We carried out an unannounced inspection of Alexandra Grange on 17 May 2017. We last inspected the service on 29 March 2016 when we found three breaches of regulations. These were in relation to person-centred care, safe care and treatment and good governance.

The service sent us an action plan identifying the actions they intended to take to address the breaches of regulations identified. At this inspection we found improvements had been made and the service was now meeting all regulatory requirements.

There was a registered manager in place. 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 who used the service, their relatives and professionals we contacted, told us they felt the service was safe. There were appropriate risk assessments in place with guidance on how to minimise highlighted risks. Safeguarding policies were in place and staff had an understanding of the types of abuse and procedures for reporting concerns..

The environment was effective for people living with dementia and provided stimulation. There was signage to aid people’s orientation and help them to be as independent as possible.

The home worked within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff had a good understanding of DoLS and the MCA, the importance of consent to care and treatment and how to act in peoples best interests.

People who used the service and their relatives told us the staff were caring and kind. We observed care in the home throughout the day. Staff interacted with people who used the service in a kind and considerate manner, ensuring people’s dignity and privacy were respected.. Relationships between people who used the service and staff members were warm. Conversations were of a friendly nature and staff’s attitude to people was polite and respectful using their chosen names, to which people responded positively.

There was an appropriate complaints procedure in place. Complaints were followed up appropriately and people who used the service and their relatives knew how to make a complaint.

A number of audits were carried out by the service, issues were identified and action plans put into place. Medication policies were appropriate and medicines were administered, stored, ordered and disposed of safely.

People’s care plans showed evidence of effective partnership working and we saw information in peoples care files that showed the involvement of relatives where appropriate.

People’s nutrition and hydration needs were met appropriately and they were given choices with regard to food and drinks. Care plans included appropriate personal and health information and were up to date.

We observed the lunchtime meal. There was a relaxed unrushed atmosphere and we saw that staff interacted with people in a respectful and dignified manner, recognising people as individuals’ and encouraging their engagement. There was a four week, seasonal menu cycle in use which was nutritionally balanced and offered a varied selection.

The home had a Service User Guide and this was given to each person who used the service in addition to the Statement of Purpose, which is a document that includes a specific set of information about a service.

The home had an End of Life Care Policy in place and people’s wishes regarding end of life were recorded in their care files, including any updates.

There was evidence of multi-disciplinary team reviews in people’s care files and evidence of best-interest decisions and discussions.

We saw that prior to any new admission a pre-assessment was carried out with the person and their relative(s).

People’s spiritual needs were met through th

This comprehensive inspection took place on 29 March 2016 and was unannounced. We returned to the home on 21 April 2016 in order to check progress against an action plan that the service sent to us shortly after the date of the inspection. At the time of the inspection, there were 53 people living at the home. Alexandra Grange is registered to provide personal care and support for 54 people.

The care home is a purpose built two storey building with bedrooms on both floors. There is a car park at the front of the home. It is located in Pemberton, near Wigan and is close to shops and public transport links.

At the last inspection on 10 January 2014 we found the service to be compliant with all regulations we assessed at that time. At this inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of the safe management of medicines, having due regard to people’s well-being when meeting nutritional and hydration needs, and effectively assessing, monitoring and improving the quality of services provided.

There was a registered manager in post. 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 we spoke with who lived at Alexandra Grange and their relatives, told us they felt safe.

We looked at five staff personnel files and there was evidence of robust recruitment procedures in place. Staff were subject to a formal induction process and probationary period.

Staff we spoke with told us they thought access to training and opportunities for on-going development were good.

We looked at staff training, staff supervision and appraisal information. Annual appraisals had either taken place or where scheduled for after the date of the inspection and supervision sessions for care staff were conducted by the manager.

We saw people had risk assessments in their care plans in relation to areas including falls, mobility and moving and handling. Accidents and incidents were recorded correctly.

There was an up to date safeguarding policy in place, which referenced legislation and local protocols. The home had a whistleblowing policy in place, recently reviewed in January 2016.

Staff who administered medicines had all completed appropriate training in the safe handling of medicines. There was a medicines administration policy in use, recently reviewed in January 2016 but this did not refer to the latest guidance from the National Institute for Health and Care Excellence (NICE) regarding the administration of ‘covert’ medicines and guidance on safeguarding in relation to medicines.

The home had a homely remedy procedure within their medication policy. The registered manager informed us that the home did not use homely remedies and where people required medicines for example for pain relief this would be prescribed by the GP.

Fridge temperatures in which medicines were stored were recorded daily, but the fridge which contained medicines was unlocked, which meant that people could potentially access these medicines. ‘Over-stock’ medicines were stored in the clinical room in an unlocked cabinet. This meant that they were potentially accessible by anyone entering the room.

We found that surfaces in the medicines room were unclean with a fine residue of powder which could be seen when wiped and an unclean floor, which was a potential infection control issue.

Not all of the medication administration records (MAR’s) that we reviewed on the day of the inspection had people’s allergy status recorded on. However allergy status was documented on the front cover sheet of each person’s MAR chart. NICE guidance states that allergies should be recorded on MAR charts.

The home was adequa

During this inspection visit we have found that action has been taken to address the issues identified during the previous inspection visit that took place on the 27 September 2013. The outstanding compliance actions have now been met.

We did identify a registration issue during the inspection visit, the Care Quality Commission's IT system and website states that the home is registered to provide nursing care when in fact it is a care home that does not provide nursing. This will be followed up as a separate issue and has not had any effect on this inspection visit.

The people using the service who were able to tell us said that they were happy living in the home. Comments included; “I really like it here”, “I am happy here and the staff are looking after me.”

We also received wholly positive comments about the home from visiting relatives, comments included; “belting, cannot fault the place” and “they look after my family member marvellously.”

We spoke to a district nurse who was visiting patients in the home, she said, “staff are caring and are good at communicating with us. They always ask us for help and advice.”

The home had an adult protection procedure that was designed to ensure that any possible problems that arose were dealt with openly and people were protected from possible harm.

Action was needed to ensure that the premises had a suitable layout and were free from odours.

The staff training matrix which showed us that staff had received mandatory training in areas such as safeguarding and moving and handling.

Information about the safety and quality of service provided was gathered on a continuous and on-going basis.

We talked with six people using the service and relatives of two people living at Alexandra Grange care home. We also talked with the senior carer on duty who was in charge on the day of the inspection visit and we talked with the registered manager by telephone. People told us they were happy with the care and treatment provided at Alexandra Grange.

People who used the service told us the care provided met their needs. They said:

“It’s alright, jolly good really.”

And

“I find it great, I enjoy being here.”

Relatives also felt that the service met the needs of people who used services. We were told:

“My (relative) is in a much better position than when they came in.”

And

“There’s good liaison and they do come into (my relatives) room to provide care.”

People also made general statements about living at Alexandra Grange.

A person who used the service told us:

“There are a lot of really poorly people here who I think are well cared for.”

A relative told us:

“The staff are very, very friendly. When (my relative) came back from hospital staff were prompt in welcoming them back and dealing with any immediate needs. It’s a nice place and they respect my relatives’ wishes.”

We observed that people who used the service were provided with support that met their personal, physical, emotional, and recreational needs.

We found that more action was needed to ensure that the premises was free from preventable and offensive odours.

The staff and visitors we spoke with told us that the manager was very approachable and were confident that she would deal with any issues they had.

Staff told us that the training was good.

Staff told us that the manager is very supportive.

Relatives told us: “The carers are brilliant”.

People told us that they were satisfied with their rooms.

People told us that they were happy living at the home.