This unannounced inspection took place on 3 May 2017. At our last inspection in October 2015 we rated the provider as ‘requires improvement’ overall. The Cottage Nursing Home provides accommodation for up to 33 people who may have nursing needs. At the time of our inspection there were 32 people living at the home.

At the time of our inspection there was a registered manager in place. 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.

People who lived at the home told us they felt safe. The provider’s recruitment system was not extensive enough to ensure staff were recruited safely. Staff understood their responsibilities in keeping people safe and knew how to report any suspected abuse. Staff knew the risks to people’s health and safety and understood the measures in place to keep people safe. People and their relatives told us there were enough staff to meet people’s needs. People told us and we saw people got their medicine when they needed it.

People were supported by staff to meet their needs. Staff sought consent from people before providing care. The registered manager had applied the principles of the Mental Capacity Act 2005 which meant people’s rights were protected. People told us they enjoyed the food at The Cottage. People told us they had access to other healthcare professionals when their health needs changed.

People told us they were supported by kind and considerate staff. We saw and people confirmed they had choices about their care and staff respected the choices they made. People were supported by staff to maintain their independence and staff supported people in a dignified way. We saw people were encouraged to maintain relationships that were important to them.

People and their relatives told us they were involved in their care. People told us and we saw staff understood people’s individual needs and supported people ways they preferred. People had access to activities which they enjoyed. People told us they were confident to raise any complaints but had not had reason to. When people did complain there was a system in place which meant they would be listened to and complaints would be investigated.

People were happy living at The Cottage and told us it was well led. Staff told us they were supported by the registered manager by means of regular supervisions and team meetings. The registered manager was aware of their legal responsibilities. The provider operated a quality assurance system which identified areas where improvements were needed and took action where concerns were highlighted.

We looked at the care files and associated records for three people who lived at the home. We found evidence to demonstrate that the issues identified at our last visit to The Cottage nursing home had been addressed.

We saw a notice on the wall encouraging family members to be involved in care plan reviews. One visitor we spoke with confirmed that staff kept them up to date with everything that went on at the home.

We saw that people who lived at the home were occupied completing activities, chatting to staff or watching the television. People we spoke with told us that they had a choice in everything. Three people that we spoke with all said that they had been told, "You live here as if it were your own home, you do as you like when you like". Everyone we spoke with was happy with the care provided and the amount of activities available.

The staff we spoke with said that they told people that it was their own home and they could do as they liked.

We looked at the medication records for three people that lived at the home, all records were correct.

We looked at training records and saw that staff received regular training. Staff we spoke with confirmed that they received a lot of training. Staff said that they felt supported and received regular supervision. We were told that the manager was approachable and helpful. One staff member that we spoke with told us, "I enjoy working at this home, we work well as a team, we are open and honest with each other".

We carried out this review to check on the care and welfare of people using the service. There were 31 people living at the home at the time of this visit. We spoke to nine people, two relatives, three staff, and the manager.

There was a very friendly and pleasant atmosphere in the home. We saw that people were well presented and wore clothes that reflected their own preferences, style, and gender.

We saw that people were able to sit in the main lounge or in a quieter lounge. This meant people had a choice about where they wanted to sit. People were happy with their rooms and the facilities that were available. One relative said, “The facilities are good, the rooms are good and we can visit when we like.”

Records showed that people and their relatives were involved in reviewing care plans and assessments. We saw that relatives were updated about people’s health when they came to visit. One relative said, “They communicate with me and tell me what is happening which is reassuring.”

We saw that staff did not offer people choices throughout the day about food and drinks. One staff said, “We tend to know what people’s choices are.” This meant that people were not encouraged to be independent and make choices where possible.

We saw that arrangements were not in place to ensure that people and their properties are safeguarded appropriately.

Records showed that staff did not receive formal supervision, take part in staff meetings, or have regular updated training. This meant that staff might not be appropriately supported to ensure they are competent to meet people’s needs.

People and their relatives told us that they knew how to raise any concerns if they had any, however everyone we spoke to told us that they did not have any concerns.

The inspection took place on 20 and 21 October 2015 and was unannounced. We last inspected this home on 13 April 2013 and found the provider was meeting the requirements of the regulations we looked at.

The Cottage Nursing Home provides accommodation for up to 33 people who require nursing care. At the time of the inspection there were 33 people living at the home.

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.

The registered manager had not considered raising safeguarding concerns to the local authority when abuse may have occurred. We saw people being supported by staff to move using techniques which may cause harm to them. Staff knew how to recognise and report suspected abuse. Risk assessments to manage peoples safety were in place but less restrictive alternatives had not always been considered by staff. Everyone who lived at the home told us they felt safe. There were sufficient staff to meet peoples’ needs. Safe recruitment practices were followed.

People’s medicines were managed effectively ensuring people received their medication on time.

Where people were not able to consent to their care the principles of the Mental Capacity Act had not been followed.People were supported by staff who had the skills and knowledge to meet their assessed needs. People were supported to have sufficient to eat and drink to maintain a healthy diet. When people required further support to meet their healthcare needs they had access to healthcare professionals.

People told us the staff were kind and caring. Staff understood people’s needs and preferences and respected people’s privacy and dignity when supporting them.

People and their relatives felt involved in their care. People had access to activities in the home both in a group situation and on a more individual basis. People and their relatives felt comfortable to raise any concerns with the registered manager. A system was in place to handle complaints and concerns.

Systems in place were not effective to monitor the quality of care within the home.

There was a welcoming atmosphere in the home for people, their families and visitors. There was an open culture amongst staff. Staff told us that they felt supported by the registered manager.