Alexandra Lodge Care Home

Staff understood their duty to protect people from abuse. They understood to report concerns to the registered manager but not all staff understood about reporting concerns to external agencies including the Local Authority and CQC. The provider had updated their safeguarding policy to reflect current legislation and who to report concerns to including who to escalate concerns to. Safety risks to people were not always managed well. Assessments regarding specific risk issues for people had not been completed and issues regarding the safety of the environment were not always responded to promptly to protect people from risk of harm. Issues regarding the cleanliness of the home and fire safety had not been addressed in full. There were enough staff to meet people’s needs however, there were only 3 people receiving care and support at the start of our assessment process. In April, there were 2 people living at the home with 2 staff present but 1 person was still able to leave the home without staff support placing them at significant risk of harm. Staff had not all received relevant training to meet people’s needs and ensure their safety. The registered manager carried out checks when recruiting staff to support them to choose people who they deemed suitable and fit to be employed to support people at the service.

Staff knew people well and understood their care needs, likes and dislikes. However, care plan documents were not robust enough to guide staff practice and risk assessments were not completed. Staff were not clear about what person-centred care was and the importance of this in ensuring people receive empowering care and are treated as individuals. People had access to food and drinks which was monitored, and people’s weight was checked and recorded. Malnutrition Universal Screening Tool (MUST) scores had not been calculated which was highlighted to the registered manager at the time. MUST is a tool to identify adults who are malnourished, at risk of malnutrition or obese. At our initial visit the inspection team spoke with the registered manager as they had identified a person at risk of choking as needing an assessment from the speech and language team. A referral had been made at our second assessment visit. The provider did not always maximise the effectiveness of people’s care and treatment by assessing their health, care and wellbeing needs robustly. This meant there was not sufficient information to create a clear person-centred care plan to inform staff practice.

The provider had not implemented clear and effective governance, management, and accountability arrangements. Providers use these systems to manage and deliver good quality, sustainable, treatment and support. Staff were not always clear about their responsibilities as part of their role which meant tasks were sometimes missed. There was a current safeguarding and whistleblowing policy in place. Although not all staff were clear about the procedure for externally reporting concerns, all staff felt able to speak up about concerns and approach the registered manager. Implementing more robust governance processes would support the provider to have increased oversight of the running of the service, identify issues earlier to improve the quality of care and treatment, and provide opportunities for learning. Failure to learn from when things go wrong means there is the potential for the same issues to reoccur.