Alexandra House

Alexandra House is a residential care home providing accommodation and personal care to up to 40 older people, including people who may live with dementia or a dementia related condition. At the time of our inspection there were 40 people using the service.

People’s experience of using this service and what we found

At our last inspection the provider had failed to ensure robust systems were in place to ensure people received safe care and treatment, including management of their medicines.

At this inspection improvements had been made and the provider was no longer in breach of legal requirements.

There was a welcoming, cheerful and friendly atmosphere at the service. A relative told us, “I’m so happy [Name] is here. It is free and easy here, people are well- presented, own choice how they dress, I value that. Staff do encourage choice and they sit and chat with people” and “Staff are lovely.” Staff spoke positively about working at the home and the people they cared for. They said communication was effective to ensure they were kept up-to-date about any changes in people’s care and support needs.

People's diversity as unique individuals with their own needs was respected by staff. The staff team knew people well and provided support discreetly and with compassion. People and relatives were positive about the caring nature of staff and had good relationships with them. They trusted the staff who supported them. People said they felt safe with staff support. A person commented, “I feel safe here. It’s friendly and staff are around.”

There were enough staff to support people safely and effectively. A relative commented, “There are plenty of staff. They are very active with the people, walking round with them.” Staff had received safeguarding training and were clear on how and when to raise their concerns. Where appropriate, actions were taken to keep people safe.

Staff followed effective processes to assess and provide the support people needed to take their medicines safely. Staff contacted health professionals when people’s health needs changed. Staff followed good infection control practices and the home was clean and well maintained. A person commented, “The place is immaculate and clean.”

There were systems to assess the quality of the service, which were closely monitored. Improvements were made as a result of analysis of any accidents, incidents and feedback to ensure people received safe and person-centred care.

Processes were in place to manage and respond to complaints and concerns. A relative told us, "You can ask them [staff] anything, they listen to you” and “If you have any complaints you can tell staff." People, relatives and staff gave us positive feedback and told us they had opportunity to comment on the service.

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 requires improvement (published 7 April 2022) and there was a breach of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced inspection of this service on 3 February 2022. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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.

Alexandra House is a care home that provides accommodation and personal care for up to 40 people, some of whom are living with a dementia. At the time of the inspection there were 29 people living in the home.

People’s experience of using this service and what we found

The premises were not always safe for people living at the home. Risks people may face had not been fully identified or mitigated causing people to be at risk within the home environment.

Medicines were not safely managed. People’s medication records detailed medicines they were no longer prescribed, medicine audits were not always completed, and medicine care plans did not reference all information for staff to safely follow.

We found there were some areas of the home where infection control procedures were not being fully followed by staff.

Following our inspection, the manager took immediate action to address all of the concerns we found with regards to risk, medicines management and infection prevention and control to ensure people were safe.

People were happy and content living at the home. Relatives were positive about the care provided by the staff and manager. Relative comments included, “Staff demonstrate a good level of care, they are well-trained and have a good level of first aid knowledge. They also show a good rapport with people who live with dementia.”

Staffing levels were safe and regularly reviewed to meet the needs of people. We found that the deployment of staff was not always appropriate. Staff were recruited safely by the provider and all pre-employment checks were in place.

The manager and provider had safely managed all risk associated with COVID-19 during the pandemic. Visitors were required to provide a negative lateral flow test before entering the service and professional visitors had to evidence that they had received both doses of their COVID-19 vaccine. Staff wore appropriate personal protective equipment (PPE) and there was an adequate supply of PPE throughout the home.

People had an initial assessment of their needs which were used to create person-centred plans. Care plans reflected the individual and included involvement from relatives and other healthcare professionals.

People were supported to maintain a healthy balanced diet and were provided with a range of options for meals. Staff worked with other agencies positively to make sure people received a continuous level of care.

Relatives and visitors were welcomed into the service. People and their relatives were part of their care planning. People were provided with choices with their care and staff worked with relatives to make sure people’s views were included.

The provider had a robust quality and assurance system in place to monitor the safety and quality of care provided. We found that checks had not always been completed prior to the manager’s appointment and they were addressing these issues to make sure that all audits and checks were effective.

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.

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 23 October 2018).

Why we inspected

We received concerns in relation to medicines management, record keeping and leadership. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements.

Please see the safe section of this full report.

You can see what action we have asked the provider to take at the end of this full report.

The provider and manager have taken action to mitigate the concerns identified during the inspection and are working to improve the service. The management team at the service have worked positively in partnership with the local authority to create an action plan to improve the quality and safety of the care provided.

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.

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 a breach in relation to safe care and treatment due to the concerns found around medicines management and risks associated with the environment at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Alexandra House is a care home that provides personal care and support for up to 40 people, some of whom are living with dementia. At the time of the inspection there were 35 people living in the home.

People’s experience of using this service and what we found

People happily interacted with staff and other people in communal areas around the home. People were supported to keep in touch with their family members.

There were systems in place to keep people safe. Accidents and incidents were recorded, monitored and analysed for trends and any lessons learned. People received their medicines in a safe way. Infection control processes were embedded into the service and staff followed government guidance in relation to infection control and prevention practices, in particular, relating to COVID-19. Staff wore appropriate PPE when supporting people. Staff and visitors to the home had their temperature checked and completed a risk assessment and COVID-19 test.

The home was well managed. People interacted positively with staff and management. The manager operated an open door policy and was approachable. An effective quality assurance process was in place.

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 23 October 2018).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service in relation to keeping people safe, medicines management and overall management of the home. We also looked at infection prevention and control measures. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. The overall rating for the service has not changed following this targeted inspection and remains Good.

CQC have introduced targeted inspections to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the Safe and Well-Led sections of this full report.

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 until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At our last inspection we rated the service as good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. At this inspection we found the service remained good. We saw evidence to show the service was meeting all of the fundamental standards.

There was a registered manager in post who had been registered with the Care Quality Commission (CQC) since September 2014. A registered manager is a person who has registered with the 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.

The registered manager was aware of their responsibilities and submitted notifications to the Commission appropriately. The registered manager worked with the provider to ensure there was a strong strategic lead to provide personalised care to people. There was a robust governance framework in place. Audits and checks were carried out by the registered manager and provider. Any issues identified were acted upon and any identified risks were mitigated. There was a complaints policy in place and we saw evidence of investigations and actions taken from these. The provider also carried out feedback surveys annually with people, relatives and staff to help improve the care provided.

The premises were safe and there were regular checks of the environment, equipment and utilities. There were infection control policies in place and staff adhered to these. Medicines were safely managed and there were medication policies and procedures in place. There was a business continuity plan in place for use in emergency situations. These were also reflected in people's care plans with personal emergency evacuation plans (PEEPs) to support the safe evacuation of people in an emergency.

Safeguarding policies were in place at the home and staff had received training around protecting vulnerable adults. Accidents and incidents were recorded, investigated and outcomes shared with people, relatives and staff. Lessons learned were documented and appropriate action taken. The registered manager escalated safeguarding concerns to the local authority.

People’s care plans were personalised and care provided to them was accurately recorded. Risks to people were assessed and mitigated. People’s care plans were reviewed regularly and people and their relatives were involved in care planning. We saw referrals to other agencies, for example the dietician and GP, in people's care files. People were supported to eat and drink a healthy balanced diet.

Staff were safely recruited, received a thorough induction programme and provided with on-going refresher training to full fill their roles. There was training provided for staff in delivering end of life care and the mental capacity act in addition to key areas such as safeguarding and moving and repositioning safely. We saw evidence of regular staff supervisions, yearly appraisals and team meetings.

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

We observed caring and kind interactions between people, staff and relatives. People’s privacy and dignity was respected. Staff supported people discreetly. People had access to a range of meaningful activities which were important to them. The service promoted advocacy and there was accessible information available detailing what support people could access to help make choices about their individual lives.

Further information is in the detailed findings below.

. Is the service safe?

. Is the service effective?

. Is the service caring?

. Is the service responsive?

. Is the service well-led?

This is the summary of what we found.

Is the service safe?

Risk assessments were in place. People were supported and encouraged to maintain their independence and this was balanced with the risk to the person. Audits were carried out to look at accidents and incidents and the necessary action was taken to keep people safe.

Information was available to show that the service worked with other agencies to help ensure people's health needs were met and to prevent admissions to hospital wherever possible.

We saw there were enough staff on duty at the time of inspection to ensure the safety of people who used the service.

Is the service effective?

We saw the service provided care to some older people with dementia and cognitive impairment. The service was very well-equipped to meet these specialist needs. The environment was well designed to meet these needs and there was good evidence of the involvement of people with dementia in daily decision making about their care needs.

People commented how helpful and friendly staff were. Relatives told us the service kept them up to date with what was happening with their relative's care and they felt able to ask any questions. Several people we spoke with commented how pleased they were with the care provided by staff at the home. We observed staff were patient and supportive as they worked with people.

Is the service caring?

We found people with dementia or cognitive impairment were involved in daily decision making. Staff were helpful and offered people information and support about their care. We observed staff interacted well with people. It was evident that staff had developed a good understanding of people's communication needs and how best to communicate with them. We saw staff had time to spend engaging with people.

Is the service responsive?

Information was collected by the service with regard to the person's ability and level of independence before they moved into the service. Various assessments were completed by the manager of the service with the person and/or their family to help make sure staff could meet their needs. Regular reviews were carried out with the person who used the service and their representative to make sure people's support plans were kept up to date. This helped ensure staff provided the correct amount of care and support.

Referrals for specialist advice were made when staff needed guidance to ensure the health needs of people were met.

People's individual needs were taken into account and they, or their representative if they were not able, were involved in decision making with regard to their care. They were kept informed and given some information to help them understand the care and choices available to them, this was developed to include and involve people with dementia.

Information collected by the service gave staff some insight into the interests and areas of importance to the person. Activity provision was developed to help ensure activities reflected people's interests and provided stimulation to people with dementia, if they wished to become involved. We saw activity provision and opportunities for socialisation were offered by support workers and activities personnel.

Regular meetings took place with staff and people who used the service and their relatives to discuss the running of the service and to ensure the service was responsive in meeting the changing needs of people.

Is the service well-led?

We saw there was a vibrant, stimulating and busy atmosphere when we visited the service. Staff we spoke with were enthusiastic about their role working with people and they were knowledgeable about the support needs of people. Staff said they felt supported by the manager and advice and support was available from the management team.

We saw there was a focus from management on the provision of individual care and support to people who used the service. There was an emphasis about individualised care and support to people with dementia and cognitive impairment.

We saw people had the opportunity to comment on the quality of the service and that they felt able to speak to the manager and staff about any issues. Comments included; "Lovely home and very caring." Another person commented; "A real home from home with friendly staff." And; "The staff are all very caring and ensure that all residents are cared for as if is their own relative who is a resident."

We found the provider had introduced a daily check of Medication Administration Records (MARs) to ensure that gaps in signatures were identified in a timely manner.

People had their needs assessed and these assessments wer used to develop personalised care plans. People we spoke with were happy with the care they received. One person commented, 'We get everything we want and need.'

The provider had sytems in place to ensure people received their medicines appropriately and in a timely manner. Medication was administered by senior care staff who had completed relevant training and had had their competency assessed.

People who used the service told us they had no concerns about the ability of the staff who cared for them. One person commented, 'The staff know what they are doing.' Another person commented the 'Staff are brilliant.'

People knew how to complain. People we spoke with told us they were happy with their care. One person commented, 'I am quite happy here, I have no concerns at all.'

During our observation we saw people were treated with consideration and respect. People and their relatives told us they were happy with the care which was provided. One person said, "It's very good here, the staff are very kind." A relative told us, "My mum has been here for 8 years and I''ve always been very happy with the care. I come and visit regularly, but they are very good at keeping me up to date with anything that's happened. She always looks well kept and well cared for whenever I come and visit."

We reviewed three care records and saw that people's preferences and care needs had been well documented. We spoke with four members of staff. Staff were knowledgeable about the people's care needs and what they should do to support them.

Staff received appropriate professional development and there was an effective system in place to make sure staff training was up to date so that staff could care for people safely and to an appropriate standard.

We found that the provider had made suitable arrangements to protect vulnerable people from the risk of abuse and that there was an effective system in place to monitor and assess the quality of the service.