Alexandra Court is an unusual establishment in that it is a care home for older people, providing single apartments with lounges and kitchens for each person. There are a several communal areas for people to make use of including spacious lounges, dining room, gardens and a large conservatory. The service provides personal care and support for people with a wide range of needs and abilities on a 24-hour basis, including waking watch care throughout the night. The home is registered to provide accommodation for a maximum of 37 people. At the time of our inspection 34 people were living at the home.

At the last inspection, the service was rated good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Alexandra Court is a 'care home.' 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, both of which we looked at during this inspection.

A registered manager was in place. 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 received consistently positive feedback about how caring the service was and how staff went over and above expectations to make sure people were at the centre of how the service was delivered.

We saw there was an emphasis on promoting dignity, respect and independence for people supported by the service. People were treated as individuals and received care that was centred on their individual and collective needs, abilities and wishes.

People who lived at the home told us they enjoyed a variety of activities and trips out which were organised for their entertainment. The service supported people to continue their involvement in groups and activities in the wider community. The service recognised people’s interests, talents and skills and provided an environment where they were fostered and celebrated their successes and triumphs.

People who lived at the home told us they were happy, felt safe and were treated with kindness at all times.

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.

People’s care and support had been planned with them or, where appropriate, others acting on their behalf. They had been consulted and listened to about how their care would be delivered.

Care plans were detailed, organised and had identified care and support people required. We found they were informative about care people had received.

The service had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

Staff had been recruited safely, appropriately trained and supported. They had skills, knowledge and experience required to support people with their care and social needs.

Staff responsible for assisting people with their medicines had received training to ensure they had the competency and skills required. Where people chose to manage their own medicines, they were supported to do so.

We looked a

We carried out an unannounced comprehensive inspection of this service in December 2015, at which we identified a breach of Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations (Safe care and treatment.) We identified that medicines were not managed safely. We found one person’s medicines were not available and medicine administration records were not always accurate. Procedures for managing controlled drugs were not adhered to.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of regulation. We carried out this unannounced focused inspection on the 09 June 2017 to check they had followed their plan and to confirm they now met legal requirements. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘ ‘Alexandra Court – Cleveleys’ on our website at www.cqc.org.uk'.

Alexandra Court is registered to accommodate up to thirty seven people with personal care needs. At the time of the inspection there were thirty five people who lived at the home. Alexandra Court provides independence and privacy in individual apartments. Each apartment has its own lounge, kitchenette, bathroom and bedroom. Accommodation is provided over two floors, with a stair lift providing access to the first floor. There are a range of communal rooms, comprising of a lounge, a dining room and a conservatory. There are garden areas with seating for people to use during the summer months. Car parking is available at the home.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At our focused inspection on the 09 June 2017, we found improvements had been made. We found medicines were managed safely. We saw records related to medicines were accurate and people told us they received their medicines as prescribed.

At this inspection we only reviewed medicines to ensure improvements had been made. We did not review all aspects of the safe domain and therefore the rating will not be changed until our next planned comprehensive inspection.

This inspection was undertaken to review improvements the provider had made following the previous inspection undertaken on 23rd October 2013. During that inspection the provider had been assessed as being non-compliant in the following area. Records. This was because people were not fully protected against the risks of unsafe care, because records in relation to their care needs were not always accurate. By not complying with regulation 20 (1)(a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2009 meant the provider was in breach of that regulation.

The provider responded by sending the Care quality commission (CQC) an action plan of how they would address the findings from the previous inspection.

We spoke with the deputy manager and a staff member. They told us all care planning records had been reviewed. This included evidence of procedures being followed, monitored and reviewed.

In order to demonstrate improvements the provider showed us records where care treatment and support was being reported, updated and acted upon accordingly.

We spoke with five residents and two relatives during our inspection. Everyone we spoke with was very complimentary about the service provided at Alexandra Court and expressed satisfaction with all aspects of life at the home. People’s comments included:

‘’I’m glad I am here it’s lovely!’’

‘’I like having my own front door.‘’

‘’I feel very lucky to be here. I am treated very well.’’

At the time of our visit, there were a number of visitors who had attended to celebrate a resident’s birthday. People were enjoying a sociable glass of sherry and some snacks. One of the visitors commented, ‘’This is a lovely place. Well let’s put it this way, I will be putting my name down in a few years’ time!’’

Other residents were preparing for a trip out to Blackpool Illuminations and were clearly looking forward to it. One resident commented, ‘’I am especially looking forward to the fish and chips.’’

During the inspection, we looked at standards in relation to the involvement, care and welfare of people who used the service. We also examined arrangements for safeguarding people from abuse. We assessed processes for training and supporting staff and how the provider monitored standards within the home. We did not identify any concerns with these areas.

However, we did identify some concerns in relation to the area of record keeping. We have asked the manager to take action in response to our concerns and will carry out further work to ensure this is addressed.

People told us what it was like to live at Alexandra Court and described how they were treated by staff and their involvement in making choices and decisions about their care. People also told us about the quality and choice of food and drink available and how they made their views known about the quality of care delivered. This was because the inspection focused on these important topics along with the management of medicines within the home.

During the course of the visit we spoke individually with five people living at Alexandra Court and briefly with another person and her visitor. We also spoke with the registered manage, deputy manager, the cook, and two members of the care staff team.

People told us they were happy living there and that staff were always kind, polite and respectful. Staff spoke in a friendly way and there was a relaxed and comfortable atmosphere. One person told us that the staff were, “Marvellous” whilst another person said, “The staff always stand and listen to you, I think we have a marvellous bunch of girls, I have no grumbles at all”.

Another person said that staff respected what people were saying and gave a good example of when she had refused something that staff suggested she may need. We were also told that the meals served were well cooked with plenty of variety with one person saying, “Meals, that the main thing. I eat everything”.

When we arrived at the home the residents were having a clothes buying party. Residents were laughing and joking with each other and staff and appeared to be enjoying themselves. One resident wanted to try on some clothes to see if they suited and we observed a staff member offer to escort her to her room to assist her.

We were able to speak to a number of residents during our visit and received some very positive feedback. People told us that they were happy living at Alexandra Court and spoke highly of staff and the manager.

One resident commented ‘’I can’t think of anywhere they do it better than here – they would be hard pressed to beat this place.’’ Another said ‘’I have the best of both worlds, I have my independence, my own little place with my own front door but help when I need it.’’

People told us that carers treated them with kindness and respect and said they were confident that they were well cared for. People also felt that they were supported to access healthcare when they needed it or other specialist services. One resident who was fairly new to the home told us that the manager had supported her to access local physiotherapy services in the community.

Most residents told us that the quality and variety of food was of very good standards at the home. People said there was a good choice available and that food was well prepared and appetising. One resident said ‘’The food is too good here! It’s doing nothing for my figure!’’

During our visit we observed staff speaking with individual residents about menu choices. A resident told us ''They come round and ask you what you want, but you can change your mind afterwards, its no problem.’’

One resident did mention that she sometimes did not like the way the vegetables were cooked at the home but did say she thought it was ‘just her preference.’

Some people that we spoke with told us that they felt the home could improve by providing more activities. One person commented ‘’Some days there isn’t much going on.’’ Another person said ‘’It’s a little bit quiet sometimes.’’

We spoke with the manager about the comments in relation to activities. She told us that she was aware of this issue and that residents had expressed these views to her previously. As a result, she had negotiated some additional funding to employ an activities coordinator at the home and confirmed that this process was currently underway.

This inspection was carried out on the 10, 11 and 30 December 2015. The first day was unannounced.

We last carried out a full inspection of Alexandra Court in October 2013 and found improvements were required in relation to record keeping. We carried out a follow up inspection in July 2014 to check improvements had been made. We found no concerns in the regulation we looked at.

Alexandra Court is registered to accommodate up to 37 people with personal care needs. At the time of the inspection there were 36 people who lived at the home.

Alexandra Court provides independence and privacy in individual apartments. Each has its own lounge, kitchenette, bathroom and bedroom. Accommodation is provided over two floors, with a stair lift providing access to the first floor. There are a range of communal rooms, comprising of a lounge, a dining room and a conservatory. There are garden areas with seating for people to use during the summer months. Car parking is available at the home.

At the time of the inspection, the registered provider had recruited a manager who was not registered with the Care Quality Commission. The manager informed us they had started this process. 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.

There were systems in place to protect people at risk of harm and abuse. Staff were able to define abuse and the actions to take if they suspected people were being abused.

We saw appropriate recruitment checks were carried out to ensure people employed were experienced and of suitable character.

We found medicines were not always managed appropriately and safely. We found one person’s medicines were not available and medicine administration records were not always accurate. Procedures for managing controlled drugs were not adhered to. This was a breach of Regulation 12 of the Health and Social Care (Regulated Activities) Regulations 2014 (Safe care and treatment.) You can see what action we have taken at the back of the main version of the report.

Staff knew the likes and dislikes of people who lived at the home and delivered care and support in accordance with people’s expressed wishes. During the inspection we saw independence was promoted wherever possible. We saw people were supported to mobilise and engage in an organised activity with patience and understanding.

Processes were in place to ensure people’s freedom was not inappropriately restricted and staff told us they would report any concerns regarding unauthorised restrictions to the manager.

People told us they liked the food provided at Alexandra Court and we saw people were supported to eat and drink adequately to meet their preferences. There was a varied menu in place with alternatives available.

People were referred to other health professionals for further advice and support when assessed needs indicated this was appropriate.

There were sufficient staff to meet people’s needs. Staff received regular supervision to ensure training needs were identified and received appropriate training to enable them to meet peoples’ needs.

We saw staff were caring. We observed staff spending time with people and taking an interest in their lives and things that were important to them. People told us staff were respectful and involved them in their care.

There were a range of activities for people to participate in. People told us they were asked to join in activities such as musical events, and arts and crafts. People told us they were happy with the activities provision at Alexandra Court.

There was a complaints policy in place, which was understood by staff. People told us they were confident any complaints would be addressed.

The manager monitored the quality of service by carrying out checks on the medicines and records. There was a quality assurance team in place to support the manager.

People who lived at the home were offered the opportunity to participate in an annual survey and meetings were held to capture their views.