We carried out a review of the data available to us about Alexander House - Dover on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Alexander House - Dover, you can give feedback on this service.
Alexander House is a residential care home providing personal care to up to 46 people. The service provides support to older people who maybe living with dementia in 2 adjoining adapted buildings. At the time of our inspection there were 32 people using the service.
People’s experience of using this service and what we found
People told us they felt safe living at the service. Potential risks to people’s health and welfare had been assessed and there was guidance for staff to mitigate risk. There were effective systems in place to protect people from discrimination and abuse.
People were supported by staff who had been recruited safely. There were enough staff to support people in the way they preferred. People received their medicines as prescribed.
Staff were following the current infection control guidance; visitors were encouraged to spend time with people and take them out. People and staff were asked their opinions on the service and their suggestions were acted upon.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
Checks and audits were completed on all areas of the service and these had been effective in identifying shortfalls, action had been taken to rectify these. Relatives told us they were confident to raise concerns with the registered manager and they would take action.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 14 July 2018).
Why we inspected
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
We received concerns in relation to risk management and staffing levels. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
The overall rating for the service has remained good based on the findings of this inspection.
We found no evidence during this inspection that people were at risk of harm from this concern. Please see the effective, caring and responsive sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Alexander House - Dover on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Alexander House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a 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. Alexander House accommodates up to 46 people in one adapted building. At the time of the inspection 30 people were living at the service.
The premises are two large detached properties that are connected by two conservatories. The accommodation is provided on each of the three floors and all of the bedrooms are single occupancy. There is a small enclosed garden area at the rear of the premises and a large paved courtyard between the two main buildings, which is shielded from the main road by gates.
There was a registered manager in post. A registered manager is a person who is registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations, about how the service is run.
We last inspected Alexander House in April 2017 when the service was rated Requires Improvement with no breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However, some improvements were required in the management of medicines records and additional information was needed about how to support people living with diabetes.
We asked the provider to take action. They sent us an action plan telling us what action they would take to improve the service. The provider had taken appropriate action with regard to these issues and the majority of the improvements had been made.
People received their medicines safely but records were not always clear to confirm this. Medicines were being stored at the correct temperature to ensure they were safe to use. Some people were living with diabetes. Staff knew what action to take if people’s blood sugar levels became unstable. Details in people’s care plans had improved, however, although staff knew what food or drink people preferred if they might need to increase their sugar levels, this was not always recorded.
Checks on the premises were not always detailed enough to show that the water temperatures and fire testing points had been consistently checked to ensure they were in good working order. The registered manager took immediate action to rectify these issues during the inspection.
Equipment, such as hoists, were serviced and checked to ensure they were working properly. Plans were in place in case of an emergency such as a fire or flood. Accidents and incidents were recorded and analysed to look for patterns and trends to reduce the risk of further events.
Staff had received safeguarding training and were clear on what action they should take if they suspected any abuse. People’s finances were protected. Risk associated with people’s care had been assessed and clear guidance was in place to make sure risks were mitigated. This included when people needed support with their behaviour or mobility needs.
There was sufficient staff on duty to ensure people received the care they needed and new staff were recruited safely. The service was clean with effective procedures in place to ensure that people were protected from the risk of infection. The premises had appropriate design and adaptation to support people living with dementia.
When people came to live at the service they had a thorough care needs assessment in line with current guidance and practice. This information formed a detailed personalised care plan which covered all aspects of their care. Staff responded to people’s needs promptly. Staff continuously observed people’s behaviour and found ways to reduce anxieties. People’s health was monitored and people were encouraged to eat and drink to maintain a healthy diet.
Staff ensured that people were referred to specialist healthcare professionals for further advice and guidance, such as the doctor, speech and language team or optician. Staff had discussed people’s wishes at the end of their life which were recorded in their care plans.
Staff received the relevant training they needed and had their performance assessed through one to one supervision and observations. Staff received a yearly appraisal to discuss their practice and development needs. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager had clear systems in place to track and monitor applications and authorisations.
Staff ensured that people had as much choice and control of their lives as possible and supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff were passionate about providing good care and worked as a team to achieve this. People were at the heart of the service and involved in their care planning. Staff had developed good relationships with people and treated them with mutual respect.
Staff calmed people when they became anxious and ensured they were relaxed before they left them. People smiled with the staff and were comfortable in their presence. People were encouraged to remain as independent as possible and staff upheld their privacy and dignity. Staff knocked on people’s bedroom doors before entering. A visitor said that staff sometimes used a screen when talking discreetly to people or when a medical professional visited.
People were treated with equality and given the time they needed to respond to questions.. Staff took time to chat and include people in conversations in topics they were interested in. Relatives and friends were made welcome and asked their views about the service. People’s confidential documents and records were stored securely.
Staff found creative ways of supporting people with activities of their choice. They had links with young people who became ‘pen friends’ with people and talked about their specific interests such as football. One of the activities co-ordinator had won a national award for their skills in supporting people with their social activities.
Any concerns or complaints were recorded and responded to in line with the provider’s policies and procedures. The complaints procedure was available in other formats so that people would understand how to complain. The service was well led. The registered manager had clear leadership skills with an oversight of the service. Effective audits had been carried on the quality of care being provided and if shortfalls were identified action plans with timescales were implemented.
The registered manager worked in partnership with other organisations and has taken part in several good practice initiatives designed to further develop the service. The registered manager was involved in a number of schemes in place to drive improvement.
The registered manager worked alongside staff observing their practice and carried out night checks to ensure people were receiving the care they needed. Staff told us that the registered manager was approachable and gave support and guidance when needed.
Everyone involved in the service had been asked their views on the service being provided. Feedback was positive and if any concerns had been raised these were investigated and actioned. People enjoyed a variety of innovative activities and were involved in different projects of their personal choice.
Staff were aware of the visions and values of the organisation and how important it was to provide safe consistent care. They told us they felt valued and supported by the registered manager. They said the registered manager’s door was always open and they listened and acted on their ideas and suggestions.
The provider had links with other organisations to keep up to date with current practice such as Enrich-Enabling Research in Care Homes to understand and gain more knowledge of people living with dementia. The initiative involved staff, people and relatives and group conferences.
Services that provide health and social care to people are required to inform CQC of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had submitted notifications in an appropriate and timely manner and in line with guidance.
The latest overall rating judgement of the service at the last inspection was displayed in the service and on their website.
The service is registered to provide accommodation and personal care to 46 older people who may also be living with dementia. At the time of this inspection there were 30 people receiving the service. The premises are two large detached properties that have been connected by means of two conservatories. The accommodation is provided on each of the three floors and all of the bedrooms are single occupancy. There is a small enclosed garden area at the rear of the premises and a large paved courtyard between the two main buildings, which is shielded from the main road by gates.
The service did not have a registered manager in post. There was an acting manager in post who had applied to the Care Quality Commission to be registered as the manager. A registered manager is a person who has registered with the Care Quality Commission (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.
At the previous unannounced inspection of this service on 26 and 31 August 2016 requirement notices were served as the provider had not ensured that care plans were person centred, were updated with people’s current needs and were not planned to include the Deprivation of Liberty (DoLS) recommendations made by the local authority. People were not being treated with dignity and respect. There was not sufficient guidance for staff to follow to show how risks were mitigated when moving people or supporting people with their behaviour. People had not been protected from abuse as appropriate referrals to the local safeguarding authority had not been made in line with safeguarding protocols. Action had not been taken to mitigate risks and improve the quality and safety of services. Staff had not been deployed in sufficient numbers to meet people’s needs. Feedback about the service from relevant people had not been sought and acted on to continually evaluate and improve the service. Records were not completed or accurately.
We asked the provider to take action. They sent us an action plan telling us what action they would take to meet legal requirements in relation to the breaches of regulations. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. The provider had taken appropriate action with regard to these issues and improvements had been made. The service was now compliant with the regulations; however in some areas further improvements were required.
People were receiving their medicines safely. Storage facilities had improved and medicines were being stored at the correct temperature to ensure they were safe to use. However, further guidance was required to ensure that people received their ‘as and when’ required medicines consistently. On two occasions people had received their medicines but staff had forgotten to sign the medicines record. At the time of the inspection there was sufficient staff on duty to ensure people’s needs were fully met, however, some people, relatives, staff and health care professionals commented that sometimes staffing levels could be improved. The manager told us that staffing levels would be reviewed in line with these comments. New staff had been recruited safely.
People living with diabetes had generic information in their care plans about the condition, however this was not personalised to each person, such as the required blood sugar level range and what drink or food they might need to increase their blood sugar levels.
Although there was no registered manager in place the current manager had applied to become the registered manager and their registered manager interview with CQC was cairned out after the inspection, therefore they were waiting for the decision to be made.
Effective audits were now in place to monitor and improve the service, but there was lack of evidence recorded to show that the actions identified had been checked to confirm they had been completed.
Records had improved and were in good order although some further improvements were required to ensure that fluid monitoring charts were completed properly.
When people needed support with their behaviours potential risks had been assessed and measures were now in place to reduce the risks to keep people as safe as possible. Care plans were personalised and had up to date mobility risk assessments to ensure people were moved safely in line with their current needs.
The manager and staff carried out environmental and health and safety checks to ensure that the environment was safe and that equipment was in good working order. Emergency plans were in place so if an emergency happened, like a fire, staff knew what to do.
People were protected from harm or abuse and the manager had reported incidents between people to the local safeguarding authority in line with safeguarding protocols. Accidents and incidents were recorded and analysed to reduce the risk of further events.
Staff received the relevant training to carry out their roles. Staff had received supervision and appraisals to discuss their current practice and training and development needs.
People’s mental capacity had been assessed and when required authorisations to deprive people of their liberty (DoLS) had been processed through the local authority.
People health care needs were monitored and they had access to health care professionals when needed. People were supported to eat and drink food that met their dietary requirements and that they enjoyed. Staff were familiar with people's likes and dislikes, such as how they liked their food and drinks.
People’s privacy and dignity was maintained. People, relatives and health care professionals told us the staff were kind and caring. People were supported by their relatives to be involved in planning their care and to make decisions about their daily lives. They were encouraged to remain as independent as possible.
People enjoyed the activities and were encouraged to maintain their hobbies and interests. There were systems in place to ensure that complaints and concerns were addressed and responded to appropriately.
The new manager had oversight and scrutiny of the service. The provider had complied with the requirement notices from the previous inspection. People’s views had been sought and analysed to show continuous improvement of the service.
The provider had ensured that the published rating from the previous inspection was on display.
As this service is no longer rated as inadequate, it will be taken out of special measures. We acknowledge that this is an improving service and further improvements are required. We will continue to monitor Alexander House to check that improvements continue and are sustained.
The service is registered to provide accommodation and personal care to 46 older people who may also be living with dementia. At the time of this inspection there were 30 people receiving the service. The premises are two large detached properties that have been connected by means of two conservatories. The accommodation is provided on each of the three floors and all of the bedrooms are single occupancy. There is a small enclosed garden area at the rear of the premises and a large paved courtyard between the two main buildings which is shielded from the main road by gates.
The service has an established registered manager. A registered manager is a person who has registered with the Care Quality Commission (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.
At the previous unannounced, inspection of this service on 29 and 30 June 2015, a requirement notice was served as the provider did not have sufficient guidance for staff to follow to show how risks were mitigated when moving people or supporting people with their behaviour. We asked the provider to take action and the provider sent us an action plan. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. The provider had not taken appropriate action with regard to these issues and remained in breach of this regulation.
Since the last inspection there had been some staffing issues. The registered manager and deputy manager had been dealing with the staffing issues with support from the provider. The provider agreed that, on reflection, this had taken the managers away from the day to day management of the service. The registered manager and management team were reviewing and trying to improve the day-to-day culture in the service, including the attitudes, values and behaviour of staff.
When people needed support with their behaviours potential risks had not been fully assessed and measures were not in place to reduce the risks to keep people as safe as possible.
Care plans did not always have up to date moving and handling risk assessments to ensure people were moved safely in line with their current needs.
People were not fully protected from harm or abuse as the registered manager had failed to report incidents between people living at the service to the local safeguarding authority in line with safeguarding protocols. Accidents and incidents were recorded but there was no further analysis to reduce the risk of further events.
There was insufficient staff on duty to ensure people’s needs were fully met. On the day of the inspection the registered manager confirmed that staffing levels were not up to the optimum levels due to staff sickness.
People were at risk of harm as they were not always receiving their prescribed medicines. The storage room for medicines was not the correct temperature to ensure the medicines were safe to use.
People’s mental capacity had been assessed and when required authorisations to deprive people of their liberty (DoLS) had been processed through the local authority. However, the registered manager had failed to ensure that specific recommendations made by the local authority to guide staff how to care for a person were included and followed when planning their care.
People’s privacy and dignity was not always upheld. There were two occasions when staff were disrespectful to people, one of which caused some distress to a person. Relatives told us the staff were kind and caring. People were supported by their relatives to be involved in planning their care and to make decisions about their daily lives. They were encouraged to remain as independent as possible.
The information in care plans varied. There were areas that showed people received person centred care while other parts of the plan such as mobility and behaviour lacked information to ensure people received their care in a way that suited them best. Although care plans had been reviewed regularly, the main care plans had not always been updated with people’s current needs.
There was a lack of oversight and scrutiny of the service. The provider had failed to comply with the requirement notice from the previous inspection. Checks carried out on the service had not highlighted the shortfalls in this report.
The systems in place to gather people’s views lacked analysis to show continuous improvement of the service. Records were not always up to date or accurate.
People health care needs were monitored and they had access to health care professionals when needed. Systems in place to monitor if people had enough to drink were not clear to show how staff encouraged people to drink enough to keep them healthy. Nutritional risk assessments ensured that people were provided with a suitable range of food.
People enjoyed the activities and were encouraged to maintain their hobbies and interests. There were systems in place to ensure that complaints and concerns were addressed and responded to appropriately.
Staff received the relevant training to carry out their roles. Staff had received supervision and appraisals to discuss their current practice and training and development needs.
The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
The inspection took place on 29 and 30 June 2015, and was an unannounced inspection. The previous inspection on 5 December 2013 found no breaches in the legal requirements.
The service is registered to provide accommodation and personal care to 46 older people who may also be living with dementia. At the time of this inspection there were 35 people receiving the service. The premises are two large detached properties that have been connected by means of two conservatories. The accommodation is provided on each of the three floors and all of the bedrooms are single occupancy. There is a small enclosed garden area at the rear of the premises and a large paved courtyard between the two main buildings which is shielded from the main road by gates.
The service has an established registered manager. A registered manager is a person who has registered with the Care Quality Commission (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.
Potential risks to people were identified regarding moving and handling and behaviour but full guidance on how to safely manage the associated risks were not always available. Plans for behaviours that challenge did not support positive behaviour but made judgements about people’s behaviour. This left people at risk of not receiving the support they needed to keep them as safe as possible.
People felt safe in the service. There were safeguarding procedures in place and staff had received training in these. Staff demonstrated an understanding of what constituted abuse and how to report any concerns in order to keep people safe.
Accidents and incidents were recorded and analysed to prevent further occurrences. Checks were done to ensure the premises were safe, such as fire safety checks. Equipment to support people with their mobility had been serviced to ensure that it was safe to use. Plans were in place in the event of an emergency.
Some refurbishment of the premises had been carried out and plans were in place to improve the environment by December 2015. People’s rooms were personalised to their individual preferences.
There was enough staff on duty to meet people’s needs. Staff were allocated their duties, on each shift, to ensure the right skill mix and experience of staff was deployed to make sure people’s needs were met. Staff received regular supervision and a yearly appraisal to support them in their role. Staff were recruited safely and there was a training programme to ensure that staff had the skills and competencies to carry out their roles. New staff received an induction and shadowed experienced staff until they were confident to perform their role.
Medicines were stored and administered safely. Staff had been trained and demonstrated good practice in medicine administration by carefully ensuring that the right person received the correct medicines.
People were supported to make their own decisions and choices and these were respected by staff. CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. The manager understood when an application should be made and was aware of the recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. There were no DoLS applications required at the time of this inspection.
People had choices of food and specialist diets were catered for. Staff understood people’s likes and dislikes, dietary requirements and promoted people to eat a healthy diet.
People were supported to maintain good health and received medical attention when they needed to. Appropriate referrals to health care professionals were made when required.
Staff treated people with kindness, encouraged their independence and responded to their needs. People told us their privacy and dignity was maintained, and the staff were polite and respectful.
People and relatives had been involved in planning their own care. Care plans had been regularly updated and relatives told us that they were invited to the care plan reviews when required.
People were being supported to engage in activities of their choice. Visitors were able to visit any time and the service welcomed lots of family and friends.
The registered manager asked people for their opinions on the quality of care they received and responded to comments and complaints in a timely and appropriate way. There were quality assurance systems in place. Audits and health and safety checks were regularly carried out.
We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.
The manager showed us the records that included information about two people who had fallen and been injured as a result. There were falls risk assessments and these had been followed and the incidents had been clearly documented. Both incidents had been documented and where risk assessments were in place regarding falls, we saw evidence that showed these had been adhered to.
On the day of our visit we found that the heating was working and the home was pleasantly warm. We checked to see if there was any hot water and found it was available throughout the service. The manager had already informed us about the lift and what procedures had been followed regarding the two people who stayed in their rooms which were appropriate. The lift engineer attended the service to reactivate the lift following its repair during our inspection so this situation was resolved.
Before people received any care or treatment they were asked for their consent and this was respected. A person who used the service who we spoke with told us that, "Help and support I recieve is of a good standard." Another person we spoke with went on to tell us that the standard of care delivered was, " Of a high standard. “The staff treat you as an individual and speak to you kindly.”
All of the people that were spoken with were very satisfied with the standard and quality of their support, care and treatment. People's health and safety risks were assessed and effective measures were taken to minimise these risks. People were supported to maintain their health and wellbeing by being supported to access health care professionals and to engage in social activities of their choosing.
People had sufficient amounts to eat and drink. People said that they liked the food and there were menu choices made available to them.
Most areas of the accommodation were decorated and furnished to make them into comfortable spaces. However, in some parts there were shortfalls that detracted from the overall standard achieved.
Members of staff told us that they enjoyed their work, which they found rewarding. They said that they felt supported by the provider to progress in their careers and that there were plenty of training opportunities available.
People told us that they had the care and support they needed to remain well and healthy. They said they were involved in decisions about their care and support. We were told, “It is wonderful here and the staff are great”.
People told us they liked living at the service and felt safe. One person said, “I have been here for three years and always feel very safe”.
We saw that staff engaged with people in a warm and positive way and supported people where needed.
Staff told us that they were happy working at the home and felt supported in their roles.