Alexandra Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Systems to assess and monitor the quality and safety of the service were in place. Regular checks and audits ensured safety and compliance. However, these needed further development to ensure they comprehensively identified and managed risks. People were supported to access different healthcare settings where information was shared with professionals, to ensure people’s needs were met. The provider and management team had improved policy and procedures which related directly to the service, in line with current legislation. There was further work to be done in developing, improving and maintaining links with some visiting professionals and in developing the staff team as a whole. The provider employed a multi-cultural and diverse workforce, and measures were in place to ensure staff were treated fairly.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The registered manager told us how they gathered feedback from people using the service, as well as staff, relatives, and stakeholders. They used this feedback to drive improvements where it was needed. Feedback from staff was predominantly that this was a good service and was continuing to improve. One staff member, had stated they felt the service was declining, but the majority of feedback from other staff was positive about the direction of the service, in providing overall good care for people and improving culture for staff.

The provider had a clear idea of the culture they wanted to promote as well as plans for improvement. Input had been sought from people and staff for service delivery. The provider and registered manager had developed an action plan supporting their vision and addressing areas for improvement; a number of which we saw, had already been completed. They were determined to drive improvements within the service and included staff in meetings, supervision sessions and daily flash meetings to ensure directives and outcomes were clear.

People and relatives told us the registered manager was visible in the service and easy to approach. One relative shared how they felt things had improved since the new registered manager started. Feedback from staff about leaders being compassionate and competent was mixed. Several staff provided feedback which was positive. However, other staff provided feedback where they felt the registered manager's leadership style was harsh and authoritarian stating improvements were required with their communication and skills set. The registered manager understood their responsibility for reporting deaths, incidents, injuries and other matters to the relevant authorities when they affected people using the service.

There had been a change in provider and management since the last inspection. The management demonstrated a good understanding of the cultures and values of their current staff and had measures in place to support newer staff. They had an open door policy and although explained they have made some difficult decisions, they have done so to improve the culture of the team. However, it appeared the communication style of the registered manager could be misinterpreted. We saw there had been recent learning from accidents and incidents and the registered manager understood their responsibilities under duty of candour. Whilst the responsibility for managing the service was with the registered manager; additional support was available from the operations manager. We saw that the senior management had oversight of the service with an action plan, and they had taken measures to improve previous areas of concern.

Staff were aware of the providers whistle blowing policy, and the process to raise concerns. Feedback received from six staff indicated they may not always choose to speak up because they believed they would not get a positive reception from the registered manager. Other staff told us they would have the confidence to raise concerns and would raise these externally if needed. Comments included, “I would go to the person above (the registered manager) and inform them, and if they didn’t take action, I would call CQC”

The provider had a whistle blowing policy in place which supported people for when and how to speak up. We saw evidence in safeguarding referrals that people had spoken up, and action had been taken to resolve the concerns. We reviewed minutes of staff meetings and found that incidents and safeguarding issues were raised, with actions to minimise risk. The manager also sent out minutes to staff to ensure they were aware of outcomes and updates.

We saw this was a very diverse staff team, with staff from a variety of ethnic backgrounds and cultures. Similarly, with the people using the service there was some ethnic and cultural diversity which the staff team appeared to understand and support well. Systems were in place for all staff, including those less likely to speak up, via regular supervision. The registered manager commented, “ The administrator is able to translate for some overseas staff if they are struggling to express concerns.”

The provider had initiatives in place to ensure all staff were aware of the company’s values and how they could embed these into their day-to-day work. The provider had identified and taken action to address equal opportunities for staff and improve where there were any disparities in the experience of staff with protected characteristics. The provider employed a multi-cultural and diverse workforce and had robust measures in place to ensure they were treated fairly in line with their equality, diversity, and inclusion policy. They had made reasonable adjustments to support staff with protected equality characteristics to carry out their roles well. This included the provision of information, guidance, and training to staff in various ways to meet their communication and language needs.

Staff were clear about their roles and knew when and how to raise any concerns. Not all staff we spoke with, felt that management had listened to them. We had mixed feedback about this which has been reflected in other areas. Feedback from the registered manager, supported by documentary evidence was that the provider had a range of quality audits; carried out daily, weekly, monthly and quarterly. The actions identified from those audits, were then tasked to individuals to be completed, and recorded once complete.

The provider had effective systems in place overall, to monitor the quality of care being delivered. For example, there were regular audits completed such as medicines, falls and oversight of environmental areas. However, we did find they had not identified the issues we found in the sluice area during our site visit; meaning this audit was not effective – improvements were completed, immediately following our visit. Systems and processes were in place supporting management oversight. For example, we saw where they had identified where staffing levels did not fully meet people’s needs and staff were increased following this. The operational policy and ongoing management arrangements, helped to ensure the safe handling and storage of people and staffs' confidential personal information in line with national guidance and legal requirements.

People and their families told us they were supported to access external healthcare appointments and also had opportunities to be involved in community activities. Several relatives told us they felt communication between them and staff had improved with the new provider. One relative told us, “The staff team has worked really well, to help ensure we knew what was happening and targets were still being met”. However, another advised improvements were still needed, as opportunities were missed when the provider held an event for relatives and families, but they weren’t aware it was on, as it wasn’t communicated to them.

The general impression received from the registered manager was that the relationship with one specific healthcare team could at times be difficult, but that staff worked well to ensure people receive the care they needed. With regard to engaging more with people, relatives and other visitors; the registered manager had a suggestion box positioned in the entrance to allow for feedback about things which could improve the service.

There had been mixed feedback from professionals; some agreed there was good collaborative working and commended their commitment to people’s safety and wellbeing. We received positive feedback from some, for example. “I have always found the staff to be helpful where they can and carry out any instructions, I have asked them to perform.” Another said, “Staff and the manager have always been always approachable and welcoming. Those we have direct contact with, have a good knowledge of residents.” However, other professionals did not agree stating, “There seems to be a lack of insight into some ongoing concerns”.

There were regular visits from the local GP service and other professionals. There was demonstrated partnership working with professionals and records of shared information. We saw the provider continued to work with the local authority and had a recent visit from them which they informed us was positive and very supportive. The provider had acknowledged there had been difficulties with some partner agencies and was working to help improve in this area.

The registered manager told us all staff were encouraged to speak up with ideas for improvement and given the opportunity to have their say. Staff confirmed they were encouraged to attend regular staff meetings to discuss what was working well and what improvements could be made. Two staff had explained about how they were working to support one person to manage and de-escalate potential trigger events, by exploring different and new ways to try to communicate. We also saw the provider was using the ‘React to Red’ series of training sessions for staff, which is a best practice training resource created by the NHS. The registered manager understood their duty of candour responsibilities by contacting relatives after any incidents, or accidents. This ensured relatives were made aware of any outcomes following such events.

A new management team had been appointed under the new provider since the last inspection. All had a good understanding of what was needed, to build on changes already made, and how to ensure these were sustained moving forward. The registered manager had systems in place to learn from incidents/accidents and had identified how to make further improvements. We reviewed a quality audit completed by stakeholders and found the registered manager had addressed a number of the identified areas. Although there was still more work to be completed, there had been significant progress made.