This unannounced inspection took place on 7 and 8 August 2018.

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

Gracewell of Salisbury 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.

The care home accommodates 63 people in one adapted building. At the time of our inspection 58 people were residing at the home. The service is in the city of Salisbury. Accommodation is arranged over three floors which are accessed via a lift. All rooms are en-suite and there are landscaped gardens.

There was a registered manager in post. 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.

At our last unannounced focused inspection in August 2016 we found the service was not meeting legal requirements. We found concerns relating to medicines management and records relating to incidents and accidents. At this inspection we found the necessary improvements had been made and we rated the service ‘Good’ overall.

Medicines were managed safely. Where appropriate people were supported to manage their own medicines. We observed staff administering medicines and found their practice to be safe. Staff had received training on medicines administration and had their practice observed to check for competence.

Accidents and incidents had been recorded in detail and action taken to minimise the risk of re-occurrence. There were opportunities for staff to discuss incidents and use reflection to learn any lessons. Risks had been identified and safety measures put in place to keep people safe from avoidable harm. All risk assessments were reviewed regularly. Care and support plans contained sufficient detail to support the staff to deliver personalised care.

The service had improved systems in place following falls. If people sustained a fall they were assessed by a nurse. If further medical advice or treatment was needed, this was sought. There were clear records of actions taken, and people were re-assessed as a precaution. Handover information was clear and up to date.

There were daily head of department meetings, regular team and ‘resident meetings’, where people and staff could share ideas. Minutes were kept and reflected on to make sure actions raised were closed. The service sought the views of people and their relatives, to try to improve the care and support.

Staff were recruited safely, and the required pre-employment checks had been completed. There were sufficient staff deployed to meet people’s needs consistently. Gracewell of Salisbury had a consistent and experienced staff team who knew people’s needs well.

Staff understood the different types of abuse and how to report any concerns. Training had been provided in a variety of topics and staff told us they felt well supported. Supervision was available, where staff could discuss any concerns, training needs or development opportunities.

The service was clean and free from unpleasant odours. We observed the staff used appropriate infection prevention and control good practice. The premises and equipment was maintained and serviced when required.

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.

People’s needs were assessed and where needed, ref