The first day of this inspection took place on 6 August 2018 and was unannounced. We also visited on 15 August 2018 for a second day which was announced. Ings Grove House is registered to provide accommodation and personal care for up to 40 people. The home has 30 beds allocated for intermediate care. The remaining places were available for people requiring respite care and people transitioning from hospital to their own homes. There were 36 people at the home during our first day of inspection and 26 people on our second day. People stayed for short periods, generally up to a maximum of six weeks. Over the past year, the registered manager reported there had been 437 people staying on a temporary basis. People requiring intermediate care were supported by a multi-disciplinary team comprising of therapy and clinical staff based at the home. The accommodation is based over two floors linked by a passenger lift.

The service was previously inspected on 11 and 16 June 2017 and was found to be in breach of the regulations in relation to the provision of safe care and treatment, good governance and staffing. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, responsive and well-led. At this inspection we found some improvements had been made but there were areas which required further improvement. We found a continuing breach around good governance.

Ings Grove House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There was a registered manager at the home although they were not present on the first day of 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.

Medicines were stored safely, and procedures were in place to ensure medicines were administered safely, although the application of creams was not always recorded. We saw people received their medicines in a timely way from staff who had been trained to carry out this role although staff were not following current best practice in relation to the signing of medication administration records.

There were sufficient numbers of staff to provide a safe service. However, people told us call bells were not always answered promptly.

There had been an improvement in the way some risks were assessed and managed. However, there still remained areas which required further improvement to ensure all risks to people were minimised through comprehensive assessment and reduction plans.

People we spoke with said they were very happy with the meals provided and were involved in choosing what they wanted to eat and where they wanted to eat their meals.

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. Most people had the mental capacity to consent to their care and treatment. Where it had been necessary, the registered manager had complied with their responsibilities under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).

The registered provider had not fully met their responsibility to ensure staff received periodic supervision, appraisal and training although there had been some improvement from the last inspection. Staff told us the registered manager sought out courses to support their development, following discussions with staff.

People had been referred to health professionals when the need a

The inspection took place on 11 and 16 June 2017. The service had previously been inspected in December 2014 and was meeting the regulations in place at that time.

Ings Grove House is registered to provide accommodation and personal care for up to 40 people. The home has 28 beds allocated for intermediate care. The remaining places were available for people requiring respite care and people transitioning from hospital and waiting for adaptations and care packages in their own homes. There is a multi-disciplinary team based at the home to support people receiving intermediate care. The accommodation is based over two floors linked by a passenger lift. Accommodation is in single rooms with each room having en-suite facilities. Lounge and dining facilities are situated on two floors.

There was a registered manager in place who has been registered since March 2017. 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 felt safe living at the home. Staff we spoke with were knowledgeable about safeguarding people. They were able to explain the procedures to follow should an allegation of abuse be made.

There were some systems and processes in place to protect people from the risk of harm. Assessments identified risks to people and management plans were in place to reduce the risks and ensure people’s safety but these had not always been updated when people’s needs had changed. Not everyone at the service had a Personal Emergency Evacuation plan.

Medicines were stored safely and procedures were in place to ensure medicines were administered safely with the exception of prescribed creams. We saw people received their medicines in a timely way from staff who had been trained to carry out this role although their competencies had not been assessed in line with good practice.

The registered provider had not fully met their responsibility to ensure staff received periodic supervision, appraisal and training to ensure their competencies were maintained and to keep up to date with best practice to enable them to perform in their role.

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. The registered manager had complied with their responsibilities under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). They had a good understanding of when a person might be deprived of their liberty.

People we spoke with said they were very happy with the meals provided and were involved in choosing what they wanted to eat and where they wanted to eat their meals. Mealtimes were a relaxed and enjoyable experience for people at the home and staff supported people with dignity and respect.

Staff interacted with people with warmth and respect and we saw the atmosphere in the home was friendly and supportive. Staff were able to spend time chatting and laughing with people. People spoke highly of the staff who cared for them and felt able to raise any concerns with staff.

Care files were person centred and evidenced people were involved in their care planning when appropriate. Due to the nature of the service, people’s needs changed frequently and the care plans were not always updated to reflect this. However, the registered manager had devised a written handover sheet which contained essential information to guide staff. Families had also been consulted with to ensure people’s preferences and views were considered when devising support plans.

There was a positive atmosphere in the home and people all told us how much they liked staying there. Staff were friendly, hel

When we visited the home in September 2013 we found the service did not have suitable arrangements in place for the purposes of obtaining consent from people. We were also told by staff that if a person did not have the mental capacity to give their consent, there were no arrangements in place to ensure appropriate action was taken. We said that improvements were needed.

We returned on this inspection to check whether improvements had been made.

We looked at the care records for three people who used the service and found that people had their ability to make choices and decisions included in their support plans.

We were told by three people using the service, two other people's relative's and 11 staff that they felt there were not enough staff on duty. The staff also told us that this was due to the increase in the dependency levels of people using the service. They said they felt worried about the quality of the care they were delivering.

We spoke with the Head of Care and the manager who addressed this issue immediately by ensuring that staffing levels were increased. This meant there were enough staff on duty to meet the needs of people using the service.

We spoke with two people who used the service and three members of staff. People were complimentary about the care they received. One person told us 'The staff are very good and the food is wonderful'. Another person told us 'Staff are very good, they really care'. We saw that people looked well cared for, they were wearing clean clothing with their hair combed. People were spoken to in a respectful manner by staff and volunteers. People were encouraged to be as independent as they could be with support from staff.

We spoke with five people who use the service and they told us that they were very satisfied with the care they receive. They also told us that staff were kind and considerate. People told us they were aware of their care and treatment and activities were available for their choice. They also commented that the food overall was very good and they had choices.

This inspection took place on 1 and 4 December 2014 and was unannounced. At the last inspection in January 2014 there were no identified breaches of legal requirements.

Ings Grove House provides accommodation for up to 40 people who require personal care. It is owned and maintained by Kirklees Metropolitan Council. The home has 20 beds allocated for intermediate care. The remaining beds were available for people requiring respite care. The accommodation is based over two floors linked by a passenger lift. Accommodation is in single rooms with each room having en-suite facilities. Lounge and dining facilities are situated on two floors. There were 30 people using the service at the time of our visit.

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.

The experience of people who used the service was positive. People told us they felt safe, staff were kind, caring and they received good care. They also told us they were aware of the complaints system. People said they felt able to raise concerns they had with the staff or the manager and were confident these would be listened to and acted upon.

We saw that people looked well cared for. We saw staff were caring and respectful of people who used the service. Staff demonstrated that they knew people’s individual characters, likes and dislikes. We also saw staff enabled people to be as independent as possible when supporting them with their everyday care needs.

People’s care plans and risk assessments were person centred. We saw they were reviewed on a regular basis to make sure they provided up to date, accurate information and also were fit for purpose.

People told us they enjoyed the food and we observed people were offered choice and independence in accessing food and drink. People’s nutrition and hydration needs were being met.

We saw that a number of falls had occurred at the home. The manager showed us how they had responded to this by carrying out an analysis of the falls. We saw action plans were in place which identified the need for extra staff at high risk times. However, we saw the staffing numbers had not been increased. We spoke with the service manager during our inspection who responded immediately to this and increased staffing numbers to ensure people were safe.

We saw that medicines were managed safely at the home. We looked at medication administration records (MAR) which showed people were receiving their medicines when they needed them.

Systems were in place to assess and monitor the quality of the service and the focus was on continuous improvement. People and staff were actively involved in developing the service. There was strong leadership in place which promoted an open culture, and put people at the heart of the service.