4 October 2022
During a routine inspection
About the service
Alexander House Private Nursing Home is registered to provide accommodation for persons who require nursing or personal care and treatment of disease, disorder or injury for up to a maximum of 25 people. At this inspection 8 people were using the service, some of whom were living with dementia, had a mental health condition, were autistic and had a learning disability.
People’s experience of using this service and what we found
The provider was not able to demonstrate how they were meeting the underpinning principles of ‘Right support, right care, right culture’.
Right Support:
• The registered manager and staff team did not support people to have choice, control and independence or focus on people’s strengths and abilities.
• There were not enough staff to fully support people to have a fulfilling and meaningful everyday life.
• The registered manager and staff did not support people to take part in activities and pursue their interests within their local area.
• Suitable arrangements were in place to ensure the proper and safe use of medicines.
Right Care:
• Staff were observed to deliver task-based care and support.
• Not all people’s nutritional needs were being met in line with their care needs or care plan.
• Recommendations and advice by healthcare professionals were not always implemented or followed up.
• The registered manager and staff did not protect people from poor care and abuse.
• People did not routinely take part in activities or pursue interests that were tailored to them.
Right Culture:
• The leadership, management and governance arrangements did not provide assurance that the service was well-led, that people were safe, and their care and support needs could be met.
• The registered manager and staff team did not help people lead inclusive and empowered lives.
• The registered manager and staff team did not ensure people are always put first. People did not receive care that was person centred or protected and promoted people’s rights.
• A ‘closed culture’ had been developed at Alexander House Private Nursing Home, whereby there was a risk of harm for people living there.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was inadequate [published December 2021]. The provider did not complete an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.
At our last inspection we recommended that the provider seek guidance to ensure the premises were suitable to meet people’s needs. At this inspection we found the provider had not fully acted on this recommendation and only minor improvements had been made.
Why we inspected
The inspection was prompted in part due to continued concerns received about people living at Alexander House Private Nursing Home not having access to professionals and stakeholders. involved in their care. The provider was continuing to not allow professionals and stakeholders to access the service to carry out their statutory obligations to ensure people’s safety and wellbeing. A decision was made for us to inspect and examine those risks.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.
We have identified breaches in relation to person-centred care, consent, risk management, safeguarding, meeting people’s nutritional needs, governance and staffing at this inspection.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.