Grasmere Lodge

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 the last inspection we rated this key question requires improvement. At this inspection the rating has changed to good. This meant people were safe and protected from avoidable harm.

The provider was previously in breach of the legal regulation in relation togood governance. Improvements were found at thisinspectionand the provider was no longer in breach of this regulation.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The registered manager had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to identify and embed good practice. Accidents and incidents were recorded and consistently reviewed to identify learning and improve the service. Staff said concerns were taken seriously and dealt with quickly, and that lessons from incidents were discussed and shared through regular staff meetings. Following delays in completing electrical remedial work, the provider reviewed the process and introduced clearer timescales, monitoring and escalation arrangements for future safety-related work.

The registered manager worked with people and healthcare partners to establish and maintain safe systems of care. Staff managed and monitored people’s safety and supported continuity when people moved between services. A professional described how staff worked collaboratively to plan a gradual and structured admission, including visits before the placement so the person and professionals could assess whether the service was suitable.

Professionals said communication was prompt and staff worked effectively with community mental health teams and primary care services. A relative also said staff responded promptly to changes in their family members’ health and arranged and supported attendance at healthcare appointments. A person said, “Staff made moving here easy.” A visiting professional said, “Rather than rushing the admission process, Grasmere enabled the client to attend planned visits and spend time at the home to determine whether it felt right.”

The registered manager and staff team worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff protected people’s right to live safely and shared concerns appropriately. People felt safe, and staff understood safeguarding procedures and took appropriate action following incidents. The registered manager’s focus on staff learning had supported prompt safeguarding responses. Staff had training and a good understanding of what to do to make sure people were protected from harm or abuse.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. Staff understood when Deprivation of Liberty Safeguards (DoLS) authorisations would need to be sought, the impact of the recent Supreme Court judgement and what to do if there were conditions imposed.

Staff worked with people to understand and manage risks holistically. Staff provided safe and supportive care that enabled people to do the things that mattered to them. Risk assessments and care plans described how staff should support people to manage identified risks, and staff understood people’s needs and presenting risks. Staff said people were involved in their care plans and that relatives and professionals contributed where appropriate. A professional described how staff supported a person to gradually access the community, use a bus and consider volunteering, while providing structured support that increased the person’s confidence and independence. A person said, “The staff always keep me right.”

The provider did not always identify and control risks in the care environment promptly. Although concerns previously identified about fire risk management and bathroom flooring had been addressed, an electrical inspection identified remedial work needed to be completed but this was not actioned in a timely manner. The provider investigated this and found monitoring and escalation of safety-related work needed to be strengthened. They introduced target timescales, regular contractor follow-up, escalation of overdue work and formal verification when actions were completed. A relative said, “The home would benefit greatly from some capital investment; however I cannot fault the care provided.” Since the last inspection the provider had been completing a refurbishment programme at the service.

The provider made sure there were enough qualified, skilled and experienced staff who received effective support, supervision and development. Staff worked together to provide safe care that met people’s individual needs. Staffing levels met people’s needs and recruitment practices met requirements. Staff received mandatory and condition-specific training and regular supervision.

Since the last inspection they had received in-depth training around the specific conditions people experienced. A staff member said, “We always have enough time and right number of staff to complete our work.I have enough support each day to carry out my role within the workplace and feel very supported by the management team and I know if I needed help, I could talk to them. Regular supervisions are given also.” Professionals described staff as knowledgeable, responsive and able to support people with complex mental health needs safely and compassionately.

Staff assessed and managed the risk of infection. Staff had systems to detect and control the risk of infection spreading. The assessment found that infection risks were well managed. The provider reported that staff completed infection prevention and control training and followed hand hygiene, personal protective equipment and safe cleaning procedures. Cleaning schedules and audits covered communal areas, bedrooms, bathrooms, kitchens and frequently touched surfaces. Staff supported people with personal hygiene and monitored people for signs of illness so they could seek medical advice when needed.

Staff made sure medicines and treatments were safe and met people’s needs, capacity and preferences. Staff received medicines training and competency assessments before working independently. Everyone prescribed medicines had received a review from a GP or another appropriate healthcare professional during the preceding 12 months. Care planning reflected people’s individual needs, and staff worked with healthcare professionals to respond promptly when people’s health changed. A person said, “Staff are good at making sure my meds are right and I get them on time.”