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Grace House Requires improvement

Inspection Summary

Overall summary & rating

Requires improvement

Updated 17 November 2020

About the service

Grace House is a residential care home providing personal and nursing care to 10 people aged 65 and over some of whom were living with dementia. At the time of the inspection, there were 10 people living at Grace House which is set out in one adapted building.

People’s experience of using this service and what we found

Improvements had been made since the last inspection in areas such as care planning and risk assessing, staff training, infection control and overall governance. The management team worked with the board or trustees to plan and implement the areas for improvement. This was reflected in the feedback we received from people, relatives and staff.

People and their families spoke positively of living at Grace House. In particular, the open and inclusive culture, helpful and friendly staff and management team were commented on. People told us they were consulted on their care preferences and felt included in the running of the home.

Despite the positive feedback, we found that medicines were not always safely managed around documentation and storage. We have also made a recommendation around the provider’s oversight of medicines management and audit processes.

People and their families also spoke positively around how the service managed the risks associated with COVID-19 to keep people safe.

Care plans had improved and were person centred and were reflective of people's current care needs. Changes to people’s care needs were assessed on a regular basis.

Staff had received training to enable them to carry out their roles effectively. Staff told us they felt supported in their roles.

People were supported to access medical and health services. The management team worked proactively to ensure people’s medical needs were met despite the challenged posed by the COVID-19 pandemic.

Processes in place supported the recruitment of staff who had been assessed as safe to work with vulnerable adults. There were enough staff available to ensure the safety of people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at

Rating at last inspection and update

The last rating for this service was requires improvement (published 13 May 2020).

We took enforcement action due to the significant concerns found. A Warning Notice for the breaches of regulations 12, 17 and 18 was issued to the Provider and Registered Manager following the inspection.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations and had met the requirements of the Warning Notices for these reasons. However, we identified concerns with medicines management and the provider remains in breach of regulation 12.

Please see the action we have told the provider to take at the end of this report.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 20 February 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, person centred care and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. Whilst improvements have been noted under each o

Inspection areas


Requires improvement

Updated 17 November 2020

The service was not always safe.

Details are in our safe findings below.



Updated 17 November 2020

The service was effective.

Details are in our safe findings below.



Updated 17 November 2020


Requires improvement

Updated 17 November 2020


Requires improvement

Updated 17 November 2020

The service was not always well-led.

Details are in our well-led findings below.