Grasmere Lodge

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At the last inspection we rated this key question good. At this inspection the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 67 (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 did not always make sure people’s care and treatment was effective because the systems used to assess and review people’s health, care, wellbeing and communication needs did not always support staff to record information clearly. Staff completed assessments with people and, where appropriate, their relatives before admission and throughout their stay.

Records contained detailed information about people’s health conditions and how these affected them. However, the provider’s templates did not enable staff to clearly evidence how they should meet all aspects of people’s needs. Staff had to handwrite new documents when needs changed because they could not amend the existing templates or access an electronic record system. The provider told us it would work with staff to develop more suitable assessment and care plan templates and give staff access to electronic records. The impact of this shortfall was reduced because staff knew people well and used this information to provide personalised care.

A professional described how staff listened to the person and professionals before admission and arranged planned visits so the person could decide whether the service was right for them. This helped the person, staff and professionals to determine whether the placement would meet their needs.

Staff planned and delivered people’s care and treatment with them, including what was important and mattered to them. Staff delivered care in line with current evidence-based practice and recognised when people’s physical or mental health needs changed. They worked with people to manage mental health conditions and addictions, supported their nutrition and hydration needs, and acted as advocates so people received appropriate treatment. Staff knew people’s food preferences and dislikes, and people were positive about the range and quality of meals available.

Staff received mandatory and condition-specific training and used care plans and risk assessments to guide their practice. One staff member said training provided by the service and external training had increased their understanding and confidence in their role. Professionals also described staff as safe, effective and compassionate when supporting people with complex mental health needs.

Staff worked well with other professionals and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services. Staff shared relevant information and worked collaboratively with GPs, community mental health teams, social workers, substance misuse services and other professionals to provide joined-up care. They supported people to attend appointments, made referrals when their needs changed and incorporated professional advice into care plans and risk assessments. Professionals consistently spoke positively about communication and partnership working. A visiting professional said, “The management team have been approachable, responsive, and flexible. Communication has been excellent, and information is shared promptly whenever required.” A relative also confirmed staff promptly arranged GP or hospital appointments when concerns arose and supported their family member to attend.

Staff supported people to manage their health and wellbeing to maximise their independence, choice and control. They supported people to understand what they needed to do to live healthier lives and reduce their future needs for care and support. Staff recognised subtle changes in people’s physical or mental health, sought appropriate professional advice and supported people to attend healthcare appointments. Staff also helped people manage addictions, develop daily living skills and access meaningful opportunities in the community. A relative said their family member’s health had improved significantly since moving to the service, that they were eating well and had started a voluntary role in the community. A person said, “The staff really care about me and make sure I’m okay.”

Staff routinely monitored people’s care and treatment to improve it. Staff reviewed care plans and risk assessments when people’s needs changed, monitored their physical and mental health, and took appropriate action when concerns arose. Staff meetings, reviews and discussions with professionals supported continuity and enabled staff to consider whether care was helping people achieve their goals. People, relatives and professionals described positive and meaningful outcomes. A relative described the improvement in their family member’s health and wellbeing as “fantastic” and said the change had been remarkable. A person said, “Staff have helped me to make a real difference to my life.”

Staff told people about their rights around consent and respected these when delivering person-centred care and treatment. Staff understood the principles of the Mental Capacity Act 2005 and associated codes of practice. They sought people’s consent before providing care and support. During our observations staff offered people choices, respected their decisions and involved them in day-to-day decisions about their care.

Capacity assessments and best interest decisions were in place. However, we found capacity assessments and best-interest decisions were not consistently in place for restrictions including access to lighters, management of finances and other limitations on people’s freedom. We also found people who had capacity had not always signed records to demonstrate they had consented to restrictions that affected them, such as requiring staff support when leaving the service. The management team acknowledged these issues and undertook immediate action to address them. Staff worked with people who may be subject to community treatment orders and conditional discharges.

Staff had a good understanding of their role supporting people to understand their right to appeal under the Mental Health Act 1983.