This inspection took place on 10 October 2016 and was unannounced.

The provider of Bower Grange Residential Home is registered to provide accommodation and personal care for up to 36 people. At the time of this inspection 35 people lived at the home.

The service was last inspected on 30 May 2013 and was meeting the requirements of the law.

There was a registered manager in post who was present for our inspection. 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 felt safe living at the home because there were enough staff to help them when they needed support. The provider had completed employment checks to ensure new staff were suitable and safe to work with the people living at the home. Staff were aware of the risks associated with people’s health and knew how to reduce the risk of harm or injury to them. Staff knew how to identify any signs of abuse and were clear who to report concerns to.

People were supported to take their medicines when they needed them. Medicines were stored safely and accurate records were maintained. Staff received regular competency assessment checks to ensure the ongoing safe management of medicine.

Staff received training opportunities that ensured they had the skills to care for people’s individual needs. Staff received regular support and guidance from the registered manager to enable them to carry out the roles expected of them. People were encouraged and supported to make decisions about their care and treatment. Staff sought people’s consent before supporting them and respected their wishes when they declined support. Where people were unable to make decisions for themselves decisions were made in their best interest to protect their human rights.

People were given choice about what they wanted to eat and drink. People’s nutritional needs were routinely assessed, monitored and reviewed. Where people required help to eat and drink they were supported in a kind and patient manner. People were able to see health care professionals as and when required. Staff monitored people’s health and made referrals to other health care professionals as required.

People found staff friendly, kind and caring. Staff communicated well with people and involved them in decisions about their care and treatment. People were treated with dignity and respect and staff promoted their independence. People received individualised care from staff who knew them well and were able to respond quickly to changes in their needs. People were able to spend their time as they wished and had access to a wide range of pastimes.

People and their relatives were aware of the provider's complaints process and were confident that any concerns would be listened to and acted upon.

There was a positive and inclusive culture in the service. The registered manager worked with the staff team to ensure people's needs and wishes were met. People and their relatives found staff and the registered manager approachable and welcoming. The provider encouraged feedback from people and their relatives and completed a range of checks to monitor the quality of the service. They used the information gathered to drive improvements in the service.

We talked with people who lived in the home and they said that they were well looked after. They said the staff always asked them how they would like things to be done. They said staff were always mindful of their privacy and treated them with respect.

People told us that they felt able to raise any issues with the manager or staff should they have any concerns. Staff spoke of their awareness of how to keep people safe from harm. Staff told us about the training that the home had arranged for them to attend so that they would recognise abuse and how to report it.

People told us that staff were always available when they needed help. They said that the staff were friendly and always acted professionally. One person said, “The staff are very good” and another said, “The staff are brilliant”.

Due to the needs of the people living at the home not everyone was able to share their experiences of what it’s like living at White Lodge. We therefore spent time observing individuals being supported by the staff on duty at the time of our visit.

People we spoke with told us they are well cared for and that care staff respect their privacy and dignity. They told us that staff work hard and care for them well but at times staff are stretched, particularly around bedtime.

Most people told us that they enjoy their meals although some people said that they would enjoy being offered a greater choice of food. One person said they would prefer a soft diet as they have difficulty with chewing their food. People told us that their visitors are made welcome and they are always offered refreshments.

People told us that they are happy with their rooms and that these are comfortable and warm. They told us that they are able to bring in their own possessions to personalise their room. They said they can either join others in the main lounge or remain in the privacy of their own room. People told us their rooms are kept clean and tidy and that the laundry facilities are, “very good”. They told us that they are looking forward to the planned improvements being made to the home. Comments gained from people who use the service include: “The care is excellent”. “The staff are angels sent from heaven, they are so patient. I can’t fault anything”.

A professional told us that they are made welcome, that staff are always friendly and helpful and always answer questions asked of them. They told us that communication is good and that staff are quick to refer individuals if they have concerns about their health, care and welfare. Other professionals told us that the manager is approachable and is working hard to implement change and that they have no current concerns about the home.

Staff told us that they enjoy working at the home, that they are generally well supported and receive good training opportunities. They described staff morale as, “good” and “very good” and considered a number of improvements had been made under the current manager. One member of staff said, “The home provides a friendly atmosphere for the residents”. Another staff member said, “I love it here”.

The Telford and Wrekin Local Involvement Network (LINk) visited the home on 3 May 2011. LINk is made up of individuals, community groups and voluntary organisations with an interest in improving health and social care services. They told us that during their visit they spoke with a number of people who live at the home of that most of them expressed praise for the care they were receiving and satisfaction with the quality and choice of food and the variety of activities provided for them. They considered the provider is committed to improving its facilities and that staff were committed and happy with their working conditions.

We visited this home on 7 August 2012.

A number of the people who lived in this home were unable to tell us about their experiences. To understand what they experienced we looked at the records that the home had developed about five people. We found that this information was accurate enabling us to ask questions in a way that would allow people to understand what we were asking and therefore express what they thought.

We did not use our Short Observational Framework for Inspection (SOFI) tool as the abilities of the people using this service made it unnecessary. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences.

We talked to a number of the people who lived in the home as well as some of their relatives. They told us that the staff had explained to them what care and treatment they would be receiving. They also told us that the care plans that had been developed for them were an accurate description of the care that they had received

The people that we spoke to also told us that their relatives and friends were always made welcome by the staff.

People told us that surveys that had been carried out by the home. The surveys gathered information about their care. These had been carried out within the last few months.

They also said that they had regularly talked to the staff and discussed what food they preferred. When we talked to one person about the food they said, “The food’s very good”.

We saw that intimate care was delivered in the privacy of people’s own rooms or in the bathrooms and when they had finished their meals or drinks the staff tidied their clothes discretely.

People also told us that they felt able to raise any issues of concern with the manager or her staff. They said that they felt safe living in this home. This was a view echoed by a number of their relatives.

The people that we spoke to were all very complimentary about the staff and the way that they treated people with both dignity and respect. They told us that the staff were helpful and confident in the way that they went about providing care.