Alexandra Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

People's needs were assessed, and care and support were delivered in line with current standards to achieve effective outcomes. People’s healthcare needs were documented. Staff worked in partnership to keep people healthy and support them to receive good quality care. People had consented to their care and treatment.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People had care plans in place which reflected their individual health and social care needs. People felt staff understood their needs well and relatives were happy with the care they received. Where one relative told us that they were not always consulted in their relative’s care plan, others had indicated they were involved during assessment and reviews. Some people needed support to move or rise from a seated position and we saw equipment was used to support people safely and this was in line with their risk assessment and care plan.

Staff knew the people well and were able to describe their current needs, and how to support them accordingly. One staff told us, “I always read care plans and risks assessment as this will guide me in delivering quality care”. The registered manager explained how assessments were completed stating, “Care plans are reviewed on a monthly basis; using ‘Resident of the Day’ arrangement, when all departments check with the person, to see if there are any improvements they need to make.”

People’s needs were assessed using a range of assessment tools to ensure their needs were identified and understood. Records held up to date information on people's needs and preferences. Risk assessments recorded how staff should assist people, and we saw these were regularly updated when things changed. People’s care plans were reflective of recognised care guidance, best practice and showed people's involvement, including in their regular review.

People were involved in planning their care and treatment, including what was important to them. One person told us, “I’m well looked after and the food is good.” And a relative shared how impressed they had been when their relative had not been eating well, telling us, “They will make something outside of what is on the menu if she doesn’t want any of the options. The manager has even driven to fetch something specific from the shops.”

Staff told us they had received training which had given them a better understanding of how to support people who had difficulties swallowing and at risk of choking. We had confirmation the kitchen staff understood people's individual food requirements, such as where people needed specific modified diets and how to prepare foods and fluids to the correct consistency. The registered manager explained how they used the electronic care records system to monitor people's fluid and nutrition, and also, how initial care plans were built on from the assessments of people's needs. Care plans were then available to be followed by staff.

People had their needs assessed using a variety of tools. The provider had a range of policies in place to promote individual safe practice, such as individual moving and handling plans and 'This is Me' documents, where information is obtained from residents (where possible) and their families to enable the team to cater for individual preferences and choices. People's weights and body mass index were monitored. People’s dietary needs had been assessed, and where they were identified as at risk of being underweight a malnutrition universal screening tool (MUST) assessment had been completed and used to develop their care plan.

Relatives told us, where their family members received care from a range of different staff, teams, or services, this was managed well. They told us they believed staff worked well with other professionals to ensure their family members received the right care.

Feedback received from registered nurses and the registered manager suggested there was a difficult relationship between the service and some external health teams. Some of the staff also raised concerns about communication amongst members of the team, their relationship with the registered manager, and how communication received was demotivating, and their time was greatly impacted by the number of meetings which happened. The registered manager had attempted to resolve some of the issues; but it is not yet known whether these had been effective or not.

We received mixed feedback from the external agencies involved. Some professionals said they worked well with staff to ensure needs of the people at the service were being met. However, we were also informed of difficulties when requesting information and that actions were not always carried out as directed to staff. We saw there were professional staff who visited the service regularly; there had been a recent visit with contracting officers, reviewing the service’s action plan. One professional shared how they witnessed staff going above and beyond with a client who was unable to communicate well; by using their body language and picture cards to gain a connection and establish what the person needed/wanted.

Systems and processes such as how information, tasks and updates should be shared with others were inconsistent. Four staff had told us they did not always feel they had the training, skills or support from management to coordinate and record people’s care and support. Professionals had identified areas where confidence and competencies around specific tasks should be built up. We saw where requested actions/events were now being reviewed in the weekly ward rounds, in order to ensure actions were not being missed.

People told us they were happy with their care and were effectively supported to maintain or improve their health and nutrition when needed. One relative told us that there was access to a GP, hairdresser, and chiropodist; they explained there had also been some recent mental health support which they had asked for. Another relative told us how initially staff had initially tried to encourage [name] to be up and out of bed, as much as they could, but that due to a decline in their health, this didn’t happen much now.

Staff told us they worked closely with other professionals to monitor people’s health needs. Staff understood people's individual needs, including any disability or health conditions and how these affected them. This information was shown in people's care records, which staff followed. This included any instructions from relevant external health professionals involved with people's care. For example, to ensure effective nutrition and fluids were reached. We received mixed feedback from professionals involved with the service which are recorded in other areas.

People's health needs had been assessed, monitored, and planned for. We saw daily care notes and task specific records (such as repositioning) which evidenced care provisions were being regularly carried out. Care plans were detailed and included clear information about how people's health conditions affected them. The provider employed nursing staff who had a good understanding of people's individual needs. The service made timely referrals when needed and liaised with other healthcare professionals to make sure people received the care and support required.

Relatives confirmed they were involved in regular reviews to ensure their family members care and health needs were being met, and felt that wellbeing needs were being considered.

Staff told us they had the relevant guidance and training to meet the needs of people they supported. Comments included, “The Home has been quite generous with training, management ensures we are up to date with our professional knowledge” and, “Residents are well prioritised, and their care reflects the core principles of being person centered.” Another staff member advised, “We have the policies and procedures in place to guide us, and are well supported by the operational manager”.

Care plan audits were completed on a regular basis. Changes to people’s care, support or treatment were reviewed, and records updated. Handovers and daily records were used to record and monitor people’s health and wellbeing and escalate where required. The computer-based system enabled checks to be completed to ensure people’s care plans were being reviewed and contained the most up to date information about their care and treatment.

People told us staff listened to them and respected their choices. One relative confirmed, “[Name], is happy here, they chose this home out of several different ones offered.” People's choices and preferences in relation to end of life care were appropriately explored and recorded with them and/or their relatives.

People's rights under the Mental Capacity Act 2005 (MCA) were respected. Staff had received training in MCA and demonstrated they understood about offering choice and fluctuating mental capacity. They gave examples about how people had been supported to make decisions about their lives. We saw evidence in people's care plans of appropriate and timely best interest decision making. We received feedback from partner agencies which confirmed, staff and management are approachable and welcoming, and happy to support with providing information to support decision making. One said, “The staff I have had direct contact with, seem to have good knowledge of their residents in a person-centered way.”

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to make decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). The provider was meeting the principles of the MCA. They had assessed people's mental capacity to make different decisions and made referrals for DoLS when needed, and monitored these to ensure any conditions were being met.