We carried out an unannounced inspection at this home on 7 and 8 June 2017. Gracewell of Edgbaston provides nursing care and accommodation for up to 70 people many of whom are living with dementia. There were 37 people living at the home at the time of the inspection 11 of whom were receiving short term care.

We carried out a comprehensive inspection in April 2016 where we found that the service required improvement and that the provider had not met legal requirements in relation to the safety of care provided, providing personalised care and the governance of the home. We last inspected the service in November 2016 where we carried out a focussed inspection to check whether these legal requirements had been met. At that inspection we found that the provider had followed their action plan and was no longer breaching regulation. However further improvements were still required.

The service has a registered manager who was present throughout the inspection. 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 had been a number of management changes at the service since it opened in April 2015.

People told us they felt safe living at the home. People were supported by staff who had been safely recruited. People reported that they didn’t think there were always enough staff available to support them.

People had the risks associated with their care identified by the home and steps had been put in place to reduce these risks. We found that monitoring of risks needed further improvement.

People were happy with the support they received with medicines. Improvements had been made to the supply of medicines to the home.

Staff informed us they had received sufficient training for their role and we saw there were systems in place to ensure staff knowledge was kept up to date.

People were involved in making choices about their care and staff ensured they sought consent from people before supporting them. Staff were able to tell us how they ensured people’s rights were respected under the Mental Capacity Act (2005).

People had their individual dietary needs met and were offered choices at meal times. People received regular access to healthcare support.

Some people living at the home were living with dementia. Whilst we saw some evidence of good practice in this area, further work was needed to ensure people had consistent access to aids that would support decision making.

People living at the home told us they felt cared for. The home was now fully recruited and new staff were in the process of getting to know the people living at the home. People were treated with dignity and were encouraged to remain independent.

We noted that the majority of care plans had been completed with people and their relatives. Other people had their reviews booked with staff to take place in the near future. Improvements had been made to the provision of activities on a group basis although further improvements were needed to ensure all people living at the home had access to activities.

People told us they were aware of and would feel able to make a complaint should they wish. We saw that the processes in place for managing complaints were not entirely robust.

Staff felt supported in their roles and told us how team work had aided this sense of feeling supported. There were systems in place to monitor the quality and safety of the service although we found they were not consistently effective. People were not sure who the manager of the service was.

We carried out an unannounced comprehensive inspection of this service on 12 and 13 April 2016. At this inspection we found that the provider was in breach of regulations related to failing to provide safe care and treatment; failing to provide care that was person centred to meet people's individual needs; failing to safely manage people's medication; failing to identify and respond to people’s healthcare needs and an ineffective governance system to manage risks and make improvements. After that inspection we met with the provider to discuss the breaches and the provider completed an action plan stating what they would do to meet legal requirements in relation to these breaches.

We undertook this unannounced focussed inspection on 30 November 2016 to check whether the provider had followed their action plan and to confirm if they now met legal requirements. This report only covers our findings in relation to those improvements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Gracewell of Edgbaston on our website at www.cqc.org.uk.

At this inspection we found that improvements had been made and the service was no longer in breach of regulations.

The registered manager of the service was absent from work and there was an interim manager supporting the service. We had identified at our last inspection that there had been a lack of consistent management at the home and this continued to be the case. 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 that improvements had been made to the systems in place to identify and assess risks, although monitoring of risks needed further improvement. Medicine management had improved and people were happy with the support they received with their medicines. Further action was required to ensure new systems introduced were fully embedded into medicine management practice.

People received support from healthcare professionals to have their healthcare needs met. Information about people’s healthcare needs had not always been updated when a person’s needs changed and further improvement was needed.

People felt cared for by staff and were involved in planning their care. People were supported by more regular staff some of whom knew people well. Further improvements were needed to ensure all staff got to know people well to enable personalised care to be provided.

Improvements had been made to the quality monitoring of the service and a director of operations was overseeing improvements at the home. Some of the quality monitoring systems were not entirely effective and had not identified that records were not always up to date or that risks to care had not always been monitored.

Further improvements were needed in all aspects of the areas we inspected to ensure that compliance with regulations would be maintained and that improvements made became fully embedded into everyday practice.

We inspected this home on the 12 and 13 April 2016. This was an unannounced inspection and was the first inspection of the service since they were registered with the Commission in April 2015. The home is registered to provide accommodation with personal and nursing care for up to 70 people. A number of people living at the home were living with dementia. At the time of our inspection there were 30 people living at the home. Of those living at the home, eight people were staying at the home for a short period of time for assessment of their needs or for a period of respite before returning to their former home.

The current registered manager of the service had been registered with the Commission a month prior to the inspection and was present throughout the inspection. 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. The service was also currently receiving support from an interim manager who was responsible for the day to day management of the service. The registered manager had advised that they were going to be leaving the home to work at another location owned by the same provider. We were advised that a new manager had been recruited who would be applying to become the registered manager. Both the interim and current registered manager advised that they would be continuing to offer support to the new manager.

People told us they felt safe and well cared for. Family members that we spoke with told us they thought their relative was safe at the home. Staff had a good knowledge of safeguarding procedures and we saw that training around safeguarding had been provided.

The provider had carried out assessments to identify risks to people. Where a risk had been identified appropriate action had not always been taken to reduce or monitor the risk for the person. You can see what action we told the provider to take at the back of the full version of the report.

Whilst most people received their medicines safely, the provider did not have robust systems in place to ensure that people had sufficient supplies of medication in a timely manner. Staff did not always have the information they needed to administer as required medications. You can see what action we told the provider to take at the back of the full version of the report.

Whilst some people and staff told us there were generally enough staff available to meet their needs, at times there was a need for higher levels of staff or improved staff deployment. We saw that there weren’t always enough staff available to meet people’s requests for support and people who chose to spend time in their bedrooms received little staff interaction.

We found examples of the service meeting people’s healthcare needs. However, there were some instances where people’s healthcare was not monitored appropriately or safely. You can see what action we told the provider to take at the back of the full version of the report.

Staff were supported to maintain their skills and knowledge through regular training. However, this knowledge was not always put into practice to support some people living at the home.

People told us that they were involved in developing their care plans. We saw that there care plans had not been completed in a timely manner or updated with changes in peoples care needs. Care plans contained little detail of how a person wished to be supported. People could not be assured of receiving consistent care that met their needs. You can see what action we told the provider to take at the back of the full version of the report.

People were happy with the care they were receiving. We saw that some staff knew people well and we saw examples of caring interactions between people and staff.

Peopl