What life is like for people using this service:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

People were at risk of harm as fire safety procedures and checks were not effective and the maintenance of fire doors did not keep people safe from the risks of fire.

People were at risk as the infection prevention and control systems were not effective and did not reflect best practice.

Medicines were not stored safely.

The physical environment did not contain appropriate signage to help people orientate themselves to their surroundings.

People’s individual protected characteristics were not clearly identified.

Staff members did not feel supported by the management team and did not feel there was appropriate guidance on how to provide ‘best care’.

People’s privacy was not always respected.

People’s individual communication needs had not been assessed in line with best practice.

The provider did not have effective systems in place to monitor the quality of the service they provided or to drive improvements where needed.

People had care and support plans which gave staff members the information that they needed to provide care but staff members did not routinely read them.

People felt that the activities that were available were limited and that at times they felt unstimulated.

Staff members had access to training. New staff members completed a structured introduction to their role. However, staff members did not demonstrate the practical application of their training in terms of the support they delivered.

People were referred to additional healthcare services when it was required.

The provider had systems in place to respond to complaints or compliments from people or visitors.

Rating at last inspection: Good (Last report published 22 June 2016). Following significant concerns regarding people’s safety the current rating is ‘inadequate’ overall.

About the service:

Alexander House Private Nursing Home is registered to provide accommodation for persons who require nursing or personal care, treatment of disease, disorder or injury for up to a maximum of 26 people. At this inspection 22 people were living there some of whom were living with dementia.

Why we inspected:

This was a planned inspection based on the rating at the last inspection, ‘Good.’

Enforcement.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up:

We will monitor Alexander House Private Nursing Home and re-inspect as part of our published inspection programme timetable. In addition, we will receive regular updates from the provider on the progress they are making in addressing the concerns we have raised with them.

This inspection took place on 04 and 07 March 2016.

Alexander House private nursing home is registered to provide accommodation and care for up to 26 people some of whom may be living with dementia. There were 23 people living at the service at the time of our inspection.

There was a registered manager in post. 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.

Staff had the necessary skills and knowledge to meet people’s assessed needs safely. Staff were well trained and supported. There were sufficient staff who had been recruited safely to ensure that they were fit to work with people.

People told us that they felt safe and comfortable living at Alexander House. Staff had a good understanding of how to protect people from the risk of harm. They had been trained and had access to guidance and information to support them in maintaining good practice.

Risks to people’s health and safety had been assessed and the service had support plans and risk assessments in place to ensure people were cared for safely. People received their medication as prescribed and there were safe systems in place for receiving, administering and disposing of medicines.

The registered manager and staff had an understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). They had made appropriate applications to the relevant authorities to ensure that people’s rights were protected.

People were supported to have sufficient amounts of food and drink to meet their needs. People’s care needs had been assessed and catered for. The support plans provided staff with good information about how to meet people’s individual needs, understand their preferences and how to care for them safely. The service monitored people’s healthcare needs and sought advice and guidance from healthcare professionals when needed.

Staff were kind and caring and treated people respectfully. Families were made to feel welcome and people were able to receive their visitors at a time of their choosing. Staff ensured that people’s privacy and dignity was maintained at all times.

There were good systems in place to monitor the quality of the service although these were not always completed timely.

During our inspection we spoke with six of the people who used the service. We also spoke with the provider, the manager and five members of the staff team. We looked at six people's care records, four staff files, training records for staff and safeguarding policy and procedure.

We thought about what we found and asked the questions that we always ask; Is the service safe, effective, caring, responsive and well-led?

This is a summary of what we found:

Is the service safe?

When we arrived at the service we were asked to sign the visitor's book and our identity was checked. This meant that people were protected from unwanted visitors or others who may pose a risk to their safety.

People told us that they felt safe living in Alexander House. One person said, “They are all lovely, they know everything I need to make sure I am looked after." Another person said, “I am very happy and I know that I can tell the staff any worries that I might have."

Staff had received training in safeguarding vulnerable adults from abuse (SOVA), the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). This meant that staff had been given the information that they needed to ensure that people were cared for safely.

Is the service effective?

People told us that they felt that the service met their needs. One person who used the service said, “The staff are very good and so caring, they help me with anything I need.” Another person said, “They really look after me."

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure their safety and welfare. The care records were well written and had been reviewed and updated monthly. This meant that staff had up to date information about how to meet people's needs.

Is the service caring?

Staff’s interaction with people who used the service was good. They spoke with people respectfully and supported them in a kind and caring way. Staff had a good knowledge of people’s likes and dislikes. People told us that all of the staff treated them well. One person said, “The staff are kind.” Another person told us, "The staff are very good, they help me with anything I need."

People told us that the staff treated them respectfully. People’s preferences and diverse needs had been recorded in their care files and care and support had been provided in accordance with their wishes. This showed that people were cared for by kind and caring staff.

Is the service responsive?

People we spoke with told us that the service had been responsive to their needs. One person said, "If I want anything, I only have to ask and the staff and manager will help me."

People were supported to see other professionals such as a general practitioner, community dentist, chiropodist, optician, and district nurse. This showed that people’s general health care needs were met and that the service responded to people’s changing needs.

Is the service well-led?

People had been asked for their views and opinions on a regular basis. People told us that they received a good quality service. One person said, “The staff are all very nice and are kind and friendly towards me.” Another said, “I have everything I want here and my family comes to visit me too.”

People who used the service told us that the staff and manager asked them for their opinions on the quality of the service. We saw evidence of meetings held with staff and residents. This showed that there was an effective quality assurance system in place and that the service was well-led.