Hunters Lodge

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• 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 had a pre-assessment before they transferred to the service and a transition plan based on their individual needs and wishes. Risks to people were assessed and staff had guidance of actions required to mitigate risks. There was a positive approach to risk taking. Health and safety checks were completed on the environment, premises and equipment. People were protected as fully as possible from the risk of abuse and harm. Staff were recruited safely and received ongoing training and support. Infection prevention and control measures were in place to reduce the risk of cross contamination; however some shortfalls were identified. People received their prescribed medicines when they needed them. We found some shortfalls with the management of medicines, but no person had come to harm and the registered manager took immediate actions.

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.

Relatives confirmed communication with the staff was good, they were informed of accidents and incidents and actions taken to mitigate further risks. A relative told us about an injury their family member had sustained, and the actions taken by the registered manager to reduce further risks. They told us they were very satisfied of the actions taken.

Staff confirmed there was a positive approach to learning and improving the care and support people received. Staff told us how information was shared during daily handover meetings, during staff meetings and supervision meetings. Staff felt involved and confident there was continuous learning and actions were taken to improve the service. A staff member said, “Concerns are listened to, lessons are learnt and shared.“

The provider had systems and processes that supported effective learning internally and across the service. This included having an accident and incident policy and procedure. Incidents and accidents were reviewed by the registered manager for any learning opportunities and shared with staff. The provider had an ongoing improvement plan to drive forward improvements. The provider had good oversight of the service, including monitoring and reporting procedures. The provider had additional services and any learning opportunities were shared across the organisation.

Relatives confirmed they were involved in pre-assessments. A relative told us how their family member had a transition plan that involved visiting the service before they moved in. Relatives were confident information was shared with others to ensure consistency of care was maintained. A relative said, “[Name] had a detailed assessment before moving to the service, everything was covered, staff visited them several times and they visited the service a few times before moving in, the assessment and transition was well organised and planned.”

Staff confirmed new admissions had a detailed assessment completed by the management team, and information was shared with staff before the person moved to the service. Staff also confirmed information was shared with others such as ambulance and hospital staff to ensure individual care needs were known and continuity of care maintained. A staff member said, “The management team always complete an assessment before the person transfers. This is shared with the staff and care plans developed. Any additional training is completed before the person moves in.” Another staff member said, “We have documents used to share information with others such as a hospital admission book and grab sheet that shares important information.”

The local authority told us they audited the service in February 2024, shortfalls were identified and actions to make improvements were required. They returned to the service in April 2024 and found all the actions had been completed. They confirmed there were no current concerns. Another external professional confirmed referrals from the service were appropriate and timely and how competent staff were. Comments included, “Staff were able to advise what elements of the person’s behaviour may be pain related and what may be long standing behaviours, this aided the assessment. Staff appeared keen to explore ways to support the person to minimise risks to their moving and handling.“

The provider had an admissions and discharge policy. This supported safe and effective assessment and discharge practice. Care records confirmed pre-assessments were detailed and involved any previous care provider, the person as fully as possible, relatives, advocates and external professionals. Any additional training and any resources were put in place before the person transferred. Transition plans were based on people’s individual needs and preferences. This could include both visits by staff to the person and the person visiting the service before they moved in.

People told us they felt safe living at the service. They told us staff were always around to keep them safe and how well they got on with other people living at the service. A person said, “Yes, I do feel safe here because it’s a safe place. There is no noise, and everybody is quiet and nice, and I like it that way.” Relatives had no concerns about safety and were confident people were cared for safely and protected from abuse and avoidable harm. A relative said, “I definitely believe that my relative is safe because staff are very good at what they are doing, and they know each resident well and their individual needs and how best to support them. I am very happy how they support my relative, they are doing so well.”

Staff confirmed they had completed safeguarding refresher training and had access to the provider’s safeguarding policy. Staff understood their role and responsibilities in protecting people from abuse and avoidable harm. They knew how and who to report any concerns to, including reporting to senior management within the organisation. A staff member said, “I would respond to a change of behaviour, agitation, frustration, new pain, I would alert the manager. I would also be alert to other staff such as rough moving and handling and would report.” Staff confirmed they had completed training on Deprivation of Liberty Safeguards and had access to the provider’s policy. A staff member said, “Some people have a DoLS authorisation, this is a legal document that means a person has some restrictions in place to protect them.”

People appeared relaxed in the company of staff and interactions were positive. Staff clearly knew people well including their routines, preferences and what was important to them. Staff picked up on and responded effectively, when people required assistance and or reassurance. Care and support provided by staff, reflected people’s support plans and was delivered with respect and kindness and safety maintained. We observed people were consistently given choices and staff were attentive and responsive.

The provider had policies and procedures that reflected best practice guidance and current legislation about how to support people to remain safe and protect their human rights. Staff had access to this information and were alerted to any updates and received annual refresher training. People had their own service user guide that included safeguarding information provided in easy read, to support people’s understanding of what safeguarding was and how to report any concerns. All incidents, accidents people had experienced were recorded and reviewed by the management team. Records confirmed these were well detailed and actions, including any lessons learnt had been taken. The registered manager monitored DoLS application submissions and authorisations, including any with conditions attached.

People told us how they did not have any restrictions placed upon them. A person said, “I can go around the house anywhere, I like making teas for my friend. My sister comes sometimes, and I make tea for her and her friends when they come to visit. We sometimes go to the corner shop, I used to go on my own but now I feel better if somebody is with me.” Relatives were positive how risks were assessed and managed. A relative said, “I have no concerns about safety at all, risks are managed well.” Another relative said, “I am very happy how they [staff] support my relative, who is doing so well with all their health conditions and risks. Health is always a priority with staff, and they don’t miss anything. With staff help, my relative lives a normal life, they go out, do the things we couldn’t dream of doing when they were at home, they are so much safer living there with staff who are so much better than any of us, family members.”

Staff gave examples of how known risks were assessed and planned for. Staff told us they were provided with guidance of how to mitigate known risks. This included receiving specific training in meeting people’s health related needs. Staff also gave examples of positive risk taking. Some people had complex clinical care and support needs and staff were found to be knowledgeable about these risks and actions required to keep people safe. A staff member said, “We do not need to provide any restrictive physical intervention here. Risk assessments and care plans provide us with guidance about how to manage any risks.” Another staff member said, “People are supported to take positive risks, for example accessing community activities, we involve the person and provide support and reassurance.”

Observations concluded staff knew people’s individual needs, routines and preferences well. We saw how staff were able to anticipate potential risks and how they were able to effectively manage these using a calm manner and approach. We saw people had access to all parts of the service including the kitchen. We saw several people making drinks independently, confirming there was a positive approach to risk management. We saw how people were offered choices to access the community with staff. We observed staff were organised and planned for any potential risks.

The provider had systems and processes to assess, monitor and review risks associated with people’s known care and support needs. Where possible people who used the service were involved as fully as possible in decisions about how risks were managed. Staff also worked with others such as relatives and health and social care professionals in the management of risks. Records reviewed such as people’s individual risk assessments, found these had been reviewed regularly and action had been taken to mitigate further risks such as making referrals to health care professionals for further assessment and or guidance. The provider had emergency procedures in place to support staff in managing risks. The management team had a positive approach to risk taking. For example, people had access to all parts of the service and regularly accessed the community, went on holidays, day trips, attended community day services and pursued leisure and recreational interests and hobbies. Some people had complex clinical risks and staff had received specific training and their competency assessed by external healthcare professionals.

People told us they were happy with their bedroom; that it was personalised, and they had everything they needed. A person said, “My bedroom is the best here, all pink, it’s my colour I love it, I would not change it. I don’t want to move ever from here.” Relatives told us the environment met their relatives individual needs. A relative said, “I am happy with building, it is hard to make any changes, I think is listed building, [name] room is beautiful, before they moved in, they [staff] organized decoration in colours and the way [name] likes it.”

Staff were aware of their role and responsibility in maintaining a safe environment for people who used the service. Staff confirmed they had completed fire safety training and evacuation procedures and had guidance about how to respond to an event that impacted the safe running of the service. A staff member said, “Staff have responsibility for many safety checks. These are completed on time and records are kept and are up to date. Any concerns are reported to management who deal, respond promptly.”

Observations found the environment, premises and equipment were maintained. People had access to a small courtyard, seating and a canopy was in place to protect people from the weather. We observed people to be enjoying time in the courtyard with staff. We observed redecoration to the ground floor corridor was happening and plans were in place for further decoration internally and externally.

The provider had systems and processes that assessed monitored and reviewed risks associated with the environment, premises and equipment. Audits and checks were continually completed internally and by external contractors to ensure safety was maintained. Any shortfalls identified, were added to the provider’s ongoing action plan with details of timescale for completion and by whom. The provider had contingency plans to respond to environmental risks that may impact the safe running of the service such adverse weather conditions and this information was available to staff.

People told us they were supported by an experienced staff team that knew them well. A person said, “I get on well with staff because they listen and are helpful and good at what they are doing.” Relatives confirmed staff were well experienced, knowledgeable and competent. A relative said, “I think there are plenty of staff, they just know their job well and how best to help residents, they are always around. It is lovely home to be in. Beautiful atmosphere, staff are kind but knowledgeable and professional.” Another relative said, “Staff are well educated, they do know how best to support my relative and others, and it’s a very stable staff team, not many changes in all these years, it just shows that whoever works there is the right person for this job. I am happy with all of them.”

Staff confirmed recruitment checks were completed before they commenced their role. Staff told us they received regular opportunities to discuss their work, training and development needs. They were reminded when their refresher training was due and completed competency assessments in relation to medicines management, moving and handling and in some clinical care tasks. A staff member said, “I had employment and DBS checks, attended an interview and had an induction, training and shadow shifts. I feel I was prepared well for my role.” Another staff member said, “I received an extensive induction and ongoing training. I was asked for my thoughts about induction at my last supervision to improve it.” Staff confirmed there were sufficient, experienced and competent staff to meet people’s needs. Staff shortfalls such as leave, and sickness were covered by staff, the management team or a regular agency was used if required. Staff raised no issues or concerns about staff deployment and safety. A staff member said, “I have no concerns about staffing. We are a stable staff team, we’re happy, and work well together. Like a family, stick together help each other out.”

Staff on duty matched the staff rota. Staff were unrushed and when staff engaged with people this was positive. People appeared relaxed within the company of staff who clearly knew them well. There was a friendly and relaxed atmosphere. We saw staff with people sitting in the courtyard enjoying the nice weather. A person was supported to attend a dental appointment, some people attended a community day centre and other people were supported to access the local community. We asked the team leader how they ensured people who were totally dependent of staff for all their care, support needs and well-being were monitored by staff. The team leader said there was no allocation of staff, but all staff took responsibility. We observed people in the lounge and the dining room with staff around and available, but not interacting with people. We raised this with the team leader and management team who agreed to follow this up.

The provider had safe recruitment procedures in place to ensure staff were suitable to work with vulnerable adults. The provider used a dependency tool to assess people’s individual care and support needs, this was used to assist in decisions about what staffing levels were required. Care staff were required to complete meal preparation, cooking and serving, laundry and weekend cleaning tasks. The Business Continuity Plan did not include consideration of an infection outbreak, and the impact on staffing and how this would be managed. We raised this with the registered manager who agreed to follow this up. The staff rota confirmed staff deployment and matched the staff on duty. The management team were well aware of staff’s individual strengths and considered this when developing the staff rota. Records confirmed staff received supervision and an annual appraisal at the frequency the provider expected. The staff training matrix showed good compliance, refresher training gaps were minimal, and action was in place to reach full compliance. Specific health care tasks such as radiologically inserted gastrostomy tube (RIG), Percutaneous Endoscopic Gastrostomy (PEG) and insulin administration, staff had received training and their competency assessed by health care professionals. Staff also had their competency assessed in moving and handling and medicines management.

People and relatives raised no concerns about cleanliness or hygiene at the service.

Staff confirmed they had received ongoing training in infection prevention and control and had access to the provider’s policy. We noted several care staff wearing nail varnish, this is potentially an infection control issue, we raised this with the registered manager who agreed to follow this up. Staff confirmed they had access to personal protective equipment (PPE) and were knowledgeable about when this should be worn. Staff were able to tell us of actions required to help prevent, manage and reduce the spread of infection should there be an outbreak. A staff member said, “I’m responsible for IPC training for staff on induction. We have very good provision of PPE and cleaning supplies with a very responsive supplier. Care staff complete cleaning at the weekend and this is completed well. I have no concerns.”

We observed a domestic staff on duty working following best practice guidance. The laundry room and cleaning cupboard were well organised. We observed PPE stocks and staff wearing PPE when required apart from a team leader on day 1 administering medicines without wearing gloves. A downstairs WC had a broken flush button cover, this could present an infection prevention and control issue. We also identified a person’s bedroom cupboard that was worn with the covering peeling, impacting on the effectiveness of cleaning and again was a potential infection prevention issues This had not been identified during health and safety audits. We raised this with the registered manager who agreed to follow it up. Overall the service was clean and hygienic, some areas of the service, including flooring appeared well worn and needed replacing. The registered manager told us plans were in place for improvements to be made.

The provider had systems and processes to assess, monitor and review the effectiveness of infection prevention and control measures. This included an up to date infection prevention and control policy. We reviewed the provider’s last two monthly infection and control audits. Compliance ratings were just below 99 percent. Where shortfalls were identified the audits recorded the action taken to make improvements. We found these improvements had been maintained. However, the audits had not identified the potential infection prevention and control issues we identified during our observations.

People received their prescribed medicines when they needed them and were supported to have their medicines reviewed by the GP. People and relatives raised no concerns about the management and administration of medicines. A relative said, “Medication is reviewed by the GP.”

Staff confirmed they had received annual training, including their competency assessed. Staff responsible for the management and administration of medicines, were knowledgeable about people’s prescribed medicines and how to manage these safely and the action required should medicine errors occur. A staff member said, “We complete yearly refresher training and competency checks. Team leaders complete daily checks, the manager audits monthly, any shortfalls are raised with us. I have no concerns, information / guidance is available and kept up to date. Any meds errors are reported immediately, and the GP / 111 called, and families informed.”

The provider had systems and processes that assessed, monitored and reviewed medicines management. Staff responsible for the management and administration of medicines had annual refresher training and their competency assessed. The provider had a medicines policy available for staff, we noted there was no reference to STOMP – supporting people to reduce the amount of inappropriate psychotropic medication. However, the registered manager was aware and advised how the GP / psychiatrist had reviewed and reduced these medicines for people. Audits and checks were completed on how medicines were managed, this included a monthly review by the registered manager. The last two audits reviewed recorded actions taken to shortfalls identified. This inspection identified a person had different eye drops, instruction on 1 bottle recorded which eye the drops were to be administered, the other bottle recorded ‘as directed’ the MARs did not clarify which eye. This may have caused confusion and was a potential risk. One person had paracetamol 500mg recorded as PRN this meant to be administered as required. Medication administration records (MAR’s) recorded between July 29 – August 13, 2024, these were administered daily at 8am. The reverse of the MARs used to record reason had only 1 entry dated 29 July 2024 and this was due to a catheter change. When raised with the team leader they advised this PRN had recently been changed to daily administration, the PRN protocol had not been updated and there was no documentation to confirm this change. We discussed this with the registered manager to follow up. One person had covert medicines, whilst there was a letter from the GP authorising this, this had not been followed up with the pharmacist to check the medicine was suitable to be given covertly, and if so how to do so safely. This was discussed with the registered manager who agreed to follow this up.