Alexander Residential Home is a 'care home'. People in care homes receive accommodation and personal care under a contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

Alexander Residential Home accommodates up to 49 older people and is situated in the Morley area of Leeds. Alexander Residential Home is a residential home providing accommodation for persons who require personal care, some of whom are living with dementia. At the time of our inspection, 49 people were using the service.

This inspection took place on 9 and 13 March 2018. The inspection was unannounced on the first day. This meant the staff and provider did not know we would be visiting. The second day was announced.

At the last inspection, the service was rated Good. At this inspection, we found the service remained Good.

A registered manager was 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.

We found improvements were needed to fully ensure records were accurate and completed. Audits did not always have completion dates and care plans had not all been updated after review. Some were without dates. Labelling of food within the kitchen was not always date recorded.

Medicines were managed and recorded safely. 'As required' medicines were administered accordingly and protocols were in place for care workers to follow.

Staffing levels were sufficient to meet people's needs and recruitment procedures were robust to ensure new staff were eligible to work with vulnerable people.

People told us they felt safe and care workers had a clear understanding of the procedures relating to safeguarding and whistleblowing.

Risk assessments were completed and reviewed to support people with specific needs to avoid any harm.

The provider followed The Mental Capacity Act 2005 with capacity assessments documented and best interest meetings recorded, when required. We found consent was obtained from people verbally and formally at annual review meetings.

People were supported with their health and nutritional needs and were provided with a range of food and drink.

People living in the home had positive relationships with the care workers; they told us care workers were kind and caring.

People were encouraged to be independent and make choices regarding their care. Care workers respected people's privacy and dignity.

Care plans were detailed and included people's preferences, likes and dislikes, which promoted person centred care.

Complaints had been responded to with outcomes recorded. People using the service told us they felt confident to discuss any concerns with the provider. Incidents and accidents were monitored and managed.

Surveys were provided to people, to gather their views of the service. The quality of the care provided was monitored through governance systems which highlighted where improvements were needed.

Further information is in the detailed findings below.

This was an unannounced inspection carried out on the 17 November 2015. At the last inspection in December 2013 we found the provider met the regulations we looked at.

Alexander Residential Home is a care home without nursing. The care provider Marloco Limited is registered to provide accommodation for up to 39 older persons including people living with dementia who require personal care.

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 and associated Regulations about how the service is run.

People told us they felt very safe. Staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines safely.

We found there were systems in place to protect people from risk of harm and appropriate recruitment procedures were in place. There were policies and procedures in place in relation to the Mental Capacity Act 2005. Staff were trained in the principles of the Mental Capacity Act (2005), and could describe how people were supported to make decisions; and where people did not have the capacity; decisions were made in their best interests.

There were enough staff to keep people safe. Staff training and support provided staff with the knowledge and skills to support people safely.

People told us they got the support they needed with meals and healthcare. Health, care and support needs were assessed and met by regular contact with health professionals.

People were supported by staff who treated them with kindness and were respectful of their privacy and dignity. People participated in a range of activities and were able to choose where they spent their time.

Staff were aware of how to support people to raise concerns and complaints and there were effective systems in place to assess and monitor the quality of the service.

We saw care being delivered in a manner which promoted the dignity, privacy and independence of service users.

We saw that care plans had been signed either by the person it related to or by one of their relatives. We saw evidence that people had been involved in the development of these documents and had been asked about their likes and dislikes.

We saw that people's care was planned and delivered in line with their individual needs. Each person had a care plan in place that provided personalised information. The care plans were divided into sections to include physical health, mental health, hygiene, food and drink and risk assessments.

We observed a member of staff whilst they conducted a medication round. We saw that the medicines were given safely and that people were sensitively helped to take their medicines.

We noted that where covert medicine administration was used the provider had a good understanding of current legislation and was sensitively and competently translating the guidance into practice.

The provider was delivering care in an environment that was suitable and adequately maintained. We found that all mandatory inspections were carried out by a competent person.

The provider and staff confirmed that the induction process was detailed and that staff had to complete the process before they were able to start lone working within the service. Formal, recorded supervision and yearly appraisal was a feature of the service.

People we spoke with during our visit were very satisfied with the care and activities within the service. They told us the care was very good and the place was clean.

People who used the service were satisfied with the care they received. Individuals told us “Staff are good, they involve me when I feel like it.”

People we spoke with were aware of safeguarding procedures and systems on how to raise a concern were in place. People were satisfied that staff or the manager would take action to solve their problems.

Our observations of the service showed that staff spoke with and interacted with people who used the service in a patient and pleasant manner.

We observed people sitting for long periods of time with little stimulation, we noted that plans were in place to release a carer during the afternoon to enhance the existing activity programmes.

There were good systems and processes, policies and procedures in place. Report writing in the care records was adequate and reflected the changes in care and treatment that people received. We also found that staff were supported and monitored in their working practice and had training and appraisals programmes in place.

People told us they could make decisions about their care and were treated with respect. One person said, “I like my own routine and they respect that. I tell them when I want to go to bed and they come and help me.” Another person said, “I’m never pushed to do anything I don’t want.”

People told us that their dignity and privacy was respected when staff assisted them with personal care tasks. One person said, “The staff are very good. They give you privacy when you need it. They say I’ll pop back in five minutes and check you’re ok.”

Several people told us many of the staff have worked at the home for a long time so knew them well, and they thought this contributed to the good standard of care. One person said, “I’m 100% happy. Staff are very nice. I know them and they know me. I don’t need much help but they are very good with the ones who do need lots of help. Another person said, “They know exactly what to do, they’re very competent.”

People told us they would feel comfortable talking to their relative, staff or the manager if they wanted to discuss any issues or problems. Several people said the manager is very approachable. One person said, “The manager is a lovely woman. She looks after us very well and makes sure we’re ok. Without hesitation, I would talk to her.”

People who required assistance generally told us they did not have to wait long for staff support but some people thought staff were sometimes busy. One person said, “There are enough staff. Now and then they’re a bit pushed but not seriously.” Another person said, “I use my buzzer if I want help. Staff come but sometimes they’re a bit busy.” Staff we spoke with said that people’s needs were met. Some staff said there were not always enough staff on duty so they often had to rush tasks.

The registered manager informed us that she had identified that staffing was sometimes a problem and had met with the care provider the previous week. They had agreed that the manager, who was included in the staffing numbers most of her working week, would have more managerial hours to enable her to have more flexibility and manage the service.

We spoke with a visiting professional who told us they had no concerns about the home. They described staff as approachable and told us staff ask for advice at appropriate times and are good at communicating.

We spoke to two visitors. They praised the staff and were complimentary about the service people received. One visitor told us they had been fully involved in all decisions that had been made about the care their relative received. Another visitor said, “They are very welcoming. Nothing is too much trouble. We’re told about everything. They are absolutely marvellous.”

Staff we spoke with said people were treated with respect and their privacy and dignity was upheld. One member of staff said, “People are treated as we would want to be treated. We’re discreet and treat people with respect.”