We inspected Inglewood Nursing Home on 18 and 20 December 2017 and our visit was unannounced. At the previous inspection Inglewood Nursing Home was rated ‘good’. Inglewood Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Inglewood Nursing Home provides nursing and personal care and accommodates up to 60 people in one adapted building. At the time of the inspection there were 53 people living at the home. People were living with a range of complex health care needs which included people who have stroke and diabetes. Some people had a degree of memory loss associated with their age and physical health conditions. Some people were also receiving care and support for end of life care needs. Most people required help and support from two members of staff in relation to their mobility and personal care needs. Accommodation was provided over two floors with a passenger lift that provided level access to all parts of the home.

There was a registered manager at the home. 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.’

Improvements were needed to ensure the service was consistently meeting the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Quality assurance systems were in place but these had not identified some areas that needed to be improved in relation to people’s records, and documentation in relation to people’s mental capacity. We made a recommendation about this. Other areas for improvement had been identified and work was taking place to address these.

Staff knew people really well. They had a good understanding of each person’s needs and choices. They could tell us about people’s personal histories including their spiritual and cultural wishes. Each person was treated as an individual and their choices and rights were respected and upheld. People were supported to make their own choices about what they did throughout the day.

People were supported by staff who were kind and caring. Staff knew people well and had good relationships with them. Staff maintained people's privacy and dignity. They understood the importance of confidentiality. Relatives were able to visit at any time, and were made to feel welcome.

There were enough staff, who had been safely recruited, working to ensure people’s needs and preferences could be met. Staff had received the training they needed to support people and deliver care in a way that responded to people's changing needs.

People were looked after safely. Staff had a good understanding of the risks associated with the people they looked after. Staff understood the procedures in place to safeguard people from the risk of abuse and discrimination.

People were supported to eat and drink a variety of food. They were provided with a choice of freshly cooked meals and drinks each day. People’s health was monitored and staff responded when health needs changed. People were supported to attend healthcare appointments and were referred to external healthcare professionals when needed.

There were systems in place to ensure medicines were ordered, stored administered and disposed of safely. There was a complaints policy and people told us they were able to discuss any concerns with the registered manager or staff.

There was an open and friendly culture at the home. The registered manager was well thought of by people, visitors and staff. She worked hard to include people and staff in decisions about the home, and was committed to improving and developing the service.

Inglewoood Nursing Home provides nursing and residential care for up to 60 people requiring respite and permanent care.

This unannounced focused inspection on the 21 March 2017 was to look specifically at the ‘Responsive’ question and we found that that they had now met the breach of regulation previously found.

At the last inspection in August 2015 we found the ‘responsive’ question required improvement. This was because documentation was not always appropriately completed. There was minimal evidence in people’s care plans of their views on how they would like to receive their care and support. Preferences and choices were not well recorded.

We received an action plan from the provider that told us how they were to meet the breach of regulation by November 2015.

At this inspection we found that improvements had been made to all areas of documentation to ensure they were person centred, accurate and up to date and the provider was now meeting the regulation. Care documentation was stored on a computerised system with summaries printed off and kept in care folders in people’s rooms. Information was documented clearly with reference to people’s preferences included throughout.

People had been involved in the assessment and review of their care. This had been done in conjunction with families or Next of Kin if appropriate. Changes to care documentation were printed off and people were given the opportunity to read and sign changes if they chose.

Inglewood had designated activity coordinators. People had access to regular activities provided in house or by visiting entertainers. We received positive feedback regarding the activities. People told us they enjoyed attending and also liked the interaction with other people.

People were given a copy of the complaints procedure and this was also displayed around the home. The registered manager had a robust system in place to demonstrate that any issues including minor concerns had been documented and addressed in a timely manner. Records were kept of email and letters sent and information recorded to show how a complaint had been resolved.

Inglewood Nursing Home is registered to provide accommodation for 60 residents. At the time of our inspection there were 55 people living in the home.

We used a number of different methods to help us understand the experiences of people using the service. Not everyone who lived in the home was able to tell us about their experiences. Those who could told us, “I am involved in all decisions. It is a good place, it’s clean and the staff are good.” We were also told “activities are good and varied, there’s always something to do.”

We spoke to relatives and visitors. One relative who visited the home regularly told us “I am happy with the care provided here, they keep me informed when something changes.”

During our inspection we found that people had been involved in decisions about their care, and chose how they spent their time.

Care plans were personalised, and documented the needs of people living in the home. We saw that risk assessments had been completed when required.

Staff had attended safeguarding training and were able to demonstrate a good understanding around recognising and reporting concerns.

Staff received regular supervision, and annual appraisals. We spoke with staff who told us they felt supported by their colleagues and appointee manager.

Inglewood Nursing Home had a complaints policy and procedure in place. Copies of this were available in the main reception. We spoke to a relative who told us they felt able to raise concerns with the appointee manager when they needed to.

We used a number of different methods to help us understand the experiences of people who used the service. Some people had complex needs, which meant they were not able to tell us their experiences. Those who were able to told us they were very happy living at Inglewood and had no concerns with the standard of care provided.

One person spoken with was at Inglewood for a period of respite, they told us “Staff are polite and seem nice, if you ring the bell it gets answered quite quickly.” A relative spoken with told us they had no concerns and were very happy with the care provided.

During our inspection we found that care and treatment was being provided to meet people’s needs. The design and layout of the home was suitable for carrying out the regulated activities, and systems were in place to maintain appropriate standards of cleanliness and maintenance. The provider had effective measures in place to regularly assess and monitor the quality of service provided.

We spoke to a number of people who lived in the home, their relatives and visitors. Everyone told us they were happy with the staff and the care provided. One person told us “I have lived here some years, I am happy here, I get on well with most of the staff. It’s up to me how I spend my time, I choose to eat in my room because I prefer it. I join in the activities when it’s something I fancy”.

Two relatives who both visited the home regularly told us staff were nice, but were always really busy. Two visitors told us they felt there were not enough staff at busy times of the day.

We spoke with six residents of the home and two visitors. All of the residents spoken with stated that the staff were kind and caring and that they were satisfied with the care they received. They commented on the fact that the staff seem to be very busy. One resident stated that “the home is extremely good” and staff are “very kind”. The visitors stated that the staff were very kind and approachable but they had noted that staff seemed to have been more rushed in the last few months.

Inglewood Nursing Home provides residential nursing care for people. People’s nursing requirements varied with some requiring support for all their daily care and support needs. People had a range of complex health care needs which included stroke, diabetes, dementia and Parkinson’s disease.

People recognised that the home had changed management and were happy and comfortable with this. They knew who the acting manager and deputy were and people spoke highly of the management telling us they found them, “Approachable,” And, “There’s a new manager and it feels very organised and helpful.”

This service provides permanent and respite care funded privately or by the local authority.

The service is registered to provide care for up to 60 people. At the time of the inspection there were 46 people living at the service.

This was an unannounced inspection which took place on 10 and 11 August 2015.

Inglewood Nursing Home did not have a registered manager. However, the acting manager was in the process of applying to register as manager with CQC. 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.

The service was in a period of transition due to changes in management. There was an acting manager who had been working at the service for less than a month, and was in day to day charge of the running of the service. People and staff told us about the recent changes made to the service. People told us that they felt supported by the new management team and knew that there was always someone available to support them.

People were not involved in care planning and regular assessment of their care needs. People did not feel involved in decisions, for example daily choices around having a bath or shower.

The acting manager and deputy had identified areas of documentation that needed to be improved and a number of changes had recently been implemented with further changes planned. The acting manager was aware that changes needed time to become embedded and was introducing each change methodically to allow staff time to become used to each change.

Staff had a clear understanding of how to recognise and report safeguarding concerns.

Personal and environmental risk assessments had been completed and regularly reviewed. This included personal emergency evacuation plans for everyone living at the service.

People’s health and care needs were reviewed monthly. Falls, accidents and incidents were analysed to identify any trends.

People were asked for their consent before care was provided and had their privacy and dignity respected.

People’s nutritional needs were monitored and reviewed. People had a choice of meals provided and staff knew people’s likes and dislikes.

Referrals were made appropriately to outside agencies when required. For example GP appointments and speech and language referrals.

A daily programme of activities were provided by designated activity co-ordinators.

There was an on-going recruitment programme to ensure that appropriate staffing levels were maintained and to ensure staff were safe to provide care to people. Staff received a period of induction with on-going support provided. There was a clear programme of staff training, regular supervision and appraisals. Staff felt their training needs were met and they had opportunity for further future development.

There was a robust system in place to ensure the organisation and management assessed and monitored the quality of service provided.

Feedback was gained from people this included questionnaires and regular meetings with reports available for people to access.

Notifications had been completed to inform CQC and other outside organisations when events occurred.

We found a breach of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of the report.