We carried out an inspection of Alexandra Villa on 21 December 2015 and 8 January 2016. The first day of the inspection was unannounced. We last inspected Alexandra Villa in September 2013. At that inspection we found the service was meeting the legal requirements in force at that time.
Alexandra Villa is a two bed care home that provides care and support to people with learning disabilities. Nursing care is not provided. At the time of the inspection there was one person accommodated there, with a second person accommodated on an emergency basis for one night at the time of our second visit.
The service did not have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.
The person living at Alexandra Villas told us they felt safe and were well cared for, although they wanted to move to a more independent setting. Staff knew about safeguarding vulnerable adults and to report concerns to a designated person within the organisation.
The home was domestic in scale and design. It was adequately decorated and maintained, but fire safety issues identified during August 2015 remained outstanding.
At the time of our inspection, the levels of staff on duty were sufficient to ensure safe care. However, because there were only two staff employed there this meant they worked three days on and three off over a continual basis; including sleep-ins. One staff member was working elsewhere, meaning there was one permanent member of staff. New staff were subject to thorough recruitment checks.
Medicines were managed safely with records completed correctly.
As Alexandra Villa is registered as a care home, CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found the overseeing line manager was familiar with the processes involved in the application for a DoLS, although we were told this was not required. Attempts by a staff member to impose restrictions on specific occasions had resulted in escalations in behaviour that challenged the service. Learning from these incidents appeared limited. Financial restrictions were subject to arrangements previously agreed with the Court of Protection.
The permanent worker had received no training since their recruitment in May 2015. Importantly, training on adult safeguarding, behaviour management, other care related topics and training on the Mental Capacity Act and DoLS had not been undertaken. They received supervision and support from a visiting line manager.
Staff kept nutritional records and helped support the person’s health needs, working with external professionals where necessary. This ensured the person’s medical needs were met.
Activities were arranged in the community, including volunteering and leisure activities which were regularly accessed. We observed staff interacting positively with the person living at Alexandra Villas. We saw staff were respectful and ensured privacy and dignity was maintained. The staff member was able to explain the person’s needs and we saw care plans were person centred.
We found there were systems to assess and monitor the safety and quality of the service, which included feedback from the person receiving care. These required refinement to make them more effective and for reflection and learning from incidents to take place. There was no registered manager in post. We had not been notified of changes in management when the previous registered manager left this post and then later left the organisation.
We made a recommendation about staffing deployment.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to relating to safety, consent, staff training and governance. You can see what action we told the provider to take at the back of the full version of this report.