This unannounced inspection took place on 14 and 15 December 2016.

Magdalen House Nursing Home provides residential and nursing care for up to 30 older people. When we visited 27 people were accommodated. The home is purpose built over two floors and a passenger lift provides easy access to both floors. There are two communal rooms, one on each floor, where people can dine and seat comfortably in easy chairs. There is a small day centre people can access adjacent to the home. There are well tended gardens and parking at the front of the home.

There was no registered manager. 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 current new manager was in the process of applying to become the registered manager.

There were some minor shortfalls in the administration of medicines and we have made a recommendation about the management of some medicines. However these issues had been identified through their own quality assurance processes. People and their relatives told us they felt safe in the home. Staff knew how to keep people safe and were trained to report any concerns. People were supported by staff that were well trained and had access to training to develop their knowledge.

People had a choice of meals. We observed one meal time and people’s experience could be improved. There were insufficient staff to support people in the dining room. When people required assistance with their food in their bedroom staff supported them and gave them time to enjoy their meal. People had a range of activities to choose from which included exercise classes, arts and crafts, musical entertainments and weekly trips out in the mini buses. There were links with the local community at the adjacent day centre and a church social club.

The current care plan records were not as person centred as they could be but we could see the new care plans were an improvement. Each day one care plan was reviewed and the person would be included in the ‘Resident of the Day’ review where all aspects of their care were looked at.

The manager, compliance manager and the Chief Executive Officer monitored the quality of the service with regular checks and when necessary action was taken. Staff felt well supported by the manager. Staff meetings and resident/relative meetings were held and they were able to contribute to the running of the home.

People were treated with kindness and compassion and we observed staff engaged with people in a positive way and they were caring when they supported them. Relatives felt welcomed in the home and told us the staff were kind.

People were able to make some choices and decisions and staff supported them to do this. Staff knew what people valued and how they liked to be supported. People's care was regularly reviewed. External healthcare professionals supported people when required and they were well supported by their GP.

Our inspection of 5 August 2013 found that people’s personal records were not always accurate or fit for purpose. This was because although the home's practice was in line with the requirements of the Mental Capacity Act 2005 (MCA), records did not always evidence this. The provider wrote to us and told us care records would be updated to record if people had the capacity to make specific decisions about their daily living. The provider told us this action would be completed by 31 January 2014.

At this inspection we looked at the care records for four people and spoke with the registered manager and a senior member of staff. We did not speak with people as the purpose of this visit was to check if assessments of peoples’ mental capacity to make decisions about their daily living were recorded.

We found records showed that people’s decision making ability in relation to day-to-day decisions had been assessed and the outcome recorded. Records also detailed the type of decisions that people would not have the capacity to make and would have to be made in their best interest. We found the provider was meeting the requirements of the MCA by keeping accurate records where people were unable to consent to some or all aspects of their care.

During our visit we spoke with seven people living in the home. People we spoke with told us they were happy living in the home and could make choices about their daily living. People we spoke with told us, “It’s not like being at home, but as places go, it’s good. This is the best one in the county” and “They are marvellous and the food is good”.

Care plans were personalised to each individual's needs, risks were identified and assessed appropriately and all records were kept under regular review. The home had a range of activities on offer including: arts and crafts, nail and hand care, music and movement and trips out. One person told us, “we went to Weston-Super-Mare last week and that was very nice”.

There were enough qualified, skilled and experienced staff to meet people’s needs. Appropriate arrangements were in place in relation to obtaining, recording and the storage of medicines. We found that although the home's practice was in line with the requirements of the Mental Capacity Act 2005, records did not always evidence this.

The regulated activities of diagnostic and screening procedures and treatment of disease, disorder or injury were being carried out at this location. Our records showed that these regulated activities had not been registered with the Care Quality Commission. However, we discussed this with the provider and we were advised that arrangements would be made to register these regulated activities at this location.

During our visit we spoke with six people living in the home and two relatives who were visiting that day.

People told us that they were happy living in the home and were positive about how they were supported by the staff team. Comments made by people included; “The manager is fantastic”, "I like the atmosphere here, the staff come and talk to me" and "I am very happy living here".

Relatives we spoke with told us, “We think the home is wonderful” and “very good home – they kept us informed”.

Staff were observed interacting with people in a respectful and attentive manner.