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Inspection Summary


Overall summary & rating

Good

Updated 28 September 2017

The inspection took place on 23 and 24 August 2017 and was unannounced. Grasmere Nursing Home provides accommodation, nursing and personal care for up to 21 older people who have a physical disability. At the time of our inspection there were 18 older people living at the home. People had various needs including physical frailty requiring personal care and nursing support with all activities of daily living. Some people were living with dementia. The ambience was warm and inviting. The accommodation is provided over three floors with a mezzanine area on the first floor. Several of the bedrooms have en-suite facilities. All rooms on the first and second floors can be accessed by a passenger lift. The mezzanine area can be accessed by a platform lift and there are stair lifts located on several staircases around the home. The home was clean and tidy and maintained to a high standard and people’s bedrooms had been personalised. There was access to attractive gardens to the front of the building and a small patio to the side for people's use. The nursing home is located in a residential area in close proximity to local shops and Worthing seafront.

There was a registered manager in post who joined us throughout our 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. They had been in post since October 2015.

At the last inspection on 20 July 2016 we identified one breach of Regulations associated with how the staff managed prescribed medicines. We found risk assessments was an area which required improvement as they did not always contain the necessary details and guidance needed to ensure risks to people were mitigated. We also identified care records failed to capture how best interest decisions had been made on behalf of people who lacked capacity to do so for themselves. Following the last inspection, the provider wrote to us to confirm that they had addressed these issues. At this visit, we found actions had been completed and the provider has now met all the legal requirements to ensure the home was safe and effective.

Significant improvements had been made to how medicines were managed. This included how medicines were stored and records of stock levels maintained. Homely remedies were administered to people as recommended and records of when they had been opened and administered were accurate. The registered manager had implemented guidance for ‘when required’ medicines. This included medicines used for pain relief. However, audits to monitor medicine systems were not always effective. This included where this guidance could be developed further. We have referred to this in the Well-led section of this report. In addition, there was a range of other health and safety audit processes to measure the overall quality of the service provided to people and to make improvements when needed.

Since our last inspection the registered manager had developed risk assessments to ensure risks to people’s health and welfare were minimised and consistency in care was provided. There were also detailed personalised mental capacity assessments on behalf of those who were assessed as lacking capacity to make specific decisions. The staff had worked in accordance with current legislation relating to the Mental Capacity Act 2005 and the Deprivation to Liberties Safeguards (DoLS).

People and their relatives told us their family members were safe at the home. Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk from harm.

Staff knew people well and kind, caring relationships had been developed. People were treated with dignity and respect. Care plans reflected information relevant to each

Inspection areas

Safe

Good

Updated 28 September 2017

The service was safe.

Staff were trained to recognise the signs of potential abuse and knew what action they should take if they suspected abuse was taking place.

Risks to people were identified and assessments drawn up so that staff knew how to care for people safely and mitigate any risks.

There were sufficient staff to meet people's needs.

Medicines were managed safely.

Effective

Good

Updated 28 September 2017

The service was effective.

Staff had completed training in a range of areas which supported them to care for people effectively. They had regular supervision meetings and attended staff meetings.

The registered provider was working within the principles of the Mental Capacity Act 2005.

Some people were provided support to maintain a nutritional balanced diet and people had access to a range of healthcare professionals and services.

Caring

Good

Updated 28 September 2017

The service was caring.

Positive, caring relationships had been developed between people and staff.

People were encouraged to be independent and to express their views and to be involved in decisions relating to their care.

People were treated with dignity and respect.

Responsive

Good

Updated 28 September 2017

The service was responsive.

People received personalised care from a staff team who responded to their needs.

The service routinely listened to people and their relatives.

Complaints were managed in line with the provider's policy.

Well-led

Requires improvement

Updated 28 September 2017

One aspect of the service was not well-led.

There was a range of health & safety audits in place to measure the quality of care provided to people. However, medicine audits were not effective in identifying the shortfalls we found during our inspection. The registered manager took prompt action.

The culture of the home was open, positive and friendly.

People and staff knew who the registered manager was and felt confident in approaching them.