This inspection took place on 17 November 2016 and was unannounced.

Alexandra House is a small private owned residential home which offers care and treatment for up to five people with learning and physical disabilities. At the time of our inspection there were four people living at the home. People living at the home were older and most had lived together for a long time.

There were two registered managers 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 last inspection in October 2015, the provider was found to be in breach of four regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014.

We carried out this fully comprehensive inspection to see what action the provider had taken in response to the shortfalls we had previously identified. We found during this inspection that the provider had made the improvements needed and was now meeting the regulations.

Staff training was tailored to the individual needs of people who lived at the home. Staff told us that they had good access to training. Staff benefitted from regular supervision where they could discuss their practice and any training needs they had.

People’s medicines were stored and administered safely by trained staff. Staff worked alongside healthcare professionals when needed to ensure that people’s health needs were met.

Risk assessments promoted independence whilst also ensuring people were kept safe from known hazards. Systems were in place to report incidents and staff knew their responsibility to do so. Staff understood their roles in safeguarding people.

Staff provided care in line with the Mental Capacity Act (2005) (MCA). Records demonstrated that people’s rights were protected as staff acted in accordance with the MCA when being supported to make specific decisions. Where people had restrictions placed upon them, these were applied for appropriately.

People were supported by sufficient numbers of staff to keep them safe whilst enabling them to participate in their chosen activities. The provider undertook checks to ensure that staff were suitable for the job.

People were supported by kind, compassionate staff who knew them well. Staff promoted people’s privacy and dignity when working with people.

People’s care plans contained information for staff on their needs, wishes and what was important to them.

People were supported to eat meals that they enjoyed in line with their dietary requirements. Care plans were person centred and reflected people’s needs and preferences. Reviews happened regularly to identify changes in people’s needs.

People lived in an inclusive atmosphere where they were involved in decisions about their home. A complaints policy was in place so people could be supported to make a complaint. People had access to a range of activities in line with their interests. People went on regular outings of their choice.

Staff felt supported by management and were involved in making decisions about the home. People’s views were sought by management and systems were in place to ensure care was of a good quality.

Alexandra House is a care home providing accommodation and personal care for up to five people with learning or physical disabilities, some of whom may be living with dementia. There were four people living at the home at the time of our inspection.

The inspection took place on 27 October 2015 and was unannounced.

The home had a registered manager. 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.

Staff were observed to use moving and handling techniques which put people at risk of harm. We saw from meeting minutes this had previously been discussed with staff.

Bathrooms were not cleaned to a satisfactory standard and infection control procedures were not always followed. People’s rooms and other communal areas were clean and personalised.

Staffing levels were sufficient to meet people’s needs during the day although as people’s needs were changing there was evidence that personal care needs may not always be adequately met during the night.

We found there were insufficient recruitment checks to ensure staff employed were suitable to work at the home. Not all staff files contained evidence that gaps in employment had been investigated and a full Disclosure and Barring check was not available for one staff member.

There were a range of activities for people to participate in although access to community activities was limited. People did not always have a choice about what they had to eat and drink, however, we saw the provider was taking steps to address this.

Each person had an individualised plan of care which gave details of the person’s preferences and needs. Staff knew people well and approached them with kindness. However, we observed staff using language that was not always respectful and one person’s communication was not always acknowledged.

Medicines were managed well and risk assessments were in place to mitigate the risk of mistakes being made. People were supported to maintain good health and had regular access to a range of healthcare professionals who told us that staff listened to their advice to keep people well.

Staff received necessary training and supervision to enable them to do their jobs. People’s rights were protected and they were safeguarded from the risk of abuse because staff understood their roles and responsibilities in protecting them.

Where people could not make decisions about their own care and support decisions made in their best interests in line with the Mental Capacity Act 2005. Deprivation of Liberty Safeguards (DoLS) had been applied for people who needed their liberty to be restricted for them to live safely in the home.

Quality assurance audits were completed and actions were addressed, however, this process was not always effective in achieving the desired improvements. Those involved in the service were regularly asked to give feedback and information regarding complaints was available should people have any concerns.

Accidents and incidents were reviewed by the manager to reduce the risk of incidents happening again. A contingency plan was in place to ensure that people’s care could be provided safely in the event that the building could not be used.

During the inspection we found some breaches 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.

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led.

There were three people living in the home on the day of our inspection. As part of this visit we spoke with the registered manager and three staff. We were unable to speak to any relatives on this occasion. However we were able to have a short conversation with one people who lived at Alexandra House. The other two people who used the service were unable to communicate with us verbally, so we used observation to reach our judgements.

We reviewed records relating to the management of the home which included, care files, policies and daily records.

Below is a summary of what we found. The summary describes what people who used the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

We saw that people were cared for in a clean and safe environment. People were able to move around the building in a way that was safe and free from hazards.

We saw that staff had received training in safeguarding vulnerable adults which ensured they knew what they should do if they suspected abusing was taking place.

Is the service effective?

We saw that people who used the service seemed happy and calm. It was clear that staff knew the needs of the people living at Alexandra House well.

Is the service caring?

We saw that people were supported by staff when necessary. We saw that people were able to make their own choices that related to food or what activity they wished to do.

Is the service responsive?

Records showed us that people had been able to indicate their preferences, likes and dislikes and they had access to activities that were important to them. We saw that various health care professionals were involved in people’s care.

Is the service well-led?

We saw that staff met with everyone who lived in the home on a regular basis to share information. These meetings were done in a way that people could understand.

Staff told us they were encouraged to make suggestions and that when they did they were listened to.

We were able to speak with one person who told us that they were happy living in the home. Some people had limited verbal communication. We observed care and support being provided in the home. We observed staff offered support in a sensitive and caring manner and they had a good understanding of their communication styles.

We looked at people's care plans, which were person centred and they were written from the person’s perspective.

People were provided with varied and nutritious meals. We observed that people were offered choice and they were provided with good support with eating and drinking. A person told us that they enjoyed their meals.

We looked at the home's medication administration practices and we found that medicines were safely administered.

Systems were in place to gather the views and experiences of people who used the service, their representatives and staff. We saw that an action plan had been implemented which ensured that people's views were acted upon.

The service had a complaints procedure in place. This information was also presented in an accessible format.

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We used a number of different methods to help us understand the experiences of people using the service; because some of the people using the service had complex needs which meant they were not all able to tell us their experiences.

We spoke with two people using the service and we spoke with one relative of a person using the service.

We observed care and support being provided in the home.

We gathered evidence of people’s experiences of the service by reviewing feedback surveys, which had been carried out by the provider in 2011.

Two people using the service said that they were happy living in the home. One person said that they liked the staff.

We observed staff respecting people’s right to privacy and we saw staff offering support in a sensitive and caring manner.

We observed people being offered choices and we observed a person using the service being involved in meal preparation.

A relative of a person using the service told us that they were kept up to date with any changes in their relative’s care and they were always invited to reviews and any meetings. They said, ‘Staff treated all people well’ and they were asked for their views about the quality of the care and support provided and they were often communicated with directly as well. They said the home was run well.

We looked at feedback surveys carried out by the provider. People’s relatives said that they were satisfied with the care.