This inspection took place on 11, 13 and 14 December 2018 and was unannounced.

Gracewell of Church Crookham is a 'care home'. People in care homes receive accommodation and nursing or personal care, as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Gracewell of Church Crookham is registered to provide accommodation for up to 60 people, including people living with a cognitive impairment. At the time of our inspection there were 45 people living in the home. The home is organised in four household units on two floors; Vogue, Poolside, Tweseldown and Galley Hill. Each of these units is staffed independently and has its own lounge and dining areas. This provided people with a sense of homeliness, while providing additional facilities, such as a cinema and ‘Bistro’. Each household was designed to and furnished to meet the needs of the people living in them.

The home did not have 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 the time of inspection, the there was a general manager responsible for the daily running of the home. They were being supported by a deputy manager and the provider’s operations director.

The service had not been consistently well-led or well-managed since our last inspection. The provider had failed to operate processes effectively to ensure the service complied with legal requirements. Relatives and staff had consistently raised concerns, which had not been effectively addressed by the provider.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

People had not always experienced care that made them feel safe and protected from avoidable harm and discrimination. When concerns had been raised, thorough investigations had not always been carried out, in partnership with local safeguarding bodies.

Risks had not always been assessed, monitored and managed effectively. Interventions had not always been put in place to mitigate or reduce identified risks. This meant that people had been exposed to the further risk of experiencing unsafe care. Care records demonstrated that staff had not always followed the provider’s policy and procedure in relation to the recording and management of falls.

Staff understood their responsibilities to raise concerns, to record safety incidents and near misses and to report them internally and externally. However, the provider had identified that such incidents had not always been reported effectively. The provider had developed an action plan to address these issues.

People’s prescribed medicines had not always been managed safely, which had led to several medicine errors. People had not always received their prescribed pain relief as required.

People had not always been supported to have access to healthcare services and receive on going healthcare support when required. The provider had addressed the need to improve and provide appropriate responses to people’s changing needs within their service recovery plan and their back to basics approach.

The provider had failed to effectively engage with community nursing team forums. Nursing professionals had been concerned that previous management teams had not been open and transparent or demonstrated a proactive approach to delivering effective care based on best practice.

The general manager had completed a review of all authorisations in relation to the Deprivation of Liberty Safeguards and identified that a further 12 applicati

Gracewell of Church Crookham is a nursing home registered to provide accommodation for up to 60 people, including people living with a cognitive impairment. At the time of our inspection there were 60 people living in the home. The home is organised in four household units on two floors; Vogue, Poolside, Tweseldown and Galley Hill. Each of these units is staffed independently and has its own lounge and dining areas. This provided people with a sense of homeliness, while providing additional facilities, such as a cinema and ‘Bistro’. Each household was designed to and furnished to meet the needs of the people living in them.

The inspection was unannounced and was carried out on 15 November 2016.

There was a registered manager in place at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

People lives and wellbeing were enriched because they experienced personalised care and support from staff who were flexible and responsive to their individual needs and preferences.

Staff were especially knowledgeable about people’s right to choose the types of activities they that were important to them. This knowledge has helped them identify innovative ways of supporting people to engage in activities that reflect their personal preferences and meaningful to them.

The registered manager and staff not only strived to improve the lives of the people using the service but took an active role in the wider community.

People and their families told us they felt the home was safe. Staff and the registered manager had received safeguarding training and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.

The risks relating to people’s health and welfare were assessed and recorded, along with actions identified to reduce those risks in the least restrictive way. They were personalised and provided sufficient information to allow staff to protect people whilst promoting their independence.

People were supported by staff who were knowledgeable in caring for people with cognitive impairments and had received an induction into the home and appropriate training, professional development and supervision to enable them to meet people’s individual needs. There were enough staff to meet people’s needs and to enable them to engage with people in a relaxed and unhurried manner.

There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and assessments. Staff had developed positive working relationships with healthcare professionals, such as chiropodists, opticians, dentists, GPs and mental health specialist which enhanced the care people received.

The management team and staff protected people’s rights to make their own decisions. Where people did not have the capacity to consent to care, legislation designed to protect people’s legal rights was followed correctly and confidently by staff.

People were treated with dignity and respect at all times. Staff demonstrated caring and positive relationships with people and were sensitive to their individual choices. Staff were skilled in helping people to express their views and communicated with them in ways they could understand.

People were supported to have enough to eat and drink. Mealtimes were a social event and staff supported people, when necessary, in a patient and friendly manner.

People benefitted from a well-managed and organised service. The provider’s clear vision and values underpinned staff practice and put people at the heart of the service. Staff were aware of the vision and values, how