We carried out an unannounced inspection of Gracewell of Weymouth on 11 and 14 July and 23 October 2017. When the service was last inspected in November 2016 we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009.

As a result of the findings of the inspection in November 2016, we set requirement actions in relation to the four breaches of regulations. The provider wrote to us in January 2017 to tell us how they would achieve compliance with these requirements which we reviewed during this inspection. During this comprehensive inspection we found improvements had been made.

Gracewell of Weymouth is a purpose built nursing home, over three floors and registered to provide nursing care for up to 70 people in the centre of a residential area of Weymouth. The ground floor is for people with residential care needs, the first floor is for people who require memory care and the second floor is for people whose care needs where associated to nursing. At the time of our inspection there were 56 people 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 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.

People, relatives, health professionals and staff told us that the service was safe. Staff were able to tell us how they would report and recognise signs of abuse and had received training in safeguarding.

Care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about their lives. Risk assessments were completed, regularly reviewed and up to date.

Medicines were managed safely, securely stored, correctly recorded and only administered by nurses that were trained and qualified to give medicines. Monthly medicine audits were carried out by clinical leads.

Staff had a good knowledge of people’s support needs and received regular training such as health and safety and infection control as well as training in response to people’s needs for example dementia.

Staff told us they received regular supervisions which were carried out by the management team. Staff told us that they found these useful. We reviewed records which confirmed this.

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 and relatives told us that the food was good. We reviewed the menu which showed that people were offered a variety of healthy meals. We saw that food was regularly discussed and recorded on food preference sheets. The head chef told us that the majority of meals are home cooked.

People were supported to access healthcare appointments as and when required and staff followed professional’s advice when supporting people with ongoing care needs. A GP visited the home every Friday.

People told us that staff were caring. We observed positive interactions between staff, managers and people. This showed us that people felt comfortable with the staff supporting them.

Staff treated people in a dignified manner. Staff had a good understanding of people’s likes, dislikes and interests. This meant that people were supported by staff who knew them well.

People had their care and support needs assessed before being admitted to the service and care packages reflected needs identified in these. We saw that these were regularly reviewed by the service with people, families and health professionals when available.

People and relatives were provided with opportunities to feedback through meetings and surveys.

There w

The inspection visits took place on 3, 4 and 7 November 2016. Gracewell of Weymouth is a purpose built home, over three floors, registered to provide care for up to 70 people in a residential area of Weymouth. At the start of our inspection there were 52 people living in the home. People living on the top floor of the home had predominantly nursing care needs. People living on the middle floor had needs associated with the impact of their dementia. The service specialised in some aspects of dementia care such as supporting people who were disoriented and those that needed assistance with continence care. They did not specialise in supporting people who were resistive to care to the extent that they would need staff to physically intervene to support them when they were resistive. People living on the ground floor needed less staff support.

The service did not have a registered manager at the time of our inspection. The last registered manager had left the service in February 2015. The current manager had taken up their post in October 2016 and planned to apply to become the registered manager. They had an agreed period of absence of one month which was being covered during our inspection by another manager from within Gracewell Healthcare Ltd, the provider organisation.

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.

Gracewell of Weymouth had been through a sustained period of management change when we inspected. We found a number of areas that required improvement during our inspection. The management and staff team of Gracewell of Weymouth was aware of some of these issues and had started work on plans to make improvements.

Staff were committed to providing a high quality of care for people living in the home and supported each other to achieve this. However, systems to ensure the quality of care were not always embedded and a lack of consistent oversight meant that monitoring was not adequate to review care practice effectively.

People were not always protected from harm because staff did not fully understand the risks they faced. Care plans were not always followed and records were not always accurate. This increased the risk that people could receive inappropriate care.

Where people needed to live in the home to be cared for safely and they did not have the mental capacity to consent to this Deprivation of Liberty Safeguards (DoLs) had been applied for. Staff did not know who had a DoLS in place and this put people at risk of receiving inappropriate care.

The home looked and smelled clean. We observed that some practice did not reflect current guidance for good practice in infection control. This put people at risk of catching health care related infections.

Statutory notifications had not been made to CQC. A statutory notification is a legal requirement for the provider to inform CQC of certain situations as part of their oversight of care provision. This meant that CQC had not received information to support their monitoring of the service.

Health professionals were not always confident that people received support for their health related needs in a timely and appropriate manner. A GP had noted an improvement in this and people felt confident they saw health professionals when necessary.

People had the support they needed to eat and drink in ways that met their needs and preferences. People told us the food was good and we saw that there were robust systems in place to ensure that the food was of a high quality and appropriate for individuals. We observed that meal times were an opportunity for choice and socialising.

Staff were safely recruited, felt supported and knew how to identify and respond to abuse. People were

The inspection visits took place on 19 and 20 August 2015 and we spoke with professionals over the following week.

Highclere House Care Home is a purpose built nursing home registered to provide care for up to 60 people in a residential area of Weymouth. At the time of our inspection there were 38 people living in the home, one of whom was in hospital. People were living on two floors of the three floors. Most people with nursing needs lived on one floor and people with dementia care needs mostly lived on the other floor.

The service did not have a registered manager at the time of our inspection and the manager was away on annual leave. The deputy manager was available throughout the inspection and they explained that the manager had put in an application to be registered. The last registered manager had left the service in December 2014. 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.

We heard some mixed opinions from people as to whether there were always enough staff and call bell records indicated people may be having long waits for staff to attend to their needs in some instances. However, most people and all the relatives we spoke with told us there were enough staff and during our inspection people received care and attention quickly. Managers were covering nursing hours and this had an impact on the management of the home. Audits were not being undertaken regularly and incidents and accidents had not been reviewed to ensure lessons were learned. There was recruitment being undertaken during our inspection to ensure senior staff were able to undertake their management functions.

Staff were confident and consistent in their knowledge of people’s care needs but not all staff had received an appropriate induction or undertaken training necessary for their role. Staff were not able to explain how they cared for people within the framework of the Mental Capacity Act 2005. The provider had plans in place to rectify this situation.

People were protected from harm because staff understood the risks they faced and knew how to identify and respond to abuse. Care and treatment was delivered in a way that met people’s individual needs but records were not always accurate. This increased the risk that people could receive inappropriate care. Where people needed to live in the home to be cared for safely and they did not have the mental capacity to consent to this Deprivation of Liberty Safeguards had been applied for.

Nurses undertook hourly checks on people to ensure that all care needs and any comfort needs were met in a timely manner. People received their medicines safely and as they were prescribed.

People were engaged with a wide range of activities that reflected individual preferences, including individual and group activities. People spoke highly of the activities staff.

People described the food as excellent and there were robust systems in place to ensure people had enough good food to eat and enough to drink.

People’s rooms and communal areas were kept clean throughout our inspection.

People and their relatives were positive about the care they received from the home and told us the staff were compassionate, kind and attentive. Staff treated people, relatives, other staff and visitors with respect and kindness throughout our inspection.