This unannounced inspection of Alexandra Care Home took place on 14 August 2018.

At the last inspection on 9 February 2016, the service was rated ‘Good’. We found during this inspection that the service remained ‘Good.’

Alexandra Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Alexandra Care home is registered with CQC to provide the following regulated activities; accommodation for people who require nursing and personal care, treatment of disease disorder or injury, and diagnostic and screening procedures.

Alexandra Care Home is a two-storey building, situated in Newton le Willows.

At the time of our inspection there were 44 people living at the home.

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 and associated Regulations about how the service is run.

Rotas showed there was enough staff at the home to support people safely. However, some staff raised that due to a recent staffing reduction on the ground floor, they sometimes felt there was not enough of them to be able to spend more time with people or take them out. A dependency tool was in place to determine people’s level of need, and this was being utilised, however, some staff still felt there was not always enough of them on duty. We discussed this at the time with the registered manager who informed is they would raise this with the registered provider.

Some of the information relating to the recording of environmental checks was confusing and duplicated. We raised this at the time of our inspection with the registered manager for further consideration. This was actioned straight away.

Practices relating to medication storage and administration were safe. We found some bottles of medicine were not dated when opened, however the registered manager rectified this straight away.

Staff were able to describe the course of action they would take if they felt anyone was at risk of harm or abuse this included ‘whistleblowing’ to external organisations. The registered manager had systems and processes in place to ensure that staff who worked at the service were recruited safely. Risks were well assessed and information was updated as and when required.

All newly appointed staff were enrolled on a work based induction when they took up post at the home. Records showed that all staff training was in date. There was a supervision schedule in place, all staff had received up to date supervision and most had undergone an annual appraisal. Those due were booked in to take place.

We saw that where people could consent to decisions regarding their care and support this had been documented. Where people lacked capacity, the appropriate best interest processes had been followed. The service was working in accordance with the Mental Capacity and DoLS (Deprivation of Liberty) and associated principles. We checked the status of peoples DoLs and any conditions on their authorisation. The registered provider had a system in place to ensure this was monitored.

The environment was pleasant and homely. There was an ongoing programme of refurbishment and we saw some people's bedrooms would benefit from this.

People we spoke with were complimentary about the staff, the registered manager and the service in general. People and relatives told us they liked the staff who supported them. We observed staff treating people with kindness and dignity throughout the day. Staff were able to give us examples of how they preserved dignity and privacy when providing care.

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The inspection was unannounced and took place on the 9 and 11 February 2016.

Alexandra House provides nursing care and support for up to 48 people in the Newton-Le-Willows area. The service has two floors, the ground floor offering residential care, and the first floor providing nursing care. There is an outdoor area which has a seating where people are able to sit. At the time of the inspection there were 43 people living within the service.

There is a registered manager in post within 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 were protected from the risk of abuse. Staff had received safeguarding training and they were able to identify the signs and indicators associated with abuse. Staff were also familiar with how to report their concerns. Safeguarding incidents were reported to the local authority by the registered manager as and when they occurred.

People’s care records were personalised and contained information around how they should be supported. People told us that care staff provided appropriate support that was in line with their preferences.

Recruitment processes were robust, and ensured that people were of suitable character to work with vulnerable adults. New staff were required to produce two references, one of which needed to be from their most recent employer. They were also subject to a check from the disclosure and barring service (DBS). A DBS check ensures that people are suitable to work with vulnerable people.

People were supported to take their medication as prescribed. Medicines were stored securely, and there were systems in place to monitor the quantities of medications kept, and to ensure that it had been administered appropriately.

Deprivation of liberty safeguards (DoLS) were in place for people who needed them. Staff had received training in the Mental Capacity Act 2005, and knew the basic principles of the Act. Staff also identified when a DoLS may be required for a person.

People’s nutritional and hydration needs were met. People told us that they enjoyed the food and that there were different options available. People with special dietary requirements were supported to take their nutrition in line guidance from professionals. People were offered a choice of drinks through the day, which included tea, coffee and juice.

Staff were kind and caring in their approach to people, and there was a positive atmosphere throughout the service. People told us that staff were respectful and that their dignity was maintained. Staff had received training in a variety of areas such as manual handling and infection control. There was an induction process in place for new staff which included a period of training, and shadowing more experienced members of staff.

People told us that there was a variety of activities available to them which they enjoyed. There was an activities co-ordinator in place who spent time doing group activities, or one-to-one sessions with people. This helped meet people social needs and protected them from the risk of social isolation.

People and their relatives were familiar with the complaints process, and told us that they found the registered manager to be approachable and responsive to their concerns. A record of comments and complaints was kept which outlined actions that had been taken in response to concerns that had been raised.

We drew the registered manager’s attention to some areas of the environment that needed addressing, for example there were dirty mop heads in one of the cleaning cupboards and the lock to one of the sluice rooms was not working properly. We also found linen being stored on the floor in one cupboard. These issues were dealt with s

During our visit we observed some of the support provided to people who lived in the home. Staff appropriately supported people during mealtimes and a variety of meals were served at lunch time.

People living in the home told us, "I am very happy living here, they are lovely, the food is good, my room is warm and the staff are pleasant”, “Staff are excellent”, "There is always enough staff available, I never wait long for anything", “They are really good and helpful” and "I have seen my care plan, they talk to my family and me about it".

We spoke with relatives of people who lived in the home they told us that they were “Very happy” with the care and support that they received. All the relatives spoken with told us that they felt that their relatives were safe in the home. They told us that they were always welcomed into the home, there was enough staff available and the home never had an unpleasant smell.

Records showed that peoples’ individual rights were supported and the care plans were written in a manner that highlighted people’s individual needs and how staff were to support them. We saw that monitoring of care were available in peoples bedrooms in order to support them to access their records as needed. Other records available showed that risks were identified by the service and action taken to reduce any potential risks.

People we spoke with said they were looked after well and that staff were available and easy to approach. Some people were unable to verbally communicate with us, however we observed staff being attentive to their needs. One person commented,” The care is excellent here. The staff are very caring to all the residents. I have seen this every time I have visited.”

Care records were well organised and included detailed assessments of need, risk assessments and strategies to manage those risks. We spoke with the home’s activity co-ordinator who showed us the schedule of activities arranged. She also told us that she spent time with people on an individual basis and kept a record of their interests and preferences.

The home had systems in place for the safe administration of medication. We observed staff support people to take their medication in a safe and timely manner. We checked a number of medication administration records (MAR charts) and they were accurate, signed and dated appropriately.

The home had systems in place to support staff to be suitably skilled to meet people's needs. The manager told us and staff confirmed that there was an induction programme in place to support new staff during their first three months.

We saw examples of the complaints received in the last six months and found that they were responded to in a timely manner and that actions had been taken as a result of the complaints.

A visitor we spoke with said that his wife has lived here for five years. He is definitely happy with the way she is looked after and has a word with the manager if there are any problems. She is usually clean and tidy but the odd time he has been a bit disappointed with her personal care. When she first came in she lost a lot of weight but it is stable now. They let him know if she is not very well. He has got to know everyone well and he visits people who live upstairs too.

A visitor told us that there aren’t usually many people in the lounge and sometimes it is not very nice in the lounge with a TV on, radio on, and some residents who shout.

We spoke with a person who was sitting in her bedroom. She had moved to live at Alexandra earlier this year. She told us that she doesn’t sit in the lounge or join in activities. She reads, watches TV, and does crosswords. She has a good friend who takes her out at the weekend.

The visitors we spoke with said that they would speak to the manager if they had any concerns or there was anything they weren’t happy about.

A person we spoke with said that she has shower once a week but has to remind staff about this. Her bed isn’t changed every week.

One person who lives at the home told us that a couple of the staff are bossy, nobody has been unpleasant, just bossy. She went on to say that she finds all the senior nursing care assistants are very nice and the nurse who is on duty today is lovely. She has a friend who she would tell if she had any complaints.

A relative told us that some staff are better than others but all are OK and ‘nobody is ill-treated’ at this home.