This inspection site visit took place on 28th September 2018 and was unannounced.

At the last inspection on 29th August 2017, we found a continued breach of Regulation 17. The registered person had failed to identify shortfalls at the service through regular effective auditing. In addition, records were not all accurate and up to date. We asked the provider to take action to make improvements and these actions had been completed.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question of well-led to at least good. At this inspection we found that the provider and manager had introduced a series of checks and audits that had ensured that shortfalls were quickly identified and resolved. We also found that records such as care plans and risk assessments contained more detail and were regularly updated in line with people's changing needs. As a result, Graywood is no longer in breach of Regulation 17.

Graywood accommodated 9 people with mental health difficulties. People's ages varied from 30 to 80 years and they all lived in one adapted building. Graywood is a ‘care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home was registered to one person who is the provider and therefore the Graywood does not require a registered manager. The provider was the registered person. Registered persons have the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. The registered provider had overall responsibility for the Graywood.

The atmosphere at Graywood was calm and relaxed. People had a high level of independence and mobility and came and went as they pleased. There was a kind and supportive culture which was embraced by all. People smiled and laughed and it was clear that everyone cared for each other. Staff knew people very well and spoke about them with fondness. One person told us; " I do like it here. Everything is so good, the staff are so good, the manager is good, they are all so helpful".

People told us that they felt safe. Staff had appropriate training to protect people from harm and abuse and any risks to people were identified and mitigated. The manager had an open-door policy and people and staff told us that they would talk to the manager straight away if they had any concerns. People were encouraged to take positive risks by trying new activities and opportunities, which promoted exercise, wellbeing and independence.

The small, longstanding team of staff knew people well and had regular training to keep up-to-date with developments in the law and best practice. They were supported by the manager and staff felt that any concerns they raised to the manager would be investigated appropriately. Checks were carried out to ensure any new members of staff were safe to work with people.

Medicines were stored and given to people safely. Guidance was in place to ensure that staff knew what medicine people took and the actions that should be taken in case of a medical emergencies such as; when people became unwell. Regular checks took place to ensure mistakes were identified and resolved.

The premises were clean, smelt fresh and met people's needs. Staff knew how to protect people from infection. Peoples rooms were decorated to their own personal taste and people helped with the cleaning of the property. Maintenance issues were quickly identified and resolved.

Graywood provided people with person-centred care and support. The manager received best practice guidance from accredited organisations and attended local forums. This information was passed to staff through meetings and supervisions. As a result, people were involved in all decisions rela

Graywood Care Home provides accommodation and personal care for up to 13 people who need support with their mental health. The service is located in a residential area of Margate, near to shops, local amenities and the sea front. There is good access to public transport. The service is set out over two floors. The first floor could be accessed by stair lift if needed. On the ground floor are communal areas and bedrooms. Each person had their own bedroom which contained their own personal belongings and possessions that were important to them.

There were 12 people living at the service at the time of the inspection. The care and support needs of the people were varied. There was a wide age range of people with diverse needs and abilities. The youngest person was in their 30’s and the oldest was over 80 years old. As well as needing support with their mental health, some people required care and support related to their physical health. People were able to make their own decisions about how they lived their lives. They were able to let staff know what they wanted and were able to go out independently.

There was no registered manager in post. This was because the service was registered to one person who is the provider and therefore the service does not require a registered manager. The provider was the registered person. 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 registered provider had overall responsibility for this service. The provider spent time at the service and there was an assistant manager in post who gave support with the day to day running of the service. The service was a family run business and family members were employed by the provider. The provider, assistant manager and staff supported us throughout the inspection.

At the last inspection in September 2016 we found a breach of regulations and the service was rated ‘Requires improvement’ . We issued a requirement notice relating to a lack of good governance. We asked the provider to take action and the provider sent us an action plan. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. Improvements had been made but further improvements were required.

Staff and people told us that the service was well led and that the management team were supportive and approachable. They said there was a culture of openness within Graywood Care Home which allowed them to suggest new ideas which were often acted on. The assistant manager had sought feedback from people, staff and others involved with the service. Their opinions had been captured, and analysed to promote and drive improvements within the service. Informal feedback from people, their relatives and healthcare professionals was encouraged and acted on whenever possible.

The assistant manager undertook checks of the environment to make sure everything was safe. Audits and health and safety checks were regularly carried out by the assistant manager and these were recorded. However, the assistant manager had not identified the shortfalls in recording some information. Some records had not been completed and did not contain all the information needed to support people.

On the whole, there was guidance in place for staff on how to care for people effectively and safely. Risk assessments were designed to keep most risks to minimum without restricting people’s activities or their life styles and promoting their independence, privacy and dignity. However, on occasions potential risks to people were identified and discussed but guidance on how to safely manage the risks was not always available and some risk assessments were not accurately recorded. This is an area for improvement.

At the last inspection f

Graywood Care Home provides accommodation and personal care for up to 13 people who need support with their mental health. The service is located in a residential area of Margate, near to shops, local amenities and the sea front. There is good access to public transport. The service is set out over two floors. The first floor could be accessed by a stair lift if needed. On the ground floor are communal areas and bedrooms. Each person had their own bedroom which contained their own personal belongings and possessions that were important to them.

There were 12 people living at the service at the time of the inspection. The care and support needs of the people were varied. There was a wide age range of people living at the service with diverse needs and abilities. The youngest person was in their 40’s and the oldest was over 90 years old. As well as needing support with their mental health, some people required care and support related to their physical health. People were able to make their own decisions about how they lived their lives. They were able to let staff know what they wanted and were able to go out independently.

There was no registered manager in post. This was because the service was registered to one person who is the provider and therefore the service does not require a registered manager. The provider was the registered person. 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 registered provider had overall responsibility for this service. The provider spent time at the service and there was an assistant manager in post who gave support with the day to day running of the service. On the day of the inspection the provider was not available. The service was a family run business and family members were employed by the provider. The assistant manager and staff supported us throughout the inspection.

At the last inspection in February 2016 we found breaches of regulations. We issued requirement notices relating to safeguarding people from abuse, safe care and treatment, fit and proper persons employed, staff training and staff deployment, person centred care and good governance. We asked the provider to take action and the provider sent us an action plan. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. There were seven breaches identified at the previous inspection and at the time of this inspection the provider had complied with six breaches and parts of the other breach. The provider had not fully met their legal requirements but improvements had been made.

A system to recruit new staff was in place. This made sure that the staff employed to support people were fit to do so. At the last inspection recruitment processes were not fully adhered to. At this inspection improvements had been made but there was an area that needed further improvement.

At the last inspection not all risks to people had been kept to a minimum. At this inspection improvements had been made but there were still some shortfalls. Fire safety checks which were supposed to be done weekly had not been completed since May 2016. Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do. There were regular fire drills at the service so that people knew how to leave the building safely. People’s personal evacuation emergency plans (PEEPS) had not been reviewed and updated to explain what individual support people needed to leave the building safely. After the inspection the assistant manager sent information to evidence this was being addressed. We have made a recommendation about the fire safety within the service.

Individual risks to people's safety were assessed and managed appropriately. Risk

Graywood Care Home provides accommodation and personal care for up to 13 people who need support with their mental health. The service is located in a residential area of Margate, near to shops, local amenities and the sea front. There is good access to public transport. The service is set out over two floors. The first floor could be accessed by stair lift if needed. On the ground floor were communal areas and bedrooms. Each person had their own bedroom which contained their own personal belongings and possessions that were important to them.

There were 13 people living at the service at the time of the inspection. The care and support needs of the people were varied. There was a wide age range of people living at the service with diverse needs and abilities. The youngest person was in their 40’s and the oldest was over 90 years old. As well as needing support with their mental health, some people required care and support related to their physical health. People were able to make their own decisions about how they lived their lives. They were able to let staff know what they wanted and were able to go out independently.

There was no registered manager in post. This was because the service was registered to one person who is the provider and therefore the service does not require a registered manager. The provider was the registered person. 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 registered provider had overall responsibility for this service. The provider was at the service every day and there was a deputy manager in post who gave support with the day to day running of the service. The service was a family run business and family members were employed by the provider. The deputy manager, staff and the provider supported us throughout the inspection.

The management and some staff knew how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care services. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. At the time of the inspection no-one living at the service was subject to a DoLs restriction and everyone had full mental capacity to make the decisions they wanted to about how they lived their lives.

Before people decided to move into the service their support needs were assessed by the provider and deputy manager to make sure they would be able to offer them the care that they needed. The care and support needs of each person were different and each person’s care plan was personal to them. People had been involved in writing the information in their care plans. In some care plans, but not in all, there was the information needed to make sure staff had guidance to care and support people in the safest way. People indicated they were satisfied with the care and support they received. When people’s needs changed some care plans had not been reviewed and updated to reflect the changes. Other plans had been updated. Potential risks to people were identified but full guidance on how to safely manage the risks was not always available. This left people at risk of not receiving the interventions they needed to keep them as safe as possible. People had an allocated keyworker who was involved in their care and support. A key worker was a member of staff who takes a key role in co-ordinating a person’s care and support and promoted continuity.

People's medicines were not always handled and managed as safely as they could be. Some medicine records were not completed accurately. There was a lack of detailed guidance for medicine needed o

At the time of the inspection 10 people were using the service. People told us and we found that, they were encouraged to develop their independence skills at a pace that was comfortable to them. One person told us, "I like to go out and since I have lived here I am able to do this safely because the staff are so supportive”. Another person told us “I have difficulty making decisions The staff find a way of making it easier for me”.

We saw that peoples care plans had been signed and they told us that they were familiar with their plans and knew what was in them. We found that the plans of care and support were written in a person centred manner, focused on people's individual assessments and contained detailed information of their needs.

Staff we spoke with were knowledgeable about people's routines and choices and they knew how to support people effectively. We saw documentation which showed that staff had received the necessary and relevant training to be able to carry out their roles.

The manager told us that they had undergone a refurbishment programme which was near to completion. We found the home to be clean and well maintained.

We saw documentation which showed that systems were in place to enable the health, welfare and safety of the people who used the service to be monitored effectively by the provider.

People who use the service told us what it was like to live at this service and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality of food and drink available.

People said that they were happy with the care and support they received and that their needs were being met in all areas. They said that the staff treated them with respect, listened to them and supported them to raise any concerns they had about their care. People told us that the service responded to their health needs quickly and that the manager talked to them regularly about their plan of care and any changes that may be needed.

Many comments received were complimentary of the service. One person said “It’s very nice here” another said “The staff are very good. I’m happy to talk about any concerns”. Other people were complimentary of the food and had no concerns regarding the quality of care.

Despite this we found that people were not protected against the risks associated with medicines because the provider had not taken appropriate steps to manage medicines in accordance with guidance and ensure they were stored appropriately.

People living within the service did not benefit from living in an adequately maintained service. Maintenance and renewal programmes were not being carried out in a timely manner which had impacted on the building and resulted in a poor environment.