We conducted an inspection of Nazareth House on 24 and 27 October 2016. The first day of the inspection was unannounced. We told the provider we would be returning for the second day.

At the last inspection on 14 and 15 July 2014, we asked the provider to take action to make improvements in relation to consent and this action has been completed.

Nazareth House provides care and support for up to 95 people who require nursing and personal care. There were 85 people using the service when we visited. There are three floors within the building. The first and second floors are home to people with nursing needs and some people with palliative care needs. The third floor is a residential floor which is home to older people some of whom had early onset dementia.

There was a registered manager at the service. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

There were good systems in place for the safe management and administration of medicines. Staff had completed medicines administration training within the last year and were clear about their responsibilities.

Risk assessments and support plans contained clear information for staff. All records were reviewed every month or sooner if the person’s care needs had changed.

Staff demonstrated a good knowledge of their responsibilities under the Mental Capacity Act 2005. Mental capacity assessments were completed as needed and we saw these in people’s care files. Where staff felt it was in a person’s best interests to deprive them of their liberty, applications were sent to the local authority for Deprivation of Liberty authorisations to ensure this was lawful.

Staff demonstrated an understanding of people’s life histories and current circumstances and supported people to meet their individual needs in a caring way.

People using the service and their relatives were involved in decisions about their care and how their needs were met. People had care plans in place that reflected their assessed needs.

Recruitment procedures ensured that only staff who were suitable, worked within the service. There was an induction programme for new staff, which prepared them for their role. Staff were provided with appropriate training to help them carry out their duties. Staff received regular supervision. There were enough staff employed to meet people’s needs.

People who used the service gave us good feedback about the care workers. Staff respected people’s privacy and dignity and people’s cultural and religious needs were met. Although Nazareth House is a Catholic care home, there were people using the service from other denominations of the Christian faith and people were welcomed and respected from other faiths and with other beliefs.

People were supported to maintain a balanced, nutritious diet. People at risk of malnutrition had appropriate assessments conducted and were referred to the community dietitian as appropriate. Advice was implemented by care staff and the kitchen staff who were also aware of people’s dietary needs. People were supported effectively with their other healthcare needs and were supported to access a range of healthcare professionals.

People using the service felt able to speak with the registered manager and provide feedback on the service. They knew how to make complaints and there was a complaints policy and procedure in place. Care staff gave excellent feedback about the registered manager and gave us examples of improvements that had been implemented and sustained.

People were encouraged to participate in activities they enjoyed and people’s participation in activities was monitored. People’s feedback was obtained to determine whether they found activities or events enjo

When asked for their thoughts on Nazareth House, Hammersmith one person told us it was “absolutely excellent in every possible way”. People received care that met their individual needs because the provider ensured their needs were properly assessed, risks identified and strategies put in place to reduce the risk.

People’s medication was safely managed and only administered by staff that could demonstrate their competence. People who use the service had their medicines administered as prescribed.

People’s care and treatment was delivered by staff that were safely recruited and had the right skills, experience and training for the post they held.

One person told us “they [staff] are so kind to us all.” Staff received training and regular supervision to do their job and reported to us that they felt well supported to do a good job.

The provider had in place an accessible and robust process for handling complaints received by the service and we saw that efforts were made to resolve matters to people’s satisfaction.

We spoke to people who use the service but their feedback did not relate to the outcome we were inspecting. We found that people lived in a clean and hygienic environment and that staff were provided with the appropriate guidance to protect people from the risk of infection.

We spoke with 15 people who used the service and/ or their relatives. They were complimentary about the care being provided and confirmed that they had been involved in making decisions about their care, were asked for their consent and that their privacy and dignity was respected. One person described the service as "wonderful" and another person told us that they were "very, very happy". Everyone was positive about the food. We observed positive interactions between staff and people during the inspection.

We looked at 15 care plans and saw that people's preferences had been documented. Furthermore, we saw that if a person lacked capacity, the provider had acted in accordance with legal requirements. People were assessed regularly by staff to ensure that all their care needs were being met. This included assessing their nutritional status on a monthly basis. People were supported to eat and drink sufficient amounts to meet their needs.

There were systems in place to monitor the quality of service provided and to obtain feedback from people. Monthly audits were carried out and quality monitoring visits were conducted by staff from one of the provider's other services. However, people were not protected from the risk of infection. We saw that some areas, including commodes were visibly unclean at the time of the inspection. There was a lack of guidance for staff on how to clean equipment and staff we spoke with were unsure of the procedure.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

We undertook an unannounced inspection of Nazareth House on 14 and 15 July 2014. Nazareth House provides care and support for up to 95 people who require nursing and personal care. There were 82 people using the service when we visited.

At our last inspection on 6 November 2013 the service met the regulations inspected.

The service had a registered manager who had been in post since October 2013. 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.

We found a breach with regard to consent arrangements. Managers and staff had received training in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). However, the manager and other senior staff confirmed that mental capacity assessments were not consistently completed when required. This meant that there was a risk that decisions were being made without people’s valid consent. This was a breach or Regulation 18 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Managers and staff had received training on safeguarding adults. Safeguarding adults from abuse procedures were robust and staff understood how to safeguard the people they supported.

People and their relatives were involved in decisions about their care and how their needs were met. People had care plans in place which reflected their assessed needs.

Recruitment procedures ensured that only people who were deemed suitable worked within the service. There was an induction programme for new staff which prepared them to perform their role. Staff were provided with a range of training to help them carry out their duties. Staff received regular supervision and appraisals to support them to meet the needs of people. There were enough staff employed in the service to meet people’s needs.

Staff assisted people to eat and drink appropriately. People were supported effectively with their health needs and were involved in making decisions about what kind of support they wanted.

Staff, people who used the service and relatives felt able to speak with the manager and provided feedback on the service. They knew how to make complaints and there was an effective complaints system in place.

The service carried out regular audits to monitor the quality of the service and to plan improvements. Where concerns were identified action plans were put in place to rectify these.