This inspection was unannounced and took place on 29 March 2017. Charlotte James Nursing Home is registered to provide accommodation and support for up to 28 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection, 25 people were using the service.

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.

At our last inspection on 21 April 2016, we found that improvements were needed in relation to the staffing levels; assessing people’s capacity to make certain decisions; and the effectiveness of the audits to monitor the quality of the service. At this inspection, the required improvements had been made regarding the staffing available and the systems in place to make effective changes in the home.

However, further improvements were required. When people were unable to make specific decisions about their care, the provider had not assessed their capacity and could not demonstrate how decisions were made in people’s best interests. The provider did not always ensure the staff had the specific training they needed to deal with certain circumstances.

People were safe and protected from harm and abuse. They were supported in a safe manner and potential risks were monitored and reviewed. People’s medicines were administered as prescribed and the provider had safe recruitment processes in place.

People were supported to maintain a balanced diet and good health. They were supported by staff who knew them well and were kind and caring in their manner. Staff had positive relationships with the people who they supported. People were supported in a dignified manner and their privacy and independence was promoted. Visitors were made to feel welcome and there were no restrictions as to when they could call.

People were involved in the assessment and planning of their care. They received support that was individual to them and took their views into account. There were opportunities for people to participate in activities they enjoyed. People knew how to raise any concerns and these were responded to.

People were positive about living at the home and felt it was well managed. There was an open culture within the service and staff enjoyed working there.

This inspection took place on the 21 April 2016 and was unannounced. At our previous inspection on the 26 June 2015 the provider was not meeting all the regulations relating to the Health and Social Care Act 2008. There were breaches in meeting the legal requirements regarding the Mental Capacity Act and staffing levels in place. The provider sent us a report in September 2015 explaining the actions they had and were taking to improve. At this inspection, we found improvements had been made since our visit in June 2015, however further improvements were required.

Charlotte James Nursing Home provides personal and nursing care for up to 28 older people

There were 20 people living at the home on the day of our inspection.

There was no registered manager in post at the time of our inspection; however the provider advised us that an application to register a manager was in progress. 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.

Where people lacked capacity to make decisions, capacity assessments had been completed but further improvements were needed to ensure these assessments were decision specific. When people were being unlawfully restricted this had been considered and Deprivation of Liberty Safeguards (DoLS) applications were in the process of being completed to ensure people’s rights were protected. Staff gained people’s verbal consent before supporting them with any care tasks and promoted people to make decisions.

The staffing levels had been increased but further improvements were needed, as people sometimes had to wait for staff support. Improvements had been made to medicines management but staff were not consistently recording when medicines had been given. Audits had not been undertaken in all areas to ensure areas for improvement could be identified.

Care staff knew about people’s individual risks and plans to support people were in place, including individual plans to support people in the event of an emergency to ensure people could be evacuated in a safe way. The provider checked that the equipment was regularly serviced to ensure it was safe to use. People were provided with the right equipment to meet their needs.

People told us they felt safe at the home and staff understood their responsibilities to protect people from harm. Staff were suitably recruited which minimised risks to people’s safety. Staff were provided training to meet the needs of people and were supported by the management team.

People received food and drink that met their nutritional needs and were referred to healthcare professionals to maintain their health and wellbeing.

There were processes in place for people and their relatives to express their views and opinions about the service provided and to raise any concerns or complaints.

This inspection took place on 26 June 2015 and was unannounced. The home had been recently purchased by a new provider. This was the first inspection since registration in March 2015.

Charlotte James Nursing Home provides personal and nursing care for up to 28 older people

There were 17 people living at the home on the day of our inspection.

There was no registered manager in post at the time of our inspection; however a newly appointed manager was on duty. 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 legal requirements of the Mental Capacity Act 2005 (MCA) were not followed when people were unable to make certain decisions about their care. The MCA and the Deprivation of Liberty Safeguards (DoLS) set out the requirements that ensure where appropriate; decisions are made in people’s best interest. Where people lacked capacity to make decisions they had not been assessed appropriately to ensure their rights were upheld. Deprivation of Liberty Safeguards were not in place where needed, to ensure people were not deprived of their liberty unlawfully.

There were not always enough staff available to meet people’s needs in a timely way and ensure their needs were fully met. People were supported to take their medicines but staff did not have clear guidance to follow regarding some ‘as required’ medicines.

Individual plans to support people in the event of an emergency were in place but were not being used as a working document to ensure people could be evacuated in a safe way.

Care staff knew about people’s individual risks and told us they had all the equipment they needed to assist people safely. The provider checked that the equipment was regularly serviced to ensure it was safe to use. Assessments were in place that identified risks to people’s health and safety. Care plans directed staff on how to minimise the identified risks and support people in a safe way.

People who lived at the home told us they felt safe and that the staff treated them in a respectful way. The staff understood their responsibilities to protect people from harm. Staff were suitably recruited which minimised risks to people’s safety. Staff received training that was appropriate to meet people’s needs.

People told us that they liked the staff and confirmed they were supported to maintain their independence and make choices and decisions. People we spoke with told us they were involved in deciding how they were cared for and supported.

People told us that the staff were caring and supported them in a way that protected their privacy and dignity. We saw that staff treated people with consideration and respect. People told us they enjoyed the meals and were provided with choices. People were supported to maintain good health and accessed the services of other health professionals.

Due to the changes in provider and manager, the quality monitoring systems required development. This was to ensure people’s views were sought and the quality of the service was monitored and improved upon as required.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities). You can see what action we told the provider to take at the back of the full version of the report.