Alexandra House

Alexandra House is a residential care home providing personal care to 7 people. The service provides support to younger adults some of whom may be living with a mental health condition or a learning disability. Alexandra House consists of 7 flats and areas within the home which offer communal space. At the time of our inspection there were 7 people using the service.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

People’s experience of the service and what we found:

Right Support: The environment was clean, tidy and spacious. People’s flats reflected the people who lived in them with photographs, artwork, and personalised decorative accessories on display. Ongoing maintenance kept the service to a good standard. People had choice in all aspects of their lives and were supported to do all they wanted to do when they wanted to do it. Staff had a flexible approach and accommodated people's wishes wherever possible. People had an active life which incorporated activities in their local community and where people had shared interests, they went out together. People received their medicines as required and staff worked in-line with recommendations from health professionals. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care: Staff promoted equality and diversity in their support for people. They understood people's cultural needs and provided appropriate care and emotional support. The registered manager had a flexible approach to staffing levels to ensure activities, hobbies, individual interests, and outings were catered for. Staff acted quickly when needed to keep people safe, whilst promoting positive risk taking to allow people to build their daily living skills. People spoke highly of the staff team and the level of support they provided.

Right Culture: People received compassionate and empowering care that was tailored to their individual needs. Staff spoke highly of people and went 'above and beyond' for them to live the best lives possible. People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. Management led by example and staff empowered people to do all that they wanted to do safely. The service was committed to a culture of improvement and regularly sought feedback from people, staff and professionals. People were at the centre of the service and staff valued and acted upon people's views.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 8 August 2018)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to review the key questions of safe and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Alexandra House on our website at www.cqc.org.uk.

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Alexandra 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. Alexandra House accommodates seven people in their own flats in one adapted building with additional communal spaces. At the time of our inspection there were six people using the service who had a learning disability.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service did not have a registered manager. A registered manager is a person who has registered with the CQC 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. The manager at the home had submitted an application to become the registered manager and was waiting for an interview with the CQC. The manager had extensive experience of working in the social care sector

Staff were trained in safeguarding, first aid, the Mental Capacity Act and infection control. Additional training was in place or planned in areas specific to people’s individual needs. However, we received mixed feedback from staff regarding the training on offer and the lack of time set aside to complete it.

Effective procedures were in place for managing medicines and we found that all aspects of medicines management, storage, administration and recording were safe.

People’s needs were assessed before they moved into the service. Care plans were then developed to meet people’s daily needs on the basis of their assessed preferences.

People were supported to have choice and control over their own lives from being supported by person centred care. Person centred care is when the person is central to their support and their preferences are respected.

Care plans were person centred regarding people’s preferences and were updated regularly.

People’s nutrition and hydration needs were met and were supported to maintain a healthy diet, and where needed records to support this were detailed.

Accidents and incidents were monitored by the registered manager to highlight any trends and to ensure appropriate referrals to other healthcare professionals were made if needed.

A programme of audits was carried out by the manager which were effective at improving the service.

People who used the service were regularly asked for their views about the support they received and this was recorded and acted upon. People’s relatives and other healthcare professionals were asked for their views via questionnaires or feedback forms.

The home was clean, tidy, well presented and infection control was carried out to a high standard.

People were supported to take risks safely and personalised risk assessments were in place to ensure people were protected against a range of risks.

Staff had received safeguarding training and were able to describe types of abuse and what they would do to report concerns and protect people.

Staff recruitment was carried out safely with robust safety checks in place for new staff.

New staff received induction training and were supported by other staff members until they could work alone.

Support for people was person centred this meant their preferences and dislikes were respected at all times. People had planned goals and were supported to achieve them.

Procedures and individualised care plans were in place to provide people with appropriate end of life care and support.

There were sufficient staff to meet people’s needs safely and in an individualised way.

Staff had a good knowledge of people’s likes, dislikes, preferences, mobility and communicative needs. People we spoke with gave us positive feedback regarding staff and how their needs were met.

People were supported to maintain their independence by staff that understood and valued the importance of this.

Notifications of significant events were submitted to us in a timely manner by the manager.

The manager displayed a sound understanding of capacity and the need for consent on a decision-specific basis. Consent was documented in people’s care files and people we spoke with confirmed staff asked for their consent on a day to day basis.

Health care professionals, including GP, dietitians or specialist consultants were Involved in people’s care as and when this was needed and staff supported people with any appointments as necessary.

Staff, people who used the service, relatives and other professionals agreed that the manager led the service well and was approachable and accountable. We found they had a sound knowledge of the needs of people who used the service and clear expectations of staff. They had plans in place to make further improvements to the service.

Throughout the day we saw that people who used the service and staff were comfortable, relaxed and had a positive rapport with the registered manager and also with each other.

People and their relatives were able to complain if they wished and knew how to complain or raise minor concerns.

Assistive technology was in use at the home and people were supported to use this for communication and for safety.

People were supported to access information in a variety of formats to suit their needs and adaptations were made to suit individual needs.

People were supported to take part in a wide range of activities at home and in the wider community as active citizens and to suit their individual preferences.

People’s rights were valued and people were treated with equality, dignity and respect.