Alexander House

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question good. At this assessment, the rating has changed to requires improvement. This meant the services management were inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The provider remained in breach of legal regulations in relation to the way they operated their governance systems. This was because they continually failed to pick up and/or take appropriate or timely action to address all the issues we identified at this and their last assessment.

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.

The provider had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Staff were supported by managers to deliver person-centred, and inclusive care and support to people in line with the provider’s vision and values for the service. Systems and processes had been designed in line with this vision and focused on people and meeting their individual needs. Managers used audits and checks to make sure staff understood how the service’s values should be achieved through their working practices.

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

The provider had made improvements in this area since our last assessment. The service now had a new permanent management team in place who were now suitably skilled, knowledgeable and experienced. This included a newly registered service manager, a new deputy manager who had recently been promoted from within the service to provide some continuity and a new director of operations. Typical feedback we received from external health care professionals about how the care home was now being led by the new management team was overwhelmingly positive. Comments included, “The services new management team seem very keen to turn the care home around, and to ensure the best care for the residents,” “As a team, we feel positive about the management changes at the care home. I know the new deputy manager well, and she will be a fantastic addition to the leadership team at Alexander House. She is thorough, fair, organised, professional, a good communicator and proactively involves us in resident’s care” and “We have confidence in the new deputy manager who was previously a team leader at the home. She is very dependable and proactively responsive to peoples care needs.”

This new management team understood the context in which the service delivered care and support and embodied the culture and values of their workforce and the provider. They had a good understanding of the needs of people using the service and how these should be met through the provision of safe, person-centred care. People living in the care home and their relatives were positive about the leadership approach of this new management team which they consistently described as professional and supportive.

We received more mixed feedback from staff about how the care home was being managed, although most staff told us the new managers were supportive. Typical comments included, “I am not sure anything has changed much. The new managers haven’t been here long and have a lot to do to improve things,” “The care is improving and the new managers are available to help us do that. I feel very supported by the new managers” and “The new managers are much better, calmer, and more approachable than the previous ones. I feel able to speak to them and raise any concerns I might have.”

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The care home had an open and transparent culture where people living there, their relatives, external health and social care professionals were all encouraged to raise concerns without fear. A relative told us, “I have regular opportunities to discuss the standard of care [name of family member] receives at the care home, and when there have been issues, they were taken seriously and resolved satisfactorily.” The provider used a range of methods to gather people’s views about what the care home did well or might do better. The provider received regular feedback through various forums people were encouraged to attend. Managers told us they explained the complaints process before people moved into the home.

The provider valued and listened to the views of staff. The provider had a ‘Speak up’ policy that was available to all staff. Staff felt able to brings things to the attention of the new managers.

The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

Managers and staff confirmed they were part of a diverse team. Most staff told us they were treated equally and fairly, and felt supported, respected and valued by the new managers. A few other members of staff stated it was too early to judge the leadership approach of the new managers and would need more time to assess this.

The new managers understood the importance of having a fair and inclusive workplace for all staff to work in. Staff were provided with support through relevant training to inform their knowledge and understanding of equality, inclusivity, and fairness in the workplace.

The service did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

At our last assessment we found the provider’s established quality and safety monitoring systems were not always operated effectively, which represented a breach of regulations. At this inspection we found not enough improvement had been made by the provider in relation to the effectiveness of how they operated their governance systems. This was because they were still failing to always take appropriate and timely action to address the all the ongoing issues, we had identified at this and their previous assessment. This included issues we found in relation to the way they managed the health and safety of the care homes environment and supervised, appraised and supported staff.

This repeated failure notwithstanding; the new managers did understand their responsibilities in relation to regulatory requirements around notifiable incidents. The new managers now submit all the notifications to the CQC they were legally required to in timely manner including, allegations of abuse, deprivation of liberty safeguards and the death of people living in the care home. In addition, the outcome of routine checks and audits the new managers conducted were now being used to identify performance shortfalls, which feed into an action plan to improve the quality and safety of the service people living at the care home received.

We saw the service's previous CQC inspection report, which was easy to access on the provider's website. The display of the ratings is a legal requirement, to inform people, those seeking information about the service and visitors of our judgments.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

The new management team had begun to work more closely with relevant external health and social care professionals and bodies. This was confirmed by the newly registered manager who told us, “We have just started working more closely with the local community nursing teams once again.” Similar feedback was received from multiple external health care professionals and included, “We were met with a lot of resistance from the former registered manager, but the new manager [registered] and his deputy manager are both very happy and keen to work in partnership with local community services,” “The new manager [registered] seems open to working in partnership with us and is open to adopting change and new practices” and “The new managers proactively report any concerns about the health of residents to us as required. They do listen to professional advice given to them”.

The service did not always focus on continuous learning, innovation and improvement across the organisation and local system.

The service did not always have an initiative-taking culture of continuous learning and improvement. We found opportunities to continuously learn lessons and improve the service had been repeatedly missed by the service’s previous management team. For example, the services former registered manager had consistently failed to identify and/or take appropriate or timely action to address many of the ongoing issues we identified at their last assessment including, ensuring all potential risk related to health and safety of the care homes environment were minimised and staff were appropriately supervised and supported. The new managers are working on this but need more time to improve things.