About the service:

Alexandra House – Harlow is a residential and nursing home providing care to up to 106 people, across three floors, in one purpose built building. Two floors provide residential care and one floor supports people with nursing needs. At the time of this inspection there were 104 people living at the service including older people, people with physical disabilities, people with long term medical conditions and people living with dementia.

People’s experience of using this service:

People told us that they felt safe but we found recorded guidance about how to keep people safe was inconsistent. Care records sometimes lacked detail about people’s needs and preferences, including information about their healthcare needs. Information about people’s background, culture and identity was not always clearly captured and recorded.

People told us they did not always have access to meaningful activities and our findings supported this. We found the providers systems to check and audit the service were not always picking up or addressing the shortfalls that we found during this inspection. We found information to calculate and monitor staffing levels was not always accurate, but people told us there were enough staff and our observations supported this.

People received their medicines safely and where nursing care was required, this was delivered competently by trained staff. The service had developed links with local health services and had a clear process for assessment and admission that was followed. There were links with the local community that had led to fundraising initiatives including for activities and development of the home environment. The home environment was suited to people’s needs with clear signage and areas for people living with dementia to engage with.

People told us that staff were well trained and kind and caring. We observed pleasant interactions between people and staff and that people were supported in a way that they could be independent. Staff told us they felt supported by management and records showed they received training and support suited to their roles. Recruitment checks had been carried out to assess the suitability of staff for their roles, but one piece of information had to be provided after our visit due to inaccurate record keeping.

People said they liked the food that was prepared for them and information about their dietary needs and food preferences were recorded. People had regular meetings and told us they felt any issues they raised would be addressed. There was a complaints policy in place and any concerns that had been raised were investigated and responded to by management. The service regularly sought the views of people and relatives to identify improvements.

Rating at last inspection: Good (Published 14 June 2016)

Why we inspected: This was a planned comprehensive inspection.

Enforcement: Please refer to the action we told the provider to take at the end of the full report

Follow up: We will ask for an action plan from the provider and continue to monitor the service closely. We will return in line with our policy to check that improvements have been made and sustained.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The inspection took place on the 29 March 2016 and 01 April 2016. Alexandra House is a purpose built nursing home for up to 106 older people who may also have care needs associated with living with dementia.

A registered manager was in post at 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.

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 had followed the MCA code of practice in relation to DoLS.

People were safe because the management team and staff understood their responsibilities in managing risk and identifying abuse. People received safe care that met their assessed needs.

There were sufficient staff who had been recruited safely and who had the skills and knowledge to provide care and support in ways that people preferred.

The provider had systems in place to manage medicines and people were supported to take their prescribed medicines safely.

People's nutritional needs were assessed and monitored by staff. Their preferences and special dietary needs were known and were catered for. Staff encouraged and assisted people to eat and drink, where necessary. Advice from relevant health care professionals was sought to ensure that people's nutritional needs were met.

Families and friends were welcome to visit the home. People were encouraged to maintain relationships important to them.

Staff respected people’s choices and took their preferences into account when providing support. People were encouraged to enjoy pastimes and interests of their choice and were supported to maintain relationships with friends and family so that they were not socially isolated.

There was an open culture in the home and people, relatives and staff were comfortable to speak with the manager if they had a concern.

The provider and manager had arrangements in place to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

We spoke with four people who lived at the home. They told us that they were quite happy with both the quality and the quantity of the food they were offered. We looked at the care records of five people who lived at the home. We saw that people's dietary needs had been assessed prior to their admission to the home. The care records showed that people's dietary needs had been reviewed regularly and people had been referred to the dietician if any significant weight loss had been identified. In a number of cases we saw that food supplements had been prescribed.

We saw that the service had a complaints policy and people were made aware of the complaints system. We looked at the records of five of the complaints that had been received in the six months prior to our inspection. We saw that a full investigation had been carried out in each case.

We saw that there was an effective system in place to notify the Care Quality Commission about the death of a person who lived at the home.

We looked at the copies of the notifications of incidents, other than the death of a person who lived at the home, that had been sent to CQC in the six months prior to our inspection. We noted that there was an effective system in place to notify the Care Quality Commission about incidents that affect the health, safety and welfare of people who lived at the home.

We spoke with 11 people and five relatives of people who lived at the home. People told us that the care workers always asked for their consent before providing any care. One person said: "I ask them and they do it." People also told us that they were satisfied with the care that they received. One person told us: "I've got no complaints at all. They are kind and caring people."

We looked at the care records of 10 people who lived at the home. We noted that whilst these were of a generic nature each had been personalised to the individual. We saw that the home worked closely with other health and social care providers to ensure that people received the care and treatment that they needed.

On the day of our inspection the home looked clean and smelled fresh. We saw that all the bedrooms were thoroughly cleaned on a daily basis and were clean and dust free. We noted that the home's infection control policy had been updated in January 2013.

Records showed that the staff members had started work only after a full and satisfactory criminal records check had been received. We saw that people had completed a medical questionnaire and signed a declaration that they were fit to undertake the work of the post.

We saw that there were regular meetings with people who lived at the home. We also saw the report from a monthly compliance visit that took place on 12 June 2013, the action plan that arose from this and that staff had been made aware of the content of it.

When we inspected the home on 25 June 2012 we judged that there were insufficient staff available to meet people's needs on the nursing floor of the home. We were told that people's call bells were not being answered and saw that there was a delay when we called for assistance for a person who lived at the home. We had also been concerned that there were insufficient numbers of staff to assist people at meal times.

During our inspection on 17 January 2013 we spoke with six people and four relatives who were visiting the home. People told us that calls were responded to quickly. One person said, "If I want anything they come quickly." We saw that when someone used their call bell to call for assistance this was answered within five minutes.

The second floor accommodated a total of 38 people with one nurse, one senior care worker and five care workers available to support and care for people during the day. Sixteen people needed assistance to eat their meals. Both the acting manager and deputy manager assisted people to eat at meal times. People told us that they could have what they wanted to eat when they wanted it. We saw that one person who had asked for boiled eggs with their mid morning cup of tea was given them. We saw that each unit had a kitchen area that contained breakfast cereal, biscuits and bread for toasting.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of an inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an "expert by experience." (Person who has experience of using services and who can provide that perspective.)

People using the service told us they were always treated with respect and that staff promoted their dignity.

People told us they were happy with the activities provided for them, they said there was a lot going on.

We spoke with six people using the service and two family carers about the food provision at Alexandra House. One person said, “We get a fantastic variety of food, particularly for breakfast.” and this was the general consensus.

People living at the home praised the service for supporting their dietary needs and preferences.

Visitors to the home told us they felt that their friends and relatives were safe at Alexandra House. People living in the home and their relatives said they would be very confident to take any concerns to the manager and know that he would respond immediately.

Relatives with whom we spoke all praised the staff team for their kind and caring approach, however they also said they were concerned about the staffing levels on the nursing floor of the home. They said there was often a delay with call bells being answered and with people who needed assistance to eat when in their own rooms. People told us that finding a member of staff on the nursing unit was, “An issue” and they were, “Always busy with paperwork.” They said that, “You hardly see anyone and as a family member you don’t feel welcome.”

People living in Alexandra House did not share their views about the service provision with us at this visit. However, we spoke with many visitors to the home on this day. People told us they were impressed with the care and professionalism of the staff team and they felt their relatives were safe living in Alexandra House. Relatives told us they felt the manager's approach was refreshing and comforting in that he was open, honest and realistic. A health professional with whom we spoke told us that the management of the home is stable and respected and that there were some 'fantastic Care Team Managers' working at the home.

We received positive comments from relatives of people who use the service about how well people are looked after in Alexandra House. One person told us “The carers are very caring, they consider my relative’s dignity and show them respect at all times.”

Relatives of people living in Alexandra House had many positive things to tell us about the care and support provided for people. One person with whom we spoke said “They always make sure the doctor comes if my relative needs medical help.” Another person told us “Generally the care is absolutely fine.”

People with whom we spoke told us that they enjoyed the food. One person said, “The food is quite good.” Another person told us, “I think it’s nice here, the food is lovely and the carers are really nice.”

Of the people living in the home, those who could verbally communicate with us told us that they were happy with the care they received.

A relative with whom we spoke said “I feel quite happy with my relative being here.”

Health professionals involved in the home with whom we spoke said “there have been so many managers at the home since it opened in 2009 that it is a worry that (manager’s name) won’t stay long.”

Staff members with whom we spoke said “The staff team are much happier at the moment. We have had so many managers here and each one wants to make changes, hopefully it will settle soon! Things are improving at the moment though.”

Relatives of people living in Alexandra House told they had concerns over the ever changing management at the home. They said “As soon as you get to know one person’s face they leave, there is no continuity, it must have a negative effect on the way the home runs.”

Relatives of people living in Alexandra House with whom we spoke praised the care the staff provided however one person said “Often there is not enough staff, people are sometimes left unsupervised in lounge, this is not so bad now that people use the lounge at this end of the building.”

People living in Alexandra house with whom we spoke said “We have nothing to complain about.” Another person said “We are very happy with everything, it is 100%.”

The inspection of Alexandra House – Harlow took place on the 02 and 03 December 2014. Alexandra House is a purpose built nursing home for up to 106 older people who may also have care needs associated with living with dementia.

A registered manager was not in post, although the newly appointed manager was in the process of registration. 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.

People’s health care needs were assessed, and care planned and delivered in a consistent way. However, we found that the information and guidance provided to staff was not always clear. It would not always enable them to provide appropriate and individual care. Any risks associated with people’s care needs were assessed and plans were in place to minimise the risk as far as possible to keep people safe.

The CQC monitors the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and report on what we find. We saw that there were policies, procedures and information available in relation to the MCA and DoLS to ensure that people who could not make decisions for themselves were protected. We saw from the records the service was applying these safeguards appropriately. This was through assessing people’s capacity and making appropriate referrals to the supervisory body, (the Local Authority,) if people’s liberty was being restricted.

People were happy with the service they were receiving and we received many positive comments about the service and the staff team. During our observations throughout the day we saw that staff clearly knew how to support people in ways that they wished to be supported. We found that sufficient numbers of staff were being provided to meet people’s needs. People’s medication was managed by trained staff to ensure that they received these in a safe and timely manner.

Staff had the knowledge and skills that they needed to support people. They received training and on-going support to enable them to understand people’s diverse needs. Staff respected people’s privacy and dignity and worked in ways that demonstrated this. Staff asked for permission before providing any personal care or any activity.

Records we looked at and people we spoke with showed us that the social and daily activities provided suited people and met their individual needs. People were supported to make their own decisions about if they undertook activities or not. People’s preferences had been recorded and we saw that staff respected these.

People were able to complain or raise any concerns if they needed to. We saw that where people had raised issues that these were taken seriously and dealt with appropriately. People could therefore feel confident that any concerns they had would be listened to.

The service used a variety of ways to assess the quality and safety of the service that it provided. People using the service and their families were consulted with. The service undertook a range of monitoring and areas such as health and safety and medication were regularly audited.

The management team at the service had been changed over the recent months and a newly appointed manager was in place.