This inspection took place on 21 June 2018 and was unannounced. This meant the provider and staff did not know we would be attending.

The service was last inspected in May 2017 and was rated requires improvement. At that inspection we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to good governance. We found records had not always been fully completed and contained gaps. We took action by requiring the provider to send us an action plan setting out how they would improve the service. When we returned for this inspection we found that records had improved and the provider was no longer in breach of regulation.

Ingleby Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Ingleby Care Home accommodates up to 56 people across two separate units, each of which have separate adapted facilities. One of the units specialised in providing care to people living with a dementia. At the time of our inspection 47 people were using the service.

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 said they felt safe living at the service. Risks to people were assessed and plans put in place to reduce the chances of them occurring. Plans were in place to support people in emergency situations. The premises and equipment were clean and tidy and effective infection control processes were in place. Medicines were managed safely. People were safeguarded from abuse. The provider and registered manager monitored staffing levels to ensure enough staff were deployed to keep people safe. People told us there were enough staff at the service to keep them safe. The provider’s recruitment processes reduced the risk of unsuitable staff being employed.

A detailed assessment of people’s support needs was carried out before they started using the service to ensure the correct support was available. Staff received training to ensure they could provide the support people needed. Staff were supported with regular supervisions and an annual appraisal. 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. People were supported to maintain a healthy diet. People were supported to access external professionals to monitor and promote their health. The premises had been adapted to ensure the comfort, health and wellbeing of the people living there.

Every person we spoke with was very positive about staff at the service and said they received kind and caring support. Relatives also praised the quality of the care people received. Staff were particularly sensitive to times when people needed caring and compassionate support. Staff were patient, caring and kind when supporting people living with a dementia. We saw numerous examples of kind and caring support being delivered throughout the inspection. Staff protected and promoted people’s dignity and sense of self-respect. People were supported to maintain their rights as active citizens and people and their relatives told us staff made them feel like welcome and valued. Staff we spoke with demonstrated a real empathy for and commitment to the people they supported. Policies and procedures were in place to arrange advocacy support where this was needed.

Care records contained evidence of personalised care planning and delivery and were regularly reviewed to ensure they refl

This inspection took place on 31 October and 15 November 2016. Both days of inspection were unannounced which meant the registered provider and staff did not know that we would be attending.

We previously inspected the service on 18 and 22 December 2014 and found that the service was not meeting all of the regulations which we inspected. We found the service was not meeting the regulations for consent to care and treatment and good governance. This was because the service did not have suitable arrangements in place for obtaining consent. The service had not been following the principals of the Mental Capacity Act 2005 and this had not been picked up by the quality assurance measures in place at the time. There were also gaps in the quality assurance systems in place at the service. We noted that audits had regularly highlighted the same areas for improvement and actions plans had not been put in place following these audits. The registered manager was not given feedback following these audits which meant they had been unable to make the changes needed.

After inspection, the registered provider supplied an action plan to show us the action they had planned to take to improve the quality of the service.

Ingleby care home is registered to provide accommodation for people who require personal care, treatment of disease, disorder and injury and diagnostics and screening for up to 56 older people including people living with a Dementia. The service is located in a residential area within its own grounds and has on-site parking. The service is located close to local amenities. At the time of inspection there were 44 people using the service

The registered manager had been registered with the Commission since 21 January 2011. 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.

At this inspection, we could see the registered provider had made some improvements to their quality assurance processes. Appropriate procedures were in place to obtain consent. This meant they were following the principals of the Mental Capacity Act 2005.

At this inspection, we found improvements were needed to the quality and accuracy of record keeping at the service.

Some risk assessments reviewed were inaccurate because scores had not been calculated correctly. We could see that there had been no negative impact on people because of these inaccuracies in the records. There were also gaps in the information contained in care plans.

Topical cream records had not always been completed. This meant it was not clear if people were receiving their topical creams as prescribed. We also noted gaps in nutrition and hydration monitoring records. The registered manager told us that although there were gaps in these records, they were satisfied that people were receiving an adequate nutrition and hydration intake.

Staff showed they understood the procedures which they needed to follow if they suspected someone was at risk of abuse. Staff were able to discuss the types of abuse which people could be at risk from and how they could help to minimise these risks. All staff spoken with told us they would not hesitate to whistle blow (tell someone) if they needed to.

Risk assessments were in place for people's specific needs and for the day to day running of the service. Some risk assessments for people contained detailed information and had been regularly reviewed.

Health and safety certificates for the premises were up to date and showed that the service was safe for people and staff. Fire safety system checks had also been completed and staff had participated in regular fire drills.

All staff had a Disclosure and Barring Services check in place. DBS checks help employers make saf

During the inspection we spoke with nine people who used the service (from both the residential and dementia unit) and four relatives. We also spoke with the manager, the area manager, the unit manager, the cook and two care assistants. People who used the service told us that they were happy with the care and service received. One person said, “It’s very good and I’m getting settled here.” Another person said, “I think that they are all marvellous.”

We were able to observe the experiences of people who used the service. We saw that staff treated people with dignity and respect. We saw that people had their needs assessed and that care plans were in place.

People were supported to eat and drink sufficient amounts to meet their needs.

People’s health, safety and welfare were protected when more than one provider was involved in their care and treatment, or when they moved between different services.

We saw that the service had appropriate equipment. We saw that regular checks and servicing of equipment was undertaken to ensure that it was safe.

We saw that there was sufficient staff with the right knowledge and experience to support people.

In this report the name of a registered manager appears, Mrs. Lorna-Sue Loughran, who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We spoke with four people who used the service and the relatives of four people. We also spoke with the manager and three staff. People who used the service expressed satisfaction with the care and service that they received. One person told us; “It’s lovely, the girls are very friendly.” Another person told us; “They are very good to me, I don’t want for anything.” One of the relatives we spoke with told us; “The carers are very good and always helpful.”

Where able, people could make their own day to day decisions and lifestyle choices. They could choose to participate in activities or spend time in their rooms. We saw people could maintain contact with their friends and family.

People's views were taken into account in the assessment and care planning process.

Staff had received training in safeguarding of vulnerable adults.

The environment was clean and well decorated and systems were in place to ensure maintenance was carried out when required.

We found there were appropriate arrangements in place for the recruitment of staff.

We saw the home had a complaints procedure in place and this was accessible to people and their relatives.

During our inspection visit we spoke with several people who used the service. They told us they felt safe living at Ingleby Care Home and said they felt they were able to make choices about how they spent their time and the care they received. For example, one person told us they chose where they ate their meal depending on how they were feeling and that they had personalised their own room.

People that we spoke with, told us they felt they received good care. One person told us “it couldn’t be better”. Another person said “the atmosphere is great” and “I like it here”. All the people we spoke with were positive about the care they received.

Ingleby Care Home is registered to provide personal care and accommodation for up to 56 older people, some of whom may be living with a dementia. The service is provided by TL Care Limited which is operated by the Hillcare Group. The home is purpose built and is set up over two floors, accessible by both stairs and a passenger lift. The ground floor offers residential care with the first floor offering dementia care.

We carried out our unannounced inspection on 18 and 22 December 2014. At the time of our inspection visit the service had 11 vacancies. The inspection team consisted of one adult social care inspector.

The registered manager had been registered with us since 20 January 2012. 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.

At the time of the inspection we found that the home was not providing nursing care to people who lived at the home. The registered manager confirmed that the home had not provided nursing care for a number of years. We discussed with the registered manager the importance of ensuring that the service held accurate registration in relation to regulated activities and advised them of the need to apply to deregister the regulated activities that they were no longer carrying on.

People told us they felt safe in the service and we found that staff were knowledgeable about their role and responsibilities in safeguarding vulnerable adults. Risks to the health and safety of people who used the service, staff and visitors, had been appropriately assessed and actions undertaken to minimise those risks.

Staff did not understand the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were failing to work within the law to support people who may lack capacity to make their own decisions.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. People and staff told us that there were enough staff on duty to meet people’s needs. The service had begun to take action to address shortfalls they had identified in the number of staff that they had employed. We looked at staff employment files and found that they were subject to rigorous pre-employment checks before they commenced work. When we spoke with staff they informed us of the checks that were carried out and the induction and training process they undertook when they took up employment. Staff told us that they were always completing training and that they felt well supported. From a review of training records we found this to be the case.

Systems were in place for the management of medicines so that people received their medicines safely.

There were positive interactions between people and staff. We saw that staff were kind and respectful. Staff were aware of how to respect people’s privacy and dignity. People told us that they were able to make their own choices and decisions and that staff respected these.

People told us they were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met and we saw that there was effective monitoring of people’s nutritional needs.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were supported to arrange appointments with relevant professionals as needed.

Assessments were undertaken to identify people’s health and support needs as well as any risks to people who used the service and others. Plans were in place to reduce the risks identified. Care and support plans were developed with people who used the service to identify how they wished to be supported. We saw that were appropriate, for example where people’s assessed care needs had changed, staff made referrals to other healthcare professionals to ensure the correct level and type of care could be delivered.

We found that people who used the service were provided with information about how they could raise any concerns and complaints as necessary. We found people’s concerns were responded to appropriately by the registered manager and there were systems in place to enable the home and the provider to learn from complaints and incidents.

The provider had systems in place in which to seek the views of people who used the service and their relatives. There were also processes in place for monitoring and assessing the quality of the service provision, but we were unable to assess its effectiveness due to issues being repeatedly identified, and no action plans produced to address those issues.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we took at the back of the full version of this report.