Alexandra House is a 'care home' which provides accommodation and personal care for a maximum of 40 people. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The home accommodates people in one adapted building over two floors and on the date of this inspection there were 38 people living at the home, some who of whom were living with dementia.

At our last inspection we rated the service as good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. At this inspection we found the service remained good. We saw evidence to show the service was meeting all of the fundamental standards.

There was a registered manager in post who had been registered with the Care Quality Commission (CQC) since September 2014. A registered manager is a person who has registered with the CQC 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 registered manager was aware of their responsibilities and submitted notifications to the Commission appropriately. The registered manager worked with the provider to ensure there was a strong strategic lead to provide personalised care to people. There was a robust governance framework in place. Audits and checks were carried out by the registered manager and provider. Any issues identified were acted upon and any identified risks were mitigated. There was a complaints policy in place and we saw evidence of investigations and actions taken from these. The provider also carried out feedback surveys annually with people, relatives and staff to help improve the care provided.

The premises were safe and there were regular checks of the environment, equipment and utilities. There were infection control policies in place and staff adhered to these. Medicines were safely managed and there were medication policies and procedures in place. There was a business continuity plan in place for use in emergency situations. These were also reflected in people's care plans with personal emergency evacuation plans (PEEPs) to support the safe evacuation of people in an emergency.

Safeguarding policies were in place at the home and staff had received training around protecting vulnerable adults. Accidents and incidents were recorded, investigated and outcomes shared with people, relatives and staff. Lessons learned were documented and appropriate action taken. The registered manager escalated safeguarding concerns to the local authority.

People’s care plans were personalised and care provided to them was accurately recorded. Risks to people were assessed and mitigated. People’s care plans were reviewed regularly and people and their relatives were involved in care planning. We saw referrals to other agencies, for example the dietician and GP, in people's care files. People were supported to eat and drink a healthy balanced diet.

Staff were safely recruited, received a thorough induction programme and provided with on-going refresher training to full fill their roles. There was training provided for staff in delivering end of life care and the mental capacity act in addition to key areas such as safeguarding and moving and repositioning safely. We saw evidence of regular staff supervisions, yearly appraisals and team meetings.

People were supported to have maximum choice and control of their lives and staff supported them in the le

We considered our inspection findings to answer questions we always ask:

. Is the service safe?

. Is the service effective?

. Is the service caring?

. Is the service responsive?

. Is the service well-led?

This is the summary of what we found.

Is the service safe?

Risk assessments were in place. People were supported and encouraged to maintain their independence and this was balanced with the risk to the person. Audits were carried out to look at accidents and incidents and the necessary action was taken to keep people safe.

Information was available to show that the service worked with other agencies to help ensure people's health needs were met and to prevent admissions to hospital wherever possible.

We saw there were enough staff on duty at the time of inspection to ensure the safety of people who used the service.

Is the service effective?

We saw the service provided care to some older people with dementia and cognitive impairment. The service was very well-equipped to meet these specialist needs. The environment was well designed to meet these needs and there was good evidence of the involvement of people with dementia in daily decision making about their care needs.

People commented how helpful and friendly staff were. Relatives told us the service kept them up to date with what was happening with their relative's care and they felt able to ask any questions. Several people we spoke with commented how pleased they were with the care provided by staff at the home. We observed staff were patient and supportive as they worked with people.

Is the service caring?

We found people with dementia or cognitive impairment were involved in daily decision making. Staff were helpful and offered people information and support about their care. We observed staff interacted well with people. It was evident that staff had developed a good understanding of people’s communication needs and how best to communicate with them. We saw staff had time to spend engaging with people.

Is the service responsive?

Information was collected by the service with regard to the person's ability and level of independence before they moved into the service. Various assessments were completed by the manager of the service with the person and/or their family to help make sure staff could meet their needs. Regular reviews were carried out with the person who used the service and their representative to make sure people's support plans were kept up to date. This helped ensure staff provided the correct amount of care and support.

Referrals for specialist advice were made when staff needed guidance to ensure the health needs of people were met.

People's individual needs were taken into account and they, or their representative if they were not able, were involved in decision making with regard to their care. They were kept informed and given some information to help them understand the care and choices available to them, this was developed to include and involve people with dementia.

Information collected by the service gave staff some insight into the interests and areas of importance to the person. Activity provision was developed to help ensure activities reflected people's interests and provided stimulation to people with dementia, if they wished to become involved. We saw activity provision and opportunities for socialisation were offered by support workers and activities personnel.

Regular meetings took place with staff and people who used the service and their relatives to discuss the running of the service and to ensure the service was responsive in meeting the changing needs of people.

Is the service well-led?

We saw there was a vibrant, stimulating and busy atmosphere when we visited the service. Staff we spoke with were enthusiastic about their role working with people and they were knowledgeable about the support needs of people. Staff said they felt supported by the manager and advice and support was available from the management team.

We saw there was a focus from management on the provision of individual care and support to people who used the service. There was an emphasis about individualised care and support to people with dementia and cognitive impairment.

We saw people had the opportunity to comment on the quality of the service and that they felt able to speak to the manager and staff about any issues. Comments included; "Lovely home and very caring." Another person commented; "A real home from home with friendly staff." And; "The staff are all very caring and ensure that all residents are cared for as if is their own relative who is a resident."

We found the provider reviewed people's dependency levels each month. We saw that where a person's needs had changed, staff had reviewed their care plans to ensure they were accurate and up-to-date.

We found the provider had introduced a daily check of Medication Administration Records (MARs) to ensure that gaps in signatures were identified in a timely manner.

People were asked for their permission before receiving care. We found people who had capacity to make decisons were asked to sign their care plans. One person commented, “I just have to ask the question and staff sort it out” and another person commented, “I can do what I want to do.” One family member commented, “Staff phone straightaway if anything has happened.”

People had their needs assessed and these assessments wer used to develop personalised care plans. People we spoke with were happy with the care they received. One person commented, “We get everything we want and need.”

The provider had sytems in place to ensure people received their medicines appropriately and in a timely manner. Medication was administered by senior care staff who had completed relevant training and had had their competency assessed.

People who used the service told us they had no concerns about the ability of the staff who cared for them. One person commented, “The staff know what they are doing.” Another person commented the “Staff are brilliant.”

People knew how to complain. People we spoke with told us they were happy with their care. One person commented, “I am quite happy here, I have no concerns at all.”

Some people who used the service had complex needs which meant they could not share their experiences. We used a number of methods to help us understand their experiences, including carrying out an observation, speaking with people who could share their experiences and speaking with visiting relatives.

During our observation we saw people were treated with consideration and respect. People and their relatives told us they were happy with the care which was provided. One person said, "It's very good here, the staff are very kind." A relative told us, "My mum has been here for 8 years and I''ve always been very happy with the care. I come and visit regularly, but they are very good at keeping me up to date with anything that's happened. She always looks well kept and well cared for whenever I come and visit."

We reviewed three care records and saw that people's preferences and care needs had been well documented. We spoke with four members of staff. Staff were knowledgeable about the people's care needs and what they should do to support them.

Staff received appropriate professional development and there was an effective system in place to make sure staff training was up to date so that staff could care for people safely and to an appropriate standard.

We found that the provider had made suitable arrangements to protect vulnerable people from the risk of abuse and that there was an effective system in place to monitor and assess the quality of the service.

This was an unannounced inspection which took place over two days on 16 and 17 December 2015. The service was last inspected in February 2014 and was complaint with the regulations in force at the time.

Alexandra House is a care home which provides personal care for up to 40 people. Care is primarily provided for older people, including people who are living with dementia. There were 39 people living there at time of inspection.

There was a registered manager who had been in post since September 2014. 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 living at the service and that staff knew how to act to keep them safe from harm. The building and equipment were well maintained and there were regular health and safety checks undertaken by staff. There was a need to repair two shower rooms.

There were enough staff to meet people’s sometimes complex needs and the staff were trained, supervised and supported to effectively meet these needs.

Medicines were managed well by the staff and people received the help they needed to take them safely. Where people’s needs changed the staff sought medical advice and encouraged people to maintain their well-being. External healthcare professionals’ advice was sought quickly and acted upon. Improvement was needed to the temperature control of the medicines storage room.

People were supported by staff who knew their needs well and how best to support them. Staff were aware of people’s choices and how to support those people who no longer had the capacity to make decisions for themselves. Families felt the service was effective and offered them the reassurance that their relatives were being cared for. Where decisions had to be made about people’s care, families and external professionals were involved and consulted as part of the process.

People were supported to maintain a suitable food and fluid intake. Staff responded flexibly to ensure people maintained their physical wellbeing and worked with people as distinct individuals.

Staff were caring and valued the people they worked with. Staff showed kindness and empathy in responding to people’s needs. Families felt their relatives were cared for by a staff team who valued them and would keep them safe.

Privacy and dignity were considered by the staff team, who ensured that people’s choices and previous wishes were respected. Our observations confirmed there was genuine empathy and warmth between staff and people living at the home. People who were receiving end of life care had their needs appropriately assessed. External professional advice was sought where needed to promote advance care planning.

The service responded to people’s needs as they changed over time, sometimes responding promptly to sudden changes in people’s needs. The service supported people to access appropriate additional support so the staff could keep them safe and well.

The registered manager led by example, supporting staff to consider the best ways to meet people’s needs. The registered manager regularly consulted families and staff to look for ways to improve the service and audits and regular reviews of care delivery were carried out. The registered manager had started to develop tools and techniques to further improve personalised care.