The inspection took place on 21 and 22 April 2016 and was unannounced. The inspection team consisted of one inspector, a specialist advisor with clinical experience of this type of service and an expert by experience who also had experience of this type of service. The service is registered for 50 people and on the day of our inspection there were 45 people living at the home.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

People spoke positively about the standards of care they received at Verulam House. Relatives were also happy with the standards of care and support their family members received. The home and the environment was clean and well maintained and there were no odours. Fresh flowers were used in many of the communal areas, creating a homely feel. People had been assisted with personal care and looked well-groomed with clean and appropriate clothes.

People’s bedrooms were personalised and people told us they were able to have any personal items including items of furniture in their room. We observed that people had a choice about how they spent their time and what activities, events or hobbies they wished to participate in.

People told us they felt safe living at Verulam House, and staff were able to demonstrate that they knew how to keep people safe. Staff had received training in how to safeguard people from potential abuse and were able to describe the process for reporting concerns both internally and externally if required.

Safe and effective recruitment practices were followed to help ensure that prospective staff were suitable to work in a care home environment. We saw that there were adequate numbers of staff on duty and people confirmed this to be the case. Call bells were answered in a timely way and staff responded efficiently to people’s requests for assistance.

People were given a choice or food, drinks and snacks. We observed people could choose where they ate their meals. Hot and cold snacks and healthy option snacks were available to people throughout the day. People told us they were able to discuss menus and food planning at residents meetings or through the committee.

Staff were trained to assist people with taking their medicines safely and people confirmed they received their medicines regularly. Potential risks to people’s health and well-being were assessed and where risks had been identified, remedial actions had been put in place to reduce risks. These were reviewed regularly to help keep people safe and to reduce the risk of harm or injury.

People, their relatives and commissioners were very positive about the standards of care in the home. Staff demonstrated that they had the right skills and abilities to support people appropriately. Staff were well supported and received training relevant to their roles and responsibilities. They had regular supervision with their line manager to discuss and review their performance and any development needs.

People had developed positive and caring relationships with the staff who supported them. Care and support was provided in a way that took account of their individual needs and preferences and the staff and management team knew people very well.

Staff obtained people’s consent before providing care and support to them. People and their relatives were involved in the planning, delivery and review of the care and support provided. Information held about people’s medical and personal histories was securely maintained. People had consented to the sharing of their personal information with other professionals who were involved in their care.

People told us that they felt their dignity and priv

This unannounced inspection was carried out on the 03 March 2015.

Verulam House provides accommodation and personal care for up to 50 older people. At the time of the inspection there were 42 people living in the home.

The service has a 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 provider had effective recruitment processes in place, and there were sufficient numbers of staff employed and they were deployed effectively on a day to day basis.

People were protected from avoidable risks and staff were aware of their duty of care to the people. Staff were trained to recognise and respond to signs of abuse. Risk assessments were carried out and reviewed regularly.

There were sufficient staff on duty to ensure the safety and welfare of people. Staff were appropriately allocated to ensure a good skills mix.

Medication was administered, recorded and managed appropriately.

The staff had appropriate training, supervision and support, and they understood their roles in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

There was a variety of choices available on the menus and people were supported to have sufficient food and drinks to meet their dietary needs.

People were supported to access other health and social care professionals when required. The people were supported to continue their relationships with their family members and friends.

Staff were caring, kind and compassionate and cared for people in a manner that promoted their privacy and dignity. People told us that they felt listened to and had their views and choices respected.

People were involved in the decisions about their care and their care plans provided information on how to assist and support them in meeting their needs. The care plans were reviewed and updated regularly.

The home was managed in an inclusive manner that invited comments from people, their relatives and staff.

The home had a system in place to assess, review and evaluate the quality of service provision.

We inspected Verulam Nursing home on 3rd December 2013 and found that they were not meeting the standards required for protecting people against the risks of malnourishment. We asked the provider for a plan of action and we re-inspected the provider on 13 February 2014. We found that the provider had taken steps to protect people from the risk of malnourishment. People were weighed regularly and their weights were records within their care plans and food within the kitchen was now stored correctly.

We spoke with five residents at the service. They told us that ‘ it’s very good here’ and ‘I wouldn’t say its 5 star food but it is 4 stars’ . People said that they had a choice of food and that they were weighed regularly. If they lost or gained weight and this was not planned they were referred to the doctor and dietician for additional support. We spoke to staff at the service; they were very enthusiastic about their job. Staff we spoke with said that there was enough staff to assist over the lunch times did not feel rushed and fed people at their own pace. Staff told us that it was ‘a very good home’ and that the ‘staff are nice and friendly’.

We inspected Verulam Nursing Home on 03 December 2013, we found the home to be clean and well presented. We noted that the home had a main reception area which provided people with information about the history of the home and what activities were available during the week. We also saw that there was a newsletter available at reception for people to view.

People who used the service told us that it was 'very nice' and that they enjoyed the food because it was 'home cooked' and 'not sloppy'. During the day we saw that people were free to move about the home and that staff were interacting with people in a positive way. People told us that the home had a 'good staff team' who were 'willing, polite and able'.

We found that the provider was gaining consent from people before any care was provided and that the care and support was available for people who required additional nutrition during the day. We found that the home had an infection control policy in place and that the cleaning staff followed strict guidelines to support infection control. We did however find that the provider had not been monitoring and recording people’s weight which could put people at risk of becoming malnourished.

People we spoke to told us that they felt well cared for and that staff were kind and caring. a number of people who use the service told us that they considered staff members to be their friends. We were told that people enjoyed the wide variety of activities on offer which included, trips to local attractions, meals out and cinema and theatre trips. People told us they felt safe and that they were treated with dignity and respect.