Alexander Residential Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities. Policies and procedures and staff training were available to guide staff in equality, diversity and human rights, helping to promote good compassionate care. Staff members commented, “The thing I most enjoy is working in a home that cares, we are here for the residents, and we want to give them the best end of life care” and “The management show great leadership and have good honest values that they promote.”

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty. Staff told us they felt valued by the registered managers and provider. One staff member said, “We recently had a team meeting held by the owner, [Name] is very open to new ideas and pushing things forward.” The provider had processes in place such as team meetings which were facilitated regularly and involved staff on improvements they planned to make within the home. The registered managers had also kept their knowledge up to date to ensure care was delivered in line with good practice and national guidance.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. The registered manager said, “Our staff team do freely speak up as we are approachable. We will always consult staff about new changes and ask for their feedback. We changed round the late shift and asked for feedback. This was a good change and a better way of working. We encourage staff to give feedback.” The registered managers were open about lessons learnt and actions taken to prevent recurrence. They understood duty of candour and their responsibilities. They had ensured relatives were kept up to date with any concerns about people's care needs. One relative commented, “There are no concerns. I can always speak to [registered Manager’s names] and things are always put right and it’s dealt with. The registered manager is amazing.” One person told us, “Last week, I had to raise an issue because I eat in my room, and they forgot my dessert. I pressed my buzzer and staff sorted this out a few minutes later and the kitchen staff came to my room and apologised.”

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them. The home encouraged inclusion by allocating champion roles including that of culture and diversity to ensure staffs and residents needs were being met. The manager told us if they were unsure about people’s diverse needs they would communicate with the champion. We found the home had allocated a room to allow staff to pray during their shifts. The manager said, “We make sure that we do shift changes for Ramadan, so staff aren’t on late shifts during that period.” The manager told us of how they ensured everyone felt included and provided an example at Christmas where they arranged a specific meal out for people who did not wish to be in the presence of alcohol, so they did not miss a Christmas lunch.

At out last inspection we found the provider needed to make improvements to their governance systems. At this inspection we found most improvements had been made however, there were still some areas which the provider was focusing on to ensure good governance. For example, records were not always accurate; however, this did not have any negative impact upon the care people received. For example, one person’s risk assessment had not included a fall that had occurred in the last 12 months. Records to monitor catheter care and fluid intake were not always recorded in the correct places which would make it difficult to audit. Audits had not always been carried out in a timely manner. For example, a mealtime audit was due to be reviewed in August 2024 however, this had not been completed. The manager told us a call bell audit had been carried out however, there was no record of this. Other audits had been completed, and relevant actions plans were in place.

The provider shared with us that surveys were overdue, and they had planned to do these shortly. However, the provider kept a log of feedback received from relatives and people through regular contact and these were all positive. Regular staff and management meetings were being held. We found the issues we had identified in relation to governance had been discussed at a management meeting with a plan of how this will improve moving forward. The home had introduced a new system to complete audits and were in the process of training to develop this.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement. One health care professional told us, “They are very responsive. We trust them and they know the residents well. They are open to change and new ways of working. They have been very fluid with us. If we ask for equipment, they are very good at getting this in a timely way. Every quarter we have a care homes forum which they attend. Every other week the registered manager will join the multi-disciplinary meeting. NHS England came out to do a review of us and the home was part of that and we got very good feedback from this. They are very person centred in their care. We have had no issues.” The home also worked alongside two local nurseries and a local primary school who attended the home. They encouraged people from the local health and social care colleagues to come to the home for work experience. Residents had also been invited to a local college to attend a Shakespeare event and after tea.

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research. The registered manager analysed incidents and accidents to identify themes or trends to reduce the risk of avoidable harm. For example, in relation to falls. The home had recently introduced a new electronic system to improve their records. The home had also worked along a physiotherapist in a research project relating to the impact of falls and medication. Through the learning tools they highlighted the risks of medication relating to falls (high and medium risk). They had a check list to go through when admitting people and did so with a pharmacist. They then looked at medication to see if there were alternative options that wouldn’t counter act any physical problem. For example, one gentleman (high falls risk) was on Bisoprolol (This medication could impact falls). This medication was then reduced and stopped. This was a study to help people stopping or prescribing alternative medications, if possible, to prevent risk of falls.