The inspection took place on 06 November 2018 and was unannounced. The service was last inspected on 11 April 2016 and was rated Good in all areas at that time.

Alexandra House accommodates 16 people with Mental Health needs in one main, adapted building, and two additional, purpose built one bedroomed bungalows. Alexandra House is a care home. People in the care home receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. There were 15 people at the home on the day of our visit.

There was a registered manager for 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 well supported to stay safe and to take appropriate risks in their daily life. They were supported by well trained staff and up to date systems and procedures in place, to keep people and others safe. This meant people lived in a home where they could develop and live a fulfilling life but still be supported to stay safe.

People, relatives, professionals and staff gave positive feedback about the home. Comments included “The staff are very good at what they do” “I never cease to be impressed by what they do”, and “Yes I would recommend this place to anyone, this is my home.”

People were supported by a team who were led by managers who were very committed to providing people with highly responsive and very flexible support. The care and support people received was goal and aspirations led. This in turn meant people thrived and could achieve long term goals and outcomes. Care was well planned to respond to people’s individual needs and goals.

People were well supported with activities that were highly personalised to them and their specific interests. Care plans were personalised with information co-written with people at the home. This supported staff to provide high quality care and support that fully met peoples needs.

People, relatives and staff were at the centre of Alexandra House’s quality checking programme. The management team followed a wide range of systems to gain their feedback and views. Systems included regular meetings and a range of satisfaction surveys.

People, relatives and staff, told us the home was very well run and well-led by the management team. One person told us “I see the manager all the time I can talk to him about anything”. Another person said, “They ask me what I want and I am involved in my care plan.”

People were supported by a team that were committed to providing them with a person-centred service. Staff who showed specific interests in areas, such as safe responses to behaviours that challenge were designated 'leads'. These leads continued to play a key role in developing and improving practice as well as sharing best practice.

People and staff benefited from a management team with a long term vision for the service and an understanding and appreciation of people's needs. The team worked with people and planned people's care in ways that were creative and person centred in approach. This meant people were at the centre and ‘heart’ of how the home was led and managed. The management team were always looking to find new and dynamic ways to support people to lead a really fulfilled daily life.

This inspection took place on 11 April 2016 and was unannounced. The previous inspection of Alexandra House was on 25 August 2015. There were no breaches of the legal requirements at that time.

Alexandra House is a care home for up to 16 people with Asperger Syndrome and Autistic Spectrum Disorders. The accommodation consisted of a main house and two self-contained bungalows.

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.

Procedures were in place which helped to ensure people were safe. These included having enough staff to support people and taking action to reduce the risk of people being harmed. Staff received training in how to provide safe care and they knew how to follow up any concerns about people’s wellbeing.

Staff helped people to manage their medicines safely. People received support to stay healthy and to have positive relationships. Individual support plans were produced with people. The plans were kept under review to ensure they were up to date and reflected people’s current needs.

People told us they liked the meals and could prepare their own food if they wished to. Staff promoted people’s independence and supported people to take part in activities they enjoyed. People told us they liked going out with staff, for example to attend sporting events. The interactions we observed between people and staff were friendly and respectful.

Staff received training and supervision which helped to ensure they were competent in their work. Staff spoke positively about working as a team to ensure they met people’s needs. People’s rights were respected because staff worked in accordance with the principles of the Mental Capacity Act 2005.

The quality and safety of the service was being checked regularly. This meant that any shortcomings would be identified and action taken where necessary. People’s feedback about the home was obtained and reviews undertaken to see where improvements were needed and the service could be further developed.

We carried out a comprehensive inspection of Alexandra House on 25 February 2015. We found breaches of the legal requirements at that time in relation to:

• The failure to adequately identify, assess and manage risks.
• Support plans not being updated to reflect changes in people’s wellbeing and the outcome of reviews.
• The provider not operating an effective system for assessing and monitoring the quality of the service.

After the inspection, the provider wrote to us to say what they would do to meet the legal requirements.

We undertook a focused inspection on 25 August 2015 to check the provider had followed their plan and to confirm they now met the legal requirements. This report only covers our findings in relation to these areas. You can read the report from our last comprehensive inspection by selecting the 'All reports' link for ‘ Alexandra House - Bristol ’ on our website at www.cqc.org.uk

Alexandra House is a care home for up to 16 people with Asperger Syndrome and Autistic Spectrum Disorders. The accommodation consisted of a main house and two self-contained bungalows.

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.

At our inspection on 25 August 2015 we found that the provider had taken action in order to meet the legal requirements.

Action had been taken to reduce the risks associated with window openings. Training had been arranged for staff which helped to ensure they supported people in a safe way.

A programme of review meetings had been introduced and changes made to people’s support plans. Further information was being added to the support plans to give a more comprehensive picture of people’s needs.

Action had been taken to ensure a more consistent approach to quality assurance and to checking standards in the home. However, a recommendation we made at the last inspection about staffing had not been followed up as thoroughly as we would have expected.

This inspection took place on 25 February 2015 and was unannounced. The previous inspection of Alexandra House was on 15 September 2013. There were no breaches of the legal requirements at that time.

Alexandra House is a care home for up to 16 people with Asperger Syndrome and Autistic Spectrum Disorders. The accommodation consisted of a main house and two self-contained bungalows.

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.

People told us they felt safe and could talk to staff if they had any concerns. However, action was not always being taken to ensure people were well protected and risks were reduced. Staff did not always feel they had received the right training when responding to incidents.

The arrangements being made for staffing the home lacked a planned and consistent approach. There was a risk that staffing levels did not provide a good level of protection at all times and enable people to exercise choice in their routines. We have recommended that a review of the staffing arrangements is undertaken.

People had individual support plans which covered different areas of their lives. These provided guidance for staff about the support people needed. However, there was a lack of information about reviews. There was a risk that the plans did not reflect people’s current needs and they would not receive the right support.

The arrangements being made for quality assurance did not ensure that standards in the home were well checked and improvements made where needed.

Staff helped people to manage their medicines in a safe way. Other support was provided which helped people to stay healthy. People enjoyed the meals that were produced for them and also liked having the opportunity to buy and prepare their own food.

Staff were aware of their responsibilities in relation to the Mental Capacity Act 2005 and respected the decisions people made. Overall, staff felt they had the support and supervision they needed to do their jobs well.

People spoke positively about the staff and how they were treated. One person commented "Its relaxed here, we can do things at our own pace." The relationships between staff and people at the home were friendly and respectful. People’s independence was being promoted. In particular, the bungalows provided a good opportunity for people to develop their independence.

We found two breaches of regulations during our inspection. The regulations have changed since we inspected the home and the breaches we found correspond to a breach of Regulation 17 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 back of the full version of the report.

At the time of our inspection there were 16 people living at Alexandra House and 12 people were at home during our inspection. 11 members of staff were on duty during our inspection and people were observed receiving one to one support, both in the home and to access their local community.

We spoke with people living in the home, staff on duty, team managers and senior managers during our inspection. We also looked at people’s support plans that were called ‘weekly programs’, to see how people were supported with their daily living needs.

Not all people wanted to speak with us as some people found it difficult to speak with people they were not used to. However those who did gave positive comments about living in the home. Comments included “yeah it’s good here I’m fine”. “staff are good here I like it”.

Staff we spoke with were knowledgeable about the support needs of people that used the service. Staff comments included; “we give choices to people about daily routines and understand their routines and rituals and support them fully”. “I have been here for only six months and I am impressed with the company. People have so much opportunity here and the staffing levels are really high to support this”.

We found the provider had systems in place to effectively monitor the service provided. Staff were trained to effectively meet the needs of people that used the service. Staff were able, from time to time, to also obtain further relevant qualifications.

As part of our inspection we spoke with three people who used the service, three relatives and three social care professionals. We also spoke with the general manager and five staff.

On the day of our inspection there were 16 people living at Alexandra House. Eight people were in the house supported by five members of staff. Some people had gone out with staff for various activities in the community. One person was supported for a cooking session in one of the organisation’s training and leisure centre.

Comments made included, "I like living here, I am taking things easy at the moment, we are going through my care plans gradually" and "staff are good to me I can talk to the senior if I have any worries we have three seniors each time" and “the staff are good to us I am well looked after".

We spoke with three relatives who all spoke positively about the support their relatives received. Comments included, "the staff are excellent, my relative is a changed person they have worked so well with them they tailor their plan to each person’s individual needs" and, "communication is good, I'm involved in reviews of care plans and risk assessments, I know what's going on".

We found systems were in place to ensure people were safeguarded from abuse.

We found staff were trained and supported to deliver care to an appropriate standard.

We found the provider had an effective system in place to monitor the quality of the service, to ensure people received safe care.

We met seven of the 13 people who lived at Alexandra House. People told us how they felt well supported by the staff to live a varied and fulfilling life. We were told “Living at Alexandra House has helped me recover my life”. “They have helped me to go to college”. “This is my home and I would not want to live anywhere else”.

There were innovative methods used to involve people in how the service was run. People who use the service with the support of staff, published their own regular newsletter that kept people up to date about important matters in their lives as well as their personal achievements.

People were treated with respect and courtesy and were supported with their range of complex needs. People were being supported to stay safe and have their welfare maintained. We read informative care plans and risk assessments records about how to protect people’s safety and wellbeing in Alexandra House, and in the community.

We saw that care plans and risk assessments were being reviewed regularly and updated to reflect peoples changing needs.

People were helped to stay safe at Alexandra House because the staff who looked after them, had been on regular training courses to help them to understand how to safeguard them from abuse. Staff were clear about who to report an allegation of abuse to within their own organisation. There was also a clear understanding of the role of the Local Authority in the safeguarding processes that need to be followed to keep people safe.

People were cared for by staff with an understanding of their different complex needs and how they impacted on their lives. People received care from staff who had a good awareness of what support they needed to be able to live a meaningful and fulfilling life in the home, and in the community. People were actively encouraged and supported to develop independence in their lives. For example, some people had voluntary jobs and others were attending college courses.

People were regularly involved in decision making about the care and support they received at Alexandra House.

We saw effective methods were in use to check monitor and improve even further the quality of the service people received. We saw there were systems to review and learn from all critical incidents and occurrences that may have impacted on people's health and wellbeing.