Alexandra House and The Lodge provides accommodation and personal care for up to 14 people who have a learning disability or autistic spectrum disorder. People who use the service may also have a physical disability. On the day of our inspection there were 6 people living in the home.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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 and associate Regulations about how the service is run.

The Care Quality Commission (CQC) monitors the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) which apply to care homes. We found the provider was following the MCA code of practice

People were safe because staff supported them to understand how to keep safe and staff knew how to manage risk effectively. There were sufficient numbers of care staff on shift with the correct skills and knowledge to keep people safe. There were appropriate arrangements in place for medicines to be stored and administered safely.

Staff had good relationships with people who used the service and were attentive to their needs. People’s privacy and dignity was respected at all times. People and their relatives were involved in making decisions about their care and support.

Care plans were individual and contained information about how people preferred to communicate and their ability to make decisions.

People were encouraged to take part in activities that they enjoyed, and were supported to keep in contact with family members. When needed, they were supported to see health professionals and referrals were put through to ensure they had the appropriate care and treatment.

Relatives and staff were complimentary about the management of the service. Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service.

The management team had systems in place to monitor the quality and safety of the service provided.

There were nine people living in the service when we inspected. Many of the people living in the service were unable to speak to us about their care. We observed interactions between staff and people living in the service.

We looked at comments made on a recent survey the service had sent to relatives of people living at Alexandra House and The Lodge. One person had written, 'On all the visits I have made to my (relative) and the home, I have found it to be welcoming and warm.' Another person had written, 'I have been so very happy with the wonderful care and love shown to (relative) by you and all of your staff.

We looked at two people's care records and spoke with two members of staff.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found:

Is the service safe?

We saw that when people presented behaviour that was challenging staff were able to manage the situation in a positive way and protected the person's dignity and rights.

Risk assessments were proportionate and person centred. Staff understood the risk associated with complex needs and managed them appropriately and safely in line with their risk management plan.

We saw that staff were provided with training in safeguarding of vulnerable adults from abuse. Records also showed that staff had received Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) training. We saw an example of where staff had not made an appropriate DoLS referral and spoke with the manager about this. They advised that a referral would be made.

Is the service effective?

People's needs were assessed and care and support was provided in line with their care plan. Due to a recent reduction in staff the amount of time staff could spend interacting with people positively on a one to one level had been reduced.

A visiting general practitioner we spoke with was positive about the care provided by the service.

Records we inspected showed that the service made referrals to relevant professionals such as a chiropodist and speech therapist.

Is the service caring?

Care was individual and centred on the person. Staff demonstrated a good understanding of the care and support each person required.

We observed staff interacting with people who used the service in a caring and supportive manner.

Is the service responsive?

We saw that the service offered a number of activities, such as reflexology and music, to allow people to live as full a life as possible.

People were protected from the risks of social isolation. Activities were organised within the service and people were assisted to access the community. However, due to staff numbers opportunities for this had recently been reduced.

We saw that the number of people living in the service had decreased over the past six months. However, when we spoke with the manager they told us that the needs of the people living in the service had increased. The service had not responded to these changes by assessing staffing levels to ensure that people's needs were met.

Is the service well led?

There was a registered manager in place. The manager worked along side staff when delivering care and promoted good practice.

Many of the people living at Alexandra House and The Lodge had complex needs and were unable or chose not to speak with us. Some people communicated with us using gestures and facial expressions. We gathered evidence of people’s experiences of the service by observing how they spent their time and noting how they interacted with other people living in the home and with staff. We saw that people were happy living at the home.

Relatives spoken with were complimentary about the service and happy with the quality of care. A relative who completed a survey as part of the home’s quality assurance process said: “My [relative] has always been cared for extremely well by the kind, caring and supportive staff at Alexandra House.”

We noted that the environment at Alexandra House and The Lodge was spacious and people’s bedrooms were decorated according to their preferences; bedrooms were clean and well maintained.

Improvements were required to the cooking and dining arrangements in the home. Food and drinks were prepared in the main kitchen in Alexandra House and carried across to The Lodge. This presented risks when transporting hot food and drinks down a narrow corridor.

We found that staff received the training they needed to provide care and support safely and were able to demonstrate that they understood the specific needs of the people using the service. We saw that staff treated people with respect.

We used a number of different methods to help us understand the experiences of people using the service because the people using the service had complex needs which meant some of them were not able to tell us their experiences. Many people shared their views through gestures, facial expressions and body language, we spoke generally with some people and we observed how people interacted with one another and with members of staff.

Relatives and health and social care professionals who completed surveys as part of the home’s own quality assurance process made positive comments about the service provided at Alexandra House and the Lodge. They were complimentary about the care, the relaxed atmosphere in the home and the friendly, welcoming staff.