This inspection took place on 3 May 2017 and was unannounced. The Grand is registered with the Care Quality Commission to provide accommodation, personal care and nursing care for up to 82 people. There were 69 people staying at the service at the time of our inspection. The service comprised of four floors and included a unit which catered for people who were living with dementia and a short stay rehabilitation unit which was run in partnership with a local health authority.

The service did not have a registered manager in place at the time of our visit. The previous manager had deregistered in January 2017. A new manager had been appointed and was registered with us shortly after our visit. 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 were supported by staff who were aware of the risk of abuse and were knowledgeable and confident about when to report any concerns. Risks to people’s health and safety were identified and assessed and measures introduced to keep people safe if required. We found that some of these measures had not always been fully implemented and the manager took swift action to address this concern. Sufficient numbers of staff were planned to meet people’s needs and action was being taken to minimise the impact of staff absences. There was a risk that people may not receive their prescribed medicines as required and improvements were needed to ensure these were managed safely.

People were supported by staff who received training and support to carry out their roles effectively. People were asked for their consent before care was provided and staff were knowledgeable about how to support people who may lack capacity in their best interests. The service was in the process of ensuring that relatives who consented on behalf of their relation had the authority to do so. People were supported to maintain their health and to eat and drink enough.

People were cared for by staff who were kind and gentle and took swift action to relieve people’s distress. Staff were knowledgeable about the people they supported and respected their choices and decisions. People were supported to be as independent as possible and their privacy and dignity was upheld. People and their relatives were involved in planning their own care.

People received care which met their individual needs and respected their preferences. Staff told us that communication systems used at the service were effective in ensuring they were kept up to date with any changes in people’s needs. The service employed dedicated activity co-ordinators who worked hard to ensure that people were provided with meaningful activities and supported to maintain their interests. People could be assured that complaints would be responded to appropriately.

People were cared for by staff who worked well as a team and were supported and encouraged to provide a good service by management. People, relatives and staff were complimentary of the manager who understood their responsibilities. Quality monitoring systems were in place and continued to be developed to ensure they were effective in identifying and acting on areas of improvement. Swift action was taken by the management team in relation to issues identified during our inspection.