The inspection took place on 01 March 2017 and was unannounced. The service was last inspected on 25 November 2014 and at the time was found to be meeting all the regulations we inspected.

Georgian House Nursing Home is a care home providing personal and nursing care to up to 26 older people. There were 22 people living at the service at the time of our visit. Some people were living with the experience of dementia and one person was being cared for at the end of their life. 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 and associated Regulations about how the service is run.

A range of activities were organised by staff. However there was a lack of person centred activities, and the environment had not been developed to meet the needs of people who were living with the experience of dementia.

The provider had taken some steps to protect people in the event of a fire and there was a policy and procedure in place. The provider carried out regular fire checks and fire drills. However, people using the service did not have personal emergency evacuation plans (PEEPs) in place. There was a fire risk assessment in place but this had not been reviewed and updated since March 2011.

The temperatures of fridges used to store medicines were not consistently recorded, and where temperatures were out of the safe range, there was no evidence of any actions taken. There was a procedure for the recording, storing and administering people’s medicines and the staff were aware of this. Staff received regular training in the administration of medicines.

We have made recommendations in relation to the provision of person-centred activities, the environment, fire safety and medicines management.

The risks to people’s safety were identified and managed appropriately. The provider had processes in place for the recording and investigation of incidents and accidents.

The provider had put systems in place to ensure people lived in a safe environment. We saw a variety of health and safety checks were conducted on a regular basis by staff and external agencies.

There were appropriate recruitment procedures and systems were in place to ensure that only suitable staff were appointed to work with people who used the service.

There were enough staff on duty to keep people safe and meet their needs, and there were contingency plans in place in the event of staff absence.

There were appropriate procedures in place for the safeguarding of vulnerable people and these were being followed.

The provider was aware of their responsibilities and had acted in accordance with the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). People’s capacity was assessed and they consented to their care and support.

People were cared for by staff who were suitably trained, supervised and appraised.

Staff treated people with kindness and dignity and took into account their human rights and diverse needs.

People’s nutritional and healthcare needs had been assessed and were being met.

Assessments were carried out before people were admitted to the service to ensure the service could provide appropriate care. Care plans were developed from the assessments and reviewed regularly.

There was a complaints procedure in place and people and their relatives knew how to make a complaint. They felt confident that their concerns would be addressed. People and their relatives were sent questionnaires to gain their feedback on the quality of the care provided.

There were regular staff meetings, and these were recorded. Staff told us that communication was good and they had regular handover meetings.

People, relatives and professionals we spoke with thought the home was well-led and th

The inspection took place on 25 November 2014 and was unannounced. The last inspection of the service was on 4 November 2013. There were no breaches of legal requirements at the last inspection.

Georgian House Nursing Home is a care home providing personal and nursing care to up to 26 older people. Some people had dementia and some were being cared for at the end of their lives. 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 and associated Regulations about how the service is run.

Some of the things people said about the service were, ‘‘the moment we arrived at Georgian House, we knew we had arrived at the right place’’, ‘‘(staff have) shown a loving care, concern and passion’’, ‘‘you could not improve on this place’’ and ‘‘ (the staff show) kindness and affection at all times’’.

People’s human rights were protected. The provider had systems in place to help protect people from harm and to keep them safe. Individual risks had been assessed and their care was planned in a way to minimise the likelihood of harm and to give people freedom and choice.

There were enough staff employed to keep people safe and to meet their needs. The staff felt supported and had the training and information they needed to care for people.

People’s medicines were managed safely and appropriately.

People were supported to maintain good health and access healthcare professionals as needed. They were provided with a varied and balanced diet and their nutritional needs were assessed and monitored.

People were asked for their consent to care and treatment. Where people did not have the capacity to consent, the provider had acted in accordance with legislation and guidance. For example, where bedrails were in use, the provider had assessed the risk of these, consulted with the person’s representatives and made a decision in their best interests about the use of these.

The staff were kind and caring, they had positive relationships with the people they cared for based on respect.

People received care which was individual and met their assessed needs. They were given opportunities to voice their opinions on the service and to be involved in planning special events, contributing ideas to the menu and commenting on their experiences. The service was well led, with an open and inclusive culture. People living at the home felt included in the quality assurance and monitoring at the home.

We spoke with ten people using the service, the relatives, friends or visitors of three other people, a visiting health care professional and the home’s manager. We also looked at the care plans for four people, four staff recruitment files, medication records and the procedures for responding to complaints received.

People told us they were happy with the care and support they received. One person told us “I’m very happy here, it’s the happiest I’ve been.” Another person said “I’m very well looked after, it’s perfect here.” A visitor told us “the staff are amazing, they are so caring.”

We saw that people were consulted about the care and treatment they received and these were delivered in line with their care plan.

People’s medication was well managed and the provider had systems in place to make sure people received the medication they needed.

Appropriate pre-employment checks were carried out to make sure staff were suitable to work with people using the service.

Arrangements were in place to investigate and resolve, if possible, complaints from people using the service or their representatives.

People using the service told us they felt safe in the home and that staff were kind and helpful. We spoke with six people using the service. Their comments included "I'm looked after well here, the staff are very good" and "I don't worry about anything, I know the staff will help me if I need it."

We saw that staff supported people in a professional and friendly way. People using the service were offered choices with regard to the food provided at lunchtime and activities in the afternoon. People using the service also told us that they were involved in making decisions. One person told us "I can get up when I like and go to bed when I like." Another person said "there's always a choice of food at meal times. If I don't like what's offered, the staff will get me something else."

We spoke with six people working at Georgian House, including the home's manager. Staff were able to tell us about how they maintained people's dignity, respected their privacy and gave them choices throughout the day. Staff also told us they felt supported and well trained. Staff comments included "it's a good team, we work well together to make sure people are happy and safe" and "this is a good place to work, we have done all the mandatory training and we are offered other training if it's needed." The staff we spoke with were aware of the risk of abuse and gave appropriate answers when asked about how they would respond if they had concerns about a person using the service.

People who use the service and their relatives told us that they are happy with all aspects of the service at Georgian House Nursing Home. They told us that they are treated with dignity, respect and consideration and that their privacy is respected.

Individual needs are assessed and met. People told us that they had not been involved in developing their care plan. One person told us that they were ’very well looked after and that the staff were very good’.

A relative told us ‘I’m very pleased about how my family member is looked after. I would definitely recommend this home to other people’.

People told us that they felt safe and that they could raise concerns with the staff.