This inspection took place on 17 and 18 July 2018. The first day of the inspection was carried out by one adult social care inspector, a Pharmacy inspector, a specialist nurse advisor and an expert by experience and was unannounced. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The second day was carried out by one adult social care inspector and a specialist nurse advisor and was announced.

Gracewell of Frome 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.

This service has a dual registration which means there are two registered providers jointly managing the regulated activities at this single location. They are: Gracewell Healthcare Limited and Gracewell Healthcare 3 Limited. This means the service is subject to one inspection visit however the report is published on our website twice, under each provider.

This was the first inspection since the location was registered with the new dual provider Gracewell Healthcare 3 Limited. No concerns were identified during the registration process.

People told us they felt safe living in the home. One person said, “Yes I feel very safe, because there is always someone here to look after me.”

There were systems and processes in place to minimise risks to people. These included a robust recruitment process and making sure staff knew how to recognise and report abuse. All staff spoken with were confident action would be taken by the registered manager and provider to address any issues they may raise.

There were sufficient staff to meet the needs of people in the home and a recruitment programme meant they no longer needed to rely on support from agency staff. However, some staff and relatives felt there could be more staff on duty at busy times. The management team had listened to people’s comments and a twilight shift had been introduced.

The administration of medicines was managed safely however it was noted that a there was some excess stocks of medicines in the home and some people had missed medicines due to stock not being replaced. The deputy manager said they were currently looking into these shortfalls and discussing with their suppliers.

People received effective care from staff who were well trained and understood their needs, likes and dislikes. However, we recommended the provider looked at ways of using the knowledge and expertise of local healthcare professionals to support training for qualified staff.

People told us the dining experience was outstanding we observed most people were supported to eat and drink with dignity and respect. The home chef had developed sensory meals for people which involved them using all their senses to enjoy a meal using reminiscence of smells and sounds. Meals for people who required pureed diets were well presented with the food still resembling its original shape through moulding and sculpting. The chef told us about the smoothie’s recipes they had adapted for people in the home. This meant they could liaise with GP’s when fortified foods were required so that people could have fortified smoothies of their choice rather than prescribed fortified drinks.

People said they received care and support from caring and kind staff. Comments included, “They [the staff] are all really nice and they care about me.” And, “They [the staff] are all lovely. They have a tough job and always do it with a smile.”

People told us they could talk with staff and the manager if they wished to raise a concern. One person said, “He [the manager] is always visible and takes the time to listen. If I felt the need to complain, which I don’t. I think he would listen to me.”

People received care that was responsive to their needs and personalised to their wishes because regular