for people receiving one-to-one care did not always clearly demonstrate why this level of care was needed or what care had been delivered. Inspectors recommended that the provider review its recording processes.
“The quality of records related to the care people received on a 1-to-1 basis could be further improved, to better demonstrate the need for this level of care.” from the report
Topical cream records
minorRecording had improved, but inspectors still found some gaps in one area of the home. The manager was addressing this through staff supervision.
“However, there were still some shortfalls in recording of topical creams in one area of the home.” from the report
- 01Has a registered manager now been appointed and registered with the CQC?
- 02How do you calculate staffing levels for each unit, and how do you make sure breaks are covered?
- 03How are one-to-one care sessions recorded, including the reason for the care and what was provided?
- 04How do you check that topical creams are recorded correctly in every area of the home?
- 05What changes have been made to quality monitoring since the new management team started?
This was a focused inspection of Safe and Well-led only; the other ratings were carried forward from the previous inspection. This explanation was written from the published report of 23 January 2024 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, August 2023
Alexandra Nursing Home - Poulton-le-Fylde is rated Requires Improvement; inspectors found inconsistent risk management and inaccurate care records.
This was an unannounced follow-up inspection on 26 April 2023. Three inspectors and a medicines team member spoke with people, relatives and staff. They observed care, checked the home, reviewed care and medicines records, and examined staffing and quality checks.
The home was not always safe. Risks, oral care and nutrition were managed inconsistently, and some care records did not match what had happened. Medicines management had improved, staffing was sufficient, and people were protected from abuse. One bathroom was taken out of use because it did not meet infection control requirements.
The overall rating is Requires Improvement. Safe and Well-led were both rated Requires Improvement. This was the home's fourth consecutive Requires Improvement rating. The home had improved medicines management since the previous inspection, but remained in breach of rules about risk management and records.
Enough staff
Inspectors found enough staff to meet people's needs safely. Recruitment checks were also carried out safely.
“There were enough staff on duty to meet people's needs safely.” from the report
Improved medicines management
Medicines training and staff checks had been completed. Covert medicines and fluid thickeners were handled safely, and the previous medicines breach had been resolved.
“At this inspection, the provider had made improvements and was no longer in breach of regulation 12.” from the report
Open culture
Inspectors saw a caring, person-centred approach. People and relatives were mainly positive about the staff and the service.
“The registered manager had created a culture that was open, inclusive and person-centred.” from the report
Risk information was inconsistent
seriousSome care plans lacked important guidance or gave contradictory instructions. Staff also did not always record behaviours, oral care or what people ate.
“Risk to individuals was not managed consistently. In some cases, care planning and risk assessments provided staff with information they needed to keep people safe, but in some cases information was lacking.” from the report
Care records were not reliable
seriousRecords about care, behaviour, oral care and nutrition were inaccurate or incomplete in one area of the home. This remained a breach from the previous inspection.
“We found the quality of care planning and records of the care people received was inconsistent.” from the report
Bathroom infection control problem
needs fixingOne bathroom did not meet infection control requirements. It was taken out of use immediately and refurbishment was planned, but the home's checks had not identified the problem.
“We found a bathroom in one area of the home which did not conform to infection control requirements.” from the report
- 01What has been done to make sure risk assessments and care plans give staff consistent, up-to-date instructions?
- 02How do you check that records of behaviour, oral care and food intake accurately reflect the care provided?
- 03What is the current position on the bathroom that was taken out of use, including its refurbishment?
- 04How are person-centred information for as-required and diabetes medicines, and records for topical medicines, now checked?
- 05What action plan has been sent to the CQC, and how can families see evidence that the required improvements are being monitored?
This was an unannounced follow-up inspection focused on Safe and Well-led; the other key question ratings were carried over from the previous inspection. This explanation was written from the published report of 11 August 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Poulton-le-Fylde
8 rated inspections over 8 years: the service has held its Good rating throughout.
- January 2024Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- August 2023Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- November 2022Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- April 2021Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- January 2021Requires improvementSafe: InadequateWell-led: Requires improvement
- August 2020Inspected but not ratedSafe: Inspected but not rated
- December 2018Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Good
- October 2017Requires improvementdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- September 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2013
Report published without a new overall rating.
- March 2013
Report published without a new overall rating.
- January 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 11 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
Weigh the report against the rest
Fees, photos and reviews from families
How to read CQC ratings and reports
What to check when you visit
85 live-in carers within about an hour of Lancashire
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £980 to £1,260 a week. 78 can care for a couple. 11 years' experience on average.
“She understands the needs of an elderly person in the early stages of dementia and has treated my mother with great kindness and skill.”
“Thanks to Tracy, Dad was always immaculately dressed and clean, his meals were all home cooked and nutritionally well balanced and his home was always kept really clean and tidy.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.