Earlsdon 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

People were involved in making decisions about how they wished to be supported to help keep them safe. Managers assessed and reviewed safety risks to people, and staff received relevant training to help meet the range of people’s needs at the service safely. People received their medicines; however, records did not always show medicines had been managed appropriately. Staff completed ongoing training to aide continuous learning and improve their working practice. Managers completed recruitment checks on all staff to ensure that were deemed safe and suitable to support people at the service. People felt safe at the home, however there was not always a staff presence in communal areas of the home, to help maintain peoples safety. The home was regularly cleaned although some areas needed additional cleaning. Systems were in place to support staff in protecting people from the risk of the spread of infection.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives told us they were informed when their family members had been involved in an accident or incident such as a fall. Relatives were made aware of changes in practice to minimise further risks of this happening again. For example, alert mats on chairs and floors set off an alarm when people moved or placed pressure on them to alert staff their assistance was required to help prevent a further risk of falls.

Staff told us learning was shared from any accidents and incidents and this was discussed during handover meetings at the beginning of their shift. One staff member told us. “The seniors have to fill in the form and this is reviewed by the manager. The manager would take action. I’m confident about that. The manager talks about things in the seniors’ meetings and staff meeting. We share the information if it’s urgent in the daily handover. All the information is updated on the handheld devices (where staff record daily information about people’s support and care) so everyone can see it.” The registered manager stated they operated an ‘open door policy’ where staff could speak with them at any time about any concerns. Staff also attended supervision meetings throughout the year where discussions took place on any training or support required.

Staff were aware of the need to report any accidents and incidents and were aware of the process to do this. Forms detailing this information were completed by staff and were reviewed by manager to ensure immediate action was taken to mitigate risk. Accident and incident forms showed relatives were informed about these to ensure they were involved in any decisions made. Risk assessments had been completed following falls and showed any actions required to keep people safe.

Relatives confirmed the service informed them when their family members became ill, and the GP needed to be called.

Staff were able to tell us how specific health conditions needed to be managed demonstrating professional healthcare advice has been sought and shared with staff to help keep people safe. For example, staff knew detailed information about supporting people with diabetes, catheters, mobility and people with special dietary needs. The registered Manager said hospital transport was used to safely transport people to hospital appointments. Relatives were asked to escort their family member if possible or staff accompanied people to aide safe transitions between the home and hospital. Where people had capacity to choose, they were able to attend their appointments alone. The registered manager ensured any necessary information about people’s health was provided to support people’s healthcare appointments. They told us, “We send medication charts, and a member of staff would be able to give additional details.” Where people may suffer with anxiety the registered manager told us, “We would either see if we can get an early appointment so it’s not as crowded or busy, or see if can be done in the home or by telephone. They are always escorted.” The registered manager advised information following appointment should be recorded into a care plan and daily notes to ensure any advice was shared is followed.

A paramedic visited the service regularly to support people’s healthcare needs. They explained how a system had been implemented to ensure following their visit their instructions were followed. This helped to ensure people received health screening in a timely manner to prevent any delays in their treatment. The Local Authority advised the provider had informed them of a problem with the passenger lift in the home which resulted in a delay to a person in hospital returning until it had been fixed. This helped to ensure the safe transition of the person returning.

Electronic care plans were used by staff and a ‘hospital pack’ could be printed should a person be admitted to hospital so key information about the person’s health and support needs can be shared with other healthcare professionals. A paramedic from the local doctor’s surgery carried out a weekly ward round which meant there was consistent monitoring of people’s health conditions. There were processes in place to ensure risk assessments and care plans were regularly reviewed to ensure they remained relevant and up to date.

People felt safe and there were no issues of significant concern raised by people and relatives during our assessment. People gave mixed feedback about staff but told us they did feel safe. One person told us, “I like all the staff, there is not a problem." Another person said, “Most of them are very nice”. When asked for further information they said, “Sometimes they are a bit tired I think, and they can be a bit sharp but that is not very often." Relatives felt their family members were safe. One relative explained how the behaviours of another person had resulted in a negative experience for their family member, but this had since been resolved. Another told us, [Person] are not anxious and have settled well even with their dementia.” Relatives were not aware of any restrictions placed on people, where this was the case for 1 person an appropriate assessment had been completed to ensure decisions around the restrictions were made in the person’s best interests.

Staff knew how to identify signs and types of abuse and and to report any concerns to their manager. Staff said the registered manager acted on any concerns they reported. Staff had completed safeguarding training and had access to the providers policies and procedures linked to safeguarding to support them in their role. One staff member who had completed training told us, “We learnt all about different types of abuse like emotional and physical. If I saw anything, it is to be reported straight away to the manager. The manager is very good.” Staff had also completed Mental Capacity Act (MCA) training and knew about Deprivation of Liberty Safeguards (DoLS). One staff member told us, “I did MCA training and learnt about assessing to see if a resident’s got things like dementia. If they have, they might not be safe. Some of the residents have got DoLS. That means they can’t go out without staff being with them because it’s not safe.” The registered manager said people and visitors were able to report any concerns to the office or tell a member of staff, or alternatively, complete a form located in the entrance hall. Regular meetings took place with staff where lessons learnt from any safeguarding incidents or concerns were discussed. They told us, checks were made to ensure all staff were up to date with their training.

During our visit we observed people in the lounges and over lunch to check they received care and support in a safe way. We saw some friendly interactions between staff and people. People responded warmly when staff approached them. When 1 person visibly became anxious, a staff member quickly intervened to ensure the situation did not escalate.

The provider had a safeguarding policy and procedure in place as well as a policy and procedure in relation to mental capacity. Systems were in place record safeguarding incidents and report them to the relevant authority as necessary. Mental capacity assessments detailed if people had the capacity to make specific decisions. Applications to apply Deprivation of Liberty Safeguards (DoLS) had been completed where it was deemed people lacked capacity to make decisions. The provider had implemented a specific tool called a “Falls Cross” to document when people had fallen to enable these to be closely monitored.

People were involved in managing some risks associated with their care as appropriate. For example, some people chose to have portable heaters in their rooms which have risks associated with their use. People had been involved in decisions to use mobility aids to manage risks associated with them falling. Relatives said staff sometimes involved them in decisions about how to manage risks relating to their family member although some felt staff had not developed all of necessary skills to manage all risks effectively.

Staff had a good knowledge of risks associated with peoples care, this included risks associated with nutrition, falling and dementia. One staff member told us, “If you saw something like a resident was unsteady, you would report it and look at what was happening and what we could do to help. It might be having a carer walk with the resident or getting a walking aid. If that happened, then the care plan would be updated, and we would tell the staff during handover.” Staff told us they followed care plans and risk assessments to keep people safe. One staff member said, “You learn about risk from the care plans. Everything is written down. On a day-to-day basis we look out for any changes and if there is anything we report it.” Staff told us senior care staff completed risk assessments and updated care plans and they shared information during handover meetings at the beginning of staff shifts. The registered manager said people were involved in discussions about their care and any associated risks. They told us, “We have a falls meeting, nutrition meeting with the cook and meetings with senior care staff monthly. “For new admissions, we do an assessment, we ask them, we ask the family (about risks and care needs), we do weights when they come in so we can monitor them. We document all fluids and meals so any issues we can see quite quickly.”

We saw people were supported safely where there were risks associated with their care. For example, staff ensured people with walking frames or walking sticks had them near to hand to prevent the risk of them falling. One person’s care plan stated they needed to have their legs elevated to manage a health condition. We saw the person sat in a chair with their legs elevated. One person started coughing during their meal at lunchtime, we saw a staff member check they were okay and pour them a drink. We observed a staff member assisting a person with their meal, they did not rush the person to ensure they did not choke and supported the person at their pace.

People’s care plans and risk assessments helped to ensure people received safe care. For example, they guided staff how to manage risks such as diabetes, weight loss and mobility. Where people had specific health conditions such as hypertension or kidney disease, there was information for staff about the signs or symptoms of these so they could identify when people’s health was deteriorating. The provider used recognised risk management tools to record and monitor risks although we found two occasions when they had not been completed accurately. This meant the level of risk and proposed actions may not be accurate or appropriate. There was guidance for staff about good catheter care management but no information about the signs of a blockage or urinary tract infection to support staff in recognising this. One person’s care records did not evidence they had received support with oral care on 19 out of 29 days we checked in April 2024. Another person’s records did not evidence they had received support with oral healthcare on 16 days. A third person had no records to show support with oral healthcare. This meant people were at increased risk of suffering with poor oral health and potential discomfort which could lead to difficulties eating and drinking. The registered manager told us they audited people’s food and fluid records each week to check for any concerns.

Relatives were satisfied their family members occupied safe and suitable rooms. Comments included; [Person] has a splendid room with decent furniture…. I don’t think their room, or the home is in need of any repair, or is unsafe.” And “[Person’s] room is perfectly fine and doesn’t need any repair, neither does the home environment as far as I can see.

The registered manager stated a maintenance person was employed at the home who checked utilities as required such as gas and water as well as equipment. They worked flexibly to support the home. The registered manager said, “On a monthly basis there is an audit where all bedrooms are checked.” They advised this included, furniture, carpets, beds, flooring, windows and the décor of the home. Staff had been told to report any specialist beds that were bleeping to ensure any maintenance of these was addressed. Refurbishment plans were in place to further improve the décor of the home.

There had been some adaptations to the home to make this safe for people who used the service. This included stair gates that could be pulled across the stairwells to deter people who were at risk of falling from using them independently. In particular those people with dementia. A passenger lift was available to the upper floor that people could use independently. There were clutter free areas with space to enable easy access for those using a wheelchair. A person was seen independently using their wheelchair across the communal areas. Window restrictors were in place in bedrooms and corridors to reduce the risk of people falling from them. Those randomly checked were fitted and operated safely. Call bell access was available in some areas of the lounge to enable people to alert staff. We saw one person using this.

The provider had processes in place to address any environmental safety risks. This included a fire risk assessment and checks such as emergency lighting. Maintenance checks completed by maintenance person were recorded to confirm checks completed. Service contracts were in place for equipment such as hoists to ensure their ongoing safety for people to use. The provider had implemented utilities audits and checks to ensure these were being completed as required.

There appeared to be enough staff on duty on the day of our on-site assessment. Staff were visible walking through communal areas and acknowledged people. However, feedback we received suggested staffing arrangements may not always be effective. ”People and relatives provided mixed feedback when asked if there were enough staff. One person told us, “I don’t think so. Often there is not enough staff to go around. They say that themselves but there is not much they can do about that." Another said, “The staff don't come quickly at all. They say they are busy, but they are not doing anything." A relative told us, “We don’t have any concerns with the staffing levels at the home. When we visit there does seem to be sufficient staff on duty.” Another said, “When carers go to look at the patients in their bedrooms there are no staff in the lounges. So if [person] needs to go to the loo they have to wait. It can be a long wait because the staff are busy. It’s not the staff’s fault. Most of the staff are very caring and kind.”

Staff said they needed to work together to ensure people’s needs were met effectively. Some staff felt there were more staff needed to ensure people received the support they required. One staff member said, “I think they need more carers to be honest when all the call bells are going.” They felt the biggest impact was that staff did not always have the time people wanted for a chat. Another said, “At times no (not enough staff). Every day is different. We always like an extra pair of hands.” Staff told us regular training was provided and they had access to the training they required. One staff member told us, “Training, yes it is sufficient. I could not work until the training had been done.” Staff confirmed they attended supervision meetings with their manager where they could discuss any support they needed. Staff confirmed they were recruited safely, and all the essential checks had been completed before they started. This included references and a Disclosure and Barring Service (DBS) check to ensure they were deemed safe and suitable to work with people. The registered manager told they were in the process of recruiting a new domestic member of staff to reduce the need for care staff to support with laundry duties. They felt this would free up more care staff time. They also told us of plans to employ a new deputy manager. The registered manager had processes in place to check staff completed their training in a timely way.

We saw there was a staff presence in communal areas most of the time. However, there were periods of time during the day when there was no staff member visible to support people if required. This increased the risk of unobserved falls if people attempted to walk without support where this was needed.

Management processes helped to ensure staffing arrangements were safe. Records showed staff were required to complete all training courses within the first 3 months of employment. They also indicated training courses staff were required to complete annually. Training completed included training linked to people’s needs such as dementia care. Recruitment checks ensured staff were suitable to work for the home. However, one recruitment file did not contain all checks required by the provider. The registered manager maintained duty rotas to show staff on duty each day and also completed a governance report. This information was shared and monitored by the provider to ensure staffing levels and training were maintained as expected.

Relatives spoken with felt the home was clean and maintained and unpleasant odours that were at the home had improved since the carpets had been removed. One said, “Yes the home looks clean and well maintained.” Another said, “There have been times when I have visited, and the home smells of urine. However, since they have removed the carpet, it smells less of urine. Overall, it is reasonably clean I would say.”

Staff told us they received training on infection, prevention and control (IPC). Staff knew how to respond to any people with infections to reduce the risk of the spread of these. One staff member told us, “We attend to them and always use PPE and if it’s a urinary infection we put soiled clothes into red bag and do a hot wash.” There were specific staff employed to complete the cleaning of the home. One of these staff told us rooms were cleaned every day and deep cleans were completed regularly. They told us records were signed to confirm cleaning once all rooms had been cleaned. A care staff member felt the home was clean and stated they took it in turns to manage the laundry. They said, “Care staff all take turns in the laundry so slings for hoists get washed.” The registered manager confirmed peoples rooms were deep cleaned once a month. They had also received an audit recently by the Local Authority Commissioning team which had resulted in changes in the records they completed.

We observed staff had access to gloves in wall dispensers and disposable aprons were being wore as needed to help prevent the spread of infection. There were some areas of the home where cleaning needed to be improved. This included table tops, shelving and stained bedding.

An Infection prevention policy was in place which staff are able to access remotely. Cleaning schedules viewed were signed by staff to confirm everything listed had been completed. Surfaces such as overbed table tops were not on the daily cleaning list to show they had been cleaned.

People received their medicines as prescribed. One relative told us, “I have no worries about [Person’s] medication.” All relatives stated they felt assured their relative was receiving their medicines and none raised any concerns.

Staff understood how to manager people’s medicines and told us they had completed medicines training. One staff member told us, “I did my medicines training on-line. When I apply the cream, I add it to the handset to show (record) it’s been done or if the resident has refused.” Another said, “I have done my on-line training and I have shadowed (worked alongside) the other seniors (care staff). Then I spent time with [registered manager], and she watched me, asked me questions and then I was signed off. Now I can do medication on my own.”

Records were kept of medicines people were prescribed and if they had been taken. However, 1 person’s care plan informed staff they could administer medication covertly (disguised) by crushing and adding this to food. The care plan did not inform staff this only applied to 1 of the medicines. This was important as crushing medicines can make them less effective. The person’s medicine record also showed a prescribed medicine that had been discontinued. This was despite a white sticker dated several months previously stating the record needed to be updated. This meant the provider’s systems and processes to monitor medicine management were not always effective. Concerns we identified in relation to medicines management had not been identified.