This inspection took place on 09 January 2018 and was unannounced. Our last inspection was in October 2016 where we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities 2014). These related to governance and the processes for obtaining consent from people. At this inspection, the provider had taken action to meet the requirements of the regulations.

Grace House is a residential home providing care and support to up to 21 older people. People living at the home had physical disabilities, frailty and some people were living with dementia. At the time of our inspection, there were 18 people living at the home.

Grace 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 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 had access to a wide range of activities that were tailored to their interests. Staff took time to find out about people’s interests and identified activities based on these. People were complimentary about the food on offer at the home and the provider regularly asked people’s feedback on food, activities and the care that people received. Staff provided support to people in a way that respected their right to consent and in line with the legal process set out in the Mental Capacity Act 2005.

Care was planned in a person-centred way. People’s care plans contained important information about their needs and what was important to them. People’s wishes for end of life care were clearly documented. Where people faced individual risks, appropriate plans were implemented to keep them safe whilst promoting their independence. Staff supported people in a way that encouraged them to maintain and develop skills. People were regularly offered choice and involved in decisions about their care.

Staff supported people safely following incidents. Staff understood their roles in safeguarding and responded appropriately where they identified concerns. The provider analysed all accidents and incidents and responded to any trends that they found. The provider was open and transparent when dealing with relatives, healthcare professionals and CQC. Regular audits were carried out to monitor the quality of the care that people received.

People’s medicines were managed and administered safely, by trained staff. Staff supported people to access healthcare professionals whenever this was required. The provider had built links with local community organisations and agencies. People were supported by kind and respectful staff who were mindful of people’s privacy and dignity whilst providing care.

People were supported by staff that were trained to carry out their roles. Staff felt supported by management and had regular one to one meetings with their line managers and regular team meetings. Staff were able to make suggestions about the running of the home that led to improvements for people. There were clear leadership structures at the home and systems were in place to enable effective communication between staff.

The inspection took place on 27 October 2016 and was unannounced. This was a comprehensive inspection.

Grace House is a residential home providing support to up to 21 older people, many of whom are living with dementia.

There was a 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.

At our last inspection in November 2014 we found breaches of the legal requirements. The provider wrote to us to inform us of the action they planned to take to address the concerns. This comprehensive inspection was conducted to check that the action had been taken by the provider and that they were now meeting their legal requirements. We found that measures had been taken to ensure breaches in regulation were met but we did identify other areas in which the provider was not meeting legal requirements.

People’s rights were not protected as staff did not work in accordance with the guidance of the Mental Capacity Act (2005). Restrictions were being placed on people before their mental capacity had been assessed. Best interest decisions were also not recorded. MCA assessments were not taking place for day to day decisions.

At our last inspection, we recommended that the provider review their systems for assuring quality. At this inspection, we found that whilst some improvements had been made, there was a lack of robust quality assurance systems in place to ensure people received care of a high quality.

Accidents and incidents were recorded and measures were taken to prevent a reoccurrence. Staff routinely carried out risk assessments and created plans to minimise known hazards whilst encouraging people’s independence. Staff understood their responsibilities in safeguarding people and knew what to do if they suspected abuse had occurred.

People had access to some activities. We recommended that the provider review the activities on offer to people.

Systems were in place to keep people safe in the event of an emergency. A contingency plan was in place to ensure people’s care could continue in the event of evacuation.

People were administered their medicines safely and as prescribed by healthcare professionals. We saw evidence of staff working alongside healthcare professionals to ensure that people’s needs were met.

People had care plans in place that reflected their needs and preferences. Where people’s needs had changed, care plans were updated to reflect this.

There were sufficient staff present to meet people’s needs safely. Staff had undergone checks to ensure that they were appropriate to be providing care to people.

People told us that they enjoyed the food and we saw evidence of people being provided with choice and also being consulted on food during meetings and reviews.

People were supported by kind and compassionate staff who knew them well. Staff demonstrated a good understanding of how to promote people’s privacy and dignity.

Staff felt supported by management and had input into how the home was run. People’s feedback was regularly sought and complaints were responded to appropriately.

During the inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The service is a care home providing accommodation, personal care and support for up to 19 older people, some of whom are living with dementia. There were 17 people living at the home at the time of our inspection. There was a 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 and associated Regulations about how the service is run.

The inspection took place on 4 November 2014 and was unannounced.

We identified some shortfalls in the way medicines were managed. Incomplete medicines administration records meant that it was not possible to know whether some medicines had not been given or given and not recorded. In a number of cases, the section relating to allergies to medicines in people’s individual medicines profiles had been left blank, which meant there was a risk of people being prescribed medicines to which they were allergic.

This was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

The provider carried out risk assessments but had not considered the risk of falls for some people. We have made a recommendation about risk assessments.

There was a quality monitoring system in place but this was not sufficiently robust. We have made a recommendation about the effectiveness of quality monitoring systems.

There were enough staff with appropriate skills and experience to keep people safe and to meet their needs. Staff felt supported and had the training and information they needed to do their jobs well. People told us that staff were kind and caring. They said that staff treated them with respect and maintained their dignity. Some of the things people said about the service were, “I’m very happy here, they look after us very well” and “I’m comfortable here, I wouldn’t want to change anything.”

People were supported to maintain good health and to access healthcare professionals as needed. They were provided with a varied and balanced diet and their nutritional needs were assessed and monitored. People received care which met their individual needs and were asked for their consent to care and treatment. Where people did not have the capacity to consent, the provider had acted in accordance with legislation and guidance.

The registered provider and the registered manager promoted an open and inclusive culture. People and their relatives had opportunities to give their views about the service they received and the provider responded appropriately to changes requested.