We inspected Graceland Care Home on 9 and 12 March 2018. The provider was given 12 hours' notice before the first day of the inspection. At the end of the first day we advised the provider that we would be returning the next working day to speak with people living in the home as they were all out on the first day of our inspection. At the last inspection in December 2014, the service was rated 'Good'. At this inspection we found the service remained 'Good'.

Graceland is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. Graceland Care Home is not registered to provide nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Graceland Care Home is registered to accommodate up to three adults; its specialism is supporting people with a learning disability. At the time of our inspection there were three people living in the home. Graceland Care Home is located off a busy main road in Thornton Heath, close to shops and good transport links. Each person had their own room which was well furnished and decorated. The decor in the communal lounge/diner required updating but all areas of the home were clean and tidy. Graceland Care Home had the feel and is run like a small family home. The registered manager told us that was her aim.

Graceland Care Home has been developed and designed in line with the values that underpin the Building the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with a learning disability were supported to live as ordinary a life as any citizen.

People’s needs had been assessed and they were involved in developing their care and support with staff. If they wanted to change any aspect of this, it was discussed with staff and care records were updated accordingly. Staff worked within the principles of the Mental Capacity Act 2005. People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were encouraged to be as independent as possible. They were supported in a way that developed their confidence to do as much as they could for themselves. People were protected from the risk of social isolation. They spent their days out at social clubs engaged in a wide range of activities which reflected their age and interests. Staff supported people to stay in contact with their relatives.

People were supported to stay healthy and well. They were given nutritious, well-balanced meals and had a sufficient amount to eat and drink. They were registered with a local GP surgery and visited specialist healthcare professionals when necessary. Staff ensured people's physical and mental health was regularly reviewed. People’s medicines were managed safely and they received them as prescribed..

There was a sufficient number of staff to meet people's needs and they had been through a satisfactory recruitment process. Staff felt supported in their roles and had access to refresher training to keep their knowledge and skills up to date. The registered manager and staff knew people well and understood how to meet their individual needs. They treated people with kindness ad respect.

People were supported by staff who knew how to protect them from abuse and avoidable harm; they knew how to report and escalate any concerns. People’s views and the opinions of staff were sought to make improvements to the service provided. People were given information on how to make a complaint and told us they would do so if necessary.

The registered manager was at the service every day which meant that they had good oversight of staff working practices. The registered manager and staff worked well as a team to ensure people received consistently good person-centred care.

We inspected Graceland Care Home on 16 December 2014. The inspection was unannounced.

Graceland Care Home is a home for people with mild to moderate learning disabilities. At the time of our visit there were two people living at Graceland Care Home which is the maximum number of people the home is registered to take.

The service had a registered manager who had been at the service for many years. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We previously inspected Graceland Care Home in May 2014. We found that Graceland Care Home was not meeting all the legal requirements and regulations that we inspected. We were concerned that people who use the service were not adequately protected from the risk of abuse, because staff did not have good knowledge about how to do so. We were also concerned about the standard of record keeping and how people’s records were stored. After the inspection in May 2014 we asked the provider to take action to make improvements This action has now been completed.

During the inspection in December 2014 people told us they were safe. They knew the type of behaviour that was unacceptable and who to contact if they had any concerns about their safety. Staff knew how to protect people against abuse and avoidable harm. There was a sufficient number of suitable staff to keep people safe and meet their needs.

People received their medicines safely because there were appropriate systems in place for storing, administering, recording and disposing of medicines which staff followed. The home was clean.

People were cared for by management and staff who had the necessary skills and experience to support them effectively.

Staff understood the general principles of the Mental Capacity Act 2005 and the specific requirements of the Deprivation of Liberty Safeguards and how they applied to people in their care.

People were supported to express their views, including where they went and what they chose to do with their time. People were given a choice of nutritious meals and had enough to eat and drink. People received the support they needed to maintain good health.

People were treated with respect and kindness. People’s privacy and dignity were maintained by staff. People received care that met their individual needs and were fully involved in making decisions about their care

The management and staff knew people well. They knew their habits and preferences and understood what was important to them. People received continuous care that met their needs. People knew how to and felt able to raise concerns or make a complaint.

At the time of our inspection there were two people using the service. We spoke with both of them, a relative and three members of staff. During the inspection we worked to answer five key questions: Is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service and staff told us.

Is the service safe?

People told us they felt safe and that they would tell the manager or social services if they had any concerns about their safety. A relative told us, “I have no concerns about their safety." We saw that risk assessments were conducted which considered a variety of risks and stated how they should be managed. Staff were aware of the Deprivation of Liberty (DoLS) legislation and how it applied to the people in their care.

However we were concerned that people who use the service were not protected from the risk of abuse, because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We spoke with staff and found they did not have good knowledge about safeguarding people using the service from abuse. On the day of our visit staff were unable to locate the care plan for one of the two people using the service. We considered this presented the risk that a person using the service could receive care and treatment that was inappropriate or unsafe.

Is the service effective?

People were satisfied with their care and the way it was delivered. One person told us, “I'm happy here. Another person told us, “I can look after myself but they help me." People were provided with a choice of suitable and nutritious food and drink. People told us they were satisfied with the quality and quantity of their meals.

We found that a variety of external healthcare professionals were involved in people's care. People using the service were encouraged and supported to be independent. We saw that people spent most of their time away from the home at day centres, doing voluntary work, going to discos or visiting friends in other homes owned by the provider.

Is the service caring?

We found the staff we spoke with to be caring and interested in the welfare of people using the service. Staff told us they knew people's needs because they had worked with them for several years. People told us the staff treated them well. One person told us, “I like living here, the staff are nice." A relative told us, “From what I've seen they are always treated with dignity and respect."

Is the service responsive?

People using the service were involved in their assessments and care planning. The care provided reflected people's individual needs and personal preferences. Staff told us the manager met regularly with them and people who use the service to get their views. People using the service confirmed this and also said they could approach the manager or staff at any time if there was any aspect of their care they were unhappy with.

People were able to give examples of when their comments had been taken into account. One person told us, “I told them I didn't like my job and they got me another one." Another person told us, “I do what I want and if I want to change something I tell X (the manager)." A relative told us, “...the manager contacted us recently to find out our views on a situation."

Is the service well-led?

At the time of our inspection there was an acting manager who was responsible for the running of the service. We were concerned the permanent manager was away from the service for an extended break but had not left the acting manager with access to many of the records relevant to the running of the service or information as to where the records were stored. This meant there was a risk of people receiving care or treatment which was inappropriate or unsafe because relevant records could not be located.

We found the service was not meeting the essential standards of quality and safety in relation to safeguarding people who use the service from abuse and their record keeping. The provider must send CQC a report that says what action they are going to take to meet these essential standards.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care.

During our visit we spoke with the two people who use the service and asked for their views about what it was like to live at Graceland. They told us they felt the standard of care and support they received was good.

Throughout our review we saw staff interacted with the people who use the service in a kind and courteous way.

The staff told us that people who use the service were actively encouraged and supported as far as they were willing to maintain and develop their independent living skills. Care plans we looked at contained information that clearly showed us the willingness and capacity of the people who use the service.

We have not been able to speak to people using the service because they were at the day-care centre when we visited. We gathered evidence of people’s experiences of the service by reviewing comment cards and looking at the minutes of the reviews that had been carried out by the placing authority. We found that people were happy with the care they were receiving. Comments were as follows:- I really like it here” and “I enjoyed staying here”.

On the day we visited, the two people who use the service were at the daycentre. We were unable to gain their views about the service. However we were able to see evidence that they were satisfied with the care and support they are receiving.