Gracefields is registered to provide nursing care for up to 50 people with enduring physical conditions or conditions resulting in physical disability. On the days of our visit there were 31 people living at the home. The visit took place on 29 June 2017 and was unannounced. We last inspected the home on March 2015 and no concerns were found at that time.

There was no registered manager for the service as they had recently left the organisation. There was a new acting manager in post. The new manager had worked for the provider for some time at other services. They were in the process of applying to be registered with us. 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 supported to stay safe. The provider was making sure that CQC and the Local Authority were told of relevant safeguarding concerns. The staff understood what actions they should take to keep people safe. Staff were fully aware of their responsibilities and how to keep people safe from the risk of abuse. New staff were recruited only after a thorough safe recruitment process. This helped to protect people at the home from the risks of unsuitable staff being employed.

We saw there were friendly and caring relationships between staff and the people they supported. People were cared for in a way that respected their privacy and dignity and helped them to maintain some independence. Staff were welcoming to visitors .We saw and people told us, that there was a homely relaxed atmosphere in the home. People were supported to keep links with family members as these were promoted and encouraged. This meant that people were helped and encouraged to maintain relationships with those who mattered to them.

People were well supported with their range of nutritional and hydration needs. Mealtimes were sociable and made into a relaxed experience and people could invite guests if they wanted to.

People were cared for in a way that was kind and caring. Staff had built close relationships with people, their families and friends. People were treated with dignity and the greatest respect at all times. Staff treated people as individuals and respected their lifestyle choices.

People were supported to take part in activities of their choosing. People enjoyed the activities and the opportunities made available to them. There were links with the local community and people were encouraged to be part of their own community. The management used feedback to improve and develop the care people received and their overall quality of life.

People were aware of how to complain and make their views known .The provider actively sought the views of people and their families. These views were acted upon and changes were made to the service when needed. Feedback that was received about the service from people, families and other professionals was positive. Regular reviews were carried out of the care people received to see where improvements were needed. These also looked at whether the service provided could be further developed. There were quality checking systems in place to monitor the service to ensure people received care that was personalised to their needs.

Staff and the people who lived at the home spoke positively about the management structure of the service. People and staff said that the managers provided strong and supportive leadership. The staff team told us they were well supported by the provider and senior managers. The acting manager and clinical care manager both spoke positively about their roles. Staff and people at the home said they saw them daily and they were always there and helped them whenever they needed support and guidance.

When people's needs changed, the home t

The inspection took place on 4 March 2015 and was unannounced. At the last inspection

• on 30 July 2014 we asked the provider to take action to make improvements in relation to supporting staff in their work and monitoring the quality of the service.

The provider sent us an action plan and at this inspection, we found these actions had been completed.

Gracefields Nursing Home is registered to provide care and treatment for up to 50 people with nursing needs. There were 50 people at the home when we visited.

At the time of our inspection, there was no registered manager for the service although an application has been made by the manager. 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.

Social and therapeutic activities were arranged for people. However, a significant number of the people we spoke with said there was not enough of these activities to meet peoples social needs. The need for suitable mental and physical stimulation was particularly relevant for the wellbeing of people who had dementia type illnesses at the home.

People who lived at the home told us they felt safe there and with the staff who supported them. Staff understood what abuse was and how to report any concerns.

Risks to the safety of people were identified and suitable actions were put in place to reduce the likelihood of them reoccurring.

There was enough staff to safely meet people’s range of needs. Staffing numbers were reviewed regularly by the manager and they had recently increased as a result. For example, when people’s needs had increased due to a change in their overall health.

Staff were caring and experienced, held relevant qualifications in health and social care and attended regular additional training.

The rights of people at the home were protected because the staff understood the Mental Capacity Act 2005. The staff knew what actions to follow to promote people’s freedom and protect their rights.

People’s needs were assessed and care plans were written to explain how to meet their care and support needs. Staff liaised with external healthcare professionals to get specialist advice when needed.

Staff were polite and respectful when supporting people who lived at the home. We saw staff patiently supported people to eat their meals at their own pace.

Staff felt they were properly supported by their manager and they made time to see them every day if they needed to. People felt they could approach the manager or any member of staff if they needed to speak with them because they had a concern to raise.

The provider had a system in place to properly monitor and improve the quality of the service. Audits showed that regular checks were carried out .

The inspection team who carried out this inspection consisted of an adult social care inspector and an expert by experience. During the inspection, the team worked together to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Is the service safe?

We observed staff assisted people with their needs in the ways that were identified in their risk assessments and care records. For example staff were observed following safe practices when they assisted people with their mobility needs. Care plans and risk assessments demonstrated that risks were identified and preventative actions that kept people safe were in place. There were also risk assessments that identified environmental hazards that may impact on people’s health and safety.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, and investigations. However the analysis of accidents and incidents was not being carried out consistently. This lack of consistent analysis meant there was a risk people may not always receive care that is safe and suitable for them.

Is the service effective?

The people we spoke with had positive views to share with us about life at the home and the way they were treated by the staff who supported them. Examples of comments peoples told us included “the staff are wonderful and can’t do enough for us”, “the staff make this place” and “they are all so attentive and kind”.

We observed staff assisted people with their needs. Staff were attentive in manner when they assisted people. We saw that staff anticipated the needs of people who were not able to make the views known. For example when a people maybe thirsty and hungry, and whether people were comfortable in the chair they were sat.

We saw that menus were planned, based on people’s personal preferences. The people who we spoke with expressed positive views about the meals served at the home. . One person told us the food was “lovely” and there is always plenty of it”. Another person told us the food was “wonderful like home cooking”.

Staff told us they were informally supported in their work and overall performance by senior staff. This was to assist them to support people effectively. However the system of formal staff supervision had not been kept up to date. The lack of an up to date staff supervision system meant staff were not consistently provided with suitable support, to ensure people received effective care.

Is the service caring?

People who used the service and relatives had generally positive views of the staff who assisted them with their needs. Examples of comments made included, “the staff make this place” and “they have been fantastic I can’t fault any one of them”, and “they are all wonderful”.

We saw that people were assisted with their needs by staff who demonstrated by their manner and approach with people that they were caring and attentive to them. We also heard staff encouraged people to make choices in their daily life. For example, we heard staff ask people what time they wanted to be assisted with their needs and how they were feeling. We also heard staff ask people what meal choices they wanted for lunch.

Is the service responsive?

We saw that there were social and therapeutic activities held in the home. The times of certain activities were flexible to ensure activities took place at times that suited people. Also more activities had been arranged for people who may experience memory loss due to dementia type illnesses.

People who were staying in the respite service in the home were assisted with their recovery by physiotherapists and occupational therapists from a community health service. The community health care organisation worked closely with people who received a rehabilitation service. This was to support and assess their needs.

We saw that people had their call bells in reach if they needed to call for staff assistance. We heard people rang their call bells and staff answered them without an unreasonable time delay.

Is the service well-led?

The home has been open since February 2014 and the current manager has been registered with us since May 2014. They demonstrated during the inspection that they were committed to improving standards in the home. They also demonstrated that they were open and transparent in their approach to the running of the home. They were assisted in their role as registered manager by a senior manager who worked for the provider. To provide additional support to the manager the senior manager had now based themselves at the home.