This inspection took place on 21 and 22 December 2016 and was unannounced. Catherine House provides nursing and personal care and accommodation for up to 67 people. At the time of our inspection there were 42 people using the service.

There is 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.

We observed inconsistencies in how staff responded to people. Staff were observed treating people with respect and in a caring manner however there were occasions when staff had failed to ensure people's dignity and respect were upheld. Since the inspection a dignity champion had been appointed. The registered manager told us they hoped this would address this failure and was part of addressing this area for improvement.

People told us improvements were needed in the quality of some of the meals. There were varied comments from people about the choices available and quality: "Need more variety" and "Food should have more taste" and "Always good meal enjoy my meals". We observed attractive meals on the days of our inspections with good choices for people. There had been a meeting where people had discussed improvements and these had been actioned. The registered manager had received verbal positive feedback and was in the process of conducting a "Dining Experience" questionnaire and observation. They recognised improvements were continuing.

Staff had a good understanding of their responsibilities in protecting people from abuse. They spoke of reporting any concerns and being confident they would be listened to and action taken to address their concerns.

The registered manager had, as required, made applications under the Mental Capacity Act 2005 and obtained an authorisation under Deprivation of Liberty Safeguards (DoLS) arrangements. The service protected people's rights by seeking consent for care and use of certain equipment.

People told us they felt safe living in the home and how there were always staff available to support them. One person told us they felt safe because "I can trust the staff". A relative told us how on leaving the home after visiting "I know (Name) is safe and well looked after". Another relative told us "I would not want (Name) anywhere else".

Staff were described by people and relatives as kind and caring. People reported how there was a friendly and welcoming environment. This was confirmed by visitors we spoke with who commented how they always felt welcomed and involved in their relatives' care. One relative told us "I never feel I am in the way when I visit". People and relatives told us there were no restrictions on visiting.

The service ensured people's nutritional needs were met and took action to address any concerns about people physical wellbeing and ensure they were able to have a healthy diet suited to their needs.

People told us they felt confident about staff having the necessary skills and training. One person told us "The carers are good and really know what they are doing and I can depend on them for anything."

People had access to community health services and their GPs when this was requested. A healthcare professional we spoke with was very positive about the care provided by the service. There were good relationships with outside professionals and people had access to specialist support and advice.

People felt able to voice their views or concerns about the service. There were regular meetings where people living in the home and their relatives were kept informed about the service and people could give feedback about the quality of care provided in the home.

There were a range of quality assurance audits which had identified areas for improvement. A home improvement pl

When we last inspected this service on 9 and 16 July 2014 we found the systems in place to reduce the risk and spread of infection were not effective. The cleanliness of the home varied.

Due to the level of risk to the people who lived or worked in the home, we took enforcement action against the provider and served a Warning Notice on 8 August 2014. We told the provider in this notice they must reach compliance with this outcome by 8 September 2014.

This inspection was carried out to check if the provider had made the necessary improvements to infection control practice. We found the systems in place to reduce the risk and spread of infection had been significantly improved. They were now effective.

We saw all areas of the home were clean and we did not identify any infection control risks. New cleaning products and cleaning equipment were in use. New flooring had been laid which was easy to clean. The laundry area had been improved as had storage for clean and soiled items. These changes significantly reduced the risk of cross infection.

The working hours of the housekeeping team were due to be extended and their numbers increased.

The provider’s audit of infection control practices was now thorough and accurately reflected the standards in the home.

We conducted a follow up inspection to check the provider had met the compliance actions we set at the previous inspections. We said the provider was not fully meeting outcome 4: care and welfare of people who use services and outcome 14: supporting workers. We found people's care was not delivered in a way that was intended, by staff who were appropriately supported to deliver care and treatment safely and to an appropriate standard. The provider sent us an action plan telling us how and when compliance was to be achieved.

We had general discussions with people who lived in the home. This was because they were living with dementia or too frail to give us detailed feedback about their care or about the staff. We saw the staff helped people to eat their meals, they distracted people’s attention to ensure their safety. We saw people enjoyed the banter they had with the staff and gentle reminders were used by the staff when people forgot dates of events.

The three relatives of people who lived in the home told us the standards of care had improved since our last inspection but said there were staff shortages. One relative said “the staff are very good and they work very hard.” Another said “the staff try hard but they are always short staffed” and the third relative said “overall the care is good but there is always something. The staff always seem very busy. If you need them for something you have to wait.”

The staff we spoke with also told us the standards of care had improved. They told us there had been significant improvements in the quality of the food. We were told people were eating better. These staff told us more staff had been recruited but while their induction was taking place staffing levels were not always maintained. The manager told us the ways the staffing levels were to be improved.

We looked at a number care plans and while more detailed information was needed the staff told us they had enough information to meet people’s changing needs.

Staff received essential training to help them deliver care and treatment to people safely and to an appropriate standard. Staff attended basic dementia training which meant that staff had some insight into needs of people living with dementia.

We carried out this review in response to concerns we had received about the care people received in the home. Some of the concerns related to people being left in bed for long periods, pressure area care, moving and handling practices and the care of people who had swallowing difficulties.

At the time of our visit there were 49 people living at Catherine House. Accommodation for people was set over four floors but the ground floor accommodation was not in use at the time of the inspection. We spent the majority of the day on the second and third floors which provided care to people who were not independently mobile and therefore required staff assistance with all aspects of care and support.

The majority of people we met were unable to fully express their views on the care that they received. One person told us “It’s nice here” and another person said “Nothing is too much trouble.”

Throughout the visit we observed that the majority of people were physically frail and cared for in bed. A small number of people were sat in chairs in their room. Staff were very task focused and the only social interaction people received was when staff assisted with care. Some rooms had the television or radio on but there was no information to state who decided what people may like to listen to or watch. A high number of people were in their rooms with no stimulation at all. As people we saw were not independently mobile, they were not able to leave their room without staff support. Therefore they had no opportunities to interact with other people or use other rooms such as the communal lounges.

We observed that people being nursed in bed all appeared clean, warm and comfortable. Care plans read stated that people should be assisted to change position every two to three hours to minimise the risks of pressure damage. Staff who worked at the home said that they assisted people to change position every two hours throughout the day. Charts in individual bedrooms confirmed that this happened.

Throughout the visit we saw that staff spoke to people in a kind and friendly manner. People who lived at the home appeared comfortable with the staff who supported them. We reported to the manager one instance where someone was not treated respectfully and this was dealt with immediately and appropriately.

Medication administration records showed that people received the correct medication at the prescribed time. We noted that people with swallowing difficulties received their medication in liquid form.

A visiting healthcare professional told us that they felt medication was appropriately managed. They said that there were regular reviews to ensure that prescribed medication remained appropriate to the individuals needs.

We carried out an unannounced comprehensive inspection of this service on 8 and 12 December 2014. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the Health and Social Care Act 2008 (regulated Activities) Regulations 2010, Regulation 9.

We undertook this focused inspection to check that they had followed their action plan and to confirm that they now met legal requirements. We also followed up other areas where the provider needed to improve the service, although they had not breached legal requirements. This report only covers our findings in relation to these issues. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Catherine House General Nursing Home on our website at www.cqc.org.uk

This inspection was unannounced and took place on 20 and 22 May 2015.

Catherine House General Nursing Home provides accommodation for up to 67 people who need nursing care. The home mainly provides care for older people who are living with dementia. The home is a large, purpose built property. Accommodation is arranged over four floors, although only two floors are currently in use. There is a passenger lift to assist people to get to the upper floors. There were 37 people living at the home at the time of our inspection.

There was a manager in post who was currently going through the process of being registered with the Care Quality Commission. 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.

At the last inspection we found people were not always cared for in accordance with their preferences and choices. Staff support for people with meals and drinks varied. People saw health and social care professionals when they needed to, but they did not always receive prompt care and treatment. At this inspection we found people received care in the way they chose to receive it. People were well supported with meals and drinks; the mealtime experience had been significantly improved. People’s changing care needs were responded to promptly.

At the last inspection we found there was a lack of consistent leadership on both floors where care was delivered; care practice was inconsistent. Care was sometimes based around completing tasks and did not take account of people’s preferences. People’s privacy was not always respected. At this inspection we found care practice and leadership had improved and people’s privacy was respected.

At the last inspection we found there was a lack of interaction between some people and staff and not enough meaningful activities to meet each person’s individual needs. At this inspection we found staff interacted a lot more with people and that both group and individual activities had been significantly improved.