Gracewell of Horley Park is a home which provides residential and nursing care for up to 60 people. People living in the home have a mixture of needs, from requiring support with personal care or living with dementia to requiring nursing intervention for a particular medical condition. At the time of the inspection there were 48 people living at the home.

This was an unannounced inspection that took place on 27 September 2016.

The home had a registered 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 and associated Regulations about how the service is run. The registered manager assisted us with our inspection on the day.

We last inspected this home on 17 September 2015 where we identified three breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to a lack of staffing, failing to follow legal requirements in relation to restriction and a lack of good record keeping. We asked the provider to submit to us an action plan outlining how they planned to meet these regulations. We reviewed the action plan during this inspection against what we observed, to see whether or not the provider had taken appropriate action. We found the provider had taken sufficient action to show they were now meeting the regulations.

There was a kind, caring and relaxed atmosphere in the home where people and staff interacted together well. People and relatives were very happy with the care provided and relatives were made to feel welcome when they visited. Staff supported people to take part in various activities and staff were attentive to people and knew them well.

People were provided with a choice of meals each day and those who had dietary requirements received appropriate foods. Staff followed the guidance of healthcare professionals where appropriate.

Staff provided care in line with the Mental Capacity Act 2005 (MCA). Records demonstrated that people’s rights were protected as staff acted in accordance with the MCA when being supported to make specific decisions. The registered manager was aware of when people may be restricted and it was appropriate to submit applications to the supervisory body in relation to this.

Staff followed correct procedures in administering medicines and medicines were stored safely. Care was provided to people by staff who were trained and received relevant support from their manager. Staff told us they felt supported by the registered manager and enjoyed working in the home. There was a positive culture within the home.

Staff understood their role in safeguarding people. Staff routinely carried out risk assessments and created plans to minimise known hazards whilst encouraging people’s independence. In the event of an emergency there was a contingency plan in place to help ensure people’s care would continue uninterrupted.

There were sufficient staff in the home to help ensure people received the care and support they required. Robust recruitment processes were in place to ensure that those staff who were providing the care were suitable to be working at the home.

Care plans contained information to guide staff on how someone wished to be cared for. Staff had a good understanding of people’s needs and backgrounds as detailed in their care plans.

Quality assurance checks were carried out to help ensure the environment was a safe place for people to live and they received a good quality of care. Staff were involved in the running of the home as regular staff meetings were held. People and relatives were given the opportunity to provide feedback on the care they received through residents meetings.

People knew how to make a complaint if they felt the need to and suggestions raised by people were responded to by

Amherst House Care Home provides care and treatment for up to 60 people, some of whom may be living with dementia. The home is divided into four units, with three units providing nursing care and the fourth residential care. On the day of our inspection 47 people were living in the home.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. The area manager was acting as the manager and had begun the application process to become the registered manager.

There were an insufficient number of staff deployed in the home. We read staffing levels did not meet the minimum requirement at times and particularly during the night people could go without appropriate care.

Staff felt supported by the manager, although they told us morale was low due to a lack of staff.

Robust records were not held about people which meant new or agency staff may not be working to the latest information.

Staff had not always followed legal requirements in respect of restrictions or decisions made on behalf of people. Although we found staff had a good understanding of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS).

Staff supported people in an individualised way and offered them a good range of activities, however people who spent a lot of time in their room did not have much attention from staff at times.

Some elements of correct medicines management were not followed by staff, although we did see staff administer medicines safely to people.

Staff had considered all risks for people to demonstrate people were safe living at Amherst House, but some of these risks were not individualised.

People could choose the food they ate and meals times were social. However, staff were not proactive with keeping good records about people’s dietary requirements.

Staff treated people in a kind and caring manner, we observed lots of attention care of people and it was evident staff had a good understanding of the individual needs and characteristics of people.

Staff were aware of their responsibilities to safeguard people from abuse or able to tell us what they would do in such an event.

People’s care would not be interrupted in the event of an emergency and if people needed to be evacuated from the home as staff had guidance to follow.

Staff were provided with training specific to the needs of people. Staff were given the opportunity to progress professionally and meet with their line manager on a one to one basis. Appropriate checks were carried out to help ensure only suitable staff worked in the home.

Quality assurance checks were carried out by staff as well as the provider and feedback was sought from relatives. Residents and staff were involved in the running of the home. Regular meetings were held where all aspects of the home could be discussed. A complaints procedure was available for any concerns.

Staff responded to people’s changing needs and people had access to external health services.

During the inspection we found breaches 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.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This was an unannounced inspection.

Amherst House care home provides care and treatment for up to 60 people, some of whom may have dementia. The home, run by Gracewell Healthcare Ltd, opened in April 2014. On the day of our inspection the service had 17 people living in the home. This meant we are unable to rate this service as it was not providing care to a full compliment of people at the time of our visit.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People and their relatives told us they felt they were safe living at Amherst House. One person told us, “I feel very safe here” and a relative said, “I feel absolutely certain (my relative) is safe here.” Staff had received safeguarding vulnerable adults training and were able to tell us what they would do if they had any concerns. Staff had also received training on the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager had a good understanding of DoLS and we saw they had recently submitted an application in respect of one person.

The provider had robust recruitment processes which helped ensure they employed people who were suitable to work with vulnerable adults.

Care plans contained individual risk assessments in order to keep people safe at the service. For example, one person required assistance with feeding in a slow manner to avoid coughing. Staff told us they felt there were enough staff on duty each day. One member of staff said, “If we use agency staff it is always the same people.” One relative said, “They seem to have plenty of staff here, they are always checking on (my relative) and others.” Staff attended to people promptly and when an alarm bell went off two members of staff responded very quickly.

Staff had regular supervision with their line managers and they told us they felt supported. They said they were encouraged to progress professionally and attend training appropriate for their role.

People were encouraged or supported to make their own decisions about their food. There was a four-weekly menu which gave people choice and people could ask for an alternative if they wished. Meals consisted of a choice of appetising mains and puddings and all of those we spoke with on the day told us the food was good. One person told us, “They do ask if you would like changes to the menus.” A relative told us, “(My relative) eats little and often but the food is good.”

People had access to other health care professionals as and when required. We heard from one person who said, “They arranged for a doctor to visit me twice.” Another person told us, “They would ask if I wanted to see the chiropodist.”

During our visit we observed staff administer care to people with kindness, compassion and sensitivity. Staff knew all residents names and were aware of their needs. One person told us, “They give me everything I want” and another said, “I can assure you that I am very well looked after here.” Everyone told us they felt staff treated them with respect and dignity and they could have privacy whenever they needed it.

Relatives told us they were involved in reviewing the care and treatment provided to their family member. One relative said, “They always tell us what is happening to (my relative).” Another told us, “The care plan was drawn up when they first came and a review was done last week. The manager said it would be done again in three months.” This was reiterated by people who lived in the home. One said to us, “I was party to the drawing up of the care plan” and another told us, “There was a chat about my needs when I came here.”

The service had an activity co-ordinator and two volunteers. In addition, the home had its own cinema and a craft room. There was a ‘café’ in the lobby, together with two computer terminals where people could ‘Skype’ or email family members or friends. People chose how they wished to spend their time. One person told us, “I like staying in my room and that’s okay with them.” Another told us, “I have my hair done weekly.”

Information was available to people on how to make a complaint. Everyone told us they would know how to make a complaint. One person said, “I have not had reason to complain, but I would to the staff.” The registered manager told us there had been no complaints since the home had opened. The service held an accident and incident log which recorded details of the incident, together with the outcome and action taken. There had been two accidents which had been dealt with appropriately.

People said the registered manager was “Very approachable and supportive.” One relative told us, “They (the manager) is absolutely fantastic.” As the home had recently opened a survey had not been carried out but staff carried out regular audits of the service which included a monthly organisational visit.