This inspection took place on 2 and 13 July 2015 and while the first day was unannounced we arranged the second day with the provider to ensure they would be there to provide the information we required. At our last inspection on 26 February 2015 to follow-up on two breaches we found the provider was meeting legal requirements in relation to consent but not in relation to care and welfare of people. We found that some risks identified by incidents or assessments had not been assessed and were not being adequately managed as a result. We served the provider a warning notice and at this inspection we checked whether the provider had taken sufficient action to meet the breach. We also carried out a comprehensive inspection.
Grasmere provides accommodation for up to 25 older people some of whom had dementia. During our inspection there were 22 people using the service.
There was no registered manager in post although the new manager who had started in March 2015 told us they had started the application process to register with CQC. Our records showed we had not yet received their application 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.
Medicines management was not always safe. The provider had not acted promptly to ensure medicines were stored at a suitable temperature which would not damage them, despite being aware of this issue before our inspection. However, the provider took appropriate action once we raised our concerns. We could not always confirm people had received their prescribed medicines as staff had not appropriately maintained medicines records. Guidance was not always in place for ‘as required’ medicines. This meant staff may not have known the signs to look out for which meant people needed these medicines, particularly when people were unable to tell staff they needed them.
Systems were in place to assess and monitor the quality of service although audits were not always recorded and had not always identified the issues we found.
In general the service managed risks to people well and the service had made improvements in response to concerns we identified at our previous inspection. In addition, the service was updating their falls policy to incorporate best practice guidelines on identifying why people were experiencing falls and to identify and address environmental hazards more clearly. The manager analysed accidents and incidents to look for patterns and to check people received the right support.
A range of checks were in place to ensure the premises and equipment were safe and the home was well maintained. However, the checks had not identified several window restrictors could be overridden and people may have been at risk of falling from height. The provider immediately installed appropriate restrictors during our inspection when we raised our concerns with them to keep people safe.
Staff monitored people’s risk of malnutrition and sought advice from dietitians and speech and language therapists when they were concerned about people. Staff provided people with a choice of food and drink and supported them to eat and drink where necessary. Staff supported people to access health services such as GP, dentist, optician and chiropodist and more specialist services such as the district nurse for pressure area care, the falls prevention team and the challenging behaviour team.
Systems were in place to safeguard people form abuse. Staff were aware of the signs people may be being abused and how to report this as they received training on this. When allegations of abuse had been made the provider took prompt action to keep people safe, carried out an investigation and liaised with the local authority safeguarding team as required.
Recruitment was safe because the provider carried the required checks before staff worked with people to see whether they were suitable. This included checking references, criminal records, qualifications and training, photographic identification and health conditions which could mean they were unable to carry out their role without reasonable adjustments being made.
A system of staff supervision and appraisal was in place and staff told us they felt well supported by the manager and provider. Staff received appropriate induction when starting their roles and a programme of training was in place to equip staff with the knowledge they required to meet people’s needs.
Staff understood their responsibilities under the Mental Capacity Act 2005 and received training in this and the service was meeting their requirements under the Deprivation of Liberty Safeguards (DoLS). These safeguards are there to help make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. The provider had assessed whether people required DoLS and made the necessary applications as part of keeping them safe.
People and their relatives told us staff treated them with kindness, dignity and respect and our observations were in line with this. Staff knew the people they were supporting well, including how they liked to receive their care and this information was available for reference in people’s care plans. End of life care plans were in place for people so staff knew how they preferred to receive their care during their final days.
A programme of activities was in place led by an activities officer, and people were supported to do activities they were interested in.
A complaints system was in place and made accessible to people and their relatives. The manager and provider responded to concerns people raised appropriately.
We identified two breaches of the Health and Social Care (Regulated Activities) Regulations 2014 during our inspection. You can see what action we told the provider to take at the back of the full version of the report.