Archived: Alexandra House - Leicester

A condition of registration was that Alexandra House had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. Alexandra House had a registered manager but they were not actively involved in the running of the service. This responsibility was delegated to a person who was managing the service. That person told us they would apply to be the registered manager.

The provider’s arrangements for monitoring the quality of the service people experienced were informal. Few records of monitoring activity were kept. Not all reportable incidents had been notified to CQC.

People’s views were sought daily through dialogue with them. An annual satisfaction survey had been carried out.

People continued to receive safe care. They were supported by staff who knew how to recognise and report any signs that people were abused or at risk of abuse. The provider had assessed risks relating to people’s care to help them to remain safe.

The provider had procedures in place for staff to report concerns and for those concerns to be investigated and acted upon.

Staff were appropriately recruited and there were enough staff to provide care and support to people to meet their needs. People were supported to received their medicines safely.

The care that people received continued to be effective. Staff had access to the support, supervision and training that they required to work effectively in their roles. People were supported to maintain good health and nutrition.

People developed positive relationships with the staff who were caring and treated them with respect, kindness and dignity.

People had care plans in place that were focused on them as individuals. This allowed staff to provide consistent support in line with people’s personal preferences.

People’s needs were met in line with their individual care plans and assessed needs. Staff understood people’s needs and provided care and support that was tailored to their needs.

People and their relatives felt they could raise a concern and the provider had systems to manage any complaints that they may receive.

We found one breach of regulation. You can see what action we told the provider to take at the back of the full version of the report.

Alexandra House provides accommodation for up to 17 people who require nursing or personal care. At the time of our inspection 16 people used the service. People using the service have use of a large communal lounge, a smaller `quiet’ lounge and a dining room. There is a small enclosed garden. Alexandra House is located in the village of Huncote in south-west Leicestershire.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People using the service were safe. Staff understood their responsibilities for protecting people from abuse and avoidable harm. They safely supported people with their mobility. People’s care plans included assessments of risks associated with their personal care routines and their safety. The premises were maintained to ensure safe environment.

Enough staff were deployed to safely meet the needs of people. On occasions staff did not report for, the registered manager or, if they were not on duty the person in charge, was involved in providing care and support. This was the case on the day of our inspection. The provider had robust recruitment procedures to ensure as far as possible that only people suited to work at Alexandra House were employed.

The provider’s arrangements for the management of medicines were safe. People received their medicines at the right times and when they needed them.

People using the service were supported by staff with the rights skills and knowledge. Staff communicated effectively with people. Staff understood and practised the requirements of the Mental Capacity Act 2005. They sought and obtained people’s consent before providing care and support.

People using the service were supported with their nutritional and healthcare needs. They had access to health services when they needed them.

Staff were caring. They developed caring relations with the people they supported. They were attentive to people’s needs and ensured their comfort. People were involved in decisions about their care and they were treated with dignity and respect.

People using the service received care and support that was tailored to their individual needs. They had opportunities to participate in activities though most chose not to do so. The provider was reviewing the range of activities and identifying new and more varied activities people could enjoy.

People using the service and their relatives were able to raise concerns and felt listened to.

The provider sought people’s views and feedback about the service though the results of feedback were not always shared with people.

The provider had quality assurance procedures. These included reviews of risk assessments associated with people’s mobility, but we found two people’s falls risk assessments had not been reviewed after people experienced falls. Three out of eight recommendations from a food hygiene audit in April 2015 had not been acted upon.

The provider had not returned a Provider Information Return (PIR) we required. A PIR asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We saw several examples of how staff treated people with dignity and respect and as individuals. Staff respected people's choices about how they wanted to be supported. Staff spoke politely to people, offered encouragement and explained why they provided support. Relatives we spoke with told us their family members were safe at the home. A relative told us, "I can go home knowing I do not have to worry about my mum." Other relatives said similar things.

Staff we spoke with told us about the training they had received. They told us their training had enabled them to provide care that was safe and met people's individual needs.

People received their medications at the right time. Staff explained why they were giving people their medicines and respected people's choices when they declined their medicines.

Staff told us that they felt enough staff were always on duty. Relatives and two health care professionals who visited the home at the time of our inspection also felt that enough staff were on duty. We saw that staff attended to people's needs promptly. We found that people who used the service were safe because enough staff were on duty.

Staff we spoke with understood how to identify and report signs of abuse. Staff also knew how to report accidents and injuries. Procedures were in place for managers and staff to learn from events such as accidents and incidents. That meant the service placed a high priority on people's safety.

Staff we spoke with had a good understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This is legislation that protects vulnerable people who are or may become deprived of their liberty through the use of restraint, restriction of movement and control. This showed that staff understood how people's safety was respected and their best interests taken into account.

We saw that people's bedrooms and communal areas were clean, tidy and free from odours. A relative told us, "The girls [care workers] keep the home clean."

Is the service effective?

People's health and care needs were assessed with them or their relatives. Care plans included details of people's needs and information about how people were supported with their needs. Care plans and records we looked at that showed that people had received the support they required.

A person who used the service told us, "People are well looked after here." Another person told us, "I'm happy here." Relatives were complimentary about the service. One told us, "It's a family home, it's not institutionalised." Another relative told us, "It's very important for me that I know my mum is very well looked after." Two health care professionals who visited the home regularly told us that the service was effective. One told us, "The care is good. The residents always look well."

Relatives were able to visit the home at times they wanted.

We found from the evidence we gathered that the service had effectively planned and delivered care that met people's needs.

Is the service caring?

People told us they were well looked after. One person told us, "It's nice here." Another told us, "I'm happy here." We saw that staff showed patience and gave encouragement when they supported people. Staff used people's preferred names when they spoke with them and showed a caring attitude. We saw staff engaged with people in a caring manner.

People we spoke with were complimentary about the staff. One relative told us, "The staff are extremely caring. They go over and above with the care they provide." A visiting health professional told us, "The personal care here is very good." Care records we looked at showed that people had been supported with their personal care routines. People had been supported to improve their mobility. This was important because it meant that people could be more independent and move freely around the home.

People had been supported with their health and nursing needs because the service worked closely with providers of those services. We found that staff monitored people's health and made referrals to the appropriate specialists when required.

People's preferences, interests and diverse needs had been respected. People had been able to attend church services or receive visits from representatives of local churches. People took part in social activities that involved other people and had also been supported to enjoy activities that were of particular interest to them. Each day a care worker had been assigned to provide and support people with meaningful activities.

Two relatives we spoke with told us that they would be happy to live at the home in older age.

We found that the service understood people's individual needs and had supported people with those needs in a caring way.

Is the service responsive?

People told us they were well looked after. Records we looked at showed that people had been supported with their personal care and health needs. Relatives told us that they knew how they could make suggestions or raise concerns and that they were confident they would be listened to. One relative told us, "I've been involved in discussions and decisions about my mother's care. I've seen her care plan and notes. I've been able to express my views, even about minor issues and they have been addressed."

We saw that the service had responded to changes in people's needs. People's care plans had been updated to show how their needs had changed. We saw that people's care and support routines had been modified or added to in order to support people with new or short term requirements. It was evident that staff regularly read people's care plans and had provided care and support that met people's new and changing needs.

All relatives we spoke with told us that the service had kept them informed about their family member's welfare.

We found that the service had been responsive to people's on-going and new needs.

Is the service well-led?

The service had a system for monitoring the quality of service. This included checks of documentation and records and observations of care worker's practice. Staff meetings took place at regular intervals. We saw from records of those meetings that the manager had shared information about the outcome of monitoring activity.

The service had procedures for reporting of accidents and injuries. We saw that reports were reviewed and analysed and that action had been taken to reduce the risk of the same type of accident occurring again.

The manager regularly sought the views of people who used the service and their relatives. That had been through one to one discussions with people and reviews of people's care plans. Relatives told us that they valued the way the service was run.

We found that staff understood their roles and had been supported to deliver care and support to people who used the service. The service worked closely with doctors, district nurses and other health professionals to ensure that people's health and well- being had been provided for. This showed that the service had been well led.

We found there was a good level of communication and contact between staff and people using the service. Care and daily routines were centred around people's individual needs and preferences. One person told us 'I'm happy here and I'm involved in my care.' A relative visiting a member of their family told us 'I have no concerns, the care is good here.'

We found there was a clear and up to date recruitment procedure in place that was followed by the service. This meant that people were cared for, or supported by, suitably qualified, skilled and experienced staff.

We found people were not always protected from the risks of unsafe or inappropriate care and treatment because proper information relating to people's care and risks was not always being included in people's care plans in a reliable and detailed way.

We found people's privacy, dignity and independence were respected. People told us they were fully involved in discussions about their needs and care. At times when a person using the service was not able to be fully involved, relatives told us that they were able to do this on their behalf. One person told us the staff are 'always polite; they do everything we ask for.'

We found there was a good level of communication and contact between staff and people using the service. Care and daily routines were centred around people's individual needs and preferences. Although care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare, some important care plans and mental capacity assessments had not been completed.

We found there were effective systems in place to reduce the risk and spread of infection.

Although there was a recruitment and selection process in place, we found that gaps in a person's employment history were not fully explained. The provider did not always ensure that the qualifications, skills and experience of the person applying for a job were recorded.

We found systems were in place to regularly obtain people's views about the care and service they receive. We found the provider had a system in place to identify, assess and manage risks to the health, safety and welfare of people using the service.