This unannounced inspection took place on the 11 and 12 October 2018.

At our last inspection in February 2016 we rated the service good in all the key questions and therefore good overall.

James House is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

James House is part of the Abbeyfield Society. This is a charitable organisation that provides care and accommodation to older people living in England. James House provides accommodation and personal care for up to 12 older people or younger adults above the age of 55 years. At the time of our inspection 11 people were living at the home.

There was not a registered manager in post as the previous registered manager had left in August 2018. 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. There was a manager appointed in August 2018 who was in the process of registering with the CQC.

We found during our inspection that the bathroom was used to store equipment. This had meant it could only be used if items were removed first. The provider had plans to refurbish and modernise the facilities but this had not taken place at the time of our inspection. In addition, at least one window on the first floor did not have a window restrictor. This increased the risk of people falling from height.

Staff told us they felt well supported by the manager who had an open-door policy and was available to speak with. Staff had received training but some staff had not received all their refresher training. This concern had been identified by the manager who was in the process of addressing the short falls. We found despite some areas of training being overdue staff spoke clearly about key areas such as safeguarding and the Mental Capacity Act 2005 (MCA) and told us about the training they had received and how they implemented it in their work.

People told us staff were kind and caring and all said how much they liked their bedrooms and the home. We observed that staff were respectful and promoted people’s self-respect by supporting them to remain as independent as possible.

People’s care needs were assessed prior to them being offered a placement to ensure appropriate care could be provided. People had signed to give their consent to care as it was stated in their care plans. Care plans were reviewed and updated on a regular basis and in response to changing circumstances.

Risks were identified through the assessment process and measures were taken to mitigate the risk of harm and guidance for staff was provided.

There were systems in place for the safe storage and administration of medicines.

People told us the food was, “very good” and “lovely.” The cook tried to make sure people had the meals they wanted and usually produced homemade meals. The staff were aware of the need for people to remain hydrated and ensured people drank enough throughout the day. People’s well -being was promoted and any sign of ill health was flagged with the appropriate health professional in a timely manner.

The manager had systems in place to recognise and report all safeguarding adult concerns. They responded well to complaints and addressed concerns. They were working in line with the MCA and Deprivation of Liberty Safeguards (DoLS) to uphold people’s rights.

Audits and checks were carried out by the senior staff, manager and provider. There were good lines of communication in the home that included, daily shift handovers, informal information sharing and bimonthly staff meetings. The manager talked with people living in

We undertook an unannounced inspection of James House on the 23 February 2016.

James House is a residential home and is part of The Abbeyfield Society. It provides accommodation for up to 12 older people in single rooms. The home is situated within a residential area of the London Borough of Hillingdon. At the time of our visit there were 10 people using the service but two of them were in hospital.

We previously inspected James House on 29 April 2014 and the provider had met all the regulations that were inspected.

At the time of the 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 told us they felt safe when they received support and the provider had policies and procedures in place to deal with any concerns that were raised about the care provided.

The provider had processes in place for the recording and investigation of incidents and accidents. A range of risk assessments were in place in the support folders in relation to the care being provided.

The provider had an effective recruitment process in place. There was a policy and procedure in place for the administration of medicines.

The provider had policies, procedures and training in relation to the Mental Capacity Act 2005 and care workers were aware of the importance of supporting people to make choices.

Care workers had received training identified by the provider as mandatory to ensure they were providing appropriate and effective care for people using the service. Also care workers had regular supervision with their manager and received an annual appraisal.

People we spoke with felt the care workers were caring and treated them with dignity and respect while providing care. Care plans identified the person’s cultural and religious needs.

A range of activities were arranged at the home and people told us they enjoyed them.

Detailed assessments of the person’s needs were carried out before they moved into the home and each person had a care plan in place which described their support needs. Care workers completed a daily record of the care provided.

The provider had systems in place to monitor the quality of the care provided and these provided appropriate information to identify issues with the quality of the service.

We spoke with four people using the service and two staff and the registered manager. At the time of the inspection there were 11 people using the service.

The inspection was carried out by a single inspector during one day. The focus of the inspection was to answer five key questions;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary

please read the full report.

Is the service safe?

People told us they felt safe and well cared for.

The medicines prescribed to people using the service were stored in a secure and appropriate manner. We saw the medication administration record (MAR) charts for all the people using the service which were up to date. Medicines were safely administered and during our inspection we observed the staff member administering medicines to people using the service. We saw that they ensured the person had water if required and they waited to see them take the tablets before recording it on the MAR chart.

Systems were in place to ensure staff reported any incidents or accidents and the manager reviewed and investigated any issues. The home had processes in place for the manager and staff to learn from events such as accidents and incidents, complaints, concerns and whistleblowing.

There were arrangements in place to deal with foreseeable emergencies. We saw that fire safety assessments had been carried out for all the people using the service. An evacuation plan had been recorded for people who had a visual impairment or mobility need. We saw that these assessments were up to date.

The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). At the time of the inspection there were no DoLS in place at the home.

Is the service effective?

Individual's health and care needs were assessed and they and/or their relatives were involved in the development of the care plans. The care plans identified specific support needs including mobility and personal care. The care plans and risk assessments were regularly reviewed and were up to date to ensure people received appropriate care and support.

Is the service caring?

We saw staff treated people with dignity and respect. People we spoke with said they felt safe and they liked the staff. One person said "The staff are wonderful and really nice".

People's preferences, interests and diverse needs had been recorded in their care plans. Support was being provided in accordance with people's wishes.

Is the service responsive?

During our inspection we saw a copy of the complaints procedure leaflet with large print in the dining room. Information was also displayed on a notice board on the ground floor. People also had access to copies of the complaints policy in their bedrooms. The manager showed us a copy of this which had been translated into braille. The manager told us the complaints procedure was discussed at the regular resident's meetings. This ensured that people using the service or their family could check the procedure if they wished to make a complaint. One person we spoke with said "I do not need to know how to complain as I am really happy here".

Is the service well led?

There were regular audits of the care plans and risk assessments carried out by the carers and manager. Any actions identified were recorded on a check list and staff confirmed when they had been completed.

The service had a quality assurance system in place. We saw records that showed us that any identified issues were addressed promptly. As a result there was ongoing improvement in the quality of the service.

We spoke with four people using the service, the manager and three staff members. We viewed five care records and five staff files. All the people we spoke with told us they were very happy living at the home. One person said "I have lived here just short of six years, it's as good as anywhere." Another said "all the staff are lovely, we couldn't have a nicer lot of people looking after us."

We found that people had been involved in decisions relating to their care and care plans had been developed to meet people's needs.

People were protected from abuse. Both staff and people using the service knew the procedure for reporting any concerns they might have.

The service had thorough recruitment processes in place to make sure that all required pre-employment checks were carried out. This meant that people using the service were cared for by suitably qualified staff.

The provider had an effective system to regularly assess and monitor the quality of the service that people received. People's concerns had been listened to and acted on and their wishes taken into consideration.

People told us what it was like to live in this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by a practicing professional. On the day of the inspection there were twelve people using the service.

People told us the staff treated them with respect and encouraged them to express their wishes regarding the way they wanted to be cared for. People's comments about their experience of living in James House included, “I have a single room with everything I need and I am completely free to do what I want.”, “I am treated with kindness – they fall over each other to help.”, “Overall I have been treated with respect and dignity and indeed I would recommend this home.”

People said they had been asked their opinions about the food and they were able to make choices. If they did not like the options available they said they could choose something different and it would be provided. People's comments and description of the meals included, “I like the home and the food.” “Food very good and varied, I get enough, sometimes too much.”

We observed staff supporting people in a gentle and professional manner and saw that people using the service were offered choices with regard to food and drink, and were able to choose the activities they wanted to participate in.

People said they were involved in the reviews of their care plans and signed to agree them and to any changes that were made. Peoples' records were comprehensive, up to date and were stored securely.

People told us they had not got any concerns, but if they did they would feel confident to speak with the staff or the manager about them. The care home had effective systems in place to ensure that people were protected from abuse.