This was an unannounced inspection carried out on 5 and 8 September 2017. Our last inspection took place on 24 February 2015 when we gave an overall rating of the service as ‘Good’.

Lindley Grange Care Home is registered to provide accommodation for persons who require nursing or personal care and treatment of disease, disorder or injury for up to 45 older people.

At the time of our inspection 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.

Protocols for the use of as and when required medicines were not always in place. The registered provider had identified this in a recent audit and action was taken to remedy this during our inspection. Not all staff responsible for the administration of medicines had an up to date assessment of their competency. However, medicines were mostly found to be stored appropriately and administered as prescribed.

Audits and monthly reviews had been completed. The registered provider had an overall home improvement plan.

The registered provider gathered feedback from people and relatives using a number of methods. Complaints were appropriately managed and information from satisfaction surveys had been analysed and feedback was on display.

There were sufficient numbers of staff to meet people’s needs. We saw staff provided timely assistance when this was needed. Rotas showed staffing cover was provided as identified by the registered provider who regularly reviewed people’s dependency levels.

Staff were seen to be attentive to people’s needs and quickly intervened to de-escalate situations where people demonstrated behaviour which may challenge others. Staff were familiar with people’s care needs and preferences. People’s privacy and dignity was respected.

Care plans were sufficiently detailed which meant staff had access to relevant information in order to provide effective care. However, the involvement of people and their representatives in the planning of their care was not always evident in the care plans we looked at. A programme of activities was taking place and we saw good recording of people’s involvement.

Risks to people had been identified, assessed and reviewed and least restrictive practices were in place. The registered manager analysed accidents and incidents and records demonstrated appropriate action was taken in response to lower risks to individuals.

People were enabled by staff to receive timely support from healthcare professionals where this was needed. A visiting health professional was complimentary about the care provided at Lindley Grange.

Training records showed staff were up to date with their training needs. Although individual and group supervisions were taking place, we recommended the recording of individual supervision be strengthened. The registered manager told us they would address this immediately.

The mealtime experience was found to be positive, although due to the layout of the building, there was limited dining space.

Staff felt they worked well as a team and told us leadership in the home was strong as the registered manager was approachable and listened to them.

Fire safety checks were regularly carried out and the building was maintained as required. Some furnishings in the home looked dated.

The inspection of Lindley Grange Nursing Home took place on 24 February 2015 and was unannounced. We previously inspected the service on 8 April 2014 and, at that time we found the provider was not meeting the regulation relating to supporting workers. We asked the provider to make improvements. The provider sent us an action plan telling us what they were going to do to make sure they were meeting the regulations. On this visit we checked to see if improvements had been made.

Lindley Grange Nursing Home is registered to provide accommodation and personal care for up to 40 older people. On the day of our inspection there were 39 residents. The home is purpose built and provides accommodation over two floors. There is also a garden that is accessible for people who live at the home.

There was a registered manager who had been registered since October 2010. 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.

On the day of our inspection we saw that there were enough staff who were well trained and knowledgeable regarding safeguarding procedures and policy. We saw risk assessments that were up-to-date and reflected the needs of the people being cared for.

We found that peoples’ medicines were administered safely and records kept in accordance with the NICE Guidance: Managing Medicines in Care Homes. There were effective links with GPs and other health professionals to ensure that people were receiving the input of external healthcare professionals.

We spoke with staff who informed us of the training and supervision they had received; this was reflected in the records we saw. We observed positive care of people who were living with a diagnosis of dementia which sought to enable people to maintain their independence whenever possible. Staff demonstrated a commitment to supporting people to be individuals through their interactions and communication.

Staff supported people with eating and drinking, and measures were in place to identify and action any concerns for people with a poor nutritional intake. We observed people were given choices around their food and drink, and were supported to make these choices as much as possible. The registered manager had a good understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLs). These safeguards make sure that people who lack capacity are not deprived of their liberty unlawfully and are protected.

Throughout the day we observed examples of care staff having a positive rapport with people and relatives. Relatives we spoke with said they ‘were happy’ and ‘staff were good’. The atmosphere in the service was very relaxed and people appeared happy and calm. Staff were observed throughout the day interacting often with people, and making comments to people which evidenced they knew them well.

Our analysis of the care records and activity files showed that various activities were arranged, appropriate to the people taking part. These were flexible and accommodating, people were able to join in as they wished and we observed people clearly enjoying undertaking them. However, we saw that a film being shown to people could not be heard by those who were watching it.

The leadership of the service was robust We spoke with the registered manager who was knowledgeable about the service and the people who lived there. We observed a good rapport between staff and the registered manager. Staff were very complimentary about working in the home.

Our inspection team was made up of two inspectors. We asked our five questions;

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who lived at the home, their relatives, staff members and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by staff. People told us they felt safe.

Systems were in place to make sure managers and staff learn from events such as accidents, incidents and concerns. This reduces the risks to people and helps the service to continually improve. The home had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff had been trained to understand when an application should be made, although some training was undertaken more than 2 years ago.

The service was safe, clean and hygienic. Equipment was well maintained.

The registered manager set staff rotas, taking people’s care needs into account when making decisions about staff numbers. This helped ensure people’s needs were able to be met.

Is the service effective?

There was an advocacy service available. This meant people could access additional support, when required.

People’s care records were assessed with their involvement and with relatives and other professionals' involvement, where possible and appropriate.

Is the service caring?

People were supported by kind and attentive staff. We saw care assistants showed patience and gave encouragement when supporting people. People we spoke with said staff were kind and caring.

People living at the home and their relatives completed satisfaction surveys and any actions identified were addressed by the provider.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People completed a range of activities at the home. On the day of our visit we observed people getting involved with singing, painting, dominoes and crafts.

People, or relatives of people, knew how to complain if they were unhappy. People we spoke with said the manager was approachable. We spoke with staff members, who said the manager was approachable. One member of staff we spoke with told us; “We can talk to the manager. She’s very open to suggestions and is more than willing to try new things”.

Is the service well-led?

The service worked well with other agencies and services to make sure people received the most suitable care. This included multi-agency work with the local authority and Care Quality Commission.

The service had quality assurance systems in place and, where shortfalls were identified, action plans were put in place and addressed promptly. As a result, the quality of the service was being maintained and, much of the time, improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home. Staff were also aware of audits and observations carried out by the manager to monitor and improve service provision. This helped to ensure people received a good quality service.

We found some issues around training for staff.

Many of the people we met during our visit were unable, due to complex care needs, to tell us about their experiences at the home. In order to gain an understanding about people's experiences, we observed care, read care records and spoke to staff. As part of the inspection we spoke with four relatives of people who lived at the home.

Before people received any care or treatment they were not always asked for their consent. We have judged that this has a minor impact on people who use the service, and have told the provider to take action.

We found care and treatment was planned and delivered in a way that ensured people’s safety and welfare.

Staff had received abuse awareness training and procedures were in place to respond appropriately to any allegation of abuse.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

During our visit we observed that there seemed to be enough staff available to respond in a timely manner to people who required assistance. There were enough qualified, skilled and experienced staff to meet people’s needs.

We spoke with one visitor and they told us that since the new manager came into post they were seeing positive improvement in the services provided to people living at the home. They were aware that new staff had joined the service and even though this was initially worrying they now felt confident they were making a difference in improving the services provided. Staff appeared more visible during their visiting times; they also told us the staff involved them in the care and treatment of their relative. They had confidence in the staff’s ability to care safely for their relative and told us that they felt at ease when leaving their relative at the end of their visits.

They commented to us positively about the opportunities now provided for them and other relatives to meet together with the managers and staff to offer their views on the development of the service. They said 'This was a positive step in the right direction'.

We carried out an unannounced inspection because we had received information from the provider and from other agencies, which concerned us. This information related to the safety and welfare of people who use the service. We conducted the inspection visit over two days.

During the course of our visit, we spent a significant amount of time observing the care provided to people who use the services on both floors of the home. We did speak with people who use the service but due to their complex needs, the majority were unable to express clearly their experiences. Each person we spoke with responded and engaged in conversations with us. From our conversations and observations, people appeared relaxed and comfortable in the staffs presence and within their surroundings.

We looked at people’s care records; we spoke with staff and looked at a range of other information to help us understand people’s experiences, which included the relatives and customer satisfaction results and minutes from resident and relative meetings.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs, which meant they were not able to tell us their experiences.

For example during the course of our visit, we visited both floors of the home and spent a significant amount of time observing the care provided to people who use the services. We were able to speak with the relatives of two people, who told us that they were involved in their relatives care, treatment and support plans. They went on to tell us that people are treated with respect and staff are very helpful and caring. Overall, they were satisfied with the care people received at the home.

People who use the service were not able to tell us about their views of the service they receive. However, through our observations, we saw that people seemed confident in their surroundings and in their interactions with staff.

People who use the service were not able to tell us about their views of the service they receive. However, through our observations, we saw that people seemed confident in their surroundings and in their interactions with staff.