Archived: Gracewell of Bath

Updated 8 June 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service and to provide a rating for the service under the Care Act 2014.

This inspection took place on 10 May 2018 and was unannounced. The inspection was carried out by two adult social care inspectors and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert by experience had experience in dementia care.

Prior to the inspection, we reviewed information we held on the service such as notifications. Notifications are specific events that registered people have to tell us about. We also contacted the local authority commissioning team and requested feedback from four healthcare professionals involved in people's care. We received feedback from one healthcare professional.

We also reviewed the Provider Information Return (PIR). The PIR is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

We observed care and spoke with people, relatives and staff. We did not use the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the needs of people who could not speak with us as most people could talk to us. We spoke with 12 people who used the service and four relatives. We also spoke with the registered manager, the deputy manager, two registered nurses, four care staff, the maintenance person, an activities coordinator and one visiting health professional.

We reviewed four people's care records including daily records, medicines records and seven staff files including recruitment, supervision and training information. We looked at records relating to the management of the service. We looked around the building and spent time in the communal areas. We reviewed additional information the provider sent us after our inspection visit.

Updated 8 June 2018

This inspection took place on 10 May 2018 and was unannounced. This was the first inspection of the service since it was registered in 2017. Gracewell of Bath 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.

Gracewell of Bath is a purpose built establishment; it provides care and support for up to 62 people. The service provides care over three separate floors depending on their level of need; Poolside (residential), Sulis Way (dementia care) and Globetrotter (nursing). Each floor has its own lounge, dining room and utility kitchen. All bedrooms are single with en-suite toilet facilities. At the time of our inspection, there were 43 people living in the home.

Staff supported people living with dementia; however there was limited evidence of the development of the environment for people with specific needs affected by their condition. We have made a recommendation about the development of the environment to meet the specialised needs of people living with dementia.

There was a registered manager in post at the service. 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.

Medication Administration Records were completed accurately and guidance was in place for people who were prescribed 'as required' medication. People told us they were happy with how their medicines were managed and received this when they needed it.

Risk assessments were detailed and contained sufficient information to guide staff on how to minimise the risk of harm for people who lived at the home.

Fire procedures in the event of an evacuation were clear and regular mock fire drills were completed.

Checks were completed to ensure the environment was free from hazards.

The training records showed staff had received relevant training to ensure they had the skills to support people effectively. Our discussions with staff showed that they had a good knowledge about the people they supported and understood people's individual needs.

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. The service operated within the principles of the Mental Capacity Act 2005 (MCA). Our review of records showed that processes were in place to assess people's capacity and make decisions in their best interests.

People were supported to maintain good health and well-being. The home had a good relationship with a local GP and had regular dialogue with the local community mental health team. Referrals were made promptly to health professionals such as speech and language team, the dietician and tissue viability nurses.

People told us they enjoyed the food served at the home. Staff knew, and catered to, people's individual dietary needs and preferences. Nutritional risk assessments were completed and diet and fluid charts were in place for those who required them.

We observed kind and compassionate interactions between staff and the people they supported. Staff offered reassurance to people in distress. People told us they liked the staff that supported them. Care plans were personalised and evaluated monthly. We noted that any changes in people's needs were documented and actioned appropriately.

A complaints policy was on display in the home, which contained details for the local authority and Local Government Ombudsman if complainants were not happy to go to the provider. People told us they would not hesitate to raise concerns with the registered manager if they felt they needed to. Complaints were documented and managed in accordance with the registered provider's complaints policy.

Quality assurance systems were effective and measured service provision. Regular audits were completed for different aspects of the service such as medication, care plans and accidents and incidents. Opportunities were provided for people and their relatives to provide feedback on their experience of the care provided and contribute to improving the service delivery. This included quality assurance surveys, a suggestion box, residents, and relatives meetings.

The registered manager had notified the Care Quality Commission (CQC) of events and incidents that occurred in the home in accordance with statutory requirements.