Alexander Care Home is situated on the outskirts of Bury town centre. The home is a large detached property in its own grounds. Accommodation is provided over two floors and can be accessed via a passenger lift. Communal rooms are available on the ground floor. These include a large lounge, two smaller lounges and a dining room. The service provides accommodation and personal care for up to 31 older people, some of whom are living with dementia. At the time of our inspection there were 29 people living at the home.

This was an unannounced inspection which took place on the 14 and 15 December 2016. The inspection was undertaken by one adult social care inspector and an expert by experience.

The service was last inspected in November 2015. During that inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. This resulted in us making one requirement action. Following the inspection in November 2015 the provider wrote to us to tell us what action they intended to take to ensure they met all the relevant regulations. During this inspection we checked if the required improvements had been made. We found that improvements had been made and the requirement aciton had been met.

We found the building to be clean and tidy with no malodours. The bedrooms we went in were spacious, well-furnished and were personalised with people's own possessions. Since our last inspection some redecoration and refurbishment had taken place, however we found all the previously planned works had not taken place and some areas of the home were in need of improvements. In the entrance hall and stairway there were two areas where paint was peeling from the ceiling, missing or peeling wallpaper had not been replaced in the lounge and flooring in the laundry was ripped leaving the floor underneath exposed. The provider told us the required work would be completed by May 2017

We saw that appropriate arrangements were in place to assess whether people were able to consent to their care and treatment. The registered manager was meeting their responsibility under the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure that people's rights were considered and protected. Staff we spoke with could demonstrate how they gained peoples consent to the support they provided, but theydid not have a good understanding of MCA & DoLS and did not fully understand their legal responsibilities. We have made a recommendation about staff training on the subject of MCA & DoLS.

Recruitment procedures were in place which ensured staff had been safely recruited. There were sufficient staff to meet people’s needs. Staff received the training, support and supervision they needed to carry out their roles effectively.

The service is required to have a registered manager in place. There was a registered manager in place at Alexander Care Home. 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 present during this inspection.

People we spoke with were positive about the service and the way it was managed. People told us the registered manager was friendly, caring and said they could approach her with any problems they had.

All the people we spoke with were positive about the support they received and the caring attitude of the staff. Visitors we spoke with told us they were made to feel welcome. We found staff were responsive when people needed support and spent time chatting with people. There was a good rapport between staff and people who used the service. We observed staff interactions that were polite, kind, patient and sensitive.

We found that the registered manager, and all the staff we spoke wit

This was an unannounced focussed inspection undertaken on the evening 26 February 2015 by one adult care inspector. A focused inspection is carried out to look at specific areas of concern that have been raised with us.

This was the first inspection to take place since the home changed ownership and was registered with the Care Quality Commission (CQC) on 22 January 2015.

Alexander Care Home is registered to provide accommodation for up to 31 older people who require support with personal care. At the time of our inspection there were 26 people using the service.

The inspection was undertaken because we had received information of concern and complaints from a number of sources which included staff and relatives and also information we had received from the local authority commissioning and quality assurance services.

The concerns raised included that, since the change of ownership of the home, staffing levels had been reduced and this had impacted on the safety and quality of care people who used the service had received. Complaints included problems with the heating and hot water systems and that accessibility to food and drink had been reduced; for example the kitchen had been locked in the evening.

There was a registered manager in place at Alexander Care Home. 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 identified two breaches 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.

We found that the records we saw showed there had been a signification drop in the care staff hours available to support people. There was evidence to support that people who used the service did not always receive the support, care and treatment they needed, for example weekly checks on people’s weight had not been carried out.

We found that there were problems with the heating system and that the temperature to radiators and hot water taps were not consistent throughout the building. We were informed by the provider that arrangements were in place for a plumber to visit the home the day after our inspection visit to check the heating system.

We noted that there was evidence to support that the registered provider was investing in improvements to the building particularly in relation to prevention and control of infection processes.

There was a lack of effective systems in place to monitor the quality of the service provided and show how management decisions were being made.

We found evidence that where complaints had been made by people who used the service there was no written evidence to support that they had been acknowledged or what action was to be taken to resolve the concerns raised. However the provider was working within the timescale of the home’s complaints procedure.

Alexander Care Home is registered to provide accommodation for up to 31 older people who require support with personal care. At the time of our inspection there were 28 people using the service.

Our last inspection was an unannounced focused inspection carried out 26 February 2015. A focused inspection is carried out to look at specific areas of concern. At the focused inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in the regulations that we reviewed. These related to staffing levels and the effectiveness of the management of the home; we made requirement actions. The service sent us an action plan informing us of what improvements they would take to meet the regulations and told us they would be compliant with these regulations by 12 May 2015.

This was an unannounced comprehensive inspection which took place on 17 and 18 November 2015 and also to check the required improvements had been made to address the outstanding requirement actions.

At this inspection we found that action had been taken to make improvements and both outstanding requirement actions were met. However we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Systems for recruitment of staff were not always safe. In three staff files we found gaps in staff previous employment history had been identified, but there was not a written explanation of the reason. Staff received the training and support they needed to carry out their roles effectively.

You can see what action we told the provider to take at the back of the full version of this report.

There was a registered manager in place at Alexander Care Home. 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.

Improvements had been made in staffing levels. A second senior care worker was now working alongside care staff during the day. During our inspection we observed that call bells were answered promptly, staff responded quickly to peoples requests for assistance and there were sufficient staff to meet people’s needs.

People told us there had been recent improvements in the standard of food provided. We saw the food was wholesome, although people waited a long time for their breakfast and choice of seating was limited. The provider has plans for increasing the amount of dining seating.

People we spoke with felt safe at Alexander Care Home. Policies and procedures were in place to safeguard people from abuse and staff had received training in safeguarding adults. Staff were able to tell us how to identify and respond to allegations of abuse. They were also aware of the responsibility to ‘whistle blow’ on colleagues who they thought might be delivering poor practice to people.

Improvements had been made to the home. Two new boilers had been fitted and all communal areas and bedrooms were warm. Some bedrooms had been refurbished and areas of the home had had flooring replaced and new furnishings had been purchased. There was a planned programme of on-going improvements.

The home was clean and equipment (except for the bath chair hoist) was serviced and maintained. Systems were in place to deal with emergencies that could affect the provision of care such as failure of gas and electric supply.

We found there were safe systems in place for managing medicines.

The manager and staff demonstrated a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA and DoLS provide legal safeguards for people who are unable to make their own decision.

People spoke positively about the staff and the care they received. During our inspection we saw the registered manager and staff were caring and responsive to the people’s needs. Staff knew people well and knew their likes and dislikes.

A programme of activities had recently been introduced. There were a number of activities on offer both within the home and in community settings. The activity coordinator knew people well and knew the activities they liked to do.

There was a policy and procedure for dealing with complaints, we saw that complaints were recorded and appropriate action taken.

Peoples care records contained good information to guide staff on the care and support required. The care records showed that risk to people’s health and well-being had been identified and plans were in place to reduce or eliminate the risk.

We found there was a system in place for quality assurance. Weekly and monthly checks had been introduced to assess, monitor and review the service. Records were kept of any issues or concerns and any actions taken to address them.

We saw there was a system for gathering people’s views about the service and acting upon suggestions and ideas.

People were complimentary about the registered manager. Staff told us the registered manager was approachable and were confident any issues they raised would be dealt with. They told us the service had improved since our last inspection and were positive about the leadership of the service.