CQC report explained · a residential care home
What the CQC found at Alexandra Grange
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People were protected from abuse and avoidable harm. Staffing, recruitment, infection control and medicines arrangements were generally safe, although daily records and some 'as required' medicine protocols needed improvement.
- Effective?
- Good
- This key question was not inspected during this visit, so its previous rating carried over to the overall rating.
- Caring?
- Good
- This key question was not inspected during this visit, so its previous rating carried over to the overall rating.
- Responsive?
- Good
- This key question was not inspected during this visit, so its previous rating carried over to the overall rating.
- Well-led?
- Good
- Managers had effective systems for monitoring the home, responding to concerns and learning from incidents. The rating improved from Requires Improvement at the last inspection.
What inspectors found, June 2023
Alexandra Grange rated Good; inspectors found people were safe and the home was well-led, but records and some medicines guidance needed improvement.
Inspectors visited unannounced on 6 and 8 June 2023. They spoke with people, relatives, staff, managers and healthcare professionals. They reviewed four care records and records about medicines, infection control, accidents, repairs, laundry, and how the home was managed.
The home was rated Good overall. Safe and Well-led were both rated Good. Staff understood safeguarding, staffing levels were considered safe, infection control arrangements were in place, and medicines were generally managed safely.
Inspectors found that daily records did not always show clearly that required observations had been completed. Some 'as required' medicine protocols did not explain what other support should be tried first. They made recommendations, but found no evidence that these issues had caused harm.
The inspection was prompted partly by notification of an incident after which a person died. The circumstances of that incident were not examined in this inspection and remained subject to further CQC investigation. The previous overall rating was Good, published on 11 December 2019.
Safeguarding
Staff received safeguarding training and understood how to report concerns. Allegations were reported promptly and lessons were shared with staff.
“Allegations of abuse were reported without delay to relevant agencies and there was good partnership working with them to make sure allegations were thoroughly investigated.” from the report
Staffing and recruitment
Recruitment checks were completed before staff started. Inspectors found staffing levels were safe and most people felt staff were available when needed.
“Staff recruitment records confirmed pre-employment and identity checks were completed before a new staff member began to support people.” from the report
Infection control
Inspectors were assured that the home used protective equipment safely and had arrangements to prevent and manage infections.
“We were assured that the provider was using PPE effectively and safely.” from the report
Improved management
The home had improved its audit, laundry and governance processes since the last inspection. Managers used meetings and supervision to address concerns and improve care.
“The provider had renewed governance processes in place which were effective and helped to hold staff to account, keep people safe, protect people's rights, and provide good quality care and support.” from the report
Daily care records
needs fixingDaily records were not always detailed enough to confirm that required observations had been completed. Inspectors made a recommendation to improve recording, although they found no evidence of harm.
“Whilst feedback and observations showed staff completing regular observations, daily records were not always detailed enough to give assurance people's safety was always monitored effectively.” from the report
As-required medicines
needs fixingSome protocols did not explain what other support should be tried before giving 'as required' medicines, including medicine used for anxiety. Inspectors found no evidence of inappropriate administration or harm.
“There was no evidence to suggest people's medicines were being given inappropriately and no evidence of harm was noted.” from the report
Safeguarding responsiveness
needs fixingOne healthcare professional said the provider was not always responsive about safeguarding concerns. Another healthcare professional described a trusting and good relationship with the manager.
“The provider is not always responsive when it comes to safeguarding concerns.” from the report
- 01How do you now make sure daily observations and care records are completed fully and accurately?
- 02What other support do staff try before giving 'as required' medicines for anxiety or distress?
- 03How quickly do you respond to safeguarding concerns, and how are families kept informed?
- 04Which Safe and Well-led improvements have been completed since this inspection?
- 05Can you explain the current ratings for Effective, Caring and Responsive, which were not inspected during this visit?
This was a focused inspection of Safe and Well-led, prompted partly by concerns about infection control and record keeping; the other key question ratings carried over from the previous comprehensive inspection. This explanation was written from the published report of 21 June 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.
What inspectors found, December 2019
Rated Good overall, but inspectors found the home was not always well-led and needed to improve audits, flooring and laundry processes.
This was an unannounced inspection over two days. Inspectors spoke with people living in the home, relatives, staff and a visiting professional. They observed care and reviewed care, medicines, staffing and management records.
The home was rated Good for Safe, Effective, Caring and Responsive. People said they felt safe, staff were kind, medicines were managed safely, and care was personalised. People also had choices about food and activities.
Well-led was rated Requires Improvement. The home’s checks had not always led to problems being fixed quickly or identified. Inspectors found issues with modified diet records, body maps for creams and medicines, flooring and missing laundry. The overall rating remained Good, but the previous Good rating for well-led had deteriorated.
Safe medicines
Medicines were managed safely, with staff training and regular checks of their competence.
“Medicines were managed safely. Staff had to undertake training before they could administer medicines” from the report
Kind and respectful staff
Inspectors saw staff treating people in a friendly, caring and respectful way. Staff knew people’s histories and preferences.
“Staff engaged with people in a friendly and caring manner. Their conversations with people were familiar and good natured.” from the report
Personalised care
Care plans included people’s preferences, lifestyles and histories. Staff knew people well and supported them in the way they wanted.
“People continued to receive personalised care that was responsive to their needs.” from the report
Activities and social life
People could choose from activities and trips, including opportunities to go into the community. Inspectors saw people taking part in meaningful activities.
“The service employed an activities co-ordinator and provided people with a choice of person-centred activities and social opportunities.” from the report
Staffing and recruitment
Inspectors saw suitable staffing levels, and recruitment checks were in place before staff started work.
“Recruitment checks were robust to ensure staff were suitable to work with vulnerable adults.” from the report
Quality checks did not always lead to action
needs fixingThe home had monitoring systems, but they did not consistently ensure that identified problems were dealt with promptly. Audits also missed some recording and modified diet issues.
“Improvement was required to ensure that these systems consistently resulted in identified issues being addressed in a timely manner” from the report
Modified diet records
needs fixingSome people on modified diets did not have records showing what they had eaten, unless they were already at risk of malnutrition. Food charts were introduced during the inspection.
“Those people on modified diets who were not at risk of malnutrition did not have any documentation to evidence what foods they had consumed.” from the report
Maintenance and flooring
needs fixingThe home needed refurbishment and some flooring needed replacing. This had already been identified in audits, but the work had not been completed by the inspection.
“Action is yet to be completed regarding the replacement flooring.” from the report
Missing laundry
needs fixingPeople and relatives said clothes were regularly misplaced or missing. The provider said action was in progress to improve the laundry process.
“People and relatives told us the laundry process required improving as people had clothing items misplaced or missing on a regular basis.” from the report
Incomplete body maps
needs fixingA couple of body maps linked to the application of creams were incomplete. Medicine audits had not identified this.
“We also found a couple of body maps were not completed in relation to the administration of people's creams” from the report
- 01What has been done to make quality checks identify and resolve problems more quickly?
- 02How are you now recording food eaten by everyone who has a modified diet?
- 03How are body maps for creams and medicines checked and kept complete?
- 04Has the flooring been replaced, and what refurbishment work is still outstanding?
- 05What changes have been made to prevent residents’ clothes from being lost or misplaced?
This was an unannounced planned inspection covering all five CQC questions, with the four Good ratings carried over from the previous inspection and well-led changing to Requires Improvement. This explanation was written from the published report of 12 December 2019 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 Grange
4 rated inspections over 7 years: the service has improved, from Requires improvement to Good.
- June 2023Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2019Goodstayed GoodSafe: GoodWell-led: Requires improvement
- June 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- January 2014
Report published without a new overall rating.
- November 2013
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- January 2012
Report published without a new overall rating.
- July 2011
Registered with the Care Quality Commission on 26 July 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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At least 100 live-in carers within about an hour of Wigan
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. 92 can care for a couple. 11 years' experience on average.
“Primrose is a very kind and compassionate healthcare professional”
“He developed a close affinity with Terence, spending time talking with him before he retired to bed and looking after his needs during the night.”
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.