The Lodge Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Staff understood their role in safeguarding people and how to raise concerns about people’s safety. Risk assessments had been carried out to identify any risks to people, when providing care and support. Sufficient staff were available to meet people’s needs and a robust recruitment system was in place. Accidents and incidents were recorded in detail, and these were investigated by the manager to prevent or minimise them from happening again. People received support with their medicine which was managed safely. There were systems in place for the monitoring and prevention of infection.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We spoke with people living in the home, one person told us, “If I have concerns, I can speak to one of the staff, they listen, If I was not well, I know they would sort it.” Relatives told us they were satisfied with the care and support and felt the staff knew how to meet the needs of people who used the service.

Staff knew what to do if there was an incident or accident. The provider kept a record of all accidents and incidents involving people using the service and/or staff.

At our last inspection, we noted there were procedures for the recording of incidents and accidents, but it was not always clear what lessons were learned. The accident and incident form that was in use to document what had happened did not contain a section for how to prevent or minimise the risk of future re-occurrence of the incident. This meant procedures to learn lessons were not effective. At this inspection, records showed accidents and incidents were recorded in detail, and these were investigated by the manager to prevent or minimise them from happening again. We saw that the provider looked at lessons that could be learnt when mistakes were made. We observed a form completed following a medicine error, exploring the reason behind the error, actions to be taken and what lessons can be learnt from the experience. We also noted that staff were periodically assessed to be competent at administration of medicine. This process was a way of checking that staff continue to demonstrate the right skills and attributes to carry out this task correctly.

The manager told us that people who used the service were often referred from home and were people who were struggling to cope or were people who had been in hospital and now needed the services of a care home. One of the home’s directors told us that assessments could be carried out by the home or through the local care association. In some cases, a conditional assessment was carried out with a review a short time afterwards to look at how the person was settling in the home.

One staff member told us that before a new person moved to the home their line manager, ensured that care plans and risk assessment and a person’s profile was in place. Staff read the information, so they were clear on what support was needed for the person.

We spoke with a person who delivered training aimed at minimising the need for people to be unnecessarily admitted into hospital. The training was aimed at teaching staff about signs to look out for when a person started to become unwell so medical intervention could be carried in the home where possible. Many staff completed this training in this area.

The provider told us about their processes of how they managed transitions into the home. As part of this they carried out a needs assessment to make sure that the home was a suitable match for a person looking for such a service. They shared their assessment form with us which contained a lot of important information they required before a person moved into the home. This included information on money management, what support the person required with personal care, if any. It also had information about risks and support if a person was approaching the end of their life.

During our visits we spoke with people living in the home. People told us that they felt safe with the staff and would feel comfortable in saying if they did not feel safe. A person said, “This is my home, I am used to it, been here a long time. I feel safe, I can call staff as they go by.”

Staff were able to explain what actions they would take if they identified any safeguarding concerns. One staff member said, “I would report to manager, and I can also report to CQC, local authority or the police if someone is being abused.”

During our visits to the home, we saw staff were able to keep people safe. We noted people being supported to do various tasks including mobilising through either walking or using mobile hoists. We observed staff taking great care and patience in supporting a group of frails elderly people.

The provider had policies and procedures to help protect people from the risks of harm or abuse. Records showed and staff confirmed they had undertaken training to support their knowledge and understanding of how to keep people safe. Staff knew the procedure to follow if they identified any concerns or if any information of concern was disclosed to them. They understood their responsibilities to protect people from harm.

Risks were assessed and managed to prevent people coming to harm. Risk assessments covered specific health conditions. People were supported to go about their lives at their own pace, taking all the risks associated with them. They were not rushed with any aspect of their care which allowed them to do the things they needed to do safely.

Staff had a good knowledge of the identified risks people had in relation to their care and support. The provider ensured the environment was safe for people, staff and visitors.

We noted during our assessment that in some rooms free standing wardrobes were not secured to the wall. Should a person be distressed, this was a potential hazard should they pull against it. This was discussed with the provider, and they took action to rectify this issue.

At our last inspection, we found risks relating to people's health and care needs were not always assessed thoroughly. Risk assessment assessments for specific health conditions such as diabetes, Parkinson's disease and hypertension were not always in place. This meant staff may not have sufficient guidance to understand the signs and symptoms of such conditions and mitigate these risks by taking suitable action. At this inspection, we noted potential risks about people’s safety were assessed to ensure they were supported to remain as safe as possible. During our visit, we viewed a number of care files. We found that there was a range of different assessments associated with older people that helped manage risk and keep people safe. We noted when reviewing the care files information was of a high quality which detailed the support a person needed as well as providing the staff with the information to be able to deliver care. All the information was written in a way that was respectful to the person. However, we noted that a person was using an air flow mattress due to specific needs around their skin. In the event of a fire such equipment required a risk assessment as it could exacerbate a potential fire. We recommended that the provider seek guidance in this area and implement a risk assessment for those people using this equipment.

We reviewed people’s personal evacuation plans which inform staff how people were to be evacuated in the event of a fire. We saw that the home stated in some of these documents that in the event of fire some people with severe mobility problems should stay in their rooms until the fire brigade arrived. We contacted the fire brigade; they told us that the care home should consult their fire risk assessor for advice. They went on to add that all people should evacuate unless a room was constructed to withstand fire for 60 minutes. We instructed the provider to change their records which included the personal evacuation plans and some risk assessments. We gave the provider 7 days to change this and demonstrate to us that this had been completed. This was completed by the provider as we requested. We noted during our visit that there was a lack of hot water in one of the bathrooms. We were told by the manager that the home had a number of immersion heaters that supplied different bathrooms around the building. Whilst it would require time to wait for the water to re-heat the tank that supplied this bathroom, we checked other bathrooms around the building and found that there was hot water in other bathrooms. During our visit we reviewed the home’s health and safety systems. We saw evidence of regular checks by qualified people that ensured people’s safety legislation. Whilst reviewing care files we saw a small number of documents that did not have a review date. We saw a bed rail care plan written for a person which was not dated. We noted from unit to unit these were signed and dated inconsistently. This was discussed with the manager who assured us they would resolve this issue.

The manager told us that, they carried out audits as part of their checks and completed spot checks and weekend checks. This helped to ensure that the staff were following health and safety protocols and that the home environment was clean and tidy. The manager also stated that they had a maintenance team and completed any work that was needed within a time frame, for example, if there was an urgent issue to be done immediately.

During our visit we saw that the home was safe, there was nothing which would impede a person’s safety and we found that all fire evacuation routes were free of obstacles.

The provider was able to demonstrate that they regularly kept check important equipment within the home to keep people safe. This included checks on utilities such as water, electricity and gas but also included other areas such as lifts within the home.

There were enough staff to meet people’s needs and to provide personalised care and support. People did not raise any concerns about staffing level with us. There was a system in place to prevent unsuitable staff from working with people who used care and support services.

Staff told as that most of the time there was another staff on shift to support people and that the only time that there may be gaps if there were staff sickness, however the management would move staff from other parts of the home where they may not be needed, or the management would also support if there was a need.

We observed sufficient staff numbers throughout the day. There were staff who were responsible for providing physical support as well as staff who were responsible for cleaning and others responsible for cooking. We saw a number of people in management posts throughout our visit who were able to give guidance and support to their team when required.

At our last inspection, we found the provider did not ensure sufficient numbers of staff were recruited and deployed to support people in the home and ensure records were up to date and processes were followed. At this inspection, we noted there were enough staff to meet people’s needs and to provide personalised care and support. The provider told us that at any given time during the day there were 26 staff which included ancillary staff. Across the home there were 11 members of staff at night including 2 senior staff. The home used 2 dedicated agencies to provide staff for emergency cover. The manager told us that they were able to utilise staff through the agencies who knew the people living in the home which provided consistency. The provider had effective recruitment and selection processes in place. A number of checks were undertaken before new staff started working for the service. Checks included staff’s previous employment history, proof of identity, written references, criminal records check and their right to work in the United Kingdom. At our last inspection, we found staff were not always being supported with suitable training to provide people with safe care. At this inspection, we noted people were supported by staff that had the necessary skills and knowledge to effectively meet their assessed needs. The provider had a training programme in place for all staff to complete whilst they were employed. Staff were given an opportunity to discuss any work-related issues, such as any training needs as well as needs of people in the service.

We noted during our assessment of the home cleaners were present cleaning areas including toilets and other communal spaces. We also observed people’s rooms being cleaned to a very high standard, helping to decrease the risk of infection.

At the time of our visit, the management team informed us that there had been no outbreak of illnesses in the home in recent months.

During our visits we saw that all environments were clean to a high standard. We noted in some rooms there was a person’s room checklist, but these were not consistently completed. This was discussed with the manager as part of our feedback which they acknowledged.

The provider had policies and procedures regarding the prevention and control of infection, and they kept staff up to date with relevant national guidance. We noted that during our visit the home had its own dedicated cleaning team who were undertaking their cleaning routines during our visit. We saw that they had access to a range of equipment including cleaning materials and personal protective equipment for them to complete their work competently and safely. Caring staff had personal protective equipment (PPE) such as gloves and aprons available to them to protect the spread of infection.

The home had care plans for people with information about how to support them with their medicine. However, this could be improved further. Whilst regular staff were aware of each person’s preferences, this would not be clear for staff unfamiliar with the people. The management team told us they would review training on these documents to help support staff. People were able to access homely remedies when required. Staff would contact their GP to ensure that over-the-counter medicines were safe to administer.

Staff told us they were supported by their managers and received training that allowed them to safely carry out their role. Staff had their competencies to administer medicines assessed. Staff and the management team told us they were able to contact the GP for any urgent queries, including out of hours. Staff could describe how they would follow up urgent queries and access urgent medicines. The management team told us they had external reviews from the regional pharmacist. They had described improvement in relation to management of medicines from the previous year. They mentioned they were in the process of moving to electronic care records and described the rollout timeline where staff would be given time to learn the new systems.

At our last inspection, medicines were not managed safely. We found concerns which put people at risk of unsafe care and possible harm. Staff had not received sufficient training and their competency was not always assessed to check they administered medicines safely. At this inspection, we noted medicines were managed safely in line with national guidance. The home had suitable arrangements in place to protect people against risks associated with the unsafe management of medicines. The home used a paper-based system to record the administration of medicines. Handwritten entries into people’s medicines administration records were countersigned by a senior staff member to ensure accuracy. The staff carried out medicines risk assessments on people receiving high risk medicines. This included those taking blood thinners and antipsychotics. The home kept a register of people taking antipsychotic medicines which was regularly reviewed by the GP. The home had a process for raising concerns with the GP. They recorded decisions on a GP list which staff were able to follow up if medicines were not received. District nurses supported people with administration of complex medicines, including insulin. The home had a process for the administration of medicines covertly when it was in the best interest of people. There was multidisciplinary team input in records of decisions to administer medicines covertly. However, in a record we reviewed, we saw no records of pharmacy input when new medicines were added. Furthermore, information about how to administer covert medicine was contained in covert administration forms but was not clearly documented on medicines administration charts. These was raised with the manager and assurance was provided post visit that all medicines given covertly had been reviewed by the pharmacy and MAR charts had been updated to include covert administration information.