Grey Ferrers Care Home 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.

Grey Ferrers Care Home accommodates 120 people across four separate units, each of which has separate adapted facilities. One of the three units provides palliative and end of live care and the other three units specialises in providing care to people living with dementia, mental health care and physical disabilities. At the time of our inspection there were 97 people were using the service.

The last inspection took place in December 2015 when the provider for this location was Bupa Care Homes (CFH Care) Limited.

This was the first inspection of the service since the legal entity changed on 31 January 2017. This inspection took place between 20 and 22 March 2018 and was unannounced.

There was 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 2008 and associated Regulations about how the service is run.

We found improvements were needed to the premises, décor and cleanliness. Infection control procedures were not always followed to ensure people’s health and wellbeing was protected. Despite the regular checks and audits on the premises and action plans developed there remained a number of outstanding actions to improve the environment. Staff trained were trained in health and safety, infection control procedures and regular cleaning was carried out but that had not assured people were protected from avoidable risks.

The provider’s governance systems and processes had not been fully implemented. The new care plans were being introduced and implemented from March 2018. We found inconsistencies in the management and the quality of care people received across the four unit. Regular audits and checks were carried out but the improvements were not made in timely manner.

A range of risk assessments were completed to ensure measures to support people to stay were put in place and reviewed regularly. Care plans provided staff with sufficient guidance to follow but the records relating to how staff monitored people’s health was not always clear.

People received their medicines as prescribed and systems were in place that ensured any discrepancies found were promptly addressed. Records were not always kept of regular monitoring or checks carried out, for example to check that the medicines administered via a transdermal patch was still in place. When these issues were raised with the respective unit managers they assured us they would review and update the care plans.

People had a choice of meals, drinks and snack available. People told us that they mostly enjoyed their meals although at some people had to wait to be supported or were not provided with their meal or food of their choice. The cook was aware of people’s dietary requirements and planned menus that were nutritious and balanced. People did not always experience a positive dining experience.

People’s privacy and dignity was not always respected by staff. We observed instances when people’s dignity had been compromised and shared our observations with the unit managers. The following day we saw staff’s approach and practices had improved whereby people’s dignity had been maintained. Despite the improvements we saw on the following day it highlighted that staff’s practices were not being observed and managed. Staff promoted and respected people’s diverse backgrounds and lifestyle choices. People’s care records were kept securely and staff maintained people’s confidentiality.

People did not always receive care and support that was personalised and responsive. Pe