The inspection took place on 29 September 2016, and the visit was unannounced.

Harley Grange provides residential and nursing care to older people including people recovering from health issues and some who are living with dementia. Harley Grange is registered to provide care for up to 27 people. At the time of our inspection there were 26 people living at the home.

Harley Grange had 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 felt there were enough staff to keep people safe and ensure, as far as possible, people could go out when they wanted to. Staff worked as a team to ensure people received the appropriate level of observation to keep them and others safe. The provider had recruitment procedures that ensured staff were of a suitable character to work with people at the home. Most staff had received training in the areas the provider considered essential for meeting the needs of people in a care environment safely and effectively. Planned training was in place for the remainder of the staff to ensure all staffs’ knowledge was up to date.

Though some staff had not been provided with safeguarding training they were still aware and had an understanding of their responsibilities to protect people from harm. The registered manager understood their responsibilities to manage any safeguarding concerns raised by staff.

New staff received an induction which included working alongside more experienced staff. This helped them get to know people’s needs and establish a relationship with them before working with them on a one to one basis.

Risk assessments and management plans covered all aspects of people’s needs and included safety when outside the home, travel, finances, health and daily routines. There were appropriate arrangements for the recording and checking of medicines to ensure people’s health and welfare was protected against the risks associated with the handling of medicines.

Staff worked within the principles of the Mental Capacity Act 2005 and had a good understanding of their responsibilities in making sure people were supported in accordance with their preferences and wishes. Staff knew people's individual communication skills and abilities and showed concern for people's wellbeing in a caring and meaningful way. They were observant of people and responded to their needs quickly.

Care records were personalised and each file contained information about the person's likes, dislikes, preferences and the people who were important to them. Plans around behaviours were written to reinforce positive behaviour rather than concentrating on the negative. Care plans also included information that enabled the staff to monitor the well-being of people. There were systems in place for staff to share information through very detailed daily records for each person.

Audits and checks of the service were carried out by the management team and the provider. These checks ensured the service had continuously improved, though this had not identified in action to ensure comprehensive cleanliness of all facilities. The provider ensured all notifications required by law had been sent to us in accordance with the legislation.

We spoke with five people who used the service and asked them for their views about the service they received. People told us they were happy with the care provided. People's comments included. “We have meetings where we can share our views and I think we’re listened to.” “I’m very happy with the care, I have no complaints and the staff are very patient.” “I’m looked after very well and the staff are polite and courteous.” “I have lived here for two years and I feel looked after, nothing is too much trouble and the staff are helpful and nice. We spoke with a visitor who was visiting their relative, they told us. “I visit every day and I have no concerns, I know she is looked after well.”

Is the service safe?

People had been cared for in an environment that was safe, systems at the home had been well maintained and serviced regularly. The service had an ongoing programme of refurbishment and maintenance.

Staff personnel records contained all the information required by the Health and Social Care Act. This meant the provider could demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support people living in the home.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Staff training records showed staff had not received training in the Mental Capacity Act 2005. We spoke with the registered manager who had a good understanding of when a DoLS application should be made and how to submit one.

Is the service effective?

People told us that they were happy with the care that had been delivered and their needs had been met. It was clear from our observations that staff had a good understanding of people’s care and support needs and that they knew them well. Staff had received on-going professional development and training to meet the needs of people of the people living at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw that both nursing and care staff showed patience and gave encouragement when supporting people. We saw staff supporting people to do things at their own pace and were not rushed. We saw a nurse when administering medication to someone with a sight impairment explain to them what medication they were taking and why. We observed staff supporting people to walk within the service, giving clear guidance and encouragement to walk in a safe manner using walking aids. One person who used the service told us. “I’m very happy with the care, I have no complaints and the staff are very patient.” Whilst a second person told us. “I’m looked after very well and the staff are polite and courteous.” We spoke with a visitor who was visiting their relative, they told us. “I visit every day and I have no concerns, I know she is looked after well.”

Is the service responsive?

People’s needs had been assessed before they moved into the home. Records confirmed people’s preferences, interests and expectations for their care had been recorded and care and support had been provided in accordance with people’s wishes. We found people were consulted and had had their views recorded within emergency health care plans when making decisions as to whether they wished to be admitted to hospital due to deteriorating health, which included agreed decisions with health care practitioners not to attempt resuscitation. People had access to activities and were supported to maintain relationships with their friends and relatives. We observed people taking part in quizzes, and crosswords along with reminiscence discussions about household appliances of their childhood, which stimulated a lively discussion between people living at Harley Grange Nursing Home.

Is the service well-led?

Quality assurance processes were in place, which included the sending out of surveys seeking the views of people who lived at the home along with their relatives and staff employed to work at the home. Meetings were regularly held for people living at the home to share their views and experiences. Relative meetings took place and were used to keep people informed of any changes and discuss general issues. We found people’s views were listened to and acted upon. The provider had an effective complaints policy and procedure which was used effectively for the benefit of those using the service and for the continuing improvement of the services provided.

During our visit we were able to speak with six people who were using the service. We asked them if they were happy with the care and support they were provided with. They told us they were. One person told us: “The staff are lovely, they look after me very well.” Another explained: “They [the staff] are very good and they treat you as a person.”

We were able to speak with four relatives and six members of the staff team. This enabled us to gain their views of the overall service provided. One relative told us: “It is brilliant, they [the staff] know what help she needs and I cannot fault them.” A staff member told us: “I love my job, it’s a good team and we work well together.”

We looked at some care plans and found these to be up to date, but other records such as food and fluid charts and repositioning charts (used for people unable to move themselves in bed) had not always been completed correctly.

We found that an electronic medication system was being used. This was linked directly to the pharmacist who supplied the services medication and reduced the risks associated with the unsafe management and use of medicines.

An appropriate recruitment process was in place and the necessary checks had been carried out to ensure that new staff were suitable to work for the service.

We were told that the staff were kind and caring. We observed them carrying out their duties in a calm and relaxed manner and they interacted well with people throughout our visit.

People told us they felt safe and cared for by the staff. They also told us their views and experiences were asked for and respected at all times. We found the staff approached their work in a caring and supportive manner. They were able to explain their role and fully understood their responsibilities to ensure people were cared for appropriately in order to ensure their needs were fully met.

The provider regularly assessed the service and environment and made adjustments to care whenever necessary to ensure people were cared for and supported at all times. They also invested in the building and environment to ensure that people using the service were cared for in a safe and welcoming location.

People who used the services of Harley Grange and visitors who were visiting relatives at the service told us they were happy with the care and support provided. People’s comments included; “I’ve been here for a short while now, I am looked after well.” “The nurses are absolutely fantastic.” “Great, I came straight from hospital to here, I looked around other homes with my relative and we both chose this one. I’ve never regretted my decision.” “I’m happy with the care my mum receives. I know about her care plan as it has been discussed with me and I have signed it.” “I am included in discussions with the doctor and someone from the home will ring me if anything of importance occurs.”