The inspection visit at The Alexandra Nursing Home was undertaken on 30, 31 October and 02 November 2018.

The home provides residential and nursing care for up to 112 people. The service has three units one with a separate dementia unit which is purpose built. This building adjoins the main home and provides dedicated care for people with a specified dementia condition. At the time of the inspection visit there were 91 people who lived at the home.

A registered manager was 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.

The Alexandra is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

At the last inspection in October 2017 we rated the service as ‘Requires Improvement’. This was because recommendations were found. These related to care plan records and medication processes. Furthermore, the management team failed to properly assess the quality assurance of the service provided. We made a recommendation to improve quality assurance systems.

During this inspection, we found the management team had made improvements to recommendations from the previous inspection CQC made in terms of medication processes and quality assurance systems. However further improvements were required in recording of people’s care documentation in order to make them person centred and accurate. We made recommendations to ensure the safety of people was maintained.

We made a recommendation the provider seeks guidance about care planning.

We spoke with people who lived at The Alexandra and relatives. Comments were positive in relation to care and support provided by the staff team. One person who lived at the home said, “A very good home with excellent staff.” A relative said, “Always made welcome and offered a tea or coffee. It is very homely.”

We observed staff interacted respectfully with people in ways that demonstrated they knew how best to support them. For example a person who lived at the home said, “I am treated with respect and they know what I need to make me happy.”

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.

Staff had been appropriately recruited, trained and supported. They had skills, knowledge and experience required to support people who lived with dementia and care for people with nursing needs.

We observed staff administered medication with a skilled and secure approach, which the registered manager strengthened through training and competency checks. They had good oversight of relevant procedures through regular auditing to ensure they remained safe.

Care records included an assessment of the level of risk and actions to guide staff to manage people’s safety. The registered manager retained an accident record and analysed patterns to assess control measures reduced the risk of incidents.

Those who lived at The Alexandra and their relatives told us staff were skilled and experienced. One person who lived at the home said, “The staff are well trained.”

We saw staff supported people with their meals sensitively and respected their dignity. They also checked they had enough to eat and what assistance they desired. Comments were positive and one person said, “Loads of choice and we have very good cooks here, nothing wrong with the food at all.”

People were supported to have maximum choice and control

This inspection visit took place on 22 and 24 August 2017 and was unannounced.

At the last inspection in July 2015 the service was rated Good. At this inspection we found the service Required Improvement.

The Alexandra Nursing Home is a listed building and stands in its own grounds on the outskirts of Poulton-le-Fylde. The service has their own car parking facility within the grounds. The service has three separate units that provide nursing care and support for people who live with dementia. There is lift access to the two floors in the main building. Alexandra Nursing Home is registered to provide care for 117 people.

During this inspection we made recommendations for the management team to improve people’s safety and welfare. These issues related to safe medication recordkeeping, care plan information for people who lived at the home and recruitment procedures. In addition we recommended the management team continued to develop their quality assurance systems to ensure the home was continuously monitored.

When we undertook our inspection visit the manager had applied to be registered with the Care Quality Commission. 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 manager informed us the process was ongoing and the registration team at CQC was processing the application. The manager is already a registered manager with another location within the organisation.

We found medication procedures at the home were not consistently safe. However the new management team was in the process of implementing more robust systems in relation to medication procedures. Medicines were safely kept with appropriate arrangements for storing in place. However recording systems required improvement to ensure people received their medication correctly and on time.

We have made a recommendation about safe medicine procedures.

Care plans had changed and were altered by staff. However they were not identified as to who changed and updated the care plan. This could cause concerns if problems occurred in a person’s care and the management team were unable to identify the staff who changed the caring support. Although care plans were up to date we saw gaps in information which put people at risk of unsafe care. The management team had started to implement new care plan documents to ensure all care and nursing information was in place for staff to support people with their assessed needs as required.

We have made a recommendation about record keeping.

Recruitment procedures required improvement and this had been identified by the management team and additional administration staff were now in place. However one record had not explored gaps in employment and two records did not contain photographs of the new staff member. These checks were required to reduce the risk of employing unsuitable staff to work with vulnerable people.

We have made a recommendation about recruitment.

New auditing systems had recently been introduced and improved. However audits had not identified issues that had we had highlighted during this inspection visit. For example care plan audits did not always identify any mistakes and ensure people who lived at the home were kept safe.

We have made a recommendation about efficient monitoring and quality assurance systems.

Staff told us the management team were supportive in their work and approachable should they wish to discuss any issues. They felt part of the team to improve the home for people who lived at the Alexandra Nursing Home.

Staff spoken with had received safeguarding training and understood their responsibility to report unsafe care or abusive practices.

We looked around the building and found it had been m

The inspection visit took place on 08 July 2015 and was unannounced.

The Alexandra Nursing Home is a listed building and stands in its own grounds on the outskirts of Poulton-le-Fylde. The service has their own car parking facility within the grounds. The service provides nursing care for up to seventy-seven people. The service has a separate dementia unit that is purpose built. This building adjoins the main home and provides dedicated care for people living with dementia. There is lift access to the two floors.

There was a registered manager 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.

At the last inspection on 27 November 2013 the service was meeting the requirements of the regulations that were inspected at that time.

People who lived at the home and relatives told us they felt safe because there were sufficient staff on duty to meet their needs. We found people’s care and support needs had been assessed before they moved into the home with risk assessments in place to ensure peoples safety. Care records we looked at contained details of people’s preferences, interests, likes and dislikes.

We observed medication being dispensed and administered in a safe manner. We looked at how medicines were managed and found appropriate arrangements for their recording and safe administration.

People were happy with the variety and choice of meals available to them. Regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration. The cook had information about people’s dietary needs and these were being met. One person who lived at the home said, “There is a pleasant atmosphere and the food is always good.”

Staff we spoke with had a good understanding of how people should be treated in terms of respect and dignity. During our observations we saw examples of staff being respectful, caring and sensitive towards people who lived at the home.

We found examples where the service had responded to changes in people’s care needs. We found evidence in records where referrals had been made to external professionals. Records were up to date and reviewed providing information for staff to deliver quality care.

People who lived at the home were encouraged and supported to maintain relationships with their friends and family members. Relatives we spoke with told us they were always made welcome at any time.

We found a number of audits were in place to monitor quality assurance. Records demonstrated identified issues were acted upon in order to make improvements. The registered manager had systems in place to obtain the views of relatives and people who lived at the home.

On the day of our visit we spoke with the deputy manager, staff, relatives and residents. We also had responses from external agencies including social services .This helped us to gain a balanced overview of what people experienced living at Alexandra Nursing Home.

During the inspection we looked at meal preparation, care planning, recruitment and staff induction training records. We also observed care practices during the day and talked with residents and relatives about the home.

We were supported on this inspection by an ‘expert by experience’. This is a person who has personal experience of using or caring for someone who uses this type of care service.

The expert by experience spoke with a number of people. Comments received were positive about the care being provided. They included, “The staff are very nice and helpful.” Also, “The staff are lovely.”

People who lived at the home told us they could express their views and were involved in making decisions about their care. One resident said, “The staff are fantastic and always listen to what I have to say.” Residents were positive about the food provided at the home. One person said, “The food is very good we have excellent cooks.”

We observed the staff team providing sensitive and flexible personal care support. Staff were kind and patient and showed a good understanding of the needs of people in their care.

There were a range of audits and systems in place to monitor the quality of the Home.

This is a large home which is divided into two separate units. One unit is for people who have a dementia condition. The other unit is for residential and nursing residents. We spent time in both units in order to have an overview of the service in general.

We spoke with a range of people about the home. They included the manager, deputy manager, nurses, staff members, relatives and people who lived at the home. We also asked for the views of external agencies in order to gain a balanced overview of what people experienced living at the Alexandra Nursing Home.

We observed staff assisting people who required care and support with personal care. Staff treated people with respect and ensured their privacy when supporting them. They provided support or attention as people requested it. Comments from residents included, “It’s a big home but the staff are really good. They are kind and do a fantastic job.” Also, “Plenty of people around which I like. They are polite and nothing is too much trouble.” Relatives comments about the care provided included, “The manager and staff do a wonderful job, the best care home around. “ Also, “They keep us informed all the time about mums care.”

People we spoke with told us they could express their views and were involved in decision making about their care. One resident said, “We looked at a few homes but this was by far the best."

This is a large home which is divided into two separate units. We spent time equally in each unit in order to gain an overview of the service in general.

We found people we spoke to were very welcoming, this included residents, staff and visitors. We also spoke to the registered manager and had a brief discussion with the registered provider.

People we spoke to told us they like living there, comments included, "Oh yes everybody is very helpful,” and, “It’s a busy home there’s always something going on.” Also, “It’s going to get busy, always does at Christmas.”

In addition to gaining the views and comments of people experiencing the service, we asked other external agencies including social services contracts team. They told us there has been some involvement with the service and the manager worked closely with social services to address some concerns raised. The infection control practitioner told us the home is compliant with their standards.

We spoke to a range of staff working in the home and they all demonstrated an awareness of individual care/nursing needs of people living there, and the importance of treating people with respect and dignity. A relative told us, "Staff are very kind, they are always respectful.”

All the staff we spoke to told us this is a good care home to work for and staff felt supported in carrying out their roles. One staff member said, "The manager is supportive and is always around.” Also, "We work really well as a team.”