The inspection took place on 14 and 15 March 2017 and was an unannounced inspection.

Gracelands provides accommodation and care for up to 31 older people living with dementia. The home has 27 bedrooms, some for double occupancy. Bedrooms, bathrooms and toilets are located on both the ground and first floor of the building. There was a passenger lift to access the first floor of the building. The home offers a range of communal areas. On the ground floor there were two lounges, a dining room and access to an enclosed garden area. One person told us, “I’m quite happy because we’re near to town and that’s the main thing. It’s easy to get there and it’ll be lovely when the summer is here because we’re close to the seafront too”. At the time of our visit, there were 22 people living at the home.

At the last inspection, the service was rated ‘Good’. At this inspection we found the service remained ‘Good’.

The service has a registered manager. The registered manager was due to step down and a new manager had been appointed. They were due to start in April 2017. In the interim, the registered manager continued to run the service, with support from a representative of 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.

There was a happy and open atmosphere at the home. People and staff got along well and appeared to enjoy each other’s company. Staff treated people with respect and had regard for their privacy.

People told us that they felt safe at Gracelands. Staff understood local safeguarding procedures. They were able to speak about the action they would take if they were concerned that someone was at risk of abuse. Risks to people’s safety were assessed and reviewed. People received their medicines safely.

People had developed good relationships with staff and had confidence in their skills and abilities. Staff had received training in supporting people living with dementia. They were quick to support people and provide reassurance when necessary. There was an established team of staff at the home, which offered continuity of care for people. Staff had received training and were supported by the management through supervision and appraisal. Staff were able to pursue additional training which helped them to improve the care they provided to people

People were involved in planning their care and staff understood what was important to them. Staff understood how people’s capacity should be considered and had taken steps to ensure that people’s rights were protected in line with the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff supported people to be as independent as they were able.

People enjoyed the meals and were offered a varied menu. People had been asked for their feedback about the food and changes had been made to the menu as a result. Staff were attentive and supported those who required assistance to eat or drink.

Staff responded to changes in people’s needs and adapted care and support to suit them. We discussed with the registered manager how staff completion of some monitoring records could be improved, to ensure that any changes in people’s health or support needs were reliably identified. Where appropriate, referrals were made to healthcare professionals, such as the GP or living well with dementia team, and their advice followed.

People had been asked about their hobbies and interests. Staff provided group and one to one activities in the home. Although some people enjoyed walks to the seafront, some said they would like to go out on day trips. The registered manager had arranged the use of a minibus and trips were being planned for the summer months.

There was strong leadership wi

The inspection took place on the 11 November and 2014 and was unannounced.

Gracelands provides accommodation and care for up to 31 older people living with dementia. People living at the home had a range of needs and required differing levels of care and support from staff related to their health and mobility. There were 27 residents' rooms in Gracelands, 24 of these were single rooms and 3 were double rooms. There were two lounges and a dining room which were located on the ground floor. Bathrooms, toilets and bedrooms were located on both floors of the building. There was a lift to access the first floor of the building.

The service had 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.

At our previous inspection in February 2014 we asked the provider to take action to make improvements to premises, in assessing people’s needs and planning their care, and how the quality of the service was monitored. The provider sent us an action plan to tell us the improvements they were going to make. At this inspection we saw that these actions had been completed.

People were cared for by kind and compassionate staff. There was a shared emphasis between staff and the management team of caring for people in a compassionate way. Staff took time to speak with the people they were supporting and staff and people chatted with each other in a relaxed and natural way. Interaction was often one to one and friendly and personal. When someone became upset staff responded quickly to reassure them and the person responded positively and quickly became calm.

People felt safe living at the service. The service had good systems and processes in place to keep people safe. Assessments of risk had been undertaken and there were clear instructions for staff on what action to take in order to mitigate them. Accidents and incidents were dealt with in timely manner and actions taken recorded. Staff knew what action to take if they suspected abuse and had received training in keeping people safe. Arrangements were in place to keep people safe in the event of an emergency. The service employed enough qualified and well trained staff and had safe recruitment practices. The provider had systems were in place to ensure staff were competent to be able to deliver the care people required. Staff felt supported and were positive about their roles. A plan of work had been undertaken to improve the environment of the home and premises to keep people safe. The home was clean and measures in place for the prevention and control of infection.

The provider had arrangements in place for the safe ordering, administration, storage and disposal of medicines. People were supported to get the medicine they needed when they needed it. Staff received training to meet the needs of the people living at the home. People were supported to maintain good health and had access to health care services when needed.

Staff followed the requirements of the Mental Capacity Act 2005 (MCA). People’s capacity to make decisions in different areas of their life had been assessed. The registered manager had made applications to the Deprivation of Liberty Safeguards (DoLS) Team to ensure that people who could not make decisions in relation to where their care and treatment was provided had the appropriate safeguards in place. Staff observed the key principles of the MCA in their day to day work checking with people that they were happy for them to undertake care tasks before they proceeded.

People had sufficient to eat and drink throughout the day and had access to the healthcare services they required. Staff knew the people they were supporting well and the choices they made about their care and their lives. The needs and choices of people had been clearly documented in their care records. People were supported to maintain independence and control over their lives. Activities took place within the home and we saw that work was being undertaken to develop activities so that they reflected people’s interests and experiences further.

The registered manager sought feedback on the care and support provided and took steps to ensure that care and treatment was provided in a safe and effective way and, where necessary improvements were made. Any complaints received were recorded along with actions taken in response. The registered manager was actively involved in the service and involved in the day to day monitoring of the standards of care and support that were provided.

At the time of our visit there were 29 people living at Gracelands. The home specialises in caring for people with dementia.

We gathered information from a variety of sources. These included talking with 12 people who lived at the home and two relatives. We also spoke with the manager and five members of staff. We also left comment cards for people to complete if they wished to inform us of their views on the home. In total 12 people completed comment cards. One person also wrote to us separately.

People told us that they were happy with the care and support they received. One said, “I’ve been very lucky. Food and people good”. Another told us, “Staff are very good and helpful”. They told us, however, that they would welcome more things to do and that they often felt bored. Relatives were generally complimentary about the home. One said, “The GP said look at the care not the paintwork. I looked at other places that were spick and span but didn’t want X there. The care was not as good”. One person used a comments card to share, 'My experience is that good quality care is given for people with dementia. As far as I have seen the right care is given at the appropriate level. The care staff are trained to a high standard and the clients are treated with compassion, respect and dignity'.

Staff were positive about the home and told us that they enjoyed working there. One told us, “Everyone can raise things”.

We observed that staff cared for people in a kind way and involved them in decisions. People told us that they were happy with the support they received from the home to access healthcare professionals. We found, however, that gaps in assessing people’s needs and planning their care meant that they were at risk of receiving care that was inappropriate or unsafe. The provider did not have an effective system to regularly assess and monitor the quality of dementia care that people received or to assess risks to people within the home environment.

During this visit we found that people were not protected against the risks associated with unsafe premises. We, therefore, included the outcome relating to Safety and suitability of premises in this inspection.

We spoke with two people who lived at the home. They said they liked living there and that they felt safe. One of them said, "The staff are all very pleasant people". Another said, "I'm quite happy here".

When we looked round the home we observed that it was clean and well maintained. We saw that staff were responsive to people’s needs and wishes and treated them with respect as individuals at all times.

We examined the care plans of four people. We found these to be personalised and clearly focused on people’s individual choices and preferences. We saw that care plans were clear and concise with evidence of individual care planning and risk assessments.

We found that people were provided with a choice of suitable and nutritious food and drink. The people we spoke with said that they liked the food and that there was always plenty to eat.

The staff we spoke with all said they liked working at the home. They said they felt well supported and trained to undertake their roles.

People told us that they were happy with the care and support they received.

The staff team told us that they felt that the new seating had improved people’s comfort and reduced the time needed for bed rest.

We spoke to four people who live at Gracelands. Conversation was limited due to impaired memory. However, they told us how the staff meet their needs and how they are treated with dignity and with respect. One person told us, ‘They (the staff) are good girls. They look after me well.’

We also spent some time with people observing the care they received from staff.

We also spoke to four members of staff who were on duty. They told us about the level of care they provide to people at Gracelands. They also told us about the support and training they have received to enable them to provide good quality care.

We spoke to the manager about the systems that were in place to assess and review the needs of each person. We also spoke to the manager about how the quality of service provision is assessed and monitored.

We were visiting at this time as a result of information we had received with regard to an allegation of neglect which is being investigated by the West Sussex safeguarding team. We conducted a review of compliance with the essential standards and not as part of the ongoing investigation.