About the service: Yardley Grange Nursing Home is a care home that is registered to provide personal and nursing care for up to a maximum of 45 people aged 65 and over and who may have a physical disability.

People’s experience of using this service:

• Without exception all the people and relatives we spoke with praised the home. People felt safe and well cared for. One person said, “I’m very happy here” and a relative said, "I can't speak more highly, very good care. It feels like one big family now. They care for mum as if she was their mother."

• People’s preferences were respected and staff were sensitive and attentive to people’s needs.

• Staff were seen to be kind, caring and friendly and it was clear staff knew people and their relatives well.

• The home was described as well managed, with one relative saying, “This place is very well run with good organisational skills.”

• There were sufficient numbers of nurses and staff employed to ensure people’s needs were met.

• Recruitment practices were safe and staff received the training they required for their role.

• Risks to people’s health, safety and well-being were assessed and management plans were in place to ensure risks were reduced as much as possible. Staff were aware of their responsibilities to safeguard people.

• People’s care plans contained personalised information detailing how people wanted their care to be delivered. People and their relatives were involved in making decisions about their care.

• People’s healthcare needs were met: the GP service visited the home twice a week. People received sensitive and compassionate care at the end of their lives.

• People received their medicines safely and as prescribed. Medicine management practices were safe.

• Consideration was given to providing a variety of leisure and social activities for people to enjoy.

• The home was spacious and well furnished. The environment was safe and equipment regularly serviced to ensure it remained in safe working order.

• Comprehensive quality assurance systems were in place to assess, monitor and improve the quality and safety of the service provided.

Rating at last inspection: At the last inspection in October 2016, the home was rated ‘Good’, (the report published in November 2016).

At this inspection we found the home continued to meet the characteristics for ‘good’ in all key questions, and the rating for the service remains ‘Good’.

Why we inspected: This inspection was scheduled based on the previous rating of the home.

Follow up: We will continue to monitor intelligence we receive about the home until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The inspection was unannounced and took place on 11 and 12 October 2016.

The home is registered to provide accommodation and personal care, diagnostic and screen procedures and the treatment of disease, disorder or injury for a maximum of 45 people. There were 42 people living at the home on the day of the inspection. There was a registered manager in place. 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 and well cared for and staff were able to demonstrate they had sufficient knowledge and skills to carry out their roles effectively and to ensure people who used the service were safe. People told us staff were available when they needed care.

People were cared for by staff who were trained in recognising and understanding how to report potential abuse. Staff knew how to raise any concerns about people’s safety and shared information so that people’s safety needs were met. People were supported by staff to have their medicines when they needed them.

The assessment of people’s capacity to consent had been completed. People’s rights and freedoms were respected by staff. Staff understood people’s individual care needs and had received training so they would be able to care for people in the best way for them. There were good links with health and social care professionals and staff sought and acted upon advice received, so people’s needs were met.

People using the service were positive in their feedback about the service. People told us they enjoyed meals times and were positive about the choice of food they received. People said their privacy and dignity was maintained and we made observations that supported this.

People received care that met their individual needs. People were encouraged to express their views and give feedback about the service. People said staff listened to them and they felt confident they could raise any issues should the need arise.

Staff spoke highly of the management team and of the teamwork within the service. Staff were supported through supervisions, team meetings and training to provide care and support in line with people needs and wishes. The quality of service provision and care was continually monitored and actions taken where required.

People were positive about the care and support they received and the service as a whole.

We carried out a ‘responsive’ inspection following concerns raised with us in relation to the care people received. We looked at people’s care records, observed how people were being supported. We spoke with four relatives, four staff and five people who live there. We asked them about their experiences of the service to enable us to identify if the service met their needs.

Is the service safe?

All four staff spoken with told us and demonstrated that they had the knowledge and training to ensure any concerns they had were reported to the relevant internal or external agency so people were protected from abuse. All five people spoken with and four relatives told us that they felt their relative was safe. One relative told us, “I do feel that mom is safe, it is other areas I would like to see improved, such as involving relatives more. I think staff are very caring and would tell someone if something was wrong ’’. We saw where concerns had been raised about people losing weight or falling out of bed effective monitoring was not being completed, for example by completing fluid and food records. Four staff spoken with were not aware that a person was losing weight or that they were on a special diet This meant although measures had been put in place they were not being utilised to reduce risks to people health.

Is it effective?

People spoke with told us that they were happy with their care. Relatives and our observation told us that some improvements were required. Risks assessments to ensure all risks identified were minimised were not being used effectively to reduce the risks to people’s health.

Is it caring?

We spent some time in communal areas observing interaction between staff and people using the service. We saw that staff were respectful and spoke with people kindly and in a way that ensured people could understand. One person told us “Staff are nice no problem with them at all.’’ A relative told us, “Some staff are outstanding and other are very pleasant, and caring. Mom loves them all.''

There were 41 people living in the home on the day of our visit. No one knew we would be visiting. We spoke to four people who lived at the home, five relatives, five staff, the manager and deputy manager.

People told us and we saw that staff respected their privacy and dignity and that they were given choices about their care. One relative told us, “We make the decisions for X but they (staff) also respect the decisions X makes.”

People’s care and health care needs were planned and met in a personalised way. Records showed and staff confirmed that people’s needs were reviewed so staff had the information they needed to meet people’s care needs. All relatives spoken with told us they were kept informed about their relative’s care so they felt involved.

Systems to protect people from harm were not utilised effectively to ensure all injuries were investigated so as to prevent re occurrence. This meant people who used the service were not always protected from unsafe care.

Staff spoken with told us they felt supported by the manager, and had regular training opportunities. This meant staff should have the skills to care for people safely.

There were systems in place to monitor how the home was run and action taken where feedback from the people using the service would improve the service provided to them. One relative told us, “The manager’s door is always open.’’

There were 45 people living at the home on the day of our visit, no one knew we would be visiting. We spoke to six people who lived at the home, five relatives, six staff and the manager.

Some of the people who lived at the home had dementia care needs. People with dementia are not always able to tell us about their experiences so we looked at records relating to their care and observed staff caring for them.

People told us and we saw that choices were offered and that people's views were sought and acted upon.

Staff spoken to was able to tell us about people's needs so that they received care in a way that the they preferred. All five relatives told us they were consulted about their relative’s care and kept informed about their relative’s health so they felt involved in their care.

We saw that people were relaxed in their environment and that systems were in place to keep people safe from harm.

Staff received a range of training so that they had up to date knowledge and skills in order to support the people who lived in the home.

There were systems in place to monitor how the home was run, to ensure people received a quality service.

People in general were happy with the home. They told us they thought the home was lovely. The food was good and if they had any concerns they would speak to the manager. The home is very relaxing and quite.

The inspection took place on 12 and 18 August 2015 was unannounced. At the last inspection on 18 September 2014 we found that the provider was meeting the requirements of the Regulations we inspected. Yardley Grange is a nursing Home providing accommodation for up to 45 older people. At the time of our visit 45 people were living there.

There was a registered manager was 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.

People were not always supported with their medication so they received their medication as prescribed.

All staff spoken with knew how to keep people safe from abuse and harm because they knew the signs to look out for and appropriate referral were made so people were protected.

People were protected from unnecessary harm because risk assessments had been completed and staff knew how to minimise the risk when supporting people with their care.

There was enough staff that were safely recruited and trained to meet people’s needs.

People were able to make decisions about their care and were actively involved in how their care was planned and delivered.

People were able to raise their concerns or complaints and these were thoroughly investigated and responded to, so that people were confident they were listened to and their concerns taken seriously.

Staff supported people with their nutrition and health care needs and referrals were made in consultation with people who used the service if there were concerns about their health.

Processes were in place to monitor the quality of the service provided to people but these were not always effective.