We inspected Alexander House Care Home on the 3 November 2016. Alexander House provides residential care for people with mental health, learning disability and physical disability needs. The home offers a service for up to 10 people. At the time of our visit nine people were using the service. This was an unannounced inspection.

We last inspected in December 2015 and found the provider was not meeting all of the requirements of the regulations at that time. People did not always receive their medicines as prescribed. Additionally people were not always protected from risks in their living environment as areas of the home could cause harm to people. During this inspection we found improvements had been made to the service and they now met the legal requirements.

There was a registered manager in post on the day of our inspection. The registered manager is also one of the providers of the service. 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 received their medicines as prescribed. Care staff kept an accurate record of when people had received their medicines. People were protected from the risks of harm in their environment. The provider and registered manager ensured the building was maintained and people were protected from harm. Where concerns had been identified in the building, maintenance work was carried out. People told us they felt comfortable in the home.

People told us they enjoyed living at the home. People were supported by a kind, caring and compassionate care team who knew people’s needs. Staff supported people to spend their days as they wished. People told us there were things for them to do in the home and how they enjoyed accessing the local community independently.

People told us they felt safe with care staff and safe in the home. Staff had a good understanding of safeguarding and the service took appropriate action to deal with any concerns or allegations of abuse.

People's needs were assessed. Where any risks were identified, management plans were in place. People were supported in a way that recognised their rights to take risks. Where people’s needs changed, care staff had taken action and made referrals to healthcare professionals where necessary.

Care staff were knowledgeable about the people they supported. They had access to professional development. Staff had received the training they required to support people with individual needs and had access to effective supervision (one to one meetings with their manager).

People views on the service were sought. People told us the management was approachable and felt confident in their ability to complain. Quality assurance systems were in place to enable the service to identify areas for improvement and ensure people received a good quality service.

We inspected Alexander House Care Home on the 18 and 22 December 2015. Alexander House provides residential care for people with mental health, learning disability and physical disability needs. The home offers a service for up to 16 people. At the time of our visit 16 people were using the service. This was an unannounced inspection.

We last inspected in April 2014 and found the provider was meeting all of the requirements of the regulations at that time.

There was a registered manager in post on the day of our inspection. 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 did not always receive their medicines as prescribed. Care staff did not always keep an accurate record of when people had received their medicines. Where people needed their medicines covertly, care staff followed clear guidance to ensure their needs were met.

People were not always protected from the risks of harm in their environment. Two bathrooms contained risks to people which included untiled flooring and items which could be pulled from the wall and cause harm and harbour infections. However, people spoke positively about the home and their bedrooms.

People told us they enjoyed living at the home. People were supported by kind, caring and compassionate care staff, who clearly knew people’s needs. Staff supported people to spend their days as they wished.

People were supported with activities, and enjoyed time spent with care staff and other people. People told us there were things for them to do in the home and how they were supported to access the local community independently.

People told us they felt safe in the home. Staff had a good understanding of safeguarding and the service took appropriate action to deal with any concerns or allegations of abuse.

People's needs were assessed. Where any risks were identified, management plans were in place. People were supported in a way that recognised their rights to take risks. The care and support people received was personalised to their needs. People were protected from the risks associated with their care. Staff had clear guidance to protect people from risks and promote people’s independence. Where people’s needs changed, care staff had taken action and made referrals to healthcare professionals where necessary. Care staff ensured people had care and support which met their needs and rehabilitation goals.

People’s relatives spoke positively about the registered manager. They felt the registered manager was approachable, listened to them and asked for their views. Relatives felt involved in people’s care. There was a positive caring culture, promoted by the registered manager. Care staff were passionate about providing high quality personalised care and support. They spoke confidently and positively about people and their preferences.

Care staff were knowledgeable about the people and carers they supported. They had access to development opportunities to improve their skills and the service people received. Care staff received the training they required to support people with individual needs and had access to effective supervision (one to one meetings with their manager).

People and their relatives view on the service sought. The registered manager made every effort to ensure people’s views mattered. People told us the management was approachable and felt confident in their ability to complain. Quality assurance systems were in place to enable the service to identify areas for improvement and ensure people received a good quality service.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the bac

During our inspection, we had a tour of the premises and spoke to people using the service in relation to their care. The feedback we received was generally positive.

We did not speak to people using the service about the training of staff. One member of staff was undertaking an online training course on the administration of medication when we arrived. They told us that training provision had increased. We also saw records that showed staff had received induction training and were having the opportunity to attend courses relating to learning disability and mental health. We found that the system for recording training was not easy to use.

One person we spoke with said that they were very nervous when they moved into this home but they felt it was the best decision and they were very happy. Another person told us they didn’t like living in the home but this was because they wanted to live on their own. Two other people said it was ok and they had no complaints. One person told us they had input from external health care professionals. People told us that they were "free to come and go" as they liked but had to inform staff if they were leaving the building for safety reasons.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found.

The summary describes what people using the service and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Care records and risk assessments identified the support people needed to keep them safe. Other health and social care professionals were contacted for advice to keep people safe. People we spoke with confirmed their care plans were an accurate reflection of the care they needed and received.

Staff had received training about safeguarding and the Mental Capacity Act 2005 and knew what to do as a result of a safeguarding concern. Staff managed the finances for one person. Records were kept of transactions but these were not being checked for evidence of financial abuse.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Care staff knew how to recognise someone being deprived of their liberty and actions to take as a result. Any restrictions in place were documented and justified in people’s care plans.

Medicines were stored and administered safely. We found, however, that balance checks were not being completed to identify whether the correct number of tablets were in stock. The registered manager told us this would be done on an ongoing basis. Staff competency was assessed before they took responsibility for administering medicines.

Is the service effective?

People’s health and care needs were assessed. This involved the person where possible. One person told us they had been involved in putting their care plan together and another person said they had not wanted to be involved. Staff were aware of changes in people's needs and shared these with colleagues. A social care professional told us the service supported people to be as independent as possible by supporting people to take appropriate risks.

We found care records contained relevant information but were not structured in a logical way to help staff find the information they needed. For example, one person’s care record contained a number of risk assessments that related to the same risk and it was not clear which one should be followed. The registered manager told us they were looking at approaches to help them bring all the information together in a logical structure

The majority of staff had received the training identified as necessary by the provider. A small number of staff were awaiting training. Condition specific training, for example dementia and the management of challenging behaviour, was also provided for staff. People told us the number of staff on shift allowed their needs to be met. One member of staff told us “I love working here”. They told us they felt they had received enough training and had the opportunity to do more condition specific training as required.

Is the service caring?

Feedback from people included “always help me when I need it”, “the home is alright” and “I like it here. It’s better than anywhere else I’ve been”. All the interactions we observed between people and staff were patient, caring and professional. People clearly enjoyed the relationship they had with staff.

People’s preferences, interests, wishes and diverse needs were noted in their care records. Staff spoken with had a good understanding of how people wished to be supported and provided care in accordance with their wishes.

Is the service responsive?

As people’s needs changed the service adapted to accommodate them. Other health and social care professionals were involved when needed to assess people’s needs and provide guidance and support. Risk assessments were produced in response to problems that occurred. Senior staff were also producing risk assessments before problems occurred using a knowledge of people’s needs and history.

Senior staff understood the need to identify the goals people wanted to achieve but had not fully understood how this could be reflected in someone’s care record. Staff were aware of people’s goals but it was not clear how they were being supported to achieve them. The registered manager told us they would review the recording and monitoring of people's goals to improve the outcomes for them.

There was evidence that learning from incidents took place and appropriate changes were implemented. We found there was no system for recording the learning process and the registered manager acknowledged this may be helpful for consistency and record keeping.

Is the service well led?

A quality assurance system was in place which included gaining the views of people who lived in the home. People said they had been listened to when they made a complaint. We were told by people they had house meetings to discuss issues important to them such as food and activities.

The administration and storage of medicines was not being routinely audited to check policies were being followed. Other audits were in place to monitor the safety of the environment people lived in. Business continuity plans were in place to mitigate the risk from major incidents such a fire, utility loss and burglary.