Grasmere Lodge

At the last inspection, we identified a breach of regulation in relation to the oversight of the service. At this inspection we found improvements had been made to the provider’s general oversight of the service. Concerns relating to fire safety, environmental risks and maintenance issues identified at the last inspection had been addressed and the provider had strengthened arrangements for monitoring safety-related works. They had also revised their governance arrangements, quality assurance processes and performance monitoring systems. At this inspection we found the provider was no longer in breach of regulation.

People told us they felt safe living at the service. Staff understood people's individual risks and worked effectively with healthcare and social care professionals to support their safety and wellbeing. Medicines were managed safely, staffing levels met people's needs, and staff received training, supervision and support to carry out their roles effectively.

People were receiving compassionate, person-centred care from staff who knew them well and had developed strong, trusting relationships. People, relatives and professionals consistently spoke positively about the support they received and described staff as caring, respectful and responsive. People found the staff had helped people achieve meaningful outcomes, including improved health and wellbeing, increased independence, greater community involvement and progress towards personal goals such as volunteering and future employment. Professionals described the service as genuinely person-centred and found staff worked collaboratively with them to support recovery and positive outcomes.

The management team had created a positive and inclusive culture where staff felt valued, supported and able to contribute to service development. Staff spoke positively about the registered manager and described an open culture where concerns could be raised and acted upon. Relatives and professionals were also complimentary about leadership within the service and the positive difference staff made to people's lives. Partnership working was a particular strength, with professionals consistently reporting effective communication and collaborative working arrangements.

We identified shortfalls in relation to assessing needs and consent. Although staff knew people well and care was generally effective, assessment and care planning systems did not always support staff to clearly record and update information when people's needs changed. In addition, decision-specific mental capacity assessments and best interests’ decisions were not always in place for some restrictions, meaning the provider could not always demonstrate that restrictions were lawful and supported by appropriate decision-making processes. We also found that handwritten care records and documentation continued to create challenges in relation to updating, reviewing and sharing information efficiently.

The provider had plans in place to improve assessment documentation, introduce electronic recording systems and strengthen oversight of maintenance and compliance actions. The management team demonstrated a willingness to learn and improve, and there was evidence lessons had been taken from previous concerns to strengthen systems and processes.