Grasmere Lodge is a care home that provides accommodation and personal care for a maximum of 20 people with mental health needs or associated conditions. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection. Grasmere Lodge accommodated 12 people at the time of the inspection. The service operates from two adjoining houses.

At our last inspection in December 2017 we rated the service good. However, there was a continued breach of regulation 17, governance, as the provider had not actioned improvements to maintain the building in a timely way.

At this inspection we found improvements had been made and the service was no longer in breach of this regulation. Other evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

.

At this inspection we found the service remained good.

People said they felt safe and they could speak to staff as they were approachable. People and staff told us they thought there were enough staff on duty to provide safe care to people. Staff knew about safeguarding procedures. Staff were subject to robust recruitment checks. Arrangements for managing people’s medicines were safe.

Improvements were required to hygiene in some areas of the home. A designated domestic person was not employed. This was actioned straight after the inspection and a domestic person was being recruited.

Risk assessments were in place and they accurately identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks. Staff knew the needs of the people they supported to provide individual care and records reflected the care provided.

People were involved in decisions about their care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People had food and drink to meet their needs. There were some opportunities for people to follow their interests and hobbies but they told us they would like this to be extended with more varied activities to be made available. They were all supported to contribute and to be part of the local community.

Staff were well-supported due to regular supervision, annual appraisals and an induction programme, which developed their understanding of people and their routines. Staff also received specialised training to ensure they could support people safely and carry out their roles effectively.

People had the opportunity to give their views about the service. There was consultation with staff and people and their views were used to improve the service. People said they knew how to complain. The provider undertook a range of audits to check on the quality of care provided.

Further information is in the detailed findings below.

Grasmere Lodge is a residential care home set in a large terraced house in Gateshead. At the time of our inspection, the service provided accommodation, personal care and support to ten adult males with mental health related conditions, including the misuse of drugs and alcohol. The service had the capacity to support up to 20 people both male and female.

This inspection took place on 17 October 2017 and was unannounced. We previously inspected this service in July 2016 where we identified the service required improvement overall. At that time, the provider was in breach of Regulation 15 of the Health and Social Care Regulations relating to the premises and of Regulation 17 relating to the governance and leadership of the service.

The service had a registered manager in post. 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.

We looked at how the service had addressed the concerns with the premises. We saw improvements had been made to the building and decoration of the property had been carried out in some areas. The downstairs communal showers, toilets and one bedroom remained in need of refurbishment due to water ingress. As a result of this, these facilities were not used by the people who used the service, however this area included a route to a fire escape. Outside of this part of the home, we identified that a shelter in the back yard was unsafe because the corrugated plastic sheeting used as roofing was badly damaged and loose. We have made a recommendation about this.

Improvements to reduce the risk of cross infection had been made. The standard of the environment had improved and we observed the home to be reasonably clean and tidy. Staff followed best practice guidelines in relation to the control of infection in order to minimise cross contamination, although some areas of the home remained hard to keep clean due to continued wear and tear.

Audits to monitor cleanliness, infection control, maintenance, medicines and finances were carried out by the registered manager and issues had been forwarded to the provider for action. However, we found the provider had not responded in a timely manner to the outstanding work.

Everyone spoke highly of the registered manager. The improvements they had made throughout the service continued to be recognised by people who used the service, their relatives and visitors. It was apparent that the registered manager had invested a lot of effort into addressing the previous concerns and they were committed to ensuring Grasmere Lodge was a safe place for people to live.

Established safeguarding procedures remained in place and staff were aware of their responsibilities with regards to recognising and reporting any suspicions of harm or abuse. Individual risk assessments were in place to mitigate risk and reduce the likelihood of repeat events. Actions which staff should take were clearly documented. Accidents and incidents continued to be recorded, monitored and reported to the local authority safeguarding team and the Care Quality Commission (CQC) as necessary.

Medicines were managed safely. We observed staff administered medicines safely to people during our visit. Procedures were in place to ensure medicines were ordered, stored, administered and recorded appropriately and we saw staff followed the process properly. There were no unexplained gaps in the recording of medicine administration.

Personal emergency evacuation plans were in place for each individual and these were regularly reviewed to ensure the service held up to date information regarding the support people would need to evacuate the building in an emergency situation.

Staff recruitment was very robust; the registered manager had

We carried out an inspection of Grasmere Lodge on 10 and 17 August 2016. The first day of the inspection was unannounced. We previously carried out a comprehensive inspection in June 2015 and focussed inspections in September 2015 and March 2016. One breach of legal requirements was found in March 2016. This related to the premises. After the focussed inspection the provider wrote to us to say what they would do to meet legal requirements. Although improvements had been made since September 2015, we found the service was not meeting the regulation related to the safety and suitability of the premises. You can read the report from our last comprehensive and focussed inspections, by selecting the 'all reports' link for Grasmere Lodge on our website at www.cqc.org.uk.

Grasmere Lodge is a care home providing accommodation and personal care for up to 20 people. The service is primarily for people with mental health needs, including people who misuse alcohol and other substances. At the time of the inspection there were 10 people accommodated there.

The service had a registered manager in post. A registered manager is a person who has registered with the CQC 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.

People told us they felt safe and supported by staff. Staff took steps to safeguard vulnerable adults and promoted their human rights. Incidents were dealt with appropriately, which helped to keep people safe.

Improvements had been made to the building and maintenance arrangements. Some rooms offered a basic level of accommodation. The downstairs shower and toilets remained in need of refurbishment. Risks associated with the building and working practices were assessed and steps taken to reduce the likelihood of harm occurring. Standards of cleanliness had continued to improve although some areas remained hard to keep hygienic and still required refurbishment.

We observed staff acted in a courteous, professional and safe manner when supporting people. Staffing levels were sufficient to meet people’s needs and offer some individual support. The provider had a robust system to ensure new staff were subject to thorough recruitment checks. Medicines were safely managed.

As Grasmere Lodge is registered as a care home, CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found appropriate policies and procedures were in place and the registered manager was familiar with the processes involved in the application for a DoLS. Arrangements were in place to assess people’s mental capacity and to identify if decisions needed to be taken on behalf of a person in their best interests. Where necessary, DoLS had been applied for. Staff obtained people’s consent before providing care or offer support.

Staff had completed safety and care related training relevant to their role and the needs of people using the service. Further training was planned to ensure their skills and knowledge were up to date. Staff were well supported by the registered manager.

Staff were aware of people’s nutritional needs. At the time of the inspection, no-one was at risk of malnutrition. Other dietary support and guidance was offered to people to promote good health. People’s health needs were identified and external professionals involved if necessary. This ensured people’s general medical needs were met promptly. People were provided with assistance to access healthcare services.

Activities and occupation were encouraged and some people using the service had been supported by staff to go on holiday. We observed staff interacted positively with people and acted within professional boundaries. We saw that staff treated people with respect and they explained clearly to us how people’s priv

We carried out an unannounced comprehensive inspection of this service on 10, 17 & 19 June 2015. Five breaches of legal requirements were found, including one where we took enforcement action. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements. These related to the breaches of regulation regarding Deprivation of Liberty Safeguards (DoLS), good governance, staffing deployment and maintaining the premises to a suitable standard. We also took enforcement action regarding a breach of regulation regarding safe care and treatment.

A further focussed inspection was carried out on 11 and 18 September 2015. This inspection was carried out to check that improvements to meet legal requirements had been made after our comprehensive inspection on 10, 17 & 19 June 2015. We inspected the service against one of the five questions we ask about services; ‘Is the service safe?’ We found continuing breaches of regulation regarding safe care and treatment.

We undertook this focused inspection to check they had made improvements regarding safe care and treatment, Deprivation of Liberty Safeguards (DoLS), good governance, staffing deployment and maintaining the premises to a suitable standard and to confirm that they met the legal requirements. This report only covers our findings in relation to those legal requirements. You can read the reports from our last comprehensive and focussed inspections, by selecting the 'all reports' link for Grasmere Lodge on our website at www.cqc.org.uk.

Grasmere Lodge is a care home providing accommodation and personal care for up to 20 people. The service is primarily for people with mental health needs, including people who misuse alcohol and other substances. At the time of the inspection there were 10 people accommodated there.

A registered manager was in post 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.

We found action had been taken to improve the safety and hygiene of the premises. Improvements had also been made to the management of medicines and the process of assessing people’s capacity. Restrictions, where imposed, were undertaken lawfully. Training had also been improved, with further training on managing behaviour described as challenging planned. Nevertheless, further work was still needed to ensure the improvements in the safety and welfare of people living at Grasmere Lodge were sustained.

Improvements had been made to several safety aspects of the home. These included ensuring hot water temperatures for baths were within a safe range. Additional control measures had also been introduced to help manage the fire hazards associated with people smoking in the home.

Medicines were safely managed. Administration records were accurate, with no significant recording omissions. Hand written administration instructions had been countersigned to show a second member of staff had checked their accuracy.

Improvements had been made to the standards of cleanliness throughout most areas of the home. The registered manager had undertaken audits to continue to check standards of cleanliness, premises safety and the safe management of medicines.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to the suitability of the premises.

We found people living at the home were provided with appropriate support to meet their individual needs. People who expressed an opinion told us they felt well supported by the staff.

People’s nutritional needs were met and they were consulted about the menus and given choice of meals.

The environment was not adequately maintained. Many communal areas and most bedrooms were in urgent need of redecoration and new floor coverings.

People received support from staff who were checked and vetted to make sure they were suitable to work with vulnerable people.

Most of the personal records, and other records held at the service, were accurate and fit for purpose.

We found that people living at the home were involved in and consented to how they were supported. They said, “I make choices”, and, “The staff help me structure my days”.

Care was planned in an individualised way and aimed to protect people’s personal safety and welfare. This included safe arrangements for people to receive their medication.

People told us they were happy with their support and felt there was enough staff who understood and helped them meet their needs. They knew how to make a complaint and expressed no concerns about the services they received.

We carried out an unannounced comprehensive inspection of this service on 10, 17 & 19 June 2015. Five breaches of legal requirements were found, including one where we took enforcement action. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements. These related to the breaches of regulation regarding Deprivation of Liberty Safeguards (DoLS), good governance, staffing deployment and maintaining the premises to a suitable standard. We also took enforcement action regarding a breach of regulation regarding safe care and treatment.

We undertook this focused inspection to check they had made improvements regarding safe care and treatment and to confirm that they met the legal requirements. This report only covers our findings in relation to those legal requirements for which we took enforcement action. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Grasmere Lodge on our website at www.cqc.org.uk.

Grasmere Lodge is a care home providing accommodation and personal care for up to 20 people. The service is primarily for people with mental health needs, including people who misuse alcohol and other substances. At the time of the inspection there were 10 people accommodated there.

A registered manager was in post 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.

We found the provider was still in breach of the relevant regulations.

Improvements had been made to several safety aspects of the home. These included improvements to window restrictors; making it harder for them to be overridden. Vacant bedrooms were locked to limit access and one bathroom had been refurbished. One unsuitable toilet facility had its door secured with screws to make it un-accessible.

Suitable cold storage for medicines had been obtained. Medication administration records were generally accurate, but there were some gaps in medicine record keeping. Hand written administration instructions had not been countersigned to show a second member of staff had checked their accuracy.

Although some improvements had been made, the standards of cleanliness remained poor in many areas of the home. Two bedrooms were not of a suitable standard to be occupied. Hand washing and hand hygiene facilities were not consistently available, with some bathroom and toilet areas not having either soap or disposable paper towels available. The hot water temperature for one bath was unsafe and control measures for the other bath meant the overall water temperature was reduced below a level to safely control the formation of legionella bacteria.

We found continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to safe care and treatment.