This inspection took place on 22 and 27 November 2017. Both visits were unannounced.

Grace Court Care Centre 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. Grace Court Care Centre accommodates up to 30 people in one building with all bedrooms and facilities located on the ground floor. The service specialises in providing care and nursing support to people living with dementia. At the time of this inspection 28 people were using the service.

During the last inspection of the service in December 2016 we identified breaches in relation to Regulations 10, 11, 12 and 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

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, is the service safe, effective, caring, responsive and well-led to at least good. During this inspection we found that appropriate improvements had been made.

Improvements had been made to infection control procedures in place. Appropriate trolleys were in use to move soiled laundry around the building safely and equipment in people’s bedroom was stored in a hygienic way. Regular audits of infection control practices and procedures had been implemented effectively. This had resulted in a positive outcome during a recent local authority infection control audit which had taken place.

Improvements had been made as to how care and treatment was planned and recorded, to ensure that it was provided in a safe way. Care plans and assessments relating to people’s needs had been reviewed and updated and further monitoring records had been developed. Having detailed care planning documents and maintaining detailed records helps ensure that people receive the care and support they require.

Improvements had been made as to how best interest decisions, made on behalf of people under the Mental Capacity Act 2005 were recorded. More detailed documents were in place which demonstrated that people’s rights under the Act were protected.

Improvements had been made as to how the quality of the service people received was monitored. The registered manager had introduced a number of auditing systems to regularly check that people’s care planning information was up to date and that people’s medicines were managed safely. In addition, accidents and incidents experienced by people were regularly reviewed to minimise the risk of the incident reoccurring.

Improvements had been made to the availability of physical and psychological activities available to people. Two activities co-coordinators were in post to provide and support people with activities.

A registered manager had been recruited since the previous 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.

Not all of the people using the service were able to verbally tell us their thoughts about the service. We spent time sitting and chatting with people in the lounge areas and during mealtimes. We saw that people were comfortable with staffs approach to them and it was evident that staff knew people well.

People and their relatives felt that the service was safe. Staff were aware of the policies and procedures in place for safeguarding people. Staff had received training in relation to safeguarding people.

People's medicines were managed safely and appropriate storage facilities were in place.

The registered provider had procedures in place that ensured the safe recruitment of staff. This helped ensure that peo

This unannounced inspection took place on the 1 and 6 December 2016.

This was the first inspection of the service since its registration in April 2016.

Grace Court is situated in a residential area close to St Helens town centre. The service can accommodate up to 30 people who require accommodation with nursing and personal care needs. All accommodation is situated on the ground floor of the building. One area of the building is designed to support 20 people and the other area to support 10 people. A dining room is situated between both areas and can be accessed by all people who use the service. At the time of our inspection 27 people were using the service.

There was no 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.

During this inspection we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Safe effective infection control procedures were not always followed. Soiled linen was dragged through communal areas in laundry bags and two face masks belonging in place for one person was stored on a dusty floor.

Equipment in use was not always safe. On two occasions we saw that people were using wheelchairs to access the community without the appropriate foot rests in place which put both people at risk of potential harm.

Care plans were not in place to identify the needs of people in relation to eating their meal or the time in which they ate their meals. We found that one person’s agreed food menu had not been provided. Failure to plan for people’s needs and wishes in relation to their dietary needs could put individuals’ at risk of not receiving the diet of their choice.

Under the Mental Capacity Act 2005 (MCA) in relation to Deprivation of Liberty Safeguards (DoLs) we found that appropriate applications had been made to the supervisory body on behalf of people. However, we found that the principles of the MCA were not always followed in relation to best interest decisions made on behalf of people unable to make the decision for themselves. Records available failed to demonstrate that best interest decisions had been appropriately recorded.

Records relating to people’s care planning and care delivery required improvement. We found that people’s needs in relation to receiving meals and their medication whilst in bed were not always planned for. Records also failed to demonstrate in detail the care and support people had received or been offered. Failure to maintain robust care planning documents and records puts people at risk of not receiving the care and support they require.

Auditing systems in place to monitor the service on a day to day basis were not effective. The systems had failed to identify areas for improvement in relation to people’s care planning, record keeping, safety of specialist equipment and responses to complaints made about the service. Regular robust audits throughout the service failed to ensure that areas of improvement were addressed quickly to improve the service that people received.

The laundry processes and management of people’s personal effects were not always effective. People and their family members raised concerns that laundry was not always returned to the right person and personal items, for example, hearing aids and foot wear were often lost within the service.

You can see what action we told the registered provider to take at the back of the full version of this report

You can see what action we told the registered provider to take at the back of the full version of this report.

Procedures were in place to protect people from harm. Safeguarding procedures were available at the service. Staff demonstr