This unannounced inspection took place on 14, 15 and 17 January 2019. Alexander Care Centre provides care and accommodation for up to 78 people. At the time of our inspection there were 73 people living at the service, some of whom were living with dementia. Care and support is provided in a purpose built care home, across three units. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At our previous inspection on 10, 19 and 25 May 2016 we found a breach in regulation in relation to safer recruitment practices because there was a potential risk that staff employed were not suitable to work with people. We then completed a focussed inspection on 7 June 2017 to follow up on the breach of regulation and we found the service now met the legal requirements.

At this inspection we found new breaches of regulation. These were in relation to staff recruitment, levels of staffing, safeguarding records, mental capacity assessments, quality of care records and ineffective audits.

There was a new home manager who was employed at the service in October 2018. During this inspection the manager was not available as they were on extended leave. An interim manager was supporting the service and had been in post for three weeks. There was no registered manager in place at the time of the inspection. 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.

We found safer recruitment processes were not always followed. This meant there was an increased risk that unsuitable staff could be employed at the service. On the day of the inspection there were enough staff deployed in the home to meet people’s care and support needs, although one member of staff was absent. However, people and their relatives told us that there were fewer staff available at weekends.

There were systems in place for staff support. However staff records showed that they did not receive regular supervision, appraisal and training as required by the provider.

There were systems in place for monitoring, reviewing and driving improvements of the service. However, many of the actions on the improvement plan had not been implemented to improve the service.

There were established systems in place that protected people from the risk of abuse and harm. Staff completed safeguarding training, but this had not been renewed as required. Staff did not always report allegations of abuse promptly.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff understood how to support people who were unable to make decisions for themselves. People gave staff their consent to receive care and support to meet their needs.

Potential risks for people were identified and a plan was in place to monitor and manage them. Care records were person centred and considered people’s needs and care plans were regularly reviewed. People were encouraged to make choices about their care and support needs. People were supported with health care support when their needs changed.

People took part in activities and were supported to do things they enjoyed and were interested in. People were supported to maintain their religious practices as they chose.

People said staff were kind and caring and provided them with care and support that showed they were respected and promoted their dignity and privacy.

People had enough to eat and drink throughout the day. Meals were provided that met people’s needs an

Alexander Care Centre is a residential care home that provides accommodation and personal care for up to 78 older people. At the time of our inspection on 7 June 2017, 76 people were using the service.

We carried out an unannounced comprehensive inspection of Alexander Care Centre on 10, 19 and 25 May 2016 at which we found a breach of regulation. At this inspection, we found that the provider had not always followed appropriate recruitment procedures to ensure suitable staff were employed.

Due to the breach of regulation, we issued a requirement notice where the provider and the registered manager were required to take action to ensure they met our regulation.

We undertook a focused inspection on 7 June 2017 to check that the service now met the legal requirements. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Alexander Care Centre’ on our website at www.cqc.org.uk.

At this inspection, we found the registered manager and provider had addressed the breach of Regulation 12 HSCA RA Regulations 2014 in relation to safe care and treatment. People received care and support from staff who were vetted as suitable to provide care.

Prior to the inspection CQC had been informed of concerns about staffing levels and arrangements at the service. This was reported to other agencies at the time of the inspection. We reviewed the staffing levels and were confident there were sufficient numbers of staff deployed to support people and meet their needs safely.

This inspection took place on 10, 19 and 25 May 2016 and was unannounced. Alexander Care Centre provides care and accommodation for up to 78 older people, some of whom have dementia. At the time of our inspection there were 75 people living at the home. The accommodation was split into three units, two of which provide nursing care. The building was accessible throughout to people with restricted mobility.

A new manager has been working in the home since April 2016 and her assessment to be registered as the manager with the Care Quality Commission is underway. 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 home had a comprehensive inspection in August 2014. We found the regulations we inspected were met and we gave the home an overall rating of good. In February 2016 we carried out a responsive inspection to look at weekend staffing levels and we found that improvements were required in that area. At this inspection we found the provider had taken action to ensure there were enough staff on duty at all times, with the correct skills to look after people and meet their needs.

We found one breach of regulation at this inspection. The provider had not always followed safe recruitment practices so there was a risk that staff employed were not suitable to work with people.

People were protected from abuse as staff were knowledgeable about the signs it might have taken place. They know how to report it so it could be investigated properly. When people were at risk of harm, for example of falling or of developing pressure sores staff carried out risk assessments to make sure the risk was managed. This helped to keep people safe. There were good arrangements for dealing with emergencies.

Staff gave people their medicines when they needed them and made accurate records to confirm they had done so.

Staff had training and support to carry out their jobs. People were cared for in line with the requirements of the Mental Capacity Act 2005. They were not deprived of their liberty unless this was properly authorised under the Deprivation of Liberty Safeguards.

People had enough to eat and drink. When people needed specialised diet to keep them safe from choking this was provided. People saw a range of health care professionals to make sure their needs were met and staff had specialist advice to give them good care.

People’s dignity and privacy was protected and staff gave them warm and compassionate care. Care took into account people’s individual needs and they or their representatives contributed to care planning.

People and their relatives knew how to complain. Investigations were through and when necessary led to changes being made. People and their family members had the opportunity to give their views about the home at meetings.

The recent management changes were welcomed by people and staff and improvements had been introduced. There were management and audit processes to check the quality of the care given.

Alexander Care Centre provides care and accommodation for up to 78 older people, some of whom have dementia. At the time of our inspection there were 75 people living at the home. The accommodation was split into three units. Two of the units provided nursing care. The building was accessible throughout to people with restricted mobility.

The service was last inspected in August 2014 when all regulations were met and we gave it an overall rating of good. In early February 2016 we received concerns about staffing levels at weekends. We undertook a focused inspection at a weekend to look into these concerns. This report covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Alexander Care Centre on our website at www.cqc.org.uk

The service does not have a registered manager. 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.’

People were not always cared for by sufficient numbers of staff with the appropriate skills to meet their needs and to keep them safe. On one occasion two staff had to work for 24 hours to cover gaps in the rota. On another day there was only one nurse available to provide nursing care for 40 people.

You can see what action we told the provider to take at the back of the full version of the report

During our visit to the service we spoke with people who lived on each unit in the service. We spoke with eight relatives, four health and social care professionals and a religious minister. We examined care plans for six people. We spoke with seven members of staff on duty who were providing care to people. We also spoke with managers from the provider organisation.

People who used the service told us that they are pleased with the service they received and had no issues of concern. One person said “I am looked after very well and from what I can see it is managed well too.” Another person described the service as “very good”. Another person said “I feel so much better since I moved here, I couldn’t get better care anywhere, and nothing is too much trouble”.People said they got on well with staff and found them responsive when they asked for assistance. They also said they were cheerful, polite and respectful.

A visitor told us that they were pleased with the care their relative was receiving; they said “the care is excellent here and staff really care about the people living in the home”. Another visiting relative told us “staff are kind and considerate; they do everything possible to make things better for my relative”. People told us that they felt well informed about their relatives' care and welfare.

Professionals gave positive feedback about the service and said the staff sought and acted on specialist advice.

At the time of our inspection, there were 75 people using the service. People in the Willow View and Tower View units were not able to communicate with us because they had complex needs, so we observed how they were being cared for. We spoke with a relative of one person. We also spoke with four people in the Garden View unit, who were able to communicate with us. One person told us, "They look after me well here, but I have some medical conditions. I have seen the doctor when he has come in."

People told us and our observations found that their immediate needs were well attended to. People were treated with care and consideration. However we observed that some staff were more focussed on completing tasks for people, rather than acknowledging and engaging with people. One person mentioned to us that staff seemed 'in a rush'.

There were appropriate recruitment arrangements in place, and staff with suitable knowledge and experience were employed in the service. Staff and people using the service felt there were enough staff available.

There were suitable arrangements in place which ensured the safe management of medicines, that people were protected from abuse or neglect, and the quality of services were monitored on an ongoing basis.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

Alexander Care Centre provides personal care and accommodation for up to 78 older people, some of whom have dementia. At the time of our inspection there were 76 people living at the home. The accommodation was split into three units. The building was accessible throughout to people with restricted mobility and a car park was available.

Our inspection visits on 12, 14 and 18 August 2014 were unannounced. When we last inspected the home on 16 April 2013 the regulations we inspected were being met.

There was a registered manager at the service. 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.

People living at the home and their relatives said they felt they were safe there. Staff were aware of signs that might indicate someone was at risk of harm and knew the action to take in such circumstances.

Staffing levels were set according to people’s needs. Staff were trained and supported to care for people well. They worked alongside health professionals and were aware of when specialist attention was necessary and who to contact to ensure people got the support they required.

People were treated with respect and warmth and their individual needs were considered and met.

The quality of the service was assessed by the registered manager and the provider so they could identify any improvements that were necessary. The views of people and their relatives were requested and listened to.