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 changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The provider was in breach of legal regulations in relation to the health and safety of the care homes environment which was not being safely managed and staff not being consistently supervised, appraised and supported. This had placed people at potential risk of harm.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People did not always receive consistently safe or a good standard of care from staff as the service did not have a proactive and positive culture of learning lessons when things went wrong.

The services previous management team had repeatedly failed to identify and/or take appropriate action to address a few ongoing issues we identified at their last assessment as well as some new ones at this one. We discussed this matter with the new managers at the time of our assessment. They confirmed they had all just been appointed to oversee the day-to-day running of the care home. It was clear from their feedback they recognised the importance of learning lessons and continuous improvement to ensure they maintained safe, person-centred care for people who lived at the care home.

People received safe care from managers and staff who had developed a positive learning culture within the care home. Managers understood the importance of reporting safety concerns and learning lessons when things went wrong. Systems were in place to support staff to report and record safety concerns and events when they arose. Any safety concerns or incidents that did occur were investigated and any lessons learnt were shared with staff and used to continually improve the service and to 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, including when people moved between different services.

Information was obtained from people, and others involved in their care, about individual’s needs and potential 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 healthcare partners to understand what being safe meant to them and the best way to achieve that. They 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 service shared concerns quickly and appropriately.

People told us they felt safe living in the care home. A relative said, “My [family member] feels safe and secure at Alexander House. I believe the manager [registered] and staff would deal appropriately with any allegations of abuse or neglect.” An external health care professional added, “We do not have concerns about the residents being kept safe at the home. The staff follow our care plans and escalate concerns to our team 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, “I have completed safeguarding training and would report it to a manager who would report it to the local authority.” Another added, “Last month I attended the local authorities safeguarding training. I would report my concerns immediately to a manager.If I was concerned about a colleagues’ behaviour, I would call it out and raise it immediately.”

Managers worked proactively with the relevant external health and social care professionals and bodies when a concern was raised and took appropriate action to safeguard people from further risk, when this was required. An external health care professional told us, “I feel very confident that if I raised concerns to the services new managers that the appropriate steps would be followed through.”

The service was working within the principles of the Mental Capacity Act (MCA) 2005. Staff involved people in their care, offering choices and respecting people’s decisions. An external health care professional told us, “It has been observed the carers always try and explain what they require people to do and respectfully ask for their agreement for any support they might need.” Mental capacity assessments were completed with people and others involved in their care. Where people did not have the capacity to consent to their care, managers and staff held best interests’ decisions and consulted with those that had legal authorisation to make decisions on people’s behalf. Managers liaised with the relevant local authorities to ensure appropriate DoLS arrangements were in place to ensure people’s safety.

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

People’s care records contained sufficiently detailed and accurate information, which ensured staff had access to all the guidance they needed to prevent or appropriately manage identified risks. Staff were aware of these risks and the steps they needed to take to prevent or safely manage them. A member of staff told us, “I know what people need from reading their care plan and notes.” Another added, “We have recently updated a person’s positive behavioural support plan as we have found out speaking slowly and playing cards with this individual really helps reduce their distress.”

Systems were in place to ensure risks people might face were continually assessed, monitored and reviewed. Staff told us they regularly discussed risk during daily handover meetings and as part of their ‘Resident of the day’ programme.

The service did not always detect and control potential risks in the care environment. They did not make sure that equipment, facilities and technology supported the delivery of safe care.

The provider had made some improvements to the care homes fire safety arrangements and physical environment since our last assessment; however, further improvements were needed. For example, fire-resistant doors now closed into their frames when released and some of the communal areas had been redecorated with hallways repainted and colourful stencils added to the walls.

However, not enough progress had been made by the provider to address other environmental safety issues we identified at their last assessment which continued to place people at potential risk of harm. This included not all radiators being safely covered, missing or inaccessible call bell alarms pullcords, and unsuitable locks fitted to some toilet/shower room doors which could not be opened from the outside in the event of an emergency.

In addition, the care home’s interior décor was still not always being maintained to a good standard. For example, we found a worn-out looking carpet in a first-floor bedroom, too much old furniture cluttering the communal areas and inappropriate and unsightly labels stuck to bedroom furniture to help staff find items of clothing. A relative told us, “Alexander House is clean but the décor needs tidying up in relation to paintwork and general smartness.”

Furthermore, while some signage and photos of people on their bedroom doors most of the care homes interior was still not particularly ‘dementia friendly.’ For example, communal 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 these ongoing environmental issues with the new managers at the time of our assessment and suggested they seek appropriate advice and guidance from reputable sources about how to make the care home a more comfortable and ‘dementia friendly’ place for people to live.

Despite the above, the newly registered manager had responded immediately during and after this assessment by turning off and then removing all the CCTV cameras from within the care home, which the former registered manager had failed to do, despite it being discussed with them at the time of their last assessment.

Staff told us they had clear guidelines available to help them deal with emergencies, including individualised plans to evacuate people in the event of a fire.

The service did not always ensure staff received effective supervision and had their overall work performance appraised regularly. There were enough qualified, skilled and experienced staff who worked well-together to meet people’s individual needs.

Most staff had only received 1 formal supervision meeting with their line manager during 2025 and only half had their overall work performance appraised in the last 12 months, contrary to the providers own staff supervision and appraisal policies and procedures and recognised good practice. Staff confirmed they had not attended regular 1 to 1 supervision meetings with the previous line managers. This meant staff still did not have enough formal opportunities to reflect on their working practices and professional development. We discussed this ongoing issue with the new managers who acknowledged this was an ongoing failure. The registered manager told us they had held 3 individuals’ supervisions with staff in their first month of overseeing the care home. They also had a time specific action plan in place for all staff to receive regular supervision meetings and annual awork performance appraisals from now on.

Staffing levels matched the staff duty rota on the day of our onsite assessment. Staff were visibly present throughout the care home and were quick to respond to people’s questions and requests for support. A relative told us, “I regularly visit the home and there always appears to be enough staff on shift.”

Staff were well-trained to meet people’s individual needs and encouraged to continually improve in their role. Staff received a mixture of e-learning and in-person practical and theoretical training, which was routinely refreshed as frequently as staff required it, which included regular competency-based assessments. A member of staff told us, “I have received all the training I need including, dementia awareness”, while another added, “I have done a lot of e-learning and face-to-face training here which is always very good.”

The provider continued to operate safe recruitment practices and only fit and suitable staff were employed to work at the care home. Newly employed staff were subject to a probationary review and received a thorough induction to ensure they could safely meet the needs of people living in the care home.

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.

The service had an in-house domestic worker who was visibly present during this assessment and continued to maintain good standards of cleanliness and hygiene throughout the care home. A relative told us, “The home always looks clean whenever I visit, which is quite often.”

Staff received up to date infection control and food hygiene training and had access to appropriate resources and equipment, such as personal protective equipment [PPE] and hand sanitiser and soap for effective hand washing. This helped them minimise the risk of infections spreading in the care home. Staff told us they had adequate supplies of PPE and were aware how to control the risk of infection spreading in the care home. A member of staff said, “We have access to everything we need to prevent and control infection including, enough PPE and cleaning materials.” The provider’s infection prevention and control policies and procedures were current and reflected national guidance and recognised good practice.

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

Medicines systems were well-organised and safely managed. A relative told us, “My [family member] receives their medicines in the most appropriate way. There is no issues with the medicines that I’m aware of.” Medicines stocks, balances and records showed people consistently received their prescribed medicines as and when they should. People told us staff supported them to take their medicines as they were prescribed. Care records included detailed guidance for staff about how people needed and preferred their medicines to be administered. This included detailed protocols in relation to 'as required' medicines which meant staff had access to clear instructions about when and how to safely administer these types of medicines. Staff received relevant training and their competency to continue managing medicines safely was routinely assessed. This helped staff remain clear about their roles and responsibilities in relation to the safe management and administration of medicines. There were regular audits of medicines at the service. Controlled drugs were stored correctly in line with national and local guidelines.