CQC report explained · a nursing home
What the CQC found at Grasmere Nursing Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, September 2017
Rated Good overall, but inspectors found the home needed to improve how it checked its medicines systems.
Inspectors visited unannounced on 23 and 24 August 2017. They spoke with people living at the home, relatives, staff and the manager. They observed care, meals and medicines being given, and checked care records, staff files, rotas, complaints and other records.
The home was rated Good for Safe, Effective, Caring and Responsive. Inspectors found people were safe, treated kindly and respectfully, and received personalised care. Staff knew people well, responded to their needs, supported food and drink, and arranged help from health professionals when needed.
The home was rated Requires Improvement for Well-led. Medicines had improved since the previous inspection, but the monthly medicine audits had not found some gaps in guidance and staff training. The manager took action during and shortly after the inspection. The overall rating remained Good.
Safe staffing
Inspectors found enough staff to meet people's needs. The manager and senior nurse worked flexibly to cover absences.
“There were sufficient numbers of suitable staff to keep people safe” from the report
Kind relationships
Staff knew people well and inspectors saw calm, warm and respectful care. People were supported to make choices and maintain their independence.
“Positive, caring relationships had been developed between people and staff.” from the report
Personalised care
Care plans included people's communication, health and mobility needs. Staff could explain how people liked to be supported.
“People lived in a home where staff were responsive to their individual needs.” from the report
Improvement since the last inspection
The home had improved medicine records and risk assessments. It had also improved how it recorded mental capacity assessments and best-interest decisions.
“At this visit, we found actions had been completed and the provider has now met all the legal requirements to ensure the home was safe and effective.” from the report
Medicine audits
needs fixingMonthly medicine checks did not identify all the gaps inspectors found. These included incomplete guidance for medicines given when needed and a medicine policy that needed updating.
“However, medicine audits were not effective in identifying the shortfalls we found during our inspection.” from the report
Formal training for creams
needs fixingCare staff had not received formal training on applying topical creams, although inspectors found they were applying them safely in practice. The manager added this training to the plan.
“However, we identified there was no formal training for care staff undertaken to apply topical creams.” from the report
Knocking before entering
minorStaff usually knocked before entering bedrooms, but inspectors saw occasions when they did not knock if the door was already open. The manager reminded staff to knock every time.
“However, on occasions when doors were already open staff were observed not knocking.” from the report
Care plan detail
minorCare plans did not always record small but useful preferences about washing, such as whether someone preferred a flannel or sponge. The manager sent updated information after the inspection.
“However, they did not always capture the level of detail which may prove helpful for new staff” from the report
- 01How do you now check that medicine audits identify gaps in guidance for medicines given when needed?
- 02What formal training have care staff completed for applying topical creams?
- 03Has the medicine policy been updated in line with the local authority policy and relevant guidance?
- 04How do you make sure staff knock before entering a person's bedroom, even when the door is open?
- 05How are individual preferences about washing and personal care recorded in the care plan?
This was an unannounced comprehensive inspection of the overall quality of the home and all five CQC questions. This explanation was written from the published report of 28 September 2017 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, August 2016
Rated Requires Improvement; inspectors found safe, kind care but medicines management and some care planning needed improvement.
Inspectors visited Grasmere Nursing Home unannounced on 20 July 2016. They spoke to residents, staff, relatives, and health professionals. They observed care and looked at records including care plans, medicines, and audits.
People felt safe and well cared for. Staff were kind and respectful, and the home was clean and welcoming. Residents enjoyed activities and had choices about their care and daily life.
However, inspectors found medicines were not always managed safely. Records did not always show allergies or how 'as required' medicines should be given. Some care plans lacked enough detail to manage risks properly. The dining room was sometimes used for hairdressing during mealtimes, which was not a good experience for residents.
The registered manager was well regarded and had systems to check and improve care. The home had improved since the last inspection in 2014 but still needed to fix the issues with medicines and care planning.
Kind and caring staff
Staff supported people warmly and respectfully, building positive relationships.
“Staff supported people cheerfully and with genuine warmth.” from the report
Personalised care
Care plans included life histories and preferences, and staff knew residents well.
“People received personalised care that was responsive to their needs.” from the report
Good activities programme
There were dedicated staff for activities and a variety of entertainment and one-to-one support.
“The provider employed dedicated activities staff and there was a programme of activities and entertainment in place.” from the report
Clean and well maintained environment
The home was clean, well decorated, and residents liked their rooms.
“People were appreciative of their environment, they told us it was clean and they liked the décor.” from the report
Approachable management
The registered manager was visible, listened to people, and led quality improvements.
“People and staff had confidence in the registered manager who was visible and approachable.” from the report
Medicines management
seriousRecords did not always show allergies or how to give 'as required' medicines safely, risking incorrect administration.
“Allergies were not recorded accurately on the medication administration record for two people, which meant they were at risk of being prescribed and administered medicines which could cause them harm.” from the report
Care planning for risks
needs fixingCare plans lacked detail on managing individual risks like swallowing difficulties and constipation.
“Guidance for staff lacked sufficient detail to manage these risks effectively.” from the report
Mental capacity decisions
needs fixingDecisions made in people's best interests were not always recorded properly as required by law.
“Where people were assessed as not having capacity it was not clear how or why decisions had been made on their behalf.” from the report
- 01How does the home ensure medicines are given safely and that staff have clear instructions for 'as required' medicines?
- 02Can you explain how decisions are made on behalf of residents who cannot decide for themselves, and how these are recorded?
- 03What steps are taken to make mealtimes a pleasant and dignified experience for residents?
- 04How are individual risks like swallowing difficulties or constipation managed and recorded in care plans?
- 05How does the manager involve residents and families in improving the service?
This was a comprehensive inspection covering all five key questions. This explanation was written from the published report of 31 August 2016 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Grasmere Nursing Home
2 rated inspections over a year: the service has improved, from Requires improvement to Good.
- September 2017Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- August 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- November 2014
Report published without a new overall rating.
- August 2013
Report published without a new overall rating.
- August 2012
Report published without a new overall rating.
- November 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 12 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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28 live-in carers within about an hour of West Sussex
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £1,020 to £1,170 a week. 23 can care for a couple. 11 years' experience on average.
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.