This inspection took place on 24 and 25 July 2017 and was unannounced. At our last inspection in April 2015 the service was rated ‘Good’. At this inspection we found the service remained ‘Good’. At the last inspection we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach was in relation to consent to care and treatment. At this inspection we found that the registered provider had addressed this breach.

Nairn House is a home for older people who are in need of nursing care. It provides accommodation to a maximum of 61 people some of whom were living with dementia. At the time of our inspection there were 53 people using the service.

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.

People told us they were well treated by staff and felt safe with them.

Risks to people’s safety had been identified and ways to mitigate these risks had been recorded in individual care plans and were understood and being followed by staff.

Staff understood their responsibilities to keep people safe from bullying, harassment, avoidable harm and potential abuse.

Systems were in place and being followed to ensure medicines were handled and stored securely and administered to people safely and appropriately.

Staff were positive about working at the home and told us they worked well as a team and appreciated the support they received from the registered manager.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People told us they enjoyed the food provided and that they were offered choices of what they wanted to eat.

People had regular access to healthcare professionals such as doctors, dentists, chiropodists and opticians.

Staff treated people as unique individuals who had different likes, dislikes, needs and preferences.

People told us that the management and staff listened to them and acted on their suggestions and wishes.

Both people using the service and their relatives told us they were happy to raise any concerns they had with any of the staff and management of the home.

People were included in monitoring the quality of the service and we saw that their suggestions for improvements and preferences about how they wanted to live their lives were respected and acted on.

This inspection took place on 24 April 2015 and was unannounced. When we last visited the home on 31 January 2014 we found the service met all the regulations we looked at.

Nairn House is a service for older people who are in need of nursing care. Nairn House provides accommodation to a maximum of sixty-one people some of who may have dementia. On the day of our visit there were 55 people using the service.

The home had 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.

Insufficient action had been taken to comply with the Mental Capacity Act 2005 (MCA) as MCA and best interest assessments had not been carried out.

People were kept safe. Risks to people were identified and staff took action to reduce those risks. Staff were available and had the necessary training to meet people's needs. Staff responded to people’s needs promptly.

There were systems in place to ensure that people consistently received their medicines safely, and as prescribed. People were supported effectively with their health needs.

Care was planned and delivered in ways that enhanced people’s safety and welfare according to their needs and preferences. Staff understood people’s preferences, likes and dislikes regarding their care and support needs. People were provided with a choice of food, and were supported to eat when this was needed.

People were treated with dignity and respect. There was an accessible complaints policy which the registered manager followed when complaints were made to ensure they were investigated and responded to appropriately.

People using the service, relatives and staff said the registered manager was approachable and supportive. Systems were in place to monitor the quality of the service and people and their relatives felt confident to express any concerns, so these could be addressed.

At this inspection there were breaches of regulations in relation to the need for consent to care. You can see what action we told the provider to take at the back of the full version of the report.

Staff knew how to engage with people. One person said about the staff, “they are very reasonable kind people.” Care plans contained detailed life histories of people, to help staff understand people’s backgrounds. Staff worked in an responsive manner with people. People told us that when they asked staff to contact their general practitioner this was done quickly. One person told us, "the doctor visits regularly." People were able to access the medical care they needed.

There were effective recruitment and selection processes in place. Staff told us that they had been through a detailed recruitment process that included completing an application form, interviews and references being taken up from their former employers.

People who used the service, their representatives and staff were asked for their views about their care and treatment and these were acted on. One relative said, “on the whole I’m quite happy with the way they are looking after my relative. I have no complaints." People told us that staff listened to them and responded to the requests. Regular audits had been carried out covering a range of areas such as medications management and care planning. These showed that the quality of service provision was assessed and monitored. Where issues were identified improvements were made.

We used a number of different methods to help us understand the experiences of people using this service. We talked to staff and looked at storage and record keeping of medication on the three floors of the home. We observed morning medication given on one floor and saw that it was given professionally with patience and explanation.

We observed that people were involved and consulted about decisions affecting their care. Staff knew how to communicate with people. Staff took the time to make sure that they involved people in decisions about their care. For example, when assisting them to eat. People said that they received the care and support they needed. A typical comment was, "staff understand and help me".

We saw that medicines were not always recorded appropriately. On 4 charts there were no records of receipts and/or balances of medicines carried forward from the previous month’s medication cycle. This made it differicult to reconcile stock balances to see if medicines were being given as prescribed. One person was prescribed the drug warfarin with a blood test due in March 2013. We saw no medication record for this person We could not reconcile records and stocks for a total of 8 supplies. There were too many tablets remaining for medicines to treat heart disease, rheumatoid arthritis, diabetes and infection and mood. We were unsure whether the correct doses of these medicines were being given as prescribed or whether nurses were signing the MAR but not actually giving the medicine.

People said that staff were available to help them. People told us that staff were, "always helpful." People's personal records including their care plans were accurate, and had been reviewed and updated at regular intervals.

People told us that staff involved them in decisions about care and treatment. One person said, "Staff do listen to me and do things the way I want." People said that they received the care and support they needed. A person said, "Staff asked how I wanted things done."

People spoken to confirmed that they trusted staff and felt safe. A person said, “I feel safe here.” We saw that staff understood peoples’ needs. People told us that staff knew how to support them. A person told us, "The staff were helpful." People told us and we observed that they felt that staff listened to them. Staff responded to any suggestions they made about the home.