The inspection was unannounced, and took place on 27 July 2018. The location was previously last inspected in August 2017. At that inspection concerns were identified in relation to the condition of the premises, and the overall rating was “requires improvement.” We told the provider that they needed to take steps to address this breach of regulation, and they supplied CQC with an action plan setting out what they would do. At this inspection we found that the provider had made considerable improvements to the premises.

Alexandra Nursing and Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Alexandra Nursing and Residential Home is in the Thrybergh suburb of Rotherham, South Yorkshire. It is in its own grounds in a quiet, residential area, but close to public transport links. The home accommodates up to 47 adults with both nursing and residential care needs. At the time of the inspection, 39 people were using the service.

At the time of the inspection, the service had a registered manager. 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.

At the last inspection in August 2017, the service was rated Requires Improvement. At this inspection we found the service still Required Improvement. We found that the provider's arrangements in for obtaining and acting in accordance with people’s consent did not meet legal requirements. We also found that although there was an audit system in place, but it did not always identify shortfalls in service provision.

During the inspection we found staff were kind and warm in their interactions with people, and people experienced care which met their needs from staff who understood them well.

Staff understood their responsibilities in relation to safeguarding, and had received appropriate training.

Medicines were safely managed, and there were suitable risk assessments in place to protect people from the risk of harm.

People told us there were plenty of activities at the home, and said they enjoyed day to day life there.

The provider managed complaints appropriately, however, changes were required to the provider’s complaints policy so that complainants understood how to make complaints to the correct bodies.

People experienced a good standard of nutrition and hydration, and told us they enjoyed the meals at the home.

Staff received a good level of training which they told us supported the in carrying out their role.

There was a registered manager in place, and most staff told us they felt supported by senior staff and the registered manager.

The inspection was unannounced, and took place on 22nd August 2017. This was the first inspection of the home since the provider took over the service at the end of 2015. Previous inspections of the home took place when it was operated by a different provider.

Alexandra Nursing and Residential Home is a 47 bed service providing nursing and residential care to older people with a range of support needs including dementia. It provides accommodation on either a long term basis, or on a short term respite basis. At the time of our inspection, 41 people were using the service.

Alexandra Nursing and Residential Home is located in the Thrybergh suburb of Rotherham, South Yorkshire. It is in its own grounds in a quiet, residential area, with parking and public transport links.

The provider had a registered manager. 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 were treated with kindness and received support in a patient and considerate way. People were treated with respect and their privacy, dignity and independence were protected. Staff had a good understanding of the care people required, and knew how to deliver this care and a way that upheld people’s dignity.

People were offered a choice of nutritious meals which they told us they enjoyed. Their health in relation to nutrition and hydration was well-monitored.

People gave informed consent to their care and treatment. The provider had appropriate arrangements in place for acting in accordance with the Mental Capacity Act 2005, and ensured that the Act was adhered to in relation to people who lacked the capacity to make decisions about their health and welfare.

There was a range of activities available, both within the home and in the wider community. People told us they regularly went on trips organised by the home, and outside entertainers often visited.

There was a complaints system within the home, and on the small number of occasions a complaint had been received, the provider took appropriate steps to investigate it and provide a remedy.

Risks to people were assessed and steps were put in place to reduce these risks. Staff had received training in protecting vulnerable adults and recognising abuse, although the provider had not correctly notified incidents of suspected abuse to the Care Quality Commission (CQC).

The condition of the premises was poor in parts, meaning that it presented a risk of cross-infection as areas could not be hygienically cleaned to a safe standard.

The arrangements in place for monitoring the quality of the service were not robust enough to identify or address shortfalls in service quality. We noted a number of occurrences that the provider was required to have notified to CQC but it had failed to do so.