This inspection visit took place on 2 December 2016 and was unannounced.

At our last inspection of June 2013, the service was found to be compliant with their legal responsibilities.

Gratia Residential Care Limited is a residential home which provides care and support for up to 20 people who live with a learning disability and mental health needs. The service is situated in the Glenfield area of Leicester. At the time of our inspection there were 20 people using the service.

There was a registered manager in post who was also the provider. 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 told us they felt safe and relatives felt their family members were safe. Staff were trained in safeguarding and knew what to do if they had concerns about the well-being of any of the people they supported.

Potential risks to people had been assessed, such as risks associated with people's health conditions and the environment. Staff demonstrated a good awareness of the risks to each person although risk assessment records were not always updated in a timely manner.

The registered manager told us there were enough staff on duty to meet people's assessed needs. However, we found that staff were not always deployed effectively to ensure people's needs were met in a timely or consistent way. The registered manager told us they would review how staff were deployed within the service at peak times. Staff were safely recruited to ensure they were suitable to work in the service.

There were systems in place to ensure medicines were stored and managed safely and people received their medicines as prescribed.

Staff received training and support that provided them with the knowledge and skills required to support people effectively. People were well supported with their healthcare needs and records showed they were seen routinely and when required by a range of health and social care professionals.

People's abilities to make some decisions were included in their care plans, including guidance on the level of support they needed to make day-to-day decisions. However, mental capacity assessments required further development to ensure people were effectively assessed to ensure their right to make informed choices about their care and treatment was protected and supported.

People were supported to have sufficient to eat and drink and maintain a balanced diet. People's individual nutritional needs were supported.

People and their relatives felt that staff were caring although some people felt, on occasions, staff were too busy to spend quality time with them. People were offered choices and were involved in their own care. We saw staff supported people to maintain their independence.

Staff were knowledgeable about the people they supported and demonstrated that they knew their likes, dislikes and interests. Care plans had been developed to focus on people as individuals and described their choices and how they wanted their care to be provided.

There were opportunities for people to become involved in activities within the service and external outings. We observed positive interactions between people and staff during our inspection visit, although there was little opportunity for staff to engage in activities with people during peak times.

People, relatives and staff spoke positively about the registered manager. They felt able to share their views with him and suggest improvements to the service.

There were systems in place to check the quality of the care people received. However, we found that audits and checks were not always robust or applied consistently in identifying where improvements were required within the service. Further improvem

The expert by experience spoke with two people who use the service. They told the expert by experience that they had a care plan, a copy of which was kept in the office. They said that staff discussed their care plan with them and said staff followed their care plan. People told the expert by experience that they had a health action plan and that staff supported them to attend medical appointments.

The expert by experience reported that they found the home to have a homely feel. The expert by experience found that people should benefit from organised days trips.

People’s care plans and records were regularly reviewed and the support and care people received was as detailed within their care plan, which included support with eating and drinking. People were supported to attend appointments with a range of health care professionals. Specialist health care professionals had been involved where people’s health care needs had changed. Discussions with staff showed they had a good understanding of the needs of people who used the service.

We haven’t been able to speak to people using the service because many people who live at the home had limited verbal communication. We gathered evidence of people’s experiences of the service by observing the interaction between people who use the service and staff. And by viewing records.

We observed people being encouraged to take part in activities in groups and on a one to one basis with a member of staff. Activities we observed taking place included board games, card games and dominoes, jigsaws and looking at catalogues. We noted people were supported to go out in to the community supported by staff, which for one person meant visiting a friend in hospital.

We spoke with staff and found they had a good understanding of the needs of people and confirmed information we had read about three people whose records we had viewed. This showed that the support and care people received was consistent with their care plan.

Our observations showed that the needs of people were being met in a timely manner. We noted staff spent time supporting people at mealtimes and that they were aware of the importance of this time. Staff spoke with the people they were helping who in some instances had dementia and required a specialised diet. Staff offered encouragement and supported people at a pace appropriate to them.

We were unable to speak to people using the service as people who were at home at the time of our inspection found it difficult to talk with someone they did not know or were unable to respond to our questions.

We observed positive interactions between people who use the service and care staff. People were supported to access community activities by care staff and to take part in activities within the service, which included wrapping presents, colouring and playing musical instruments.

People told us that they went into the community and took part in activities which supported their hobbies and interests. People told us they were happy at Gratia Residential Home and that they felt supported by the staff.

We saw people were engaged in activities within Gratia Residential Home, which included taking part in household duties within the service. We saw people playing musical instruments and group games which included bingo and cards. People told us that they had been on holiday.

People had had the opportunity to complete questionnaires about the service they received and had attended meetings to talk about issues which affected them such as menus, activities and holidays.