The inspection took place on 19 and 23 January 2017 and was unannounced on the first day. This meant no one working at the home knew we would be inspecting the service. At the last rated inspection in April 2015 the service was rated as requires improvement.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘China Cottage Nursing Home’ on our website at www.cqc.org.uk’

China Cottage Nursing Home is a care home situated in Carcroft, Doncaster which is registered to care for up to 33 people. The service is provided by Doncaster Property Investment Fund Limited. At the time of the inspection the home was providing nursing and residential care for 29 people.

The service had 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.

The requirements of the Mental Capacity Act 2005 were in place to protect people who may not have the capacity to make decisions for themselves. The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including balancing autonomy and protection in relation to consent or refusal of care or treatment.

People’s physical health was monitored as required. This included the monitoring of people’s health conditions and symptoms so appropriate referrals to health professionals could be made. From the care records that we looked at, we saw that appropriate referrals had been made to speech and language therapists [SALT] and occupational therapists [OT].

People were protected against the risks associated with the unsafe use and management of medicines. Appropriate arrangements were in place for the recording, safe keeping and safe administration of medicines. Protocols were in place for administering ‘as required’ medication for pain.

There were sufficient staff with the right skills and competencies to meet the assessed needs of people living in the home. There were robust recruitment procedures in place and staff had received formal supervision. Qualified nursing staff had also received some clinical supervision to assess their competencies and skills. Annual appraisals were also taking place. These ensured development and training to support staff to fulfil their roles and responsibilities was identified.

Staff were aware of people’s nutritional needs and made sure they supported people to have a healthy diet, with choices of a good variety of food and drink. People we spoke with told us they enjoyed the meals and there was always something on the menu they liked.

We found the home had a friendly relaxed atmosphere which felt homely. Staff approached people in a kind and caring way which encouraged people to express how and when they needed support. People we spoke with told us that they were encouraged to make decisions about their care and how staff were to support them to meet their needs. Without exception relatives told us they were very satisfied with the care provided to their family members.

People were able to access activities. The activity coordinators had developed a plan of activities. People could also access religious services which were held periodically at the home. We saw a range of activities were available to people during the inspection. For example, arts and crafts, bingo, hairdressing and one to one pampering.

Staff told us they felt supported and they could raise any concerns with the registered manager and felt that they were listened to. People told us they were aware of the complaints procedure and said staff would assist them if they needed to use it

There were effective systems in place to monitor a

We spoke with seven people who used the service and four relatives who were visiting the home at the time of the inspection. People who used the service told us that overall, they were happy with the care provided at the home. They said the nurses and care staff were kind. One person said, “They have done well by me. One nurse in particular is a very hard worker.” Another person said, “All of the staff are very nice, not just one or two, but all of them are kind.”

People experienced care, treatment and support that met their needs and protected their rights. Relatives we spoke with said they were happy with the care provided. We saw that staff treated people with dignity and kindness. We observed that a friendly and positive approach was used, to ensure that the wishes and needs of people using the service were respected.

We found that systems were in place that protected people who used the service against the risks associated with the unsafe use and management of medication.

Appropriate checks had been undertaken on staff when they were recruited to work in the home and complaints were investigated and responded to in a timely manner.

We spoke with two people who used the service. They told us they were treated with dignity and their independence was respected. They said care workers asked them what help they required and involved them in their care. We also observed care workers treating people with consideration and respect.

People who used the service told us they were happy with the care they received. We observed care being given in a way which was both safe and considerate. We also reviewed care records which showed that risk assessments and formal reviews were undertaken to ensure care was effective and safe.

People who used the service told us they felt safe at the home. Care workers had undertaken training in safeguarding and were aware of their responsibility to report any abuse.

People who used the service told us they thought care workers were well trained and knew what they were doing. We spoke to care workers who said they had regular training, supervision and appraisal. We also reviewed a training matrix which showed that staff had regular training in all appropriate areas.

People who used the service said they were asked for their opinion as to the quality of care in the home. We saw that regular meetings were held with people who used the service, relatives, and staff. There were also systems in place to assess and monitor the quality of the service people received, and to manage any risks to people's health.

People who used the service told us they were happy with the care provided and were involved in decisions about their care and welfare needs. Three people we spoke with told us they had not read their care plan but that was their choice.

We spoke with three relatives during our inspection who told us they had been involved in the development of their relative’s care plan. They also told us they were able to make changes and contribute to their relative’s care if they wished. They told us their relative’s dignity was respected and confidentiality was always maintained.

We spoke with three relative’s who told us they were happy with the care and their family member was well looked after. The three relatives we spoke with told us that the staff understood the care needs of their family member. They also told us they were contacted by the home straight away if their family member required any treatment.

People who used the service told us that they felt safe at the home and they would tell staff or the manager if they were worried about anything. We spoke with three relatives who confirmed they would talk to the manager if they had any concerns. All three relatives told us their relative felt safe.

We carried out an unannounced comprehensive inspection of this service on 6 and 13 October 2014. At which breaches of legal requirements were found. This was because care and treatment was not planned and delivered in a way that was intended to ensure people's safety and welfare. Also the provider did not have effective systems to regularly assess and monitor the quality of service that people receive. The provider did not have effective systems in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others. Also people were not protected against the risks associated with the management of medicines. People did not receive care or treatment in accordance with their wishes. People were not always asked for their consent before treatment was given. Comments and complaints people made were not responded to appropriately.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook a comprehensive inspection on the 14 and 22 April 2015 to check that they had followed their plan and to confirm that they now met all of the legal requirements.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘China Cottage Nursing Home’ on our website at www.cqc.org.uk’

China Cottage Nursing Home is a care home situated in Carcroft, Doncaster which is registered to care for 33 people. The service is provided by Doncaster Property Investment Fund Limited. At the time of the inspection the home was providing nursing and residential care for 27 people.

The service did not have a registered manager in post. However the Commission had received an application to register the manager who has been in post since January 2015. 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 inspection on the 14 and 22 April 2015, we found that the provider had followed their plan which they had told us would be completed by the 31 March 2015 and legal requirements had been met.

People were kept safe at the home. However we found that some staff did not have a good understanding of the legal requirements as required under the Mental Capacity Act (2005) Code of Practice. The Mental Capacity Act 2005 sets out how to act to support people who do not have the capacity to make a specific decision.

People’s physical health was monitored as required. This included the monitoring of people’s health conditions and symptoms, so appropriate referrals to health professionals could be made. The home involved dietician and tissue viability nurses to support people’s health and wellbeing.

We found the home had a friendly relaxed atmosphere which felt homely. Staff approached people in a kind and caring way which encouraged people to express how and when they needed support. People we spoke with told us that they were encouraged to make decisions about their care and how staff were to support them to meet their needs.

Medication systems had improved so that the administration of medicine was safer. However, the incorrect stock count for some medicines meant we could not confirm that people are getting their medication as prescribed. There was still a lack of PRN protocols. We found the systems still needed to be embedded into practice.

There were robust recruitment procedures in place; most staff had received formal supervision since the new manager had been in post. Qualified nursing staff had also received a monthly clinical supervision. Annual appraisals had been scheduled. These ensured development and training to support staff to fulfil their roles and responsibilities was identified.

Staff told us they felt supported and they could raise any concerns with the registered manager and felt that they were listened to. People told us they were aware of the complaints procedure and said staff would assist them if they needed to use it

The provider had introduced new systems to monitor the quality of the service provided. We saw these were more effective. Although improvements were now taking place the provider needs time to ensure the systems are embedded and sustainable.