Keychange Charity Alexander House Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last inspection we rated this key question good. At this assessment, the rating has remained good. This meant people were safe and protected from avoidable harm.

However, although we found no evidence that people had been harmed, the provider was in breach of legal regulations in relation to the safe management of medicines.

This was because staff did not always have access to sufficiently detailed instructions about when to administer people's prescribed medicines safely.

This represented a breach of regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can find more details of our concerns in the evidence category findings below.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

People were encouraged and supported to raise safety concerns with the provider. The managers and staff understood the importance of reporting safety concerns and learning lessons when things went wrong. An external care professional told us, “Staff are eager to learn lessons and improve.”

Systems were in place to support staff to report and record safety concerns and events when these arose. Managers investigated safety concerns and events and used the learning from these to support staff to continually improve their practice, reduce risk and keep people safe

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care.

Information was obtained from people, and others involved in their care, about people’s individual needs and risks they might face. This was used to develop individualised care and risk management plans to ensure people received safe and appropriate care and support from the moment they moved into the care home.

The service worked with people and external health and social care partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Managers and staff understood how to safeguard people. They knew how to recognise and report abuse and were able to articulate how they would spot signs if people were at risk of abuse or harm. A member of staff told us, “If we see signs or suspect people are being abused or harmed here, I will report it immediately to my line manager and to the safeguarding lead of the organisation.”

People and relatives told us they felt the care home was a safe place to live. Typical feedback included, “I feel very safe living here,” “We are confident the staff have my friends safety uppermost in their mind” and “Overall, I think that clients are safe at Alexander House.” Managers worked proactively with the relevant external agencies, when a concern was raised, and took appropriate action to safeguard people from further risk, when this was required.

The service was working within the principles of the Mental Capacity Act 2005 (MCA). Staff understood people’s capacity to make decisions about the care and support they received. Managers and staff had received up to date safeguarding, mental capacity Act (2005) andDeprivation of Liberty Safeguards (DOLs) training.

The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff ensured potential risks people might face were mitigated, so that people remained safe when taking part in activities and events of their choice. A relative told us, “Staff are very good at always ensuring my [family members] alarm mat is activated, their bedside rails are secure and have certainly been active in preventing pressure sores from happening.” Another relative added, “They [staff] manage any risks that my [family member] might face well.”

People moved freely around the care home and spent their time as they wished, with no unnecessary restrictions. Staff were aware of where people were and remained present and available in case people required their assistance. People’s care records contained up to date, sufficiently detailed and accurate information, which ensured staff had access to all the guidance they needed to prevent or appropriately manage identified potential risks people might face and to keep them safe. A member of staff told us, “I have received positive behavioural support training and feel confident supporting someone who has become distressed.” Systems were in place to ensure risks to people were continually assessed, monitored and reviewed.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The premises were kept free of obstacles and hazards which enabled people to move safely around the care home. An external care professional told us, “The care home is a very homely and a safe place for my clients to live.”

There were effective arrangements to monitor the safety and upkeep of the premises. Regular checks were completed to help ensure the safety of the home’s physical environment and fire safety equipment. Staff told us they had clear guidelines available to help them deal with emergencies. In relation to fire safety we saw emergency evacuation plans were in place to help staff evacuate people in an emergency.

General risk assessments were regularly reviewed and updated including, equipment used to support people, such as mobile hoists. This equipment was regularly serviced and maintained.

The service did ensure there were enough qualified, skilled and experienced and they worked together well to provide safe care that met people’s individual needs. However, the service did not always make sure staff received formal supervision.

The service did not always ensure staff received regular supervisions or had their overall work performance appraised at least annually. We found in the last 12 months each member of staff had only received one formal individual supervision with their line manager and no one had had their overall work performance officially appraised for over a year. This contradicted recognised best staff support practice and the providers own staff supervision and appraisal policies and procedures.

We discussed these staff supervision and appraisal issues with the managers at the time of our inspection. They acknowledged formal support staff received needed improving and agreed to take appropriate action to address this matter. The manager told us an improvement plan has already been developed and timeframes agreed for all staff to attend at least one formal supervision meeting with their line manager bi-monthly from now on and have their overall work performance appraised by the end of the year [2025].

Staff received a mixture of e-learning and in-person practical and theoretical training, which was routinely refreshed as frequently as staff required it including, competency-based assessments. Staff told us the training they received was always relevant and routinely refreshed, so it remained up to date and relevant. One member of staff said, “We receive regular and relevant mandatory training here, which is constantly being refreshed.”

People living in the care home and their relatives told us staff were well-trained, in line with people’s choices and preferences. A relative said, “Staff I’ve encountered are competent and truly care about the wellbeing of the residents.” An external care professional added, “They do have some residents with complex dementia needs and the manager has sourced training with us to improve staff awareness around supporting people living with dementia.”

The provider operated safe recruitment practices and only suitably ‘fit’ staff were employed to work at the care home.

Staffing levels matched the staff duty rota on the day of our site visit. Staff were visibly present throughout this onsite inspection and were always quick to respond to people’s questions and requests for support. People told us the care home was adequately staffed. Typical feedback included, “The home is always well-staffed”, “I would say there’s usually enough staff on duty. As you can see there’s lots of staff around today in the communal areas” and “The home was short staffed for quite a while and they became heavily reliant on agency staff at that time to plug the gaps. The agency staff were nice but they didn’t really know the people who lived here. That said, things have really improved lately since the new manager has started recruiting lots of really good new staff.”

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. People were supported to live in a clean, hygienic environment.

People lived in a clean, hygienic environment. The care home was kept clean and free from offensive odours. One person said, “The home is always kept clean”, while an external care professional added, “It’s always clean and tidy whenever I visit the service”. Staff had received relevant infection control and food hygiene training, which meant they knew the processes to follow to minimise the risk and spread of infection. Staff also had access to resources and equipment to help them reduce infection risks. People told us staff wore appropriate personal protective equipment [PPE]. An external care professional said, “I always witness staff wearing appropriate PPE.” A member of staff added, “We have access to all the PPE we need.” The provider’s infection prevention and control policy was current and reflected national guidance.

The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They did involve people in planning, including when changes happened.

We found no evidence that people had been harmed however, medicines records relating to when staff need to consider administering ‘as required’ behavioural modification medicines were not sufficiently detailed. Medicines records clearly stated the maximum number of doses permissible in a 24-hour period, however, it was not always clear when staff should consider using this type of medicines. For example, the reasons why staff should consider giving ‘as required’ medicines were often not particularly person-centred and simplistic, generic terms such as, use to treat anxiety or restlessness were found on multiple protocols to guide staff. This meant staff did not always have access to enough sufficiently detailed, clear or person-centred instructions about when they should consider administering these types of ‘as required’ behavioural modification medicines.

In addition, some external health and social care professionals we contacted also raised concerns about the lack of detailed guidance available to staff to help them reduce risk and safely manage ‘as required’ medicines. One told us, “It is often brought to our attention from the staff about behaviours that challenge and whether people who become distressed can be given ‘as required’ medicines to help them manage the situation. We explained this is not always in the residents' best interest and this type of ‘as required’ medicines only ever given as a ‘last resort’. I would recommend staff need more detailed instructions to ensure they know exactly when it’s appropriate to use this type of medicines.” Another added, “I have worked with the team at AlexanderHouse to raise awareness in relation to the use of ‘as required’ medicines and its potential overuse if proper guidelines aren’t followed, which would constitute a form of restraint if that happened. We have already discussed this issue with the new service manager and we have seen some improvement around this recently.”

This issue notwithstanding medicines stocks, balances and records showed people consistently received their daily prescribed medicines as and when they should. We found no gaps on any medicines administration record (MAR) sheets we looked at. People confirmed they received their medicines as they were prescribed. A relative told us, “The staff ensure my [family member] receives her prescribed medication correctly.”

Staff received relevant training and their competency to continue managing medicines safely was routinely assessed. There were regular audits of medicines at the service. This included regular checks of staff’s medicines handling practices.