This inspection took place on 29 June 2018 and was unannounced. At our last inspection in July 2017 we rated the service as good.

We undertook this inspection because we had received concerns about the safety of equipment available and staff competence to respond to health emergencies at the home. During our inspection we did not identify any risk relating to this.

Innage Grange is a ‘care home’ which is registered to provide nursing care. 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.

Innage Grange accommodates 83 people within seven separate units. Each unit has their own bathrooms, kitchenette, dining area and lounge. All but one of the units are the ground floor and are connected by a wide central corridor. There is a passenger lift to the first floor. The home accommodates older people who may be living with dementia. At the time of our inspection there were 79 people were living at the home.

A registered manager was in post but they were not present for this 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 were kept safe from avoidable harm and abuse. The provider had safeguarding procedures in place, which staff understood and followed. Risk assessments reflected how care should be provided to the person to minimise any risks to them; they were regularly reviewed to adapt the level of support needed in response to people's often rapidly changing needs.

People received their medicines when they needed them and these were managed safely. People were protected against the risk of infection. People were supported by sufficient numbers of staff who had been employed through safe recruitment processes.

People received care and support that was effective in meeting their needs. People's care and support needs were assessed and good practice guidance was followed. People were involved in the planning and review of their care and were encouraged to express their views, preferences and wishes regarding their care, support and treatment. This included any end of life wishes they had.

The training staff received was specific to people's individual needs. Staff practice was assessed and monitored to ensure they were competent to meet people's needs. People were supported in an environment which had been designed and adapted to meet their needs.

People were supported to eat and drink sufficient amounts and risks associated with their dietary intake were assessed and monitored to ensure people's safety. Staff worked in partnership with other professionals and people confirmed they received the support and treatment they needed to maintain their health.

People were supported to have maximum choice and control of their lives and care workers supported them in the least restrictive way possible. Staff supported people to make decisions about their care and treatment. Where people could not make their own decisions, the provider worked within the law to ensure their human rights were respected.

People had developed positive relationships with staff and agreed all staff were kind, caring and compassionate. Staff ensured people understood the information they received about their care.

People were treated with dignity and respect and staff supported people's independence.

People received care and support that was individual to them and considered their diversity. Staff understood people's routines and preferences and supported their social needs.

People understood how to make a complaint and there was a system in place to investigate these.

Innage Grange is a service which provides accommodation with nursing and personal care for up to 80 people. Some people may be living with dementia. There were 77 people living at the home on the day of our inspection.

Rating at last inspection

At the last inspection, in July 2015, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good.

People continued to receive care which protected them from harm and abuse. Staff supported people safely, monitored risks to their safety and were available when people needed support. People's medicines were managed and stored in a safe way, and they were given their medicines when they needed them.

Staff received training to give them the skills and knowledge they needed to meet people's needs. These skills were refreshed through regular training, Staff were supported in their roles by managers and their colleagues.

Staff asked people's permission before they helped them with any care or support. People's right to make their own decisions about their own care and treatment was supported by staff.

People were supported by staff who knew them well and had caring relationships with them. People felt involved in their own care and staff and managers listened to what they wanted. Staff respected people's privacy and dignity when they supported them.

People received care and support that was individual to them. Their support needs were kept under review and staff responded when there were changes in these needs.

People were able to give feedback and make complaints about the care and support they received. They also had opportunities to make suggestions for improvements at the home and these were listened to.

The provider had systems in place that continued to be effective in assessing and monitoring the quality of the service provided.

Further information is in the detailed findings below.

The inspection visit took place on 7 July 2015 and was unannounced.

Innage Grange is registered to provide care for up to 83 people some of whom may be living with dementia. There were 81 people living at the home on the day of our inspection.

A registered manager was in post in the service. 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 who lived at the home, relatives and friends told us they felt safe and secure with staff to support them. We found people’s care and support needs had been assessed before they moved into the home. Care records we looked at contained details of people’s preferences, interests, likes and dislikes.

Staffing levels and the skill mix of staff were sufficient to meet the needs of people and keep them safe. The recruitment of staff had been carried out through a thorough process. We found all checks that were required had been completed prior to staff commencing work.

Medication was dispensed and administered in a safe manner. We saw that staff dealt with one person at a time to minimise risks associated with this process. Staff had received formal training to ensure they were confident and competent to give people their medicines.

People and their relatives told us they were happy with the variety and choice of meals available to them. Regular snacks and drinks were available between meals to ensure they received adequate nutrition and hydration

People who lived at the home were encouraged and supported to maintain relationships with their friends and family members. Relatives and visitors we spoke with told us they were always made welcome when they visited their loved ones.

The care plans we looked at were centred on people’s personal needs and wishes. Daily events that were important to people were detailed, so that staff could

provide care to meet their needs and wishes. People we spoke with were confident that their care was provided in the way they wanted.

Staff were seen to organise activities designed to stimulate people living with dementia. People participated willingly and enjoyed the fun. People we spoke with told us they enjoyed activities with the staff.

We found a number of audits were in place to monitor quality assurance. Records demonstrated identified issues were acted upon in order to make improvements. The registered manager and provider had systems in place to obtain the views of people who lived at the home and their relatives.

We conducted a short period of observation during the morning in a nursing unit for people living with dementia. This was because not all people were able to tell us their views.

We also visited the general nursing unit. People told us that they were content at the home. They described staff as, "very pleasant" and, "always on hand to help".

We observed that people received caring support from staff on duty. We observed care that was not rushed and the staff knew the people and their individual personal needs.

We considered that people who lacked the ability to manage their own care received caring support that was responsive to their changing mood and need. Care records were in place that provided staff with instructions on how people should be cared for and why.

Staff understood the importance of keeping people safe from harm.

We saw recruitment procedures were robust to ensure people who used the service were safeguarded from the risk of harm.

The provider had robust systems in place to assess risk and monitor the quality of the service provided. This meant that the service was effective and well led.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by a practising professional.

Eighty three people lived in the home when we visited. We talked with eight people who lived in the home, two relatives, the manager and deputy manager of the home and three staff. We looked at the care records for four people to see how their needs should be met.

Some of the people who lived in the home were not able to talk directly with us because of their health conditions. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

People we spoke with were happy with the quality of the care provided and felt involved in making choices about their care. Comments included, ‘’I’m happy here, the staff are supportive. Carer is really good after my shower we decide together what I’m going to wear that day,’’ ‘’Staff will always have time to listen to me and If I have any concerns they will try to put it right, they are so patient with me’’ and ‘’I’m really happy here staff are so wonderful and attentive, they look after me very well.’’

We observed staff treated people who lived in the home with respect and helped them to be as independent as possible. Throughout the day we saw staff supporting people with words of reassurance where needed whilst completing tasks. It was evident that staff had a good rapport with people and knew people’s likes and dislikes.

Many of the people who lived in the home who we spoke with told us that they were happy with the meals provided and we saw meal choices were offered. One person told us that if they were hungry between meal time’s staff would provide a cake or biscuits or other food.

There was enough staff employed to meet people’s needs. People who lived in the home told us that when they needed assistance staff responded to promptly.

Care records were stored securely so that people’s confidentiality was maintained and were readily accessible when staff needed them.

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 Innage Grange. We therefore spent time observing individuals being supported by the staff on duty at the time of our visit.

People we spoke to told us they are very well cared for at Innage Grange and that the staff are kind and caring. People said they see a doctor if they need one and that the staff make arrangements on their behalf to access other health care professionals such as the chiropodist and optician.

We were told there are a variety of meals on offer and that the food is very nice.

One individual who visits the home daily told us staffing levels are always very good and that they are given regular feedback about their loved one’s condition.

One person stated they had looked at several homes but Innage Grange just felt the right place for their relative. They visit regularly and the staff always make them welcome. They said that meals look appetising and that portion sizes are good. They told us their relative’s needs are fully met and that they always look well cared for. They stated they have no concerns about the home.

A professional told us that they are always welcomed and attended to by the staff when they visit people living at the home. They also told us that the staff communicate very well, they listen to advice and always carry out any instructions that they leave. They said the home always acts promptly and professionally, and makes referrals to their service in a timely way. Hygiene at the home was reported to be of a high standard and the home always appears to be well staffed. They stated the staff appear to work as a team and that any information the home shares is relevant and good.

The Shropshire Local Involvement Network (LINk) visited the home 21 January 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 the home was clean and tidy. Staff interaction with residents was positive and seemed to reflect genuine concern.

Staff told us they are well supported and receive good training opportunities and there were usually enough staff on duty.