This inspection took place on 28 August 2018 and was unannounced. This was the provider's first inspection since their registration in July 2017. Gracewell of Bookham 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. Gracewell of Bookham is a care home set over three floors that provides nursing and personal care and support for up to 70 older people. At the time of our inspection, 58 people were using the service.

There was a manager in place who had applied to become the registered manager with the CQC. 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. On the day of the inspection the manager was on leave, however the deputy manager was available and spoke with us.

At this inspection, we observed that medicines were not always managed safely. Infection control checks were carried out but were not robust. There were system’s in place for monitoring and investigating accidents and incidents, however, learning from these were not disseminated to staff. Food and fluid charts were not always completed in full. The provider did not have an accessible information (AIS) policy in place so that people were provided with information about the service in a format that they could easily understand. Staff understood the Mental Capacity Act (2005), however, best interest meetings had not always been documented. Care plans were not always available in people’s care files for staff to consult should the need arise. People were supported to have a balanced diet; however, food and fluid charts were not completed in full and monitored. Care plans did not always record people’s diverse needs. There were not effective systems in place to monitor the quality and safety of the home as the provider had failed to identify the issues we found at this inspection. You can see what action we told the provider to take at the back of the full version of the report.

People told us they felt safe and there were appropriate safeguarding procedures in place to protect people from the risk of abuse. There were enough staff deployed to meet people’s needs and the provider followed safe recruitment practices.

Staff received an induction when they started work and were supported through a programme of regular training and supervisions to enable them to effectively carry out their roles. People's needs were assessed prior to moving into the home to ensure their needs could be met. 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. Staff told us they asked for people’s consent before offering support. People’s care files included assessments relating to their dietary support needs and they were supported to have enough to eat and drink. People had access to healthcare professionals when required to maintain good health and the service worked with them to ensure people received the support they needed. The service met people's needs by suitable adaptation and design of the premises, which included appropriate signage to help people orientate themselves and appropriately adapted bathrooms to manage people’s needs effectively.

People told us staff were caring and respected their privacy and dignity and that they had been consulted about their daily care and support needs. People were supported to be independent wherever possible. People were provided with information about the service when they joined in the form of a 'service user guide' so