This inspection took place on 23 November 2017 and was unannounced. At the last inspection carried out on 14 September 2015 we found that the provider was meeting all of the legal requirements set out by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and those associated with their registration and was rated as ‘Good’. At this inspection, we found that the provider continued to provide a good standard of care to people, but there were some areas that required improvements.

Bloomsbury House 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. The care home is registered to provide accommodation and personal care to up to 24 people. The home provides care for older people, including those living with dementia. At the time of our inspection we were told that there were 21 people living at the home.

Bloomsbury House is required to have 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 and associated Regulations about how the service is run. At the time of this inspection a registered manager was in post. People knew who the registered manager was and felt able to speak with them to raise any comments or concerns they had.

There were some systems in place to monitor the quality of the service; however we found that some improvements were required to the oversight and management of the service. This included the need for continuous development, in accordance with evidence based practice, particularly relating to specialist dementia care.

We found that people were protected from the risk of abuse and avoidable harm because safeguarding systems and processes were in place and implemented effectively. People were supported by sufficient numbers of staff who had the knowledge and the skills they required to care for people safely and effectively.

People were also protected against any risks associated with their health and care needs because risk assessments and associated care plans were developed holistically, reviewed and monitored. This ensured that people received the support they required to remain safe. People and their relatives were involved in this process alongside any key professionals and care staff. This ensured that care was person-centred and any decisions made in respect of their care and support needs, were done so within their best interests and in accordance with the Mental Capacity Act 2005. Where people were assessed to lack the capacity to consent to the support they received, the provider had followed key processes to ensure that care was provided in the least restrictive ways possible. Applications had been made to safeguard people against the unlawful deprivation of their liberty, where necessary. People’s privacy, dignity and independence were respected at all times.

The premises and equipment were well maintained and clean but would benefit from being adapted to ensure people were supported to remain as independent as possible, particularly those living with dementia.

People received support from staff to take their prescribed medicines as and when required. Systems and processes were in place to ensure medicines were managed safely and only senior members of staff who had undergone specific training and supervision were permitted to administer medicines within the home.

People were supported to maintain a healthy diet and all health needs were met with the support from staff. It was evident that people had developed positive relationships with staff and there was a friendly, calm, relaxed atmosphere within the home. Staff knew

This inspection took place on 14 September 2015 and was unannounced. At the last inspection carried out or on 23 November 2013 we saw that the provider was not meeting the requirement in respect of management of medicines. The provider had made all the required improvements.

Bloomsbury House is registered to provide accommodation and personal care to up to 24 people.

The home specialises in the care of older people. At the time of our inspection we were told that there were 15 people living there.

Bloomsbury House is required to have 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 and associated Regulations about how the service is run. At the time of this inspection a registered manager was in post.

People were protected from the risk of avoidable harm because systems and processes were in place to protect people. Staff understood the different types of abuse and knew what actions to take if they thought a person was at risk of harm.

There were sufficient numbers of staff that had received appropriate training so that they were able to meet people’s needs.

People received their prescribed medicines as required and were supported to maintain some medicines themselves if appropriate.

Staff sought people’s consent before providing care and support. Staff understood the requirements of the Mental Capacity act (2005) and the Deprivation of Liberty Safeguards (DoLS).

People enjoyed their food and were supported to eat their meals when required and support to have additional drinks to boost their calorie intake where required.

People were treated with kindness, by staff who knew their needs . People were supported to receive medical attention when required so that their health care needs were met.

People’s right to privacy, dignity and independence were promoted and encouraged.

People knew who the registered manager was and felt able to speak with her to raise any comments or concerns.

There were systems in place to monitor the quality of the service and the service was being developed to grow in size to provide a better environment for the people who lived there.

When we visited there were 15 people living in the home. We spoke with five people, two staff and the registered manager.

We saw that people had good relationships with staff and when they asked for assistance staff responded to people in a discreet and friendly manner. Staff provided support throughout the day to people. All the people we spoke with told us that they were happy in the home and three people told us, "We are looked after well." This meant that people received the support they wanted and needed to ensure their health and care needs were met.

People's nutritional and hydration needs were met through varied meals and support so that they were able to eat and drink safely. One person told us, "There is soup and sandwiches for tea. Suits me just right."

Staff had been provided with the skills and knowledge to protect people from abuse.

The provider had systems in place to ensure the safe storage and handling of medicines but had not ensured that changes to medication regimes were implemented in the home quickly. This meant that people did not always get their medicines as prescribed.

Bedrooms were personalised, communal areas were comfortable and adaptations were in place to ensure people's needs were met. This meant the premises met people's needs.

There was a complaints procedure and suggestions box in place to enable people to suggest improvements to the service.

We visited the service to follow up on the improvements required from our inspection in October 2012. People using the service told us that they were not always offered food and drink in between meals. Records seen at the time of our visit were not up to date to show what food people had eaten or if it was in sufficient quantity to meet their nutritional needs. We found that people were not always protected from the risks of inadequate nutrition and dehydration.

During our visit we spoke with four people using the service, two staff and the manager. People spoken with told us that they were given a choice about what they wanted to eat each day, snacks and drinks were available and if they wanted anything to eat at night they were asked what they would like. One person told us, “The food is very good we get plenty to eat and drink any time we ask’’.

At this inspection, we found that the provider had taken the necessary action to ensure people were provided with a choice of suitable and nutritious food and drink to meet their nutritional needs.

On the day of our visit there was nice people living in the home. We spoke with five people using the service, two relatives, four staff, the manager and the provider. The inspection team was led by a CQC inspector joined by an "expert by experience". An expert is a person who have experience of using services and who can provide that perspective of what people say about the service and what it may mean.

We saw that staff treated people with respect and dignity. Three of the five people spoken with told us, staff are very kind and considerate nothing is too much trouble for them.

All of the staff spoken with was able to tell us about people's needs so that they received care in a way that the they preferred. All five relatives told us they were consulted about their relative’s care and kept informed about their relative’s health so they felt involved in their care. All five people spoke with told us they felt safe living there.

People were not always supported to eat a healthy and nutritious diet to help keep them healthy.

Staff told us they had a range of training so that they have up to date knowledge and skills in order to support the people who live there.

The provider was in the process of seeking people views about the service provided. The manager told us when all the information had been collated and analysis would be completed to improve the service where needed.

People living at Bloomsbury House were generally happy with the care provided. They told us they received the support that they needed. One person told us that they were sometimes not assisted to the toilet when they asked.

Relatives told us that they were happy with the service being provided. They said the home “Was marvellous.”

Systems were in place to enable people to make choices about the food they ate. Most people told us they were able to choose their food on a daily basis. One person told us they did not get choices. People enjoyed the food they received.

People were spoken to by care workers in a friendly way. We saw some interactions between care workers and people in the home that were respectful and kind.

Care workers told us that on occasions they experienced difficulties helping some people to move. We saw some practices that were not safe.

People told us that the staff were kind. We saw some good interactions between people and care workers. We saw some interactions that did not indicate that people were being acknowledged and reassured all the time.

Some people enjoyed their midday meal on the day of our visit but most people did not. People told us that they had not been asked what they wanted to eat that day.

We spoke with some relatives visiting Bloomsbury House during our visit. They told us that they were happy with the service being provided. We saw two questionnaires that had been completed by relatives. These showed that they were happy with the care workers and the service provided.

After our visit to Bloomsbury House we received a letter from a relative telling us how pleased they had been with the service.