Grasmere Lodge

Grasmere Lodge is a care home that provides accommodation and personal care for a maximum of 20 people with mental health needs or associated conditions. The service consists of two conjoined houses in a terrace street. At the time of this inspection 15 people were living at the service.

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

The senior management team oversight of the operation of the service needed improvement. The audit tools they used were very basic and did not allow for full scrutiny and critical review. Since the pandemic the management team had infrequently visited the service. The nominated individual stated this was because the service had Covid-19 outbreaks for six out of 25 months but it was unclear why this precluded visiting at other times.

The nominated individual told us they were aware work was needed to repair parts of the building but this had been delayed. They could not say when this work would be completed.

Risk assessments did not always cover pertinent issues or set out the actions needed to keep people safe. Some people smoked in their bedrooms and would not leave the room when the fire alarm sounded. Individual fire risk assessments had not considered issues around the fire integrity of the bedrooms. The provider confirmed they would explore improvements, which could be made fire risk management in the service.

Recruitment practices needed to be improved as items such as full employment histories, interview questionnaires, current photographs and references which matched the people named on the application form were missing.

The nominated individual confirmed none of the senior management team’s audits had led to the development of action plans. The governance system had not picked up issues despite there being areas for improvements. such as the repairs to the building, improving care records and staff files. No refurbishment plan was in place which meant the registered manager could not know about or plan for any works.

People felt safe. They commented on how staff were able to provide kind and compassionate care. People and relatives told us they had a positive relationship with the registered manager and staff. The registered manager and staff team had worked hard to maintain good working relationships with health and social care professionals. These relationships had supported them to deliver effective care and support.

There were enough staff on duty. Medicine management was effective. Incident monitoring records showed staff reviewed accidents and identified were lessons could be learnt. Staff adhered to COVID regulations and procedures.

Rating at last inspection

The last rating for this service was good (published 23 November 2018).

Why we inspected

We undertook this inspection as part of a random selection of services which have had a recent Direct Monitoring Approach (DMA) assessment where no further action was needed to seek assurance about this decision and to identify learning about the DMA process.

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. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Grasmere Lodge on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to the provider oversight of the service. Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service and we will continue to work with partner agencies. We will also request a specific action plan to understand what the provider will do immediately to ensure the service is safe. We will work alongside the provider and the local authority to closely monitor the service. We will return to visit in line with our re-inspection programme. If we receive any concerning information we may inspect sooner.

At our last inspection in December 2017 we rated the service good. However, there was a continued breach of regulation 17, governance, as the provider had not actioned improvements to maintain the building in a timely way.

At this inspection we found improvements had been made and the service was no longer in breach of this regulation. Other evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

.

At this inspection we found the service remained good.

People said they felt safe and they could speak to staff as they were approachable. People and staff told us they thought there were enough staff on duty to provide safe care to people. Staff knew about safeguarding procedures. Staff were subject to robust recruitment checks. Arrangements for managing people’s medicines were safe.

Improvements were required to hygiene in some areas of the home. A designated domestic person was not employed. This was actioned straight after the inspection and a domestic person was being recruited.

Risk assessments were in place and they accurately identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks. Staff knew the needs of the people they supported to provide individual care and records reflected the care provided.

People were involved in decisions about their care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People had food and drink to meet their needs. There were some opportunities for people to follow their interests and hobbies but they told us they would like this to be extended with more varied activities to be made available. They were all supported to contribute and to be part of the local community.

Staff were well-supported due to regular supervision, annual appraisals and an induction programme, which developed their understanding of people and their routines. Staff also received specialised training to ensure they could support people safely and carry out their roles effectively.

People had the opportunity to give their views about the service. There was consultation with staff and people and their views were used to improve the service. People said they knew how to complain. The provider undertook a range of audits to check on the quality of care provided.

Further information is in the detailed findings below.

This inspection took place on 17 October 2017 and was unannounced. We previously inspected this service in July 2016 where we identified the service required improvement overall. At that time, the provider was in breach of Regulation 15 of the Health and Social Care Regulations relating to the premises and of Regulation 17 relating to the governance and leadership of the service.

The service had a registered manager in post. 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 looked at how the service had addressed the concerns with the premises. We saw improvements had been made to the building and decoration of the property had been carried out in some areas. The downstairs communal showers, toilets and one bedroom remained in need of refurbishment due to water ingress. As a result of this, these facilities were not used by the people who used the service, however this area included a route to a fire escape. Outside of this part of the home, we identified that a shelter in the back yard was unsafe because the corrugated plastic sheeting used as roofing was badly damaged and loose. We have made a recommendation about this.

Improvements to reduce the risk of cross infection had been made. The standard of the environment had improved and we observed the home to be reasonably clean and tidy. Staff followed best practice guidelines in relation to the control of infection in order to minimise cross contamination, although some areas of the home remained hard to keep clean due to continued wear and tear.

Audits to monitor cleanliness, infection control, maintenance, medicines and finances were carried out by the registered manager and issues had been forwarded to the provider for action. However, we found the provider had not responded in a timely manner to the outstanding work.

Everyone spoke highly of the registered manager. The improvements they had made throughout the service continued to be recognised by people who used the service, their relatives and visitors. It was apparent that the registered manager had invested a lot of effort into addressing the previous concerns and they were committed to ensuring Grasmere Lodge was a safe place for people to live.

Established safeguarding procedures remained in place and staff were aware of their responsibilities with regards to recognising and reporting any suspicions of harm or abuse. Individual risk assessments were in place to mitigate risk and reduce the likelihood of repeat events. Actions which staff should take were clearly documented. Accidents and incidents continued to be recorded, monitored and reported to the local authority safeguarding team and the Care Quality Commission (CQC) as necessary.

Medicines were managed safely. We observed staff administered medicines safely to people during our visit. Procedures were in place to ensure medicines were ordered, stored, administered and recorded appropriately and we saw staff followed the process properly. There were no unexplained gaps in the recording of medicine administration.

Personal emergency evacuation plans were in place for each individual and these were regularly reviewed to ensure the service held up to date information regarding the support people would need to evacuate the building in an emergency situation.

Staff recruitment was very robust; the registered manager had continued to ensure pre-employment vetting checks included references and police checks before new staff commenced with their role. Staff were monitored for suitability through a probationary period and were closely supervised until they were assessed as competent in the role. There were enough staff employed at the service to meet people’s needs. Staff told us they had enough time to complete their duties; people and a relative told us the staff were available whenever they needed them.

Staff continued to be robustly inducted into the service and trained in topics which were relevant to their job. The registered manager sourced external training to enhance staff skills and knowledge. The registered manager completed routine competency spot checks on the staff to ensure they continued to be fit for their role.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. The registered manager told us one person had an authorised DoLS application to restrict their freedom in line with the MCA. All staff demonstrated an understanding of the MCA and worked within its principals.

People were encouraged by staff to eat and drink properly. Staff provided a varied, well balanced diet. There was a choice of cooked meals from a menu and alternatives were always available. Special dietary requirements were adhered which included a diabetic diet.

People and a relative told us the registered manager and staff were caring. They were impressed with the continued support provided by all staff at the home, as was the external professionals we spoke with. We observed staff were patient and considerate of people’s varying needs. We saw staff treated people with respect and ensured their privacy and dignity were maintained. Staff were helpful, friendly and professional throughout our visit.

Records showed that people had been involved in planning their care. A relative confirmed that they had been heavily involved in devising care plans and they were involved with reviews and future planning. The care records were detailed and very person-centred. They contained assessments of people’s needs, personalised care plans and individual specific risk assessments. These had all been regularly reviewed, changed as necessary and updated.

The staff endeavoured to plan meaningful activities to reduce isolation and encourage socialisation but people who used the service were difficult to engage with and often refused to participate. Staff provided a lot of one-to-one support to people to offer encouragement and reassurance, particularly if there had been a period of relapse.

The complaints made about the service since our last inspection has been dealt with in line with the provider’s complaints policy and people had received a response from the registered manager in a timely manner. Nobody raised any new issues with us during our inspection and the feedback we received from a relative and the external healthcare professionals was positive.

The service worked in partnership with several outside agencies and other services to support people to regain their independence and confidence. The registered manager has fostered good links within the local community to help people integrate back into society. They had also kept themselves abreast of best practice guidance and attended networking events for providers of community services. This helped them to maintain a good working relationship with the local authorities they contracted with.

Grasmere Lodge is a care home providing accommodation and personal care for up to 20 people. The service is primarily for people with mental health needs, including people who misuse alcohol and other substances. At the time of the inspection there were 10 people accommodated there.

The service had a registered manager in post. A registered manager is a person who has registered with the CQC 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.

People told us they felt safe and supported by staff. Staff took steps to safeguard vulnerable adults and promoted their human rights. Incidents were dealt with appropriately, which helped to keep people safe.

Improvements had been made to the building and maintenance arrangements. Some rooms offered a basic level of accommodation. The downstairs shower and toilets remained in need of refurbishment. Risks associated with the building and working practices were assessed and steps taken to reduce the likelihood of harm occurring. Standards of cleanliness had continued to improve although some areas remained hard to keep hygienic and still required refurbishment.

We observed staff acted in a courteous, professional and safe manner when supporting people. Staffing levels were sufficient to meet people’s needs and offer some individual support. The provider had a robust system to ensure new staff were subject to thorough recruitment checks. Medicines were safely managed.

As Grasmere Lodge is registered as a care home, CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found appropriate policies and procedures were in place and the registered manager was familiar with the processes involved in the application for a DoLS. Arrangements were in place to assess people’s mental capacity and to identify if decisions needed to be taken on behalf of a person in their best interests. Where necessary, DoLS had been applied for. Staff obtained people’s consent before providing care or offer support.

Staff had completed safety and care related training relevant to their role and the needs of people using the service. Further training was planned to ensure their skills and knowledge were up to date. Staff were well supported by the registered manager.

Staff were aware of people’s nutritional needs. At the time of the inspection, no-one was at risk of malnutrition. Other dietary support and guidance was offered to people to promote good health. People’s health needs were identified and external professionals involved if necessary. This ensured people’s general medical needs were met promptly. People were provided with assistance to access healthcare services.

Activities and occupation were encouraged and some people using the service had been supported by staff to go on holiday. We observed staff interacted positively with people and acted within professional boundaries. We saw that staff treated people with respect and they explained clearly to us how people’s privacy, dignity and confidentiality were maintained. Staff understood the needs of people and care plans and associated documentation were clear and person centred.

The feedback from people receiving care was sought to help improve the care and support offered. People using the service and the staff spoke highly of the registered manager. We found systems to assess and monitor the quality of the service had been strengthened, although further efforts were required to ensure these resulted in improvements to personal finance records.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to the suitability of the premises and good governance (quality management).

You can see what action we told the provider to take at the back of the full version of the report.

A further focussed inspection was carried out on 11 and 18 September 2015. This inspection was carried out to check that improvements to meet legal requirements had been made after our comprehensive inspection on 10, 17 & 19 June 2015. We inspected the service against one of the five questions we ask about services; ‘Is the service safe?’ We found continuing breaches of regulation regarding safe care and treatment.

We undertook this focused inspection to check they had made improvements regarding safe care and treatment, Deprivation of Liberty Safeguards (DoLS), good governance, staffing deployment and maintaining the premises to a suitable standard and to confirm that they met the legal requirements. This report only covers our findings in relation to those legal requirements. You can read the reports from our last comprehensive and focussed inspections, by selecting the 'all reports' link for Grasmere Lodge on our website at www.cqc.org.uk.

Grasmere Lodge is a care home providing accommodation and personal care for up to 20 people. The service is primarily for people with mental health needs, including people who misuse alcohol and other substances. At the time of the inspection there were 10 people accommodated there.

A registered manager was in post at the time of 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.

We found action had been taken to improve the safety and hygiene of the premises. Improvements had also been made to the management of medicines and the process of assessing people’s capacity. Restrictions, where imposed, were undertaken lawfully. Training had also been improved, with further training on managing behaviour described as challenging planned. Nevertheless, further work was still needed to ensure the improvements in the safety and welfare of people living at Grasmere Lodge were sustained.

Improvements had been made to several safety aspects of the home. These included ensuring hot water temperatures for baths were within a safe range. Additional control measures had also been introduced to help manage the fire hazards associated with people smoking in the home.

Medicines were safely managed. Administration records were accurate, with no significant recording omissions. Hand written administration instructions had been countersigned to show a second member of staff had checked their accuracy.

Improvements had been made to the standards of cleanliness throughout most areas of the home. The registered manager had undertaken audits to continue to check standards of cleanliness, premises safety and the safe management of medicines.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to the suitability of the premises.

People's nutritional needs were met and they were consulted about the menus and given choice of meals.

The environment was not adequately maintained. Many communal areas and most bedrooms were in urgent need of redecoration and new floor coverings.

People received support from staff who were checked and vetted to make sure they were suitable to work with vulnerable people.

Most of the personal records, and other records held at the service, were accurate and fit for purpose.

Care was planned in an individualised way and aimed to protect people's personal safety and welfare. This included safe arrangements for people to receive their medication.

People told us they were happy with their support and felt there was enough staff who understood and helped them meet their needs. They knew how to make a complaint and expressed no concerns about the services they received.