About the service: Alexandra House provides accommodation and personal care and support for up to 47 older people. People living at Alexandra House may have a mental health need or may suffer from dementia. On the day of inspection 42 people were using the service.

People’s experience of using this service:

During the inspection, we observed there was sufficient staff to keep people safe and we found call bells were answered in a timely manner. However, we did still receive some mixed feedback in relation to staffing.

People said they felt safe and cared for in the service. Thorough recruitment checks were carried out. Risk assessments were in place and had been regularly reviewed. Staff were aware of the measures in place to reduce risks to people. People received their medication as prescribed. Accidents and incidents were monitored to help prevent a reoccurrence. Infection control measure were in place to reduce the risk and spread of infection.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. There had been ongoing issues with the quality of the food at the service and a new menu had just been introduced. The registered manager was actively monitoring feedback from people in relation to food.

Staff were knowledgeable about people's needs and how they were to be met. There were designated activity staff members to support people to engage in activities they were interested in, on an individual and group basis.

There were a range of quality assurance systems and processes in place to monitor the service. People's views were sought and these were taken into account when considering the development or improvement of the service.

Rating at last inspection: Good (report published on 09 September 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained Good overall.

Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Alexandra House is owned by Methodist Homes. It provides accommodation and personal care and support for up to 47 older people. The building was purpose built, offering accommodation over three floors. Alexandra House is supporting a range of people’s needs, including people living with dementia. Nursing care is not provided at Alexandra House.

This unannounced inspection took place over two days, 2 and 3 June 2016. At the time of the inspection there were 47 people living in the service.

There was not 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. There was a new manager in post who had started working in the service on 1 April 2016, who was in the process of submitting their registered manager application with the CQC.

People and their relatives felt that the service was providing safe care. Risks to people were assessed and appropriate measures taken to minimise risk, without unnecessarily restricting people’s independence. Where restrictive practices were in place to ensure people’s safety, the service was aware of the changes to the law regarding the Deprivation of Liberty Safeguards (DoLS). Therefore where needed, appropriate referrals were made to external professionals.

People were cared for by staff who were safely recruited, supported, supervised, appraised and trained. There were sufficient numbers of staff to provide safe care, and the service were proactively recruiting to vacant posts.

The premises were purpose built and the manager / provider kept an overview of any on-going maintenance and refurbishment to ensure that the building was safe and fit for purpose. However, we found improvements were needed to the internal décor to support people living with dementia and have made a recommendation.

People and their visitors were complementary about the relaxed atmosphere of the service and welcoming, friendly staff. Staff had good relationships with people who used the service and their relatives. Staff interactions with people were caring, respectful and supported people’s dignity.

People told us that the food was very good, and that they were supported to have enough to eat and drink. Dietary needs and nutrition were well managed and advice sought from appropriate health professionals as needed. Health care needs were met through developing good working relationships with external health care professionals.

People’s, relative’s and staff’s views were sought about the service, and their feedback used to monitor the quality of the service, and be influential in driving improvements.

People and where applicable, their relatives, participated in the development of their care plans which stated their preferences. The service offered a range of activities for people to choose from and participate in. The ‘in-house’ magazine kept people updated on what was happening in the service.

People felt their concerns and suggestions were listened to and acted on to drive improvements in the quality of the service they received. A complaints procedure was in place to ensure people’s comments, concerns and complaints were listened to and addressed in a timely manner and used to improve the service.

There were quality assurance processes in place to monitor the quality and safety of service people received and used to drive continuous improvement.

People we spoke with said they were happy with the arrangements made for their medicines.

Medicines were kept safely and disposed of appropriately. There was sufficient guidance for staff on the use of some medicines.

People were protected against the risks associated with medicines because the provider had got appropriate arrangements in place to manage medicines.

We gathered evidence of people’s experiences of the service by talking with people, observing how they spent their time and noted how they interacted with other people who lived in the home and staff.

We saw that Alexandra House provided a relaxed and homely environment for people. Staff were friendly and respectful in their approach and interacted with people who used the service in a confident and considerate manner.

During the course of our visit we saw that people were supported to express their views and choices by whatever means they were able to and staff clearly understood each person’s behaviours and their way of communicating their needs. Staff looked after people's healthcare needs in a proactive way. One person told us: "The staff here are as good as they can possibly be. They work very hard.” and another said: “I am as happy as a sandboy."

The staff team were well trained and supported to carry out their role. The provider had effective systems in place to monitor complaints and the quality and safety of service that people received.

We gathered evidence of people's experiences of the service by talking with people, observing how they spent their time and noted how they interacted with other people living in the home and staff.

We saw that Alexandra House provided a relaxed and homely environment for people. Staff were friendly and respectful in their approach and interacted with people using the service in a confident and considerate manner.

During the course of our inspection we saw that people were supported to express their views and choices by whatever means they were able to. Staff clearly understood each person's behaviours and their way of communicating their needs. Staff looked after people's healthcare needs in a proactive way.

The staff team were well trained and supported to carry out their role.

The provider had effective systems in place to monitor the quality and safety of service that people received.