This inspection took place on 14 and 15 January 2019 and was unannounced. This means the provider was not aware we were visiting the service to carry out an inspection. We also telephoned health and social care professionals and relatives of people who used the service during the week commencing 21 January 2019. A previous inspection of the services, undertaken in September 2017, rated the services as requires improvement overall but did not identify any breaches of regulations.

Alexandra Park is registered for both personal care and accommodation for those requiring nursing or personal care. The service consists of a number of individual bungalows on a campus style site. Some people receive accommodation and personal care as single package under one contractual agreement. Where this happens CQC regulates both the premises and the care provided, and both were looked at during this inspection for these people. The service also provides care and support to people living in ‘supported living’ settings, so that they can live as independently as possible. In supported living 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. At the time of the inspection there were 22 people using the service. Seven people were receiving accommodation and personal care under a single package and 15 people were receiving personal care and support through a supported living arrangement.

Although the service was delivered from a campus style site, separated from the local community, the care service and its managers had an awareness of the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service were supported to live as ordinary a life as any citizen.” Registering the Right Support CQC policy.

At the last inspection we had recommended that the provider improved documentation, particularly in relation to risk. At this inspection we found records relating to both risk and care remained complex, difficult to follow and were not always complete. Risks with regard to the equipment and physical environment of the service were monitored and appropriate safety certificates were forwarded to us. The provider had a safeguarding policy in place and any issues had been investigated and dealt with appropriately. The service had in place contingency plans to support people in the event of emergencies.

Medicines were not always managed effectively or safely. Care records did not always indicate how staff should support people with medicines and there was limited information about how people should be supported with creams. Management and administration of medicines was not always carried out in line with NICE guidelines.

Accidents and incidents were appropriately recorded and reviews took place to consider how best to manage any future matters. The service considered how the provision of care could be changed or improved in light of events or recommendations.

People and staff told us sufficient staff were employed to support people’s personal care needs. Care was delivered to individuals by a small number of care staff in individual bungalows. Staff and people told us having a consistent support team was important. Appropriate recruitment systems were followed to ensure properly experienced and qualified staff were employed.

Systems regarding staff training were not robust. Records presented showed training had not always been refreshed or updated in a timely manner. Systems for checking training had been completed were not actively in place. Staff told us, and records showed regular supervision and annual appraisals had not been undertaken and not been monitored.

We checked whether the service was working within the principles of the MCA, and whethe

This inspection took place on 18, 20 and 29 September 2017. The first visit was unannounced. This meant that the provider and staff did not know we would be visiting. Following the inspection visits we requested and reviewed further information from the service. We concluded these inspection activities on 11 October 2017.

Alexandra Park is registered to provide accommodation and personal care for up to 32 people with learning difficulties and mental health needs. It is comprised of 28 single occupancy bungalows and a four bedroomed house, located within extensive grounds. Support is provided over a 24 hour period by staff who are based in individual bungalows and managed from the on-site resource centre. The resource centre is also used for training, social activities and administration of the site. There were 21 people using the service at the time of the inspection.

A registered manager was 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.

We last inspected in January 2017 when we carried out an unannounced comprehensive inspection of this service. At that time we rated the service as ‘requires improvement’ and found it was in breach of five regulations. We had found people were not protected from the risk of abuse, the Mental Capacity Act 2005 (MCA) was not being followed, care was not always person-centred, people were not always treated with dignity and respect and the provider’s quality assurance system was ineffective. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. During this inspection we checked that they had followed their plan to confirm that they now met legal requirements.

The inspection was prompted in part by notification of an incident of a safeguarding nature. These incidents had been brought to the attention of the police and local authority. At the time of the inspection the police were carrying out an investigation into the incident. The information shared with CQC about the incident indicated potential concerns about how people were safeguarded from abuse. This inspection examined those concerns.

At this inspection we found the provider was no longer in breach of any regulations. The provider and registered manager had made significant improvements, but some areas for improvement remained. The rating for the service remained 'requires improvement'.

Since our last inspection the provider had strengthened their safeguarding procedures. Staff had undertaken more training focusing on people's rights, and what constitutes institutional abuse. More stringent checks were carried out of records, and support plans were reviewed to ensure they were promoting people's rights. We have recommended safeguarding training is provided to people who use the service, appropriate to their needs.

Risks were monitored and mitigating actions to reduce potential risks had been identified. Records were repetitive and risks assessed across multiple care documents. We recommend the provider reviews their records to ensure key information is consistently recorded.

The areas of good practice which we found at the last inspection had been maintained. Accidents continued to be monitored and where possible action taken to reduce future risks. There were enough staff to meet people’s needs and robust recruitment processes had been followed.

Medicines were administered safely, by staff who had undertaken training and competency assessments.

The provider had reviewed all decisions made on people's behalf to ensure they were in line with the MCA. Restrictions placed on people had also been audited and many had been reduced or removed altogethe

This inspection took place on 7, 12, 15 December 2016 and 17 and 18 January 2017. Visits on 7 December 2016 and 17 January 2017 were unannounced. This meant that the provider and staff did not know we would be visiting.

Alexandra Park is registered to provide accommodation for up to 32 people with learning difficulties and mental health needs. It is comprised of 28 single occupancy bungalows and a four bedroomed house, located within extensive grounds. Support is provided over a 24 hour period by staff who are based in individual bungalows and managed from the on-site resource centre. The resource centre is also used for training, social activities and administration of the site.

A registered manager was 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 service was last inspected in August 2015 and at that time we rated the service as ‘requires improvement’ but it was found to be meeting all legal requirements.

During this inspection we found people had not been protected from the risk of abuse and improper treatment. We found entries within two people's care records which detailed safeguarding incidents. These records had been signed by a team leader but staff had not identified the improper treatment or informed the registered manager. During our inspection two safeguarding referrals were made to the local authority who are investigating the incidents.

Accidents were monitored and reviewed by the registered manager. Action had been taken to reduce the risk of them reoccurring.

People, relatives and our observations confirmed there were enough staff to meet people’s needs. Records showed safe recruitment processes had been followed.

Staff had been trained to administer medicines and followed good practice. Before our inspection the provider had noted there had been an increase in medicine errors, but action had been taken to address this, staff were in the process of receiving additional training in this topic.

Care Quality Commission (CQC) is required by law to monitor the operations of the Mental Capacity Act 2005 (MCA), and to report on what we find. MCA is a law that protects and supports people who do not have the ability to make their own decisions and to ensure decisions are made in their ‘best interests’.

The MCA had not always been followed. Some decisions had been made on people’s behalf, however the provider could not demonstrate how the person’s capacity had been assessed or that they had considered the principles of MCA and ‘best interests’ in determining the decisions. Where capacity assessments had been undertaken these were often broad, and not decision-specific. People's care plans described their routines, and stated these plans were in people's best interests, but information had not been provided for staff about how to balance people's right to make choices with their planned routines.

Where people displayed behaviours which may challenge staff, such as anxiety or aggression, detailed care plans were in place to describe to staff how they should respond to people. However these had not always been followed. Staff had introduced new responses which were not based on an assessed need, care planned or evaluated. This meant people could be at risk of receiving inconsistent or inappropriate care.

Where restraint was practiced, additional recording was in place to monitor the use. We found two incidents where people had been restrained but these additional monitoring records had not been completed. On one of these occasions and non-approved method had been used.

Staff received training and supervision to ensure they had the skills and knowledge to meet people’s needs.

People were involved in plann

This inspection took place on 27 August and was unannounced. Further visits to the site took place on 1 and 4 September 2015 and were announced. This was the first inspection of the service under the current provider.

Alexandra Park is registered to provide accommodation for up to 32 adults and children with learning difficulties and mental health issues. It comprises 28 single occupancy bungalows and a four bedroomed house, located within extensive grounds. Support is provided over a 24 hour period by staff who are based in individual bungalows and managed from the on-site resource centre. The resource centre is also used for training, social activities and administration of the site.

The home had a registered manager who had been registered with the Care Quality Commission since February 2015. A registered manager is a person who has registered with the 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.

Staff were aware of safeguarding issues, had undertaken training in this area, including safeguarding children training, and told us they would report any concerns about potential abuse. Records showed staff were able to raise concerns and these were addressed by management. We found some minor issues in relation to the management of medicines. Some medicine records were not complete, “as required” medicines did not always have plans in place on how they should be used and there was some over stocking of medicines because effective checking systems were not in place.

People and staff told us there had been a high turnover of staff in recent months and this had caused some people to feel unsettled. The registered manager told us all shifts had been covered, although a number of staff were undertaking additional shifts at the current time. Proper recruitment procedures and checks were in place to ensure staff employed at the home had the relevant skills and experience to support people. The registered manager told us there was a need to balance new staff coming into the service with more experienced staff, to maintain the quality and continuity of care. Staff told us they had access to a range of training. Training records indicated a wide variety of training was offered and checks were made to regularly update staff skills.

People told us they were encouraged and supported to go shopping and cook their own food. They told us they could make their own choices about what they ate, although staff encouraged them to eat healthily.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005. These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. The registered manager confirmed appropriate assessments and applications had been made, where people met the criteria laid down in the DoLS guidance. Staff did not always understand the concept of best interest decisions and one staff member suggested that where a person was unable to make a decision for themselves they would contact a person's care manager for advice. Capacity assessments were not always used appropriately and it was not clear how or why best interests decisions had been taken.

People and relatives told us they were happy with the care provided. We observed staff interacted well with people and supported them appropriately. They supported people to make choices and understood about their personal and particular needs. People had access to health care clinicians such as doctors, nurses and mental health professionals, to help maintain their wellbeing. People were treated with dignity and respect and staff appreciated people’s need for privacy at times.

People had individualised care plans that were thorough, addressed their identified needs and provided good detail for care staff to follow. Some care plans were not individualised and did not reflect the personal needs of people. All people had care plans for sun care and swine flu, without any particular identified risks. Reviews of care plans were not always detailed and some consisted of a simple date and signature. The support manager demonstrated a new review system they were looking to introduce. Activities were based around people’s individual needs, such as trips out, swimming and meals at local cafes and pubs. People also told us they could socialise with their friends and often had friends round to their bungalow in the evening. One person told us he thought there should be more organised activities. There had been nine formal complaints in 2015. There was evidence that complaints had been responded to, although where investigations were on going is was not always possible to ascertain the outcome. People living at the home were able to raise concerns with the registered manager and these were addressed.

Regular checks and audits were carried out at the home. These were based around individuals and their needs. New audits had recently been introduced by the provider but an action plan had not been developed at the time. Existing audits process had not identified some of the issues we noted around medicines and the use of the MCA. Staff were positive about the leadership of the home and felt better supported by management over recent months. They felt they were able to raise issues with the management, if they had concerns.