About the service: Waterside Grange provides residential and nursing care for up to 83 people. Some people using the service were living with dementia. At the time of our inspection there were 75 people using the service.

People’s experience of using this service:

People were protected from the risk of abuse. Staff we spoke with knew how to recognise abuse and how to report it. Risks associated with people’s care were identified and actions were taken to minimise risks occurring. From our observations we saw people’s needs were responded to in a timely way. However, it was not clear if adequate staffing levels were in place on Kirkstall unit. We raised this with the provider who informed us that a dependency tool was used to determine staffing numbers on all units and reassured us there were sufficient staff available. Medicines were managed in a safe way. People receiving medicines on an ‘as and when’ required basis had protocols in place to identify when they were required. However, some protocols had limited information. The provider was in the process of addressing this.

The service was clean and well maintained, minimising the risk of infection. We identified some areas which required attention and the registered manager took immediate action to address them. Accidents and incidents were recorded and analysed to identify any trends and patterns. Action was taken to minimise repeated accidents and incidents.

People’s needs were assessed and care and treatment was delivered in line with people’s needs. Staff we spoke with told us they received appropriate training and support to carry out their roles and responsibilities. People were supported to eat and drink enough to maintain a balanced diet. People told us they enjoyed their meals. People had access to healthcare professionals who were referred to in a timely way.

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.

We spent time observing staff interacting with people and found they were kind, caring and supported people in a sensitive way. Staff were very patient and gave people time and opportunities to remain independent.

Staff knew people well and supported them in line with their current needs and wishes. Staff ensured people received social stimulation in line with their interests. Staff were knowledgeable about people’s favourite flowers and colours and could engage in meaningful conversations. People and their relatives felt able to raise complaints and were confident that appropriate actions would be taken to address their concerns.

The service had a registered manager in place who was responsible for the day the day running of the service along with a management team. Audits were completed to ensure the service operated within the providers policies and procedures. People who used the service, their relatives and staff were given opportunities to be involved in the service and discuss their opinions about the home.

More information is in the full report.

Rating at last inspection: Good (report published 13 August 2016)

Why we inspected: This was a planned comprehensive inspection based on the rating at the last inspection.

This inspection took place on 19 and 20 July 2016. Waterside Grange is a nursing home that is registered to provide care and accommodation for up to 83 older people. The home is located in the Rotherham suburb of Dinnington. At the time of the inspection there were 72 people living at the home and many of them were living with dementia, some people also had mental health problems.

The home had a registered manager. 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 spoke highly of the staff and the care they received, one person said, "I have a good relationship with all the staff and I trust them, they take great care to make me feel comfortable and I'm never rushed." A visiting healthcare professional told us, "It is an excellent home that I am happy to recommend." Staff knew the people they were caring for well and spoke about them knowledgeably. People appeared happy and relaxed in the company of staff and told us that they had confidence in them, one person said, "The staff are wonderful, they help me in any way I need." Staff received regular supervision and their training was up to date. Staff told us they felt well supported within their roles.

People were protected from harm by staff who understood their responsibilities with regard to safeguarding procedures. There was an effective recruitment procedure in place to ensure the right sort of people were working in the home, and only staff who were trained and competent were able to give people their medicines. People received support to ensure they had enough to eat and drink and if they were identified as being at risk of malnutrition or dehydration suitable monitoring systems were used to maintain their health. Referrals were made to health care professionals in a timely way when required and people were supported with a range of health care services to maintain good health.

Staff understood the importance of obtaining people's consent to care and treatment and where people lacked capacity staff acted in line with legislation and guidance to ensure decisions were made in people's best interests. Staff showed a high regard for people's dignity and privacy and treated them with respect, one staff member said, "I have to make sure that the care I provide is person centred, even if it takes a little longer it's important that people are supported to retain as much independence as possible."

People and staff told us that the registered manager was approachable and that they felt comfortable raising any concerns or complaints they had.

People, staff and visiting professionals spoke highly of the registered manager, saying that the service was well led. One visiting professional said, "Waterside Grange is well run, the provider, the manager and the staff are extremely dedicated, they are always here and available to talk to at any time." Staff described an open culture where practice was discussed and challenged and they received clear guidance and leadership from the registered manager.

Our inspection looked at 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 using the service, speaking with the staff supporting them and looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Staff were given guidance to ensure that they cared for people safely. Detailed risk assessments and records were in place to ensure people received the care and support they required. People were cared for in a clean, hygienic environment and were protected from the risk of infection.

Appropriate checks were carried out before staff commenced employment.

Is the service effective?

People's needs were assessed and care was planned and delivered in line with their individual care plan.

Care plans contained assessments of people’s care and support needs. These assessments described the steps staff should take to ensure each person’s needs were met. Evidence we checked showed that staff were following people’s care plans and risk assessments.

Audits and reviews took place to ensure that care was delivered in a way that met people’s needs.

Is the service caring?

People we spoke with praised the service. One said: “It’s a second home, if you want anything you just ask.” A visiting relative told us: “All the staff are approachable, and they know my mum well.” We observed that staff knew people’s needs well, and interacted warmly and considerately with people.

Is the service responsive?

Where the provider identified areas for improvement, these were implemented. Where people’s needs changed, the way they were cared for was changed to meet their needs.

Is the service well-led?

There was a quality assurance system in place, where audits of all aspects of the service were carried out. This was thorough, and where action was required we saw it was implemented.

People’s personal records including medical records were accurate and fit for purpose. Records described how support and care should be delivered so that people were kept safe and treated according to their preferences. All the records we checked were personalised so that they met people’s needs and supported the delivery of good quality care.

People we spoke with, and their relatives, told us their care in the home was good. One person spoke very positively about the staff. They told us: “I think they are a lovely bunch of people.” Another person told us: “I’ve got no complaints about the care at all. They [the staff] do a good job and you never hear them complain.”

We observed care taking place within the home and saw that people were routinely treated with dignity and respect. Staff showed consideration for people’s preferences and wishes when they spoke with them.

Staff received appropriate professional development. We checked records of staff employed within Waterside Grange, and saw that the provider enabled staff to undertake development to enhance their skills and knowledge. For example, some staff had recently commenced nationally recognised qualifications in care.

Records we checked showed that where people may be vulnerable to abuse, for example, if there was someone living within the same unit whose mental impairment meant they may present a risk to other people, there were appropriate care plans in place. However, we found that the provider did not always follow the correct procedures when an incident of abuse or suspected abuse occurred.

We checked care records belonging to nine people. We saw that records were not all completed to a sufficient standard to ensure the provider held appropriate information about people or the care provided to them.