Alexandra Park

Updated 5 October 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 undertaken by 3 inspectors including a medicines inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. We also sought advice from a CQC registration inspector.

Service and service type

Alexandra Park currently provides two types of care provision. 5 people received care and support in a ‘supported living’ setting, so they could live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

3 people were supported with both accommodation and personal care under 1 contractual agreement. Nursing care was not provided. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was no registered manager in post. A new manager was in place who was in the process of registering with CQC to become registered manager for the service.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 23 May 2023 and ended on 23 June 2023. We visited Alexandra Park on 23 May 2023 and 25 May 2023. We reviewed evidence which the management team sent us electronically between the 25 May 2023 – 23 June 2023.

What we did before the inspection

The provider completed a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service and liaised with the local safeguarding adults team. We used all this information to plan our inspection.

During the inspection

We spoke with people who used the service on the days we visited Alexandra Park. The Expert by Experience spoke with 3 relatives by phone. We spoke with the regional operations director, area manager, manager, estates manager, team leaders, support workers and administrator. We reviewed a range of records relating to people, staff and the management of the service. We received feedback about the service from 3 health and social care professionals.

Updated 5 October 2023

Alexandra Park is a campus style service supporting people with autism and a learning disability. People live in bungalows situated in extensive grounds. Alexandra Park is both a ‘care home’ providing people with both accommodation and personal care and an independent supported living service, where people rent their bungalows from a separate landlord and only receive personal care from the staff at Alexandra Park.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

The service is registered to support a maximum of 32 people. At the time of the inspection, 8 people were supported under the CQC regulated service. 3 people used the ‘care home’ model of care and 5 people were supported under the independent supported living service.

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

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.

Right Support:

Staff followed effective processes to assess and provide the support people needed to take their medicines safely. However, further improvements were needed in relation to medicines records which weren’t always completed correctly. The service ensured people’s behaviour was not controlled by excessive and inappropriate use of medicines. Staff understood and implemented the principles of STOMP (stopping over-medication of people with a learning disability, autism or both) and ensured that people’s medicines were reviewed by prescribers in line with these principles.

An effective system to ensure safeguarding allegations were appropriately managed and monitored was not fully in place. Staff however, did not raise any safeguarding concerns. They spoke positively about people’s care and support. Relatives also considered their family members were safe at Alexandra Park.

Whilst accidents and incidents were recorded individually; these were not all recorded centrally to ensure management oversight and identify if there were any themes and trends, so action could be taken to help prevent any reoccurrence.

An effective system to ensure the principles of the MCA were followed was not in place. Records did not fully evidence that any decisions/restrictions made in people’s best interests had been assessed in line with the MCA and the appropriate individuals involved.

People were supported to eat and drink enough to meet their needs. Where concerns were identified with people’s weight, referrals were made to the dietitian and their weight was monitored. The monitoring of people’s weights was sometimes inconsistent, and a recognised nutritional risk assessment tool was not used. We have made a recommendation about his.

Right Care:

There were enough staff deployed to meet people’s needs. Work was ongoing to ensure people were supported by a consistent staff team.

Records did not always evidence how people were involved in their care, especially those people who were unable to communicate verbally. Relatives spoke positively about how people’s ‘core team’ of staff supported people and promoted their independence. One relative said, “They are very caring, they go out of their way to support them, even when we’re there, they are not bothered about us, they want to be with their carers. If the carers go, they’ll hang onto them.”

Whilst the ‘campus style’ setting did not align with current best practice; the provider was introducing additional features to promote people’s independence and personalise the service. Individual post boxes were being introduced to ensure people could receive their own post; intercom/fob operated gates were being fitted to allow people independent/supported access to the local community and people’s bungalows were being refurbished to meet their individual needs. There was an on-site resource centre that was used for training, social activities and administration for the site. Plans were in place to refurbish the resource centre and outdoor space.

People were supported to maintain their hobbies and interests; however, relatives and several staff said there was sometimes a lack of staff on duty who could drive people’s mobility cars or the company vehicles. This meant that people were not always able to access the local community in line with their needs and wishes. Following our inspection, the manager wrote to us and explained there were now 5 additional drivers onsite and 3 members of staff who were due to start work and were also drivers. In addition, 2 new company vehicles had been purchased.

Staff gave examples of how being at Alexandra Park, with the support of staff, had led to an improvement in people's independence and wellbeing.

Right Culture:

An effective quality monitoring system was still not fully in place. We identified shortfalls relating to the management of medicines, the assessment of risk including infection control, records relating to people’s involvement and the MCA. Relatives told us that further improvement with communication was required. They explained the frequent changes in management staff and structure had affected communication. They also said communication was not always timely.

There was a cheerful atmosphere at Alexandra Park. Staff spoke positively about the people they supported and working at Alexandra Park. One staff member told us, “I am happy to come to work now, I can't wait to see people. The [previous] manager’s office was out of bounds – but not now.”

Management staff were honest and open with us during the inspection. They themselves exhibited caring values and spoke positively about the changes and improvements which were being made.

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 19 September 2022.) There were multiple breaches of the regulations relating to staffing levels and staff training, medicines management, infection control, person centred care and the overall management of the service.

This service has been in Special Measures since 19 September 2022. During this inspection the provider demonstrated improvements had been made; however, further improvements were required. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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 and Recommendations

We have identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 during this inspection. These related to good governance and the need for consent. We also identified a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 (notification of other incidents).

Please see the action we have told the provider to take at the end of this report. Full information about CQC's regulatory response in relation to Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 (notification of other incidents) and CQC’s response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

We have made a recommendation in the effective key question in relation to the assessment of nutritional risk. Please see this section for further details

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety.

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.