This inspection was carried out on the 16 and 17 March 2017. Our visit on the 16 March 2017 was unannounced.

At the last inspection on the 25, 26, 28 July and the 15 August 2016 we rated the service as ‘Inadequate' which meant the service was placed in ‘special measures.’ At that inspection we identified multiple regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014, affecting peoples’ safety, well-being and the quality of service provided to people living at the home.

Following the inspection the provider sent us information detailing how the identified breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

At this inspection we found significant improvements and the provider had taken action. As a result of the improvements the service is no longer rated “inadequate” and has moved out of special measures.

Alexandra Nursing Home is situated directly opposite Alexandra Park approximately half a mile from Oldham town centre. Accommodation is provided over three floors which are accessible via a passenger lift. The home has single and double rooms, with some rooms having en-suite facilities. The service is registered to provide the regulated activities, accommodation for persons who require nursing or personal care and the treatment of disease, disorder or injury, for up to 35 people. At the time of our inspection there were 23 people living at the home.

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 2008 and associated Regulations about how the service is run.

Staff had a good understanding of safeguarding procedures and what action they should take if they identified abuse. Recruitment checks had been carried out on all staff to ensure they were suitable to work with vulnerable people in a care setting.

The home was clean and well-maintained and staff had access to personal protective equipment (PPE) to help reduce the risk of cross infection. Environment checks on the building and equipment were up-to-date.

Medicines were safely stored and administered by people who received the appropriate training.

Staff had undertaken a variety of training to ensure they had the correct skills and knowledge required for their roles. Supervision of staff was carried out regularly. This enabled the registered manager to discuss any training and development needs and ensure staff were carrying out their duties safely and effectively.

People were complimentary about the caring nature of the staff and from our observations of staff interactions and conversations with people we saw staff had good relationships with the people they were caring for. A range of activities were available for people to take part in.

People were supported to maintain good health and where needed specialist healthcare professionals were involved with their care.

The service had a complaints procedure in place and people we spoke with felt that any complaints would be dealt with appropriately. People we spoke with made positive comments about the registered manager and about how the home was run.

People living at the home and their relatives were provided with an opportunity to comment on the service through an annual survey. Results of the February 2017 survey were all very positive.

A range of monthly audits were carried out to monitor the service and help maintain and improve the standard of care given at the home.

This inspection took place on 25, 26, 28 July and the 15 August 2016 our visit on the 25 July was unannounced.

The Alexandra Nursing home was last inspected in August 2013 and was compliant with the regulations we assessed against at that time.

The service is registered to provide the regulated activities, accommodation for persons who require nursing or personal care and the treatment of disease, disorder or injury, for up to 35 people. At the time of this inspection there were 29 people living at the home.

The Alexandra Nursing home is located ½ mile from Oldham town centre, adjacent to a park and accessible by public transport. There is a secure car park at the rear of the property and maintained gardens to the front.

Accommodation is provided over 3 floors, which are accessible by a passenger lift. Single and double rooms are available, some with an en-suite washing facilities.

Our inspection was brought forward as a result of a Coroner’s regulation 28 report for avoidable deaths. Coroners have a legal power and duty to write a report following an inquest if it appears there is a risk of other deaths occurring in similar circumstances. This is known as a “Report under regulation 28” or “Preventing Future Deaths report”.

We found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, affecting people’s safety, well-being and the quality of service provided to service users. CQC is considering the appropriate regulatory response to resolve the problems we found. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 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. We may also take other enforcement action proportionate to the seriousness of any shortfalls and breaches at any time, including within the six month timescale of a revisit.

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 2008 and associated Regulations about how the service is run.

The service had a nominated individual. An organisation needs to have a nominated person who acts as the main point of contact for us.

We looked to see how the provider and registered manager had responded to concerns raised by the Coroner in the regulation 28 report issued in May 2016, in relation to staff responding appropriately to people's needs, the administration of medicines, seeking medical attention and the home's admission criteria for residential placements. The registered manager had on receipt of the report attended a safeguarding strategy meeting with the Local Authority to discuss the regulation 28 report. The nominated individual and registered manager confirmed that they had not completed an investigation in relation to the Coroner’s verdict and had not completed an appraisal as to the competencies, skills and fitness of staff to ensure the safe delivery of care. We found that the provider and registered manager had failed to implement all the necessary actions they had identified within the timeframes they had set out in their response to the regulation 28 report. Following the inspection CQC placed conditions on the provider’s registration, to which the provider co-operatively responded to. CQC is considering the appropriate regulatory response to addres

Arrangements were in place to obtain and act in accordance with the consent of people using the service. We spoke with two people living at the home. One person said "I'm happy here, it suits me" and another told us "I love it here, the staff are very good and I'm well looked after".

At the time of our inspection a new manager had been in post for five weeks. A number of changes were being introduced to the way in which people's needs were assessed, to the planning and delivery of care, and to the environment. One person told us there had been "lots of change but for the better". A member of staff said "as long as it is in the best interests of the residents it's all good".

We found that a refurbishment programme was underway. Those areas which had been redecorated appeared fresh whilst those yet to be completed were tired. As part of the refurbishment new equipment had been purchased and several changes made to use of the available space.

A number of systems were in place to monitor quality of service and to identify and manage any health, welfare or safety risks to service users. The provider had a complaints procedure in place.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of service and a practicing professional.

All the people we spoke with told us they were treated with dignity and respect by the staff at Alexandra – Oldham. One person commented “Staff are more like friends to us, very pleasant”. People said that staff knocked on their doors before entering and one person said they liked it that staff called into their room if they were passing to make sure everything was all right.

People told us that they were involved in decisions about their care, with one person telling us “We have regular residents’ meetings and things are discussed there as well”. They said there were choices available at all mealtimes, and snacks were available in-between meals.

One person told us they could raise any issues with staff, and added “The manager is very good”. People told us they were happy, and one person said “I’ve never had anything to complain about”.