Grafton 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 our last assessment we rated this key question requires improvement. At this assessment the rating has changed to 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 were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

People had their needs assessed before moving to the service. These assessments were used to develop the person’s care plans and make the decisions about the staffing hours and skills needed to support the person. However, some people’s assessments had not been used to fully prepare a care plan to detail how staff should meet the person’s needs. For example, their likes and dislikes had not been recorded and nor had their life history. Religious needs had not been recorded or their marital status and culture. These sections had not been completed, which meant staff did not have access to information about the person's preferences, history, culture and personal circumstances within the care plan. Assessments and care plans had not been reviewed on a regular basis.

Some people told us they had been involved with care planning. A person told us, “I only saw my care plan in July after asking to see it. They presented me with 117 pages and said I could amend it. I spent two hours a day for six days going through it. I disagreed with quite a bit of it. They updated some of it before I saw it. I was not involved in any reviews.” People told us that staff knew them well. The registered manager told us no agency staff had been used by the service for many years. We observed staff interacting with people and they appeared to know them well.

Assessments were undertaken with people if they had been out of the service, for instance in hospital, before they came back into the service to make sure their needs could still be met by staff.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did not always do this in line with current evidence-based good practice and standards.

People had choices of food which met their assessed needs. A person had a risk assessment in place to eat soft foods due to some recent choking episodes. The provider had put this in place whilst awaiting a speech and language therapy (SALT) assessment. Whilst the person’s risk assessment had been updated their care plan had not.

Staff had a good understanding of people’s assessed needs in relation to type of food as well as any likes or dislikes. The chef had a good understanding of people’s allergies and intolerances. Staff told us they helped people to make their meal choices if they needed it. The menu for the week was on display on the wall at the end of the lounge area. This was updated daily to list what was on offer. Pictures of the foods on offer were not consistently used to help people make an informed choice. We observed on 1 day that there was a picture of a trifle only which showed the dessert option. We observed that plated meals were not shown to people who appeared confused about the food options.

People were weighed regularly to enable the service to monitor people’s weight and take timely action if people lost or gained too much.

Food records showed people had a varied diet. People had access to snacks and drinks to meet their wants and wishes. Most people told us they enjoyed the food at the service. Comments included, “I eat very little, but I am given choices. If I wanted something like a hard-boiled egg, they would provide it for me”, “The food is great. I must say it is much better than what I eat myself at home”, “Meals are on time and there is a variety of food” and “The food is really good. I always enjoy the food.”

Relatives said, “The menu looks good. She is eating well and putting on weight. They are trying different snacks and making the menu more varied” and “The food here is amazing.”

The provider worked well across teams 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.

The provider had a clear process in place to escalate health concerns in a timely manner. People’s care plans included hospital passports. Staff worked with health professionals to ensure people got the care and support they needed. A health professional told us, “If there is an issue, staff are quick in referring to the district nursing team and they follow instructions given.”

Staff told us, they worked with the local hospice when people were at end of life, to seek advice and support. Staff also told us there were good links with other health professionals such as SaLT (Speech and Language Therapy), physiotherapy, the GP, dieticians and dementia services. People requiring nursing care and treatment received this through regular visiting of the community nursing team.

People told us staff worked with GPs and health professionals to meet their health needs. During day 1 of our assessment a community nurse visited to provide nursing care to a person. Relatives told us health needs were well met. Comments included, “They are managing her health well, she has not got any worse with general health, they have picked up when she’s off colour”, “I am happy with how they organise healthcare” and “Everyone uses the same GP surgery.”

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

Medical professionals from the GP practice carried out a weekly visit to the service. People living at the service had access to other health care professionals, for example, the community mental health team, chiropody, dietician, dentists and SALT (Speech and language therapists). People were supported to attend medical appointments. Staff had a good understanding of meeting people’s changing needs. Some people were living at the service on a temporary basis following a stay in hospital and were supported by staff to rehabilitate and regain their skills and confidence before being assessed by health and social care professionals to determine if they were able to go back to their own homes.

People told us they were supported with their healthcare. People said, “There is a nurse practitioner who comes every week. The chiropodist comes here as well. I saw him last week.” and “The chiropodist came last week, they will come again in 8 weeks.” A relative said, “They have a chiropodist who comes in. I take her to optician appointments myself.”

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff worked together as a team to support people and to ensure people received their care and support in the way they chose. People said, “They have the right skills to support me” and “I have no concerns about the care home's ability to meet my healthcare needs.” A healthcare professional told us people’s health needs were monitored well by staff and when people’s health needs changed staff took timely action.

Staff also recognised when people’s relatives needed help and support. A relative told us, “They are very supportive to me. I struggle visiting, but they are really supportive to me. It gives me anxiety going, but the staff are so good about it.” Another relative said, “We even had emails from [provider] after mum passed to offer condolences and tell us we are always welcome back.”

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

We checked whether the service was working within the principles of the Mental Capacity Act (MCA). The service worked within the principles of the MCA. When people were assessed as lacking capacity to make decisions appropriate procedures were followed to ensure principles within the MCA were followed. Decisions made were appropriately documented to demonstrate who had been involved in the decision.

People's ability to consent to care and support had been assessed. Care was person centred, people were offered choices throughout the day, and people told us they felt listened to and their views and opinions were important to staff. A person said, “They do give me choices.” Staff told us how they supported people to make choices, such as holding up different sets of clothing to help people make an informed choice of what to wear. We observed a person having a discussion with the registered manager about flu vaccinations, the registered manager was providing details of the flu vaccination process from the GP surgery and explaining that they could choose to have it at the service or with their own surgery when they left the service.

A relative told us, “I have seen her being given choices and she goes to bed when she wants.” Another relative said, “They respect her decisions and I always go with her decision. She has capacity.”