Ings House Nursing Home is a registered nursing home in a quiet residential area of Liversedge. It provides accommodation, personal and/or nursing care for up to 32 people. The home was built in the early 1800s and has been extensively renovated and refurbished. Accommodation is provided over two floors, which can be accessed using a passenger lift or a stair lift. On the day of inspection there were 27 people living at the home.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

The manager and staff understood how to keep people safe. There were clear policies and procedures to follow for staff to raise concerns and staff were aware of these.

Risk assessments were in place for aspects of people’s care and support and these were updated regularly to protect people from harm. People were supported to have 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.

Staff were trained to give medicines safely, all training was monitored, competencies were checked and staff received regular support from the manager through supervision and appraisals.

People had a choice of what to eat and where they ate their meals. People were supported to eat when appropriate and their nutritional intake was monitored. People were regularly weighed to make sure they were healthy. We observed staff were caring and told people what they were doing at all times, we observed that people were treated with dignity and respect. We saw in people’s care plans what is important to them and how these needs were met. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Some mental capacity assessments were in place. We have made a recommendation about decision specific capacity assessments for consent to care and support.

The manager was visible and spent time each week working alongside the staff. Meetings with staff were inclusive with staff describing the manager as approachable. Systems and processes for ensuring the quality of the service were securely and effectively in place.

Further information is in the detailed findings below.

On the day of our visit there were 25 people living at the home. The manager told us 11 of these were residential, three were ‘continuing care’ and the remaining 11 residents required nursing care.

During our inspection we spoke with three people who used the service, two care assistants, the manager and the provider. The care workers we spoke with were aware of their responsibilities regarding reporting abuse and were aware of the local procedures for doing this. The people living at the home told us they felt safe

When we visited the service on 15 April 2013 we found there was a lack of meaningful activities for people to engage in and there were no staff dedicated to activities. This meant the emotional and social needs of people living at the home were not being met.

When we asked people about activities at this visit they all told us there was plenty going on. One of them said, “I’ve been here for over six years and the activities went down a while since. It’s much better now that the activities are back. We’ve had a couple of entertainers and they were very good. Everybody liked them” Another person told us “Yes there’s plenty to do every day now, games and things; I join in them all. I like to play cards and we go out a lot.

All of the people we spoke with told us they were very happy with the care provided and that there was nothing that needed improving. One person said “I couldn’t wish for a better, cleaner place” and another said “I wouldn’t have come in here if it wasn’t okay. You feel right at home and it’s nice and quiet here.”

On the day of our visit there were 23 people living at the home. The manager told us nine of these were residential, three were ‘continuing care’ and the remainder required nursing care.

During the inspection we spoke with five people who used the service, three care assistants, the registered manager, the provider and the administrator. We saw people’s individual needs were assessed and care and support was developed from this information.

We spoke with three care workers who told us they felt confident the care provided to people living at the home was good. Care workers received appropriate training for their role and told us they felt well-supported. One of them said “We all get on very well” and another said “We know where to go if we have a problem.”

People we spoke with all told us they felt safe living at the home and they felt there were enough staff. No-one we spoke with had made a complaint. One person said “The immediate response to my call bell could be quicker” another said “The staff are all nice with me, every one of them.”

When we asked people about activities during the day they all told us there was not a lot to do, one said “There are no activities really; I had a game of dominoes this morning.” Relatives had also commented about the lack of stimulation and activities in the 2012 user survey.

The inspection of Ings House Nursing Home took place on 7 and 9 December 2015 and was unannounced. The home had previously been inspected in August 2013 and found to be fully compliant with the requirements of the Health and Social Care Act 2008 and its associated regulations.

Ings House Nursing Home is located in a residential area of Liversedge. It provides accommodation, personal and nursing care for up to 32 residents. The home was built in the early 1800s and has been extensively renovated and refurbished. Accommodation is provided over two floors, which can be accessed via two lifts. The home had recently completed an extension providing a further four rooms. On the day of inspection there were 27 people living in 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.

People and relatives said they felt safe at Ings House and staff understood how to report safeguarding concerns. We found risk assessments reflected individual need and were comprehensive.

Staffing levels were appropriate for the needs of the people living in the home but we discussed with the registered manager how they may be better deployed at certain times of the day to manage people’s anxiety levels better. Medicines were administered and recorded correctly but we found issues with the storage and security of liquid medication along with time taken to administer it. This was a breach of Regulation 12 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 safe care and treatment. However, we did note this had been remedied with immediate action by the second day of our inspection.

Staff had received a detailed induction and were up to date with current training requirements. They had regular supervision and appraisals from the registered manager who constantly sought to improve practice and ensure their knowledge was relevant.

The home followed the requirements of the Mental Capacity Act 2005 and its associated Deprivation of Liberty Safeguards (DoLS) by ensuring people had capacity assessments that were decision specific and that best interest decisions were made with all relevant parties.

People’s nutritional and health care needs were met through the provision of regular food and drinks throughout the day, and visits from health and social care professionals as needed.

Staff were caring, kind and considerate and clearly knew people well, as retention of staff was positive. They paid attention to small details as well as the more general support needs of people. People were encouraged to be as involved and active as possible and staff supported them where needed. We saw staff treating people with respect, honouring their dignity and promoting their wellbeing in meeting their needs.

We could see that people had choice about what they wished to do, and the home had a good programme of activities for people to join in as they wished.

The home was well led by a visible registered manager and supported by an actively involved registered provider. Both were keen to embed high quality practice and the systems were in place to support this.

You can see what action we told the provider to take at the back of the full version of the report.