Alexandra House - Ludlow

Alexandra House is a residential service which provides accommodation and personal care for up to 22 older people. At the time of our inspection visit, 19 people were living at the home.

People’s experience of the service and what we found:

People were cared for by staff in a way that kept them safe and protected them from avoidable harm. Enough staff were available to respond to people’s needs in a timely manner. People received their medicines when they needed them, and systems were in place to ensure medicines were stored and administered safely and adequate supplies were available. Accidents and Incidents were investigated, and measures were taken to prevent re-occurrences. The premises were clean, and staff knew and followed infection control principles.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were cared for by staff who were kind and caring, the atmosphere in the home was friendly and relaxed. We observed staff interacting with people as equals. People were involved in making decisions about their care and were supported to maintain their independence.

People gave us positive feedback about the quality of care they received. The feedback on the leadership of the service and the registered manager from people and staff was positive. There were effective governance systems in place to monitor the quality of service and the health, safety of welfare of people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good; published (24 November 2017).

Why we inspected

We inspected this service due to the length of time since the previous inspection.

We undertook a focused inspection to review the key questions of safe, caring and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Alexandra House on our website at www.cqc.org.uk.

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Visitors were checked on arrival for proof of vaccination where it was applicable.

The provider completed regular checks to ensure staff followed effective infection prevention and control practices.

The provider received regular updates from other healthcare professionals to ensure they were following best practice guidance in preventing the spread of infections.

Staff and people were regularly tested, and staff had received COVID-19 vaccinations unless exempt.

The provider ensured PPE supplies were plentiful and accessible throughout the buildings. We saw staff were using PPE appropriately at all times.

Staff developed exceptionally positive caring and compassionate relationships with people. The ethos of the home was that of an extended family. Staff knew each person as an individual and what mattered to them. They treated people with the utmost dignity and respect during their life and at the end of their life. The whole staff team were extremely passionate about providing people with support based on their individual needs and aspirations.

People received care based on best practice, by staff with an in-depth knowledge of their care and treatment needs. Staff were skilled and confident in their practice. Staff worked with people, other professionals and continually developed their skills. The service trained and developed staff to put their learning into practice to provide care that met people's individual needs.

People's experience of eating and drinking was enhanced because staff promoted improved health and wellbeing through good nutrition and hydration.

Each person had a trusted member of staff, known as a keyworker, who took a lead role in each person's care and wellbeing. They continuously looked for ways to ensure people had positive experiences and led fulfilling lives. Staff knew about people's lives, their interests and talents and encouraged them to share them with others.

There were enough staff on shift to meet the needs of people who used the service. People were supported to have as much choice and control over their lives and were supported in the least restrictive way possible. Policies and systems in the service supported this practice.

Staff understood how to keep people safe and could describe the correct steps they would take if they were concerned that abuse had taken place. Accidents and incidents were appropriately recorded and investigated. Risk assessments were in place for people who used the service.

Medicines were managed safely and staff members understood their responsibilities.

There was a strong culture within the service of treating people with dignity and respect. People and the staff knew each other well and these relationships were valued. The staff, registered manager, and management team were always visible and listened to people and their relatives and friends, offered them choice and made them feel that they mattered.

There was a culture of openness and transparency at the service. Staff were extremely positive about the management and leadership which inspired them to deliver a high quality service. They encouraged ideas from staff to benefit the people in their care and maintain a strong, stable staff team with a shared goal.

The management team undertook regular audits and improvements were carried out when these were needed. The quality of the service was monitored and assessed consistently. The registered manager gathered people's views and used this information to look at ways they could continuously improve the service.

People who used the service, family members, and visitors were encouraged to make comments, complaints, or compliments about the service.

Further information is in the detailed findings below.

Is the service safe?

People felt safe because their rights and dignity were respected when making decisions about any risks that they may wish to take. The registered manager described a situation when a person displayed behaviour that challenged staff and other people who used the service. The staff team dealt with this situation well in collaboration with other health professionals to keep people safe.

People were safe because the service had good system to manage accidents and falls and learnt from them, so they were less likely to happen again. For example, the service had a falls prevention officer, whose role it was to analyse and monitor falls and assist people to maintain their safety after a fall.

Staff understood about the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and how they would be put this into practice. No DoLs applications had been submitted.

The people considered they were kept safe and were listened to. We observed that people were free to go about their daily routine as they wished. One person told us, 'I feel happy here. The staff are always on hand to help me and I can do as I please'. Another person said, 'Since my fall the staff have helped me enormously. I have a special routine and my call bell is always placed near me wherever I choose to sit'.

Is the service caring?

The people we spoke with told us they felt that their dignity was respected and they were assisted to live their life as they wished. Staff took the time to find out people's personal social histories. Staff we spoke with knew people's needs well and how they wished to be cared for. This meant that staff cared about the person as an individual and were concerned about their well-being.

People and those that mattered to them were encouraged to make their views known about their care. We saw that weekly emails were sent to family members asking for an update on their point of view regarding the care of their relative. A relative we spoke with confirmed that this was a positive gesture and they considered their views were professionally respected. This meant that people were listened to and they felt that their views mattered.

Is the service responsive?

The registered manager and the team of staff demonstrated a clear understanding of the importance of communicating with people and their relatives to find out their aspirations, preferences and diverse needs. For example, the team were undertaking an in depth review of how to provide support and care at the end of a person's life. This was done in full consultation with people who used the service and their family or advocate.

Is the service effective?

Staff had identified the need to review the content and arrangements of care plans so that they were more clear and accessible to people and staff. This would improve the standard of recording and make care provision more effective.

People were involved in the assessment of their needs and one person said, 'The manager asked me a lot of questions and after I had been in a while they asked me if my views were the same or had changed. I found this reassuring because you don't always know what you feel when you're in the middle of changing your whole life'.

People told us they were happy to discuss their personal preferences with staff. They said that staff kept an eye on them and got help very quickly if they were unwell. We saw how the service had referred an individual to health professionals when their mental health had deteriorated. This meant people were supported to maintain good health, have access to health care services and received ongoing support.

Is the service well led?

The management and staff demonstrated values that included involvement, compassion, dignity, respect and independence. Staff we spoke with showed they understood this as they discussed their role and responsibilities in their work. This meant the service promoted an open culture that was centred on the individual and empowered them to take control of their life as they were able.

Developments in guidance and best healthcare best practice were used as an opportunity for learning and improvement. For example, the service was exploring how they could provide end of life care better so that people were empowered to make advanced decisions or be assured of appropriate management and decision making on their behalf.

Concerns were listened to. The service hadn't received any complaints but people told us they would 'Go straight to the manager' if they were unhappy.

The management had systems in place to assess and monitor that staff had the right competencies, knowledge, qualifications, skills and experience to meet the needs of people at all times, no matter how complex their needs became. Resources and support were available to staff to develop and drive improvements in care, for example, manual handling and falls prevention. This meant staff were motivated to carry out their role and to meet people's needs.

People said they felt safe living at the home. One person commented, "The staff treat me well and are very caring. I can see the doctor when I need to and they all keep an eye on my health".

Staff told us they had attended a range of training courses to equip them with the knowledge and skills to effectively carry out their duties.

There was evidence that residents' views and the opinion of their relatives were being sought and listened to.

The provider monitored the service robustly. The systems in place enabled them to identify problems swiftly and act upon them to be responsive to people's needs. The management arrangements in place were effective which meant that the service was well led.