Alexander House

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 assessment we rated this key question Good. At this assessment, the rating has remained Good.

This key question has been rated Good. This meant people were safe and protected from avoidable harm.

However, we found some aspects of the service were not always safe and there was limited assurance about safety in relation to fire safety. This was because the systems failed to always assess, monitor and mitigate risks to the health, safety and welfare of people using the service, which had placed them at risk of harm.
 

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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

The registered manager carried out regular reflective practice sessions with staff following any incidents or accidents. This gave staff the opportunity to reflect on what happened, action to be taken and to identify any learning to prevent similar incidents from occurring in future.
 

The provider 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 before they moved into the service. This was used to develop individual care plans to ensure people received safe and appropriate care and support when they first began to use the service.

The provider worked with people and healthcare 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 atmosphere remained pleasant and relaxed. People looked at ease and were comfortable interacting with staff throughout our onsite assessment. People told us they felt safe living at this care home. One person said, “The staff are nice and treat me well. I do feel safe here.”

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, “I’ve had safeguarding training, so I know what abuse is and that I must tell the person in-charge if I ever see it happen to anyone living here.” A manager added, “I would let the local authority and the CQC know if any safeguarding incidents occurred at the home.”
Training records showed staff had received training in this area.
 

The provider 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 were aware of the risks people might face and the steps required to prevent or safely manage them. Staff were attentive and alert to any changes that indicated people needed support for any anxiety or discomfort they might be experiencing. An external health care professional told us, “I’ve noticed when people living here do become distressed staff are very good at responding quickly and compassionately to calm the situation down and keep everyone safe.”

Risk assessments were clearly documented and updated as per guidelines.
 

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.
People lived in an environment which was homely and comfortable however, we found a number of potential issues with the environment which might put people at risk of harm. For example, fire-resistant doors not always closing into their frames when released, despite the provider conducting regular fire safety checks on them. A number of fixed and standalone radiators that were hot to the touch not being suitably covered and the risks associated with them not being assessed. Pull cords missing from some call bell alarms; toilet/shower room doors not fitted with suitable locks that could be easily accessed from the outside in the event of an emergency; and, screws unsafely protruding from a chest of drawers in a person’s bedroom.

The provider’s internal audits had failed to pick up and/or address all the aforementioned health and safety issues described above.

In addition, we saw the care home’s interior décor was not always maintained to a good standard. For example, paintwork throughout the care home was worn and shabby in some communal areas , including the ground floor toilet/shower and hallways. An external health care professional told us, “I think the homes interior décor is overdue redecoration as it looks very shabby and out dated in places.”

Furthermore, we found the care homes environment was not ‘dementia friendly.’ For example, most areas lacked colour contrasting doors and walls or memory boxes near people’s bedroom doors. A memory box is a container placed outside a person’s bedroom that holds special objects that are important to a person, such as photographs or ornaments. The introduction of these visual clues would help people living with dementia orientate themselves and identify rooms that were important to them. We discussed this issue with provider and suggested they seek advice and guidance from reputable sources about how to make the care homes environment more ‘dementia friendly’. Progress made by the provider to achieve this stated aim will be closely monitored by the CQC.

Regular checks were completed by managers and staff to maintain the safety of the care homes physical environment. This included regular health and safety checks on the homes electrical, gas and water systems, and equipment used to support people, such as mobile hoists. The provider had up to date Personal Emergency Evacuation Plans [PEEPs] in place for everyone who lived at the care home.
 

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staff were visibly present throughout this assessment and were quick to respond to people’s questions and requests for support. For example, we saw several instances of staff responding quickly to people asking for assistance to use the toilet or have a hot drink. Staff were also vigilant when people were moving around the care home.

People told us the care home was adequately staffed. A relative said, “There always seems to be plenty of staff around whenever I visit, which is quite often.” An external health care professional added, “The care home is always adequately staffed whenever I visit.”

Records showed staff received and induction to their role which included a period of shadowing an experienced staff member and successful probation completion.

There was a planned programme of upcoming training for staff and records showed that staff were up to date with their training. The registered manager attended ‘train the trainer’ courses which meant that they was competent and able to deliver training to staff.

A member of staff told us, “The training we have is very good. The registered manager makes sure we attend regular training sessions.” Another added, “My induction has been very good so far and I know I have a lot more to learn.” We observed the registered manager present infection prevent and control training to new staff during our assessment.
 

Staff had the opportunity to discuss issues through group and individual supervision meetings. A member of staff told us, “We have regular one-to-one supervision meetings with our line managers and I do feel supported by all the staff who work here.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People lived in a clean, hygienic environment. The care home looked clean and was free from offensive odours.

Staff knew the processes to follow to minimise the risk and spread of infection. Training records showed staff had received training in infection control and were also assessed as being competent in this area and also in relation to Personal Protective Equipment (PPE).

Staff had access to resources and equipment to help them reduce infection. A member of staff told us, “As you can see, we have lots of stations throughout the care home where we keep stocks of all the personal protective equipment we need including, gloves, aprons and hand-gel.”

Staff maintained cleaning and food safety records to provide a clear audit trail of measures taken to reduce infection risks.
 

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Medication Administration Records (MAR) were in date and signed by staff. Staff demonstrated a good understanding of medicines management, including gaining consent, administering medicines that were needed ‘as required’ and homely remedies. Staff were able to give clear examples of assessing for pain medication and when to administer pain medication. Homely remedies were used in the home and staff had a book that they completed when administering these medications.

Medications were stored correctly in lockable medications cabinets and were in date and labelled correctly. We observed a medicines round and saw that staff demonstrated good practice when dispensing and administering medicines.