Grasmere Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety in respect of incidents and accidents. Staff listened to concerns about safety, investigated and reported safety events. Lessons were learnt to continually identify good practice. Records of incidents and accidents were made, and these were audited monthly and included a lesson learnt section. Staff told us they had regular meetings where they discussed incidents and how to reduce future re-occurrence. For example, one person was very subdued and seemed unhappy, staff suggested they be offered a different room as they felt this might be part of the concern. The person was offered a different room with more light and a better view. they moved as soon as they could and has remarked how much happier they are.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. People and relatives told us their loved ones were supported to access health care. Staff and leaders had a collaborative approach with people and partners to maintain safe systems of care. People had detailed plans to take with them if they needed to go to hospital or for appointments. We reviewed records which demonstrated relevant and timely contact with external health professionals.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care, in which safety was mostly managed or monitored.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making specific decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take specific decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). Staff received training in the principles of the MCA and understood their role around offering choices to people

At the last inspection there were shortfalls in the management of capacity assessments which were not in line with the expectations of the Mental health Act (MCA). We found the service was still not always working within the principles of the MCA. For example, MCA were lacking in detail and did not address specific decisions.

People and relatives all told us they felt Grasmere was safe. People told us they could raise concerns and found the staff and manager easy to talk to. A person told us, “Staff are friendly and gentle.” Another said, “I have the very best of care here.”

Staff were clear about their role in safeguarding people and confirmed they took part in regular training in the subject.

The provider did not always work well with people to understand and manage risks. Risk assessment practice and processes were not always consistent. For example, a falls risk assessment identifies the risk and provides a score but does not detail the steps staff are to follow to mitigate the risk. Some people had risk assessments, where high risks were identified but those were not reviewed in a timely fashion consistent with the persons progressive cognitive decline. This was raised with the manager who acted to create a new risk assessment and a referral to occupational therapy to review the situation.

The provider mostly detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

There was a CCTV to cover shared areas of the building, which was not externally recorded or included sound. Appropriate use certificates were in place, however the signage to alert people, staff and visitors to its presence had been removed during recent refurbishment. The manager was not able to find any consent to the use of CCTV by any people living at Grassmere or by their families in the event of a best interest decision needing to be made. This was raised with the manager and area manager and actions were taken to obtain consent and restore signage. While this was being carried out the system was temporarily paused.

People spoke positively about the building and their bedrooms in particular; each person’s room was decorated to include their own personal possessions.

The service was clean and fresh with shared areas decorated in an uncluttered fashion to suit the needs of people but remaining homely.

Staff had received fire awareness training and understood the actions they should take should a fire occur. Staff were clear about the regular safety checks to be carried out. One staff showed us the food checks carried out in the kitchen. Staff told us they participated in regular training around all aspects of environmental safety. People had individual plans in place to aid their evacuation in the event of fire. These were specific to the needs of each person.

Records confirmed the staff training that had been undertaken.

Systems were in place to identify and manage foreseeable environment risks within the service. This meant people, visitors and staff were effectively protected from the risk of harm. Equipment was monitored and maintained according to a schedule. In addition, gas, electricity, and electrical appliances were checked and serviced regularly. Fire safety risks had been assessed by a specialist and where necessary action taken to ensure the environment was safe.

Staff were recruited through a recruitment process which mostly ensured they were safe to work with people. Improvements to the process were discussed with the provider, specifically around the follow up process if references received were basic in nature. Appropriate checks had been completed prior to staff starting work which included checks through the Disclosure and Barring Service (DBS). DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. The manager checked the qualifications of registered nurses with the nursing and midwifery council.

Grasmere had a consistent staff team, who knew people well. Some staff had worked at Grasmere for several years and could talk about change and improvement which had happened over time. New staff completed a full induction and probationary period. Training had mostly been identified and provided to staff, the exception was training to support people with dementia. At the time of our visit only 3 staff were recorded as having had the training. Staff were able to discuss other training they had undertaken demonstrating their understanding said they and valued the opportunities to gain more knowledge. Although the service did not support people with a learning disability or autistic people, staff had undertaken training to be prepared if someone with those needs in addition to nursing needs moved in. Staff spoke positively about their experience of training and said the more bespoke training around people’s specific health and well-being was particularly useful. Staff demonstrated a clear understanding around people’s individual likes and dislikes, nurses had clear understanding of people’s clinical needs.

People and relatives spoke positively about the numbers of skilled staff that supported them. One person said, “Brilliant care all the staff are great.” A relative said, “There is a good level of staff to provide the care she needs, they have time to talk.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. People were supported to live in a clean and maintained environment, where processes were in place to support staff to manage risks of infection and apply safe food hygiene practices. Regular checks were made to confirm cleaning was done and food checks such as fridge temperatures were recorded. Relatives told us the service was always clean and tidy, one said, “This place is spotless.”

The provider did not always make sure that medicines were safe and met people’s needs, capacities, and preferences. For example, we reviewed medicines for 3 people. Nine different medicines in total were sampled against a stock check. Seven of the medicines had incorrect stock amounts recorded. The nurse on medicines duty confirmed the numbers. The manager gave an explanation which did not fully reflect the issue as stock figures were incorrect both higher and lower than records noted. The manager told us they would investigate in order to establish the reason for records not being reflective of actual stock to ensure that this was not due to missed dosages.

We observed staff supporting people to receive their medicines in line with their wishes.

Trained nurses administered medicines and had been assessed as competent to do so safely. Medicines given were recorded and medicines were stored safely.

Staff were able to give detailed information about the medicines people took and what they were for. For example, a staff member described the protocol for giving medicine to a person who preferred to receive their medicine in a certain way.