Princess Lodge Care Centre

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

We assessed 8 quality statements in safe relating to learning culture, safe systems, pathways and transitions, safeguarding, involving people to manage risks, safe environments, safe and effective staffing, infection prevention and control (IPC) and medicines optimisation. Staff were able to tell us how to keep people safe from harm and abuse and there was an effective safeguarding process within the service. The service promoted a learning culture following incidents and accidents. People’s risks were managed safely, however, at times, people did not receive care and support at the frequency outlined in their care plan. Some staff told us this was impacted by staffing levels. During our first on-site visit, we identified various health, safety, and IPC concerns, and in some cases, these posed a risk to people living at the service, however, the manager took immediate action to address these. During our second on-site visit, many of these higher risks had been addressed or mitigated, and there were appropriate plans in place to address the remaining risks. People were supported with medicines safely, however we identified some missing documents for some people, such as protocols for ‘as required’ (PRN) medicines. The service was in breach of the legal regulations relating to the premises and equipment.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they felt listened to, and they had the opportunity to provide feedback to staff and leaders about their care. Staff were knowledgeable about safeguarding and told us they felt confident in raising any concerns. There was evidence to demonstrate all incidents were responded to appropriately, including the involvement of any relevant agencies where appropriate. We observed staff supporting people safely during our site-visits.

There were processes in place to ensure safe systems, pathways and transitions between services. People had personalised documents to take with them if they were being admitted to hospital, which included their communication preferences, personal care needs, dietary requirements, allergies and the reason for hospital admission. Relatives spoke positively about the pathway their family member experienced following hospital discharge and admission into the service. One relative told us, “Well they have been fantastic, so kind, [relative] went in 9 weeks ago from Hospital, I always said I would never put [relative] in a nursing home, but I couldn’t care for her anymore myself, but after a week I was so impressed, they have been so kind and helpful, I don’t worry anymore.” People told us they were involved in the creation and review of their care plan. The manager explained how they had oversight of people’s transition between hospitals through an online platform.

People told us they felt safe, and relatives supported this. One relative told us, “I am sure [relative] is 100% safe there, it is so good to know [relative] is somewhere secure and looked after all the time.” There were processes in place to ensure people were protected from abuse. Staff were knowledgeable about safeguarding and felt any concerns would be responded to appropriately. The manager explained how they learnt from incidents and accidents, to reduce the risk of re-occurrence. We observed people being supported safely during our site visits.

Staff had a good understanding of people’s risks and knew how to access information to support this. People had equipment to help them manage any identified risks where appropriate. We observed people being supported safely with any identified risks. People had risk assessments in place which identified any risks, and detail about how to manage these risks was transferred to people’s care plans. There was a process to ensure these were reviewed regularly, which included feedback from people and their relatives, and we saw evidence of some family involvement, however, some relatives told us they had not been involved in any reviews. We found people were repositioned regularly; however, this was not always in line with their care and support plans . The manager addressed this with the staff team in a staff meeting.

We observed various health and safety concerns during our first on-site visit. For example, we observed pieces of broken furniture, broken equipment, and a loose panel with a large nail protruding in a communal toilet, which posed a risk to people living at the service. We raised this with the manager who took immediate action to address this, and by the second on-site visit, one week later, many of the concerns were resolved or made safe and plans were in place to action the rest of the concerns. Relatives felt the environment was safe and raised no concerns. Staff were knowledgeable about the fire evacuation process. Health and safety audits took place quarterly, where maintenance tasks, training, risk assessments and IPC were reviewed. Actions were recorded following these audits and we saw evidence of actions completed, however the audits had failed to identify some of the health and safety concerns identified in this assessment. The manager told us how they have since put processes in place to improve the oversight in relation to health and safety. For example, they told us “To ensure the environment remains safe, clean and free of hazards, we have enhanced the daily management checks we carry out every day. Until now we have been carrying out a manager walkabout every morning and address any concerns identified immediately. We will now carry out an additional management walkabout in the afternoon and the Hospitality manager will also carry out additional checks focusing on the cleanliness, health and safety and maintenance.”

Staff were recruited safely. This included a check with the Disclosure and Barring Service (DBS). Staff had completed a variety of training courses appropriate to their roles and responsibilities. The manager used a staffing dependency tool to ensure people’s needs could be met effectively. The manager explained how the tool was used as a guide, but told us, “The tool does not direct the need, there might be other factors which influence... If for any reason I need additional staff, for example due to a change in behaviour, I can request this, and this is usually given.” Staff felt staffing levels were sufficient to meet people’s needs. One staff member described staffing levels as, “So much better than any other care homes I have worked in,” and told us sickness gets covered. Most relatives felt there were “plenty of staff about” and described staff as “well-trained.” One relative told us they did not feel there were sufficient staff to manage incidents prior to an incident which occurred previously with their relative and another person living at the service. However, they told us staffing levels have improved since they had raised this with the manager. Some people told us they, at times, had to wait for staff to attend to them, but told us this was not a long wait. For example, one person told us, “I don’t usually have a long wait but sometimes if they are busy you have to wait and that is difficult if you need the toilet.”

We identified various infection prevention and control (IPC) concerns during our first on-site visit. For example, dirty equipment, stained toilets, and areas of the premises and equipment which could not be cleaned effectively. We observed dirty gloves left in communal toilets and staff cupboards, and loose crisps in cupboard drawers in communal lounges, and an offensive odour in many areas of the home. We raised this with the manager, who took immediate action to address this, and by the second on-site visit many of these concerns had been resolved. The service had conducted IPC audits every 3 months and the manager completed a daily walkaround of the service which included checks on IPC, however these had not identified some of the above concerns and had not been effective in resolving some of these. Despite these issues, staff, people and their relatives described the service as clean. Staff told us they had access to personal protective equipment (PPE) and relatives told us staff wore this where appropriate to do so. The service assessed the employees IPC compliance through competencies such as PPE competencies, hand washing competencies and mandatory PPE and infection control training. The manager explained how they had since improved their processes in relation to the oversight of the cleanliness and IPC, and we observed during our second on-site visit this had improved but still required sustaining.

Medicines training and competency processes for staff were thorough. A comprehensive medicines policy was available for staff to read and refer to, that supported staff in the management of medicines, including administration and ordering of medicines. There were adequate arrangements for the storage of and any disposal of medicines, including for controlled drugs, and medicines requiring refrigeration. We observed a medicines round with a staff member and observed people receiving their medicines safely as prescribed for them. Staff were knowledgeable about people and their medicines, and people’s preferences were considered. There was no observable missed doses, and residents appeared to receive their medication on time. However, following a review of 15 people’s medication records, we found 3 people did not have ‘when required’ (PRN) protocols in place where appropriate. In addition, one person who received their medicines covertly, had a best interest form around medicines which did not include specific guidance from an appropriate professional, regarding how these medicines should be administered. We raised this with the manager, who told us this was recorded elsewhere and that these documents were now in place. They also explained how they had now improved their process in relation to medicines audits, to ensure better oversight.