This unannounced comprehensive inspection took place on the 11 December 2018.

Nazareth House - Northampton is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Nazareth House – Northampton can accommodate up to 50 people in one purpose built building. The service provides residential care for older people including people living with dementia. At the time of this inspection 47 people were using the service.

At the last inspection in September 2017, the service was rated ‘Requires Improvement’. We made a recommendation about the environment specific to meet the needs of people living with dementia. We saw at this inspection the environment has improved which enhanced people’s well-being.

At this inspection, we found the evidence supported an improvement in rating of the service to Good.

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.

Staff had a good understanding of abuse and the safeguarding procedures that should be followed to report abuse and incidents of concern. Risk assessments were in place and provided detailed information and guidance for staff about the potential risks people faced. The service learnt from incidents and accidents and acted to mitigate the risks of them occurring again.

Staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. People were supported by sufficient numbers of staff to meet their needs.

People were supported to take their medicines as prescribed. Infection control procedures were in place and followed by staff to protect people from the risk of infection.

Staff were supported, supervised and completed induction and development training. This helped to ensure they had the skills, knowledge and expertise they needed to perform their roles. Suitable training was provided to ensure people's needs were met.

People's needs were assessed, and people were supported to maintain good nutrition and access healthcare to maintain their health and wellbeing.

People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible; the policies and systems in place in the service supported this practice. Staff had received training and information which enabled them to provide care in line with the guidance of the Mental Capacity Act 2005.

The provider made the necessary improvements to the premises, which included two bedrooms and a small hallway restructured into two large bedrooms, refurbished bathrooms including new accessible bathing equipment and redecoration of an area where people living with dementia were supported.

People received care from staff that knew them well and consistently treated people with dignity and respect. People were supported to maintain their independence and staff protected people's right to privacy.

People and their representatives were involved in developing their care plans, which enabled them to receive care and support in line with their preferences. People and relatives were involved in reviews of people's care to ensure the care provided met people's current needs.

A process was in place which supported people to raise concerns and complaints. People felt confident their concerns would be listened to and acted on.

People, relatives and staff had confidence in the leadership and governance of the service. The provider had effective systems in place

This unannounced inspection took place on the 15 September 2017. Nazareth House Northampton provides accommodation for up to 50 people who require residential care for a range of personal care needs. There was one area of the home which was specifically for people living with dementia. There were 45 people in residence during this inspection.

In March 2016 the service was rated as 'Inadequate' due to serious concerns about the safety and well-being of the people who lived there. We inspected the service again in August 2016 and found the service had made improvements and was rated overall requires improvement.

At this inspection we found that some improvements had been sustained but further improvements still needed to be made.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated regulations about how the service is run.

Peoples known risks had not always been recorded and there were not clear guidelines in place for staff to follow which gave them details about how to reduce the risks. The systems and processes in place to ensure that regular maintenance to the environment, medicines and health and safety required strengthening.

There was enough staff to meet people’s needs; however the registered manager must ensure this is kept under review when people’s needs change or new people move in to the home.

Staff did not always receive the training to meet the needs of the people they were caring for and the induction process required strengthening.

Care plans contained information about peoples assessed needs and their preferences, however they required completing in more detail to enable care staff to offer a more person centred approach.

People and their relatives knew how to make a complaint; however, care staff required refreshers on how to direct people to the correct process to make a complaint.

We made a recommendation about the environment specific to meet the needs of people living with dementia.

The majority of people received their medicines when they were required and medicine profiles were accurate to reflect the current medicines people were prescribed. They also helped staff to understand the side effects of people’s medicines.

People were safeguarded from harm as the provider had systems in place to prevent, recognise and report concerns to the relevant authorities. All staff knew their responsibilities as defined by the Mental Capacity Act 2005 (MCA 2005) and Deprivation of Liberty Safeguards (DoLS) and had applied that knowledge appropriately.

People were supported to have sufficient quantities to eat and drink to maintain a balanced diet. Staff monitored people’s health and well-being and ensured people had access to healthcare professionals when required.

Staff understood the importance of obtaining people’s consent when supporting them with their daily living needs. People experienced caring relationships with staff, who provided good interaction by taking the time to listen and understand what people needed.

People’s needs were met in line with their individual care plans and assessed needs. Staff took time to get to know people and ensured that people’s care was tailored to their individual needs.

People were supported by a team of staff that had the managerial guidance and support they needed to carry out their roles.

This unannounced inspection took place on the 31 August 2016. Nazareth House Northampton provides accommodation for up to 50 people who require residential care for a range of personal care needs. There were 33 people in residence during this inspection.

Following our inspection in March 2016 the service was rated as ‘Inadequate’ due to serious concerns about the safety and well-being of the people who lived there. The commission placed the service in special measures and the provider could not admit any new people until they had improved the care provided. At the time of this inspection we found that there has been improvements in the way that the home operated and in relation to the way in which care was being provided. However the rating reflects that more time is required to evidence sustainability of the improvements made.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated regulations about how the service is run.

People felt safe in the home. Staff understood the need to protect people from harm and knew what action they should take if they had any concerns. Staffing levels ensured that people received the support they required at the times they needed and recruitment procedures protected people from receiving unsafe care from care staff unsuited to the job.

Care records contained risk assessments and risk management plans to protect people from identified risks and helped to keep them safe. They gave information for staff on the identified risk and informed staff on the measures to take to minimise any risks. People were supported to take their medicines as prescribed and medicines were obtained, stored, administered and disposed of safely.

People received care from staff that were supported to carry out their roles to meet the assessed needs of people living at the home. Staff received training in areas that enabled them to understand and meet the care needs of each person and people were actively involved in decisions about their care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). People were supported to maintain good health and had access to healthcare services when they were needed.

People received care from compassionate and supportive staff and people and staff had positive relationships with each other. Staff understood the needs of the people they supported and used the information they had about people to engage them in meaningful conversations. People were supported to make their own choices and when they needed additional support people’s relatives were also consulted.

Care plans were up to date, reviewed and reflected people’s current assessed needs and focussed on giving people choices and opportunities to receive their care how they liked it to be. They detailed how people wished to be supported and people were fully involved in making decisions about their care. New care plans were in the process of being written in a person centred manner. People participated in a range of activities and received the support they needed to help them do this. People were able to choose where they spent their time and what they did. People were able to raise complaints and they were investigated and resolved promptly.

People and staff were confident in the new registered manager of the home and felt listened to. People were able to provide feedback and this was acted on and improvements were made. The service had audits and quality monitoring systems in place which ensured people received good quality care that enhanced their life. Policies and procedures were in place which reflected the car

This unannounced inspection took place on the 1 and 2 March 2016. Nazareth House Northampton provides accommodation for up to 50 people who require residential care for a range of personal care needs. There were 42 people in residence during this inspection.

The service did not have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated regulations about how the service is run.

People were not protected against the risks of avoidable harm and abuse. Some staff were not aware of their responsibilities with regards to safeguarding people who lived at the home. The provider had not ensured that assessments of risk and associated risk management plans were up to date and accurately reflected people's circumstances. This left people vulnerable to significant risks to their health and wellbeing.

The provider had failed to deploy sufficient numbers of staff in order to meet the needs of people who used the service and failed to demonstrate a systematic approach in determining the number of staff required. People were not cared for by staff that had the knowledge, skills, experience and support to carry out their roles. Staff did not receive appropriate supervision, appraisal or training to enable them to fulfil their responsibilities.

The provider failed to protect people who used the service against the risks associated with the safe management of medicines. Medication was not administered as per instructions; errors were identified on Medication Administration Charts (MAR) and MAR records could not be relied on as an accurate account of the medicines administered to people. Medicines were not kept securely.

People living at the home did not always consent to their care and treatment. Mental capacity assessments were not carried out for the people living in the service to measure whether they were able to make their own decisions. Staff did not have a good working knowledge of the Deprivation of Liberty Safeguards and the key requirements of the Mental Capacity Act 2005.

There was poor monitoring of peoples nutritional and hydration needs which put people at risk. Records could not be relied upon as an accurate account of people’s food and fluid intake. There was lack of monitoring and oversight of people who were at risk of not eating or drinking enough.

People were not always given the opportunity to have stimulation or follow their hobbies and interests. The newly appointed activities coordinator was very proactive but was unable to provide a stimulating environment for all people living at the home without the support and input from other staff members.

Some staff had a caring approach to the people they cared for but there were significant shortfalls in the caring attitudes and approaches of other staff due to low numbers of staff. There was a task focussed culture at the home, positive, caring relationships between staff and people who lived at the home had not been developed.

People were not always treated with dignity and respect. There was limited interaction or conversation with people during personal care or when supporting people with other activities. People were not spoken about in a dignified or respectful manner and people were not listened to.

People were supported by staff who did not have guidance on people's current needs and how they should be supported. Care plans did not reflect people’s current or changing needs and many had not been reviewed or updated. People were at risk of inappropriate care.

Although assessment, auditing and monitoring of the service took place, this was limited, insufficient and not designed in a way to address existing shortfalls and make improvements. As a result, people’s safety and the service they r

We looked at the arrangements that had been made following our previous inspection for the storage of medicines that were due to be removed from the service. We found a new secured cupboard had been put in place and the medication cupboard had also been strengthened.

We found observational supervisions had been carried out with staff to ensure they were using appropriate moving and handling techniques. We saw that concerns about people's welfare and safety were being addressed and where required they were being referred to appropriate external professionals.

We spoke with four people that used the service. They all told us that they were happy with the care that they received. When asked about the service one person told us “They look after us very well”. Another person told us “The food is good”.

We spoke with four staff members. They all enjoyed their roles and felt that they provided people with a personalised service. One staff member told us “People get the best care that they could get”.

We spoke with the relative of a person who used the service who told us that the service was meeting both the social and spiritual needs of their relative.

We found that people’s likes, dislikes and preferences were recorded and respected. We saw that people needs had been assessed but we were concerned as they had not been updated to reflect changes in people’s needs.

We found that there were adequate staff members on duty during our visit. We saw that a quality assurance questionnaire had recently been sent out to people that used the service to ask for their opinions and feedback. We saw that regular audits were carried out by the manager of the service.

We saw that medication was administered safely but that we identified concerns with the storage of medication.