CQC report explained · a nursing home
What the CQC found at Alexandra View Care Centre
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found enough staff, safe recruitment, risk assessments, safe medicines processes and suitable infection control arrangements. A small number of staff wore face masks incorrectly, but this was addressed immediately.
- Effective?
- Good
- This key question was not inspected during this visit. Its previous rating was used in calculating the overall rating.
- Caring?
- Good
- This key question was not inspected during this visit. Its previous rating was used in calculating the overall rating.
- Responsive?
- Good
- This key question was not inspected during this visit. Its previous rating was used in calculating the overall rating.
- Well-led?
- Good
- Inspectors found improved care records, regular quality checks and action plans to address problems. People and staff gave positive feedback about the management and care.
What inspectors found, September 2022
Alexandra View Care Centre rated Good; inspectors found safe care and improved management, with a minor face-mask concern addressed immediately.
The inspection was unannounced and took place on 24 August 2022. One inspector spoke with four people and five staff, and reviewed care, medicines, recruitment and management records.
The home was rated Good for Safe and Well-led. Inspectors found enough staff, safe recruitment, suitable risk assessments, safe medicines processes and appropriate infection control overall. People said they felt safe.
The home had improved since its previous inspection, when it was rated Requires Improvement. The provider was no longer in breach of regulations. The other three key question ratings were carried forward because they were not inspected this time.
People felt safe
People told inspectors they felt safe, and staff said they could raise safeguarding concerns. The home assessed risks and recorded the support people needed in emergencies.
“People told us they felt they safe living at the home, staff also confirmed they thought people were safe.” from the report
Enough staff
Inspectors found enough staff to meet people's needs. Staffing levels were monitored and changed when people's needs changed.
“There were enough staff available to meet people's needs.” from the report
Improved records and checks
Care records had improved since the previous inspection. The provider used regular checks and action plans to identify and address areas for improvement.
“The provider had improved the quality of care records to accurately account for the care people received.” from the report
Positive management
People and staff gave positive feedback about the care and said the manager was approachable. Residents and relatives were also asked for their views.
“People and staff told us the registered manager was approachable and had improved the home since the last inspection.” from the report
Face masks
minorA small number of staff were not wearing face masks correctly during the inspection. The provider dealt with this immediately.
“A small number of staff did not wear a facemask correctly. The provider addressed this immediately.” from the report
- 01How do you make sure all staff wear face masks correctly when required?
- 02How are risk assessments reviewed when a resident's needs change?
- 03How do you check that care records accurately show the care each person has received?
- 04What areas are currently covered by your quality checks and action plans?
- 05What were the previous ratings for Effective, Caring and Responsive, and when will these areas next be inspected?
This was a focused inspection of Safe and Well-led, including infection prevention and control; the other key question ratings were carried forward from the previous inspection. This explanation was written from the published report of 30 September 2022 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, January 2021
Rated Requires Improvement; inspectors found enough staff, safe medicines and good infection controls, but risk assessments and care records were not reliable.
This was a focused inspection on 30 September and 16 November 2020. The inspectors looked only at Safe and Well-led, because concerns had been raised about staffing, medicines, communication, hospital discharge beds, care plans, cleanliness and dignity. They reviewed care plans, medicines records and management records, then contacted eight relatives and checked further information after the visit.
The home had enough staff, safe recruitment, safe medicines systems and suitable infection control measures. Relatives said people were safe, and staff knew how to report concerns. However, some people did not have the required moving and handling plans, and other risk assessments did not explain clearly how risks would be reduced.
Care records were not always accurate or complete. Quality checks had repeatedly found problems with records about repositioning, food and fluids, but the provider had not taken strong enough action. The overall rating fell from Good to Requires Improvement. The report identified legal breaches in safe care and treatment and good governance.
Staffing
Inspectors found enough staff to provide care and support. Recruitment processes were also effective in checking new staff safely.
“There were enough staff on duty to provide people's care and support.” from the report
Medicines
Medicines were stored properly and records matched the medicines people received. Managers checked that staff followed the agreed procedures.
“Medicines were stored appropriately. Records accurately accounted for the medicines people received.” from the report
Infection control
Inspectors were assured that the home used protective equipment safely and had suitable arrangements for preventing and managing infection outbreaks.
“We were assured that the provider was using PPE effectively and safely.” from the report
Staff support
Staff said the manager was approachable and that the home had good teamwork. People and staff had regular opportunities to give feedback.
“Staff told us the registered manager was approachable and made them feel valued.” from the report
Incomplete risk assessments
seriousSome people assessed as high risk did not have the specific moving and handling plans required by the provider. Other risk assessments lacked enough detail about how risks would be reduced.
“Some people had been assessed as high risk in relation to moving and assisting. They did not have an specific moving and assisting assessment and plan as described in the provider's guidance.” from the report
Poor care records
seriousCare plans and supplementary records were not always complete or accurate. Repeated problems had been found in quality checks, but action had not been strong enough to correct them.
“Supplementary charts and records were not always completed accurately, such as for positional changes and food and fluid records.” from the report
Hospital discharge beds
needs fixingPeople arriving from hospital often came with too little information about their needs and risks. Health professionals had since helped improve referral arrangements and the admissions process.
“People admitted from hospital into the designated discharge beds arrived with often minimal information about their needs and potential risks.” from the report
- 01Have all residents now got individual moving and handling assessments and plans where needed?
- 02How do you check that care plans and records about repositioning, food and fluids are accurate every day?
- 03What changes have been made to the hospital discharge bed referral process and the information received before admission?
- 04What action plan did you send to CQC, and what improvements have been completed since this inspection?
- 05How will you show families that the quality assurance checks are finding and fixing problems promptly?
This was a focused inspection of Safe and Well-led only; the other key question ratings were not inspected and previous ratings were used. This explanation was written from the published report of 27 January 2021 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 Alexandra View Care Centre
6 rated inspections over 6 years: the service has improved, from Requires improvement to Good.
- September 2022Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2021Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- January 2020Goodup from Requires improvementSafe: GoodWell-led: Good
- November 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- October 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- August 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- April 2014
Report published without a new overall rating.
- January 2014
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- October 2011
Registered with the Care Quality Commission on 5 October 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.
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