Ings Grove House

Ings Grove House is a care home which can support up to 40 people. The home provides intermediate care, which supports hospital discharge through rehabilitation to help people regain previous levels of independence. At the time of the inspection, there were 24 people using the service.

People’s experience of using this service and what we found

The service was not always managed well. Quality assurance systems were in place and happening regularly, however these had not always been effective in identifying the issues found at this inspection. Improvements were required to ensure records in relation to people’s care were complete and accurate. This area had already been identified by the registered manager as requiring improvement.

Medication was not always managed safely. We found concerns in relation to the management of ‘as and when’ required medicines and thickeners. There had been several medication errors at the service and although none had a detrimental impact on people’s health, there was a high risk lessons were not being learnt to prevent reoccurrence.

We received mixed feedback from people and staff in relation to the staffing levels at the service. We reviewed the time of response to call bells and found examples of this being responded to over the expected time set by the registered manager. Some of these issues had already been identified by the registered manager, others had not. We recommend the provider reviews their staffing levels, taking into consideration dependency levels, call bell response times and the layout of the building.

People and relatives told us the care received at the service had a positive impact on people. People told us they felt safe and enjoyed being at the service; their comments included, “[Coming to Ings Grove] was the best thing that ever happened.” Relatives shared positive feedback as well.

People were supported to have maximum choice and control of their lives, and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Throughout the inspection the registered manager was honest and open with us. They acknowledged the shortfalls identified at this inspection and were eager to put processes in place to ensure people receiving care and support were safe and protected from harm.

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

Rating at last inspection

The last rating for this service was good (published on 24 October 2019).

Why we inspected

This was a planned inspection.

We have found evidence the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

We made a recommendation for the provider to review good practice guidance in relation to safe staffing levels.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Ings Grove House is a care home which can support up to 40 people. Most people stay in the home for short periods of up to 6 weeks. The home provides 30 intermediate care beds, which supports hospital discharge through rehabilitation to help people regain previous levels of independence. A respite service is also provided. At the time of the inspection there were 29 people using the service, with occupancy reduced due to refurbishment work.

The accommodation is spread over two floors each of which has their own communal areas including dining room and lounge.

People’s experience of using this service and what we found

People told us they felt safe staying in the home and their care needs were consistently met by the service. Overall medicines were managed in a safe way. Risks to people’s health and safety were assessed and staff had a good understanding of the people they were caring for. There were enough staff to ensure prompt care and support. The building was appropriately maintained.

People said they were provided with good quality care from knowledgeable staff. Staff told us they felt well supported and we saw they had access to a range of training and support. People praised the food provided by the home. The service worked with a range of professionals to ensure people’s needs were met.

Without exception people said staff were kind and compassionate and this was confirmed by our observations of care and support. Staff knew people well and ensured they were treated with dignity and respect. People were given choices and their views were respected.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People’s care needs were assessed, and people received good quality person centred care. People had access to a range of activities. Complaints were well managed, with reflection and learning taking place to continuously improve the service.

People and staff praised the way the service was led. The registered manager had good oversight of the service and had improved the quality of the service of the last year. A range of audits and checks were undertaken to help ensure the service operated to a high standard. People’s feedback was sought through various mechanisms and their comments were used to improve the service.

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

Rating at last inspection and update: The last rating for this service was requires improvement (published 29 September 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service was previously inspected on 11 and 16 June 2017 and was found to be in breach of the regulations in relation to the provision of safe care and treatment, good governance and staffing. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, responsive and well-led. At this inspection we found some improvements had been made but there were areas which required further improvement. We found a continuing breach around good governance.

Ings Grove House is a ‘care home’. 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.

There was a registered manager at the home although they were not present on the first day of our 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.

Medicines were stored safely, and procedures were in place to ensure medicines were administered safely, although the application of creams was not always recorded. We saw people received their medicines in a timely way from staff who had been trained to carry out this role although staff were not following current best practice in relation to the signing of medication administration records.

There were sufficient numbers of staff to provide a safe service. However, people told us call bells were not always answered promptly.

There had been an improvement in the way some risks were assessed and managed. However, there still remained areas which required further improvement to ensure all risks to people were minimised through comprehensive assessment and reduction plans.

People we spoke with said they were very happy with the meals provided and were involved in choosing what they wanted to eat and where they wanted to eat their meals.

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. Most people had the mental capacity to consent to their care and treatment. Where it had been necessary, the registered manager had complied with their responsibilities under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).

The registered provider had not fully met their responsibility to ensure staff received periodic supervision, appraisal and training although there had been some improvement from the last inspection. Staff told us the registered manager sought out courses to support their development, following discussions with staff.

People had been referred to health professionals when the need arose and we saw this had positively affected people’s wellbeing. The service had the benefit of an on-site multidisciplinary team to provide intermediate care for people assessed as requiring this service.

We observed staff were very kind and caring when they were supporting people with care and they were treated with dignity and respect.

Care records although brief contained information about a person’s needs and abilities and outlined the goals they wished to achieve during their stay.

Not every area of care had been audited in enough detail to assess the quality of the service provided. Delegated tasks had not always been completed. Where audits identified shortfalls, it was not always clear improvements had been made as we found similar issues recurring from our previous inspection.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to staffing and good governance. You can see what action we told the provider to take at the back of the full version of the report.

Ings Grove House is registered to provide accommodation and personal care for up to 40 people. The home has 28 beds allocated for intermediate care. The remaining places were available for people requiring respite care and people transitioning from hospital and waiting for adaptations and care packages in their own homes. There is a multi-disciplinary team based at the home to support people receiving intermediate care. The accommodation is based over two floors linked by a passenger lift. Accommodation is in single rooms with each room having en-suite facilities. Lounge and dining facilities are situated on two floors.

There was a registered manager in place who has been registered since March 2017. 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 living at the home. Staff we spoke with were knowledgeable about safeguarding people. They were able to explain the procedures to follow should an allegation of abuse be made.

There were some systems and processes in place to protect people from the risk of harm. Assessments identified risks to people and management plans were in place to reduce the risks and ensure people’s safety but these had not always been updated when people’s needs had changed. Not everyone at the service had a Personal Emergency Evacuation plan.

Medicines were stored safely and procedures were in place to ensure medicines were administered safely with the exception of prescribed creams. We saw people received their medicines in a timely way from staff who had been trained to carry out this role although their competencies had not been assessed in line with good practice.

The registered provider had not fully met their responsibility to ensure staff received periodic supervision, appraisal and training to ensure their competencies were maintained and to keep up to date with best practice to enable them to perform in their role.

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. The registered manager had complied with their responsibilities under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). They had a good understanding of when a person might be deprived of their liberty.

People we spoke with said they were very happy with the meals provided and were involved in choosing what they wanted to eat and where they wanted to eat their meals. Mealtimes were a relaxed and enjoyable experience for people at the home and staff supported people with dignity and respect.

Staff interacted with people with warmth and respect and we saw the atmosphere in the home was friendly and supportive. Staff were able to spend time chatting and laughing with people. People spoke highly of the staff who cared for them and felt able to raise any concerns with staff.

Care files were person centred and evidenced people were involved in their care planning when appropriate. Due to the nature of the service, people’s needs changed frequently and the care plans were not always updated to reflect this. However, the registered manager had devised a written handover sheet which contained essential information to guide staff. Families had also been consulted with to ensure people’s preferences and views were considered when devising support plans.

There was a positive atmosphere in the home and people all told us how much they liked staying there. Staff were friendly, helpful and were all positive about their experiences working at Ings Grove House. The registered manager had only been in post a short time when we inspected but demonstrated she was changing systems and processes to improve the service delivered to ensure they met their regulatory obligations. We found not all the existing systems, processes and audits had been robust and did not identify all issues.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, the training and supervision of staff, and in good governance. You can see what action we told the provider to take at the back of the full version of the report

We returned on this inspection to check whether improvements had been made.

We looked at the care records for three people who used the service and found that people had their ability to make choices and decisions included in their support plans.

We were told by three people using the service, two other people's relative's and 11 staff that they felt there were not enough staff on duty. The staff also told us that this was due to the increase in the dependency levels of people using the service. They said they felt worried about the quality of the care they were delivering.

We spoke with the Head of Care and the manager who addressed this issue immediately by ensuring that staffing levels were increased. This meant there were enough staff on duty to meet the needs of people using the service.