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

People said they felt safe with staff and enjoyed their company. Staff knew how to report any abuse and knew people well. Staff supported people who had capacity to make decisions about risk. Risk assessments were completed to promote independence and minimise risks to people. Care plans were clear and detailed with sufficient guidance for staff to keep people as safe as possible. Referrals were made to local health professionals when required such as the community nurses and GP. One relative said, “There’s never a problem for my wife to see a GP if necessary.” A local GP carried out regular ward rounds with separate emphasis on those living with dementia. There were sufficient, safely recruited staff who had received training to meet peoples’ needs. The service had safe systems for appropriate and safe handling of medicines, and people received their medicines safely in the way prescribed for them. We identified a few areas for improvement. Risk assessments for medicines sometimes lacked detail, and some medicines with additional safety requirements had not been individually risk assessed. The home was clean and tidy with a homely feel during our visit. People’s individual needs were met by the adaptation, design and decoration of the premises. The provider undertook regular health and safety checks of the premises.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives were supported to raise any concerns and were able to meet with the manager if required. A recent independent health and safety audit scored ‘outstanding’. The auditor commented, “The training is amazing. This is a reflection of high standards and a commitment to health and safety. A huge well done to the team.”

Accidents and incidents were monitored for any patterns to aid learning and staff were well trained.

There was a clear focus on keeping people safe. Health professionals were referred to for advice as necessary.

The service worked well with partners and shared good information between services.

The service worked well with partners and shared good information between services. Some people were on discharge to assess schemes and their care plans were detailed. Some people had chosen the service themselves and were happy with their care. One person said, “I’m glad I came here. It’s a lovely home.” Their care had been tailored to their needs and the deputy manager had carried out training for staff in their particular medical condition to ensure their needs were met.

The service accepted college students for placements for health and social care education. One college student told us they felt supported and involved saying, “I like coming here, it’s a nice home and they look after me well.”

Staff felt they were well supported and had enough information to meet peoples’ needs. One nurse told us, “This job has ignited a fire in nursing in me again. There were some teething issues at first, but we are all trying to gel as a team. I love working here. There had been a previous issue with sourcing equipment for end-of-life care, but this had been addressed with action planning and learning.”

People felt safe with the staff that supported them and felt able to raise any concerns. We saw kind and respectful interactions between people and staff. The manager gave examples of how they advocated for people, for example to ensure they and families were acting in peoples’ best interests.

Staff demonstrated an understanding of what might constitute abuse and knew how to report any concerns they might have. For example, staff knew how to report concerns within the organisation and externally such as the local authority, police, and the Care Quality Commission (CQC). Staff had received safeguarding training, to ensure they had up to date information about the protection of vulnerable people.

The registered manager demonstrated an understanding of their safeguarding role and responsibilities. They explained the importance of working closely with commissioners, the local authority and relevant health and social care professionals on an on-going basis. There were clear policies for staff to follow. Staff confirmed that they knew about the safeguarding adults’ policy and procedure and where to locate it if needed. We found the service was working within the principles of the MCA and if needed, appropriate legal authorisations were requested to deprive a person of their liberty.

Staff were visible and attentive and knew how peoples’ risks were managed. Staff ensured there were enough staff to support people, for example in the communal areas. People with complex needs were able to be supported in a pleasant sensory room. Pressure care was well managed with daily reviews and appropriate equipment to minimise risk. For example, some people had been risk assessed to use electronic wheelchairs safely with reviews. The chef was new to the role but had dietary information and was being supported with an induction and training in cooking for a care home environment.

People’s individual risks were identified, and the necessary risk assessment reviews were carried out to keep people safe. For example, risk assessments had been carried out for mobility, falls, diabetes, eating and drinking and skin care. Where indicated, monitoring charts were in place to ensure people received safe care and support. For example, charts were in place to monitor people’s food and fluid intake, repositioning, weight and mattress settings. Risk management considered people’s physical and mental health needs and showed that measures to manage risk were as least restrictive as possible. This included ensuring necessary equipment was available to increase a person’s independence and ability to take informed risks. There was evidence that learning from incidents and investigations took place and appropriate changes were implemented. For example, care plans and risk assessments were updated. Involvement of other health and social care professionals was requested where needed, to review people’s plans of care and treatment.

People who were able told us staff helped them feel safe without minimising their independence. They felt able to move freely around the home and spend the day as they wished. One person said, “They come to find me if they don’t know where I am. I am missed. I can do what I want.”

People were supported and encouraged to be as independent as possible, with measures in place to minimise known risks. One person was being supported on a one-to-one basis in a sensitive and discreet manner.

People’s individual needs were met by the adaptation, design and decoration of the premises.

People had a variety of spaces in which they could spend their time and their bedrooms were personalised.

Reasonable adjustments had been made to enable people to move around as independently as possible.

The provider undertook regular health and safety checks of the premises. Safety systems and equipment used at the service were maintained and serviced at regular intervals to make sure these remained in good order and safe for use.

Staff were well trained and competent in their jobs. Staff received training, which enabled them to feel confident in meeting people’s needs and identify changes in people’s health. Staff received training on a range of subjects including, safeguarding vulnerable adults, the Mental Capacity Act 2005 (MCA), moving and handling, first aid, infection control and a range of topics specific to people’s individual needs. For example, dementia, diabetes, skin care, end of life care and stroke awareness. Staff had also completed nationally recognised qualifications in health and social care, including the Care Certificate, which encouraged them to provide safe, compassionate care. Staff received on-going supervision in order for them to feel supported in their roles and to identify any future professional development opportunities. Staff confirmed they felt supported by the registered manager. There were safe and effective recruitment and selection processes in place.

Staff were visible throughout our visit providing timely care and support. Staff agreed there were sufficient staffing numbers, based on peoples’ needs, with a supportive ancillary and management team. There was a friendly, homely atmosphere with all staff engaging with people throughout the visit. Although some people commented that there was a need for more staff, we did not see anyone having to wait for support and call bells were not ringing excessively.

People said they liked the staff supporting them and support was available in a timely way. There had been some issues with recruitment, due to a new care home opening locally, but the care and nursing team were well staffed now and there was a stable team.

The provider ensured there were sufficient numbers of staff deployed to meet the needs of the people at the service. The registered manager explained that staff skills were integral to enable people’s care and support needs to be met. They added that people received support from a consistent staff team. This ensured people were able to build up trusting relationships with staff who knew their needs.

There had been issues with recruiting housekeeping staff which was being addressed. The housekeeper told us there were cleaners every day although there was a lot to do at the moment. Care staff maintained cleanliness late afternoon and evenings. Although the premises were large, there were only 29 people living there during our visit and the manager said they were slowing admissions until the housekeeping team was more stable. Staff were trained in infection control and said there was plenty of equipment, including stocks of flannels and towels. Each room had bowels for washing and we looked in each room which were all clean.

Staff wore appropriate personal protective equipment appropriately. Hoists and other equipment were kept clean and monitored. Cleaning charts were up to date, for example, in the kitchen.

Infection control audits were completed on a regular basis as part of monitoring the service provided.

The home was clean and tidy with a homely feel during our visit. People told us, “Our rooms are clean, it’s very good” and “It’s so clean, like a palace.” However, people commented there had been issues with laundry. The manager was aware and there was a button labelling system to aid with laundry distribution.

People’s medicines appeared to be given in the way prescribed for them. One person self-medicated some of their medicines. This was recorded and signed by them in their care plan, but the frequency of ongoing monitoring of this by staff was not noted. People had information and medicines care plans to help identify and support their needs. ‘PRN’ (as required) protocols were in place and contained some person-centred information. Medicines reviews were completed by the pharmacist at the GP surgery. There were no risk assessments for flammable topical preparations, and some risks assessments and one care plan seen lacked details. Time specific medicines were given correctly. Medicines were seen to be stored safely and securely. Staff were knowledgeable about people and their medicines.

Medicine administration charts (MAR) were well completed, showing medicines were given as prescribed. One handwritten MAR had not been double signed but others had been. Patch charts were in use, and topical MARs gave instructions for care staff how to apply each preparation (these were recorded electronically when applied). When ‘PRN’ medicines were administered times and effect were recorded. When changes were made to prescribed medicines copies of correspondence such as messages from GP surgery or hospital discharge summaries were kept as an audit trail for these changes. Temperatures were monitored, and there were suitable arrangements for storage, and disposal of medicines including homely remedies and medicines that required further security. There were regular checks of these medicines for safety.

Nurses told us they felt well supported. Training was provided, although one newer nurse had not completed this yet, they reported they had regular competency assessments which were recorded by managers. They told us medicines systems worked well and they had good support from the GP surgery and pharmacy. There were not usually supply problems or issues.