Alexander House

Updated 16 June 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 12 April 2018 and was unannounced. This was the first inspection of the home, the provider registered with the Care Quality Commission on 13 April 2017. Three inspectors and one expert by experience visited the home. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service.

Before the inspection we reviewed information relating to the home. This included three ‘share your experience’ forms which we used to inform what we looked at on inspection, correspondence from people, professionals, and notifications sent to us by the registered manager. A notification is information about important events which the provider is required to tell us about by law. We also used information the provider sent to us in the Provider Information Return (PIR). This is information we require providers to send us at least once annually to give some key information about the home, what the home does well and improvements they plan to make.

We spoke with the registered manager, the nominated individual, five staff, three visitors and four people who live at the home. We looked at four care plans, staff duty rosters, four staff files and reviewed records relating to quality assurance, health and safety, safeguarding, infection control, compliments and complaints, medicines, staff training, supervision and appraisal. During the inspection, we observed people having their lunch, spending time in the lounge and taking part in an afternoon activity. Following the inspection, we spoke with a pharmacist and a social care professional to gain their feedback.

After the inspection, we asked the registered manager to send additional information relating to evidence of portable appliance testing (PAT), electrical certification, evidence of a Depravation of Liberties Safeguard (DoLS) application, the provider’s sick absence policy and a contact list of professionals who support people living at the home. The registered manager provided this information within the requested time frame.

Updated 16 June 2018

The inspection took place on 12 April 2018 and was unannounced. Alexander House is a care home that provides personal care for up to 23 people. On the day of inspection there were 11 people living at the home. This was the first inspection of Alexander House; the home was registered with the Care Quality Commission on 13 April 2017.

The registered manager told us they were operating on half occupancy due to a variety of reasons. They wanted to ensure a safe takeover of the home and have time to understand the service and embed safe practices before increasing occupancy. The registered manager said they wanted to raise the profile of the home, they are working on advertisement, creating a website, integrating with the local community and working with the local authority to make the home more known to social workers. The nominated individual said they had a large refurbishment programme to undertake when they purchased the home and wanted to do this with minimal disruption to people. Strategies are in place to support more people moving into the home which include; using established working practices embedded in their other care homes; staging the number of people moving in and a team of staff that can support from their other homes which will ensure they have experienced staff to meet people's needs.

Alexander House is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home is one adapted building with private bedrooms, shared communal areas and bathrooms. Some people living at the home are living with dementia, frailty and physical disabilities.

Alexander House 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 said they felt safe living at the home. One person said "I feel safe here, I know that I can speak to the registered manager whenever I need to. Everything here is perfect”. Staff were knowledgeable about safeguarding and had received training. We saw safe moving and handling support being provided and the service had suitable staffing levels to meet people’s needs. The provider had a robust recruitment process which ensured people were safe to work prior to them starting. Risks were managed effectively to ensure people were kept safe. People had access to medicines as and when they needed them and trained staff administered these. The provider ensured the management, administration, storage and disposal of medicines was safe.

People’s needs were assessed when they moved into the home and regularly thereafter. Staff understood people's needs, choices and preferences. For example, one care plan said a person enjoyed ‘Music, activities and communication’ and the person wanted support to access 'Activities on a daily basis.' We observed this person having meaningful interaction and attending an activity with a guest musician, which they engaged in and appeared to enjoy. People and relatives said that they were involved in their care planning and decisions made about their care. People were assisted to eat healthy and balanced diets and were offered the appropriate support to meet their nutritional needs.

The registered manager and staff had a good understanding of the Mental Capacity Act 2005 (MCA). They supported people to make their own decisions and sought consent before delivering care and support. If people's care plans contained restrictions on their liberty, relevant applications had been made to legal bodies in line with current legislation. Staff received a range of training opportunities to support them within their role which ensured they had the knowledge and skills to deliver effective care and support. Staff spoke highly of the training provided and said they felt supported within their roles.

Staff were kind and caring. One person said “The carers and kind, good and soft. Nothing is ever too much trouble.” We saw consistently positive and meaningful interactions between staff and people. Staff were compassionate and offered people reassurance and emotional support as required. People and relatives said they were involved in decision making and we saw this informally through observed interactions and within people’s care plans. The service had privacy, dignity, independence and respect as part of their core values and this was demonstrated in practice by both staff and the management team. People told us they felt respected and were very complimentary of the staff team.

The service was responsive to people’s needs. We observed care and care planning that was personalised and considered people’s life histories, preferences and choices. We observed a variety of activities throughout the inspection. These activities were meaningful to the individual and people were having fun and enjoyed themselves. Complaints and concerns were listened to and actioned in line with the provider’s policy. People’s wishes at the end of their lives were sought and the manager described this as an open and ongoing conversation.

The management team played an active role within the home. People and their relatives knew them and were complimentary of them. One relative said "The new management team who took over the care home have worked wonders in such a short time." There was a respectful, person centred and family orientated ethos embedded in practice.

The provider has implemented extensive renovations to the home to improve the environment for people living there. They acknowledged there were further renovations to be done as some areas remained in need of attention. The provider had a renovation plan, which is due to be completed in summer 2018. People and their relatives had responded very positively to the renovations already completed.

The provider had quality assurance systems in place and used the results from audits to action positive change. People, healthcare professionals and staff told us there was good communication in the home and staff worked effectively with other professionals to meet the needs of people.