Earlfield Lodge

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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. The provider was previously in breach of the legal regulations relating to safe care and treatment, premises and equipment and fit and proper persons employed. Improvements were found at this assessment and the provider was no longer in breach of these regulations. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 63 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice. Accidents and incidents were reported and recorded. Staff were clear on their responsibilities to report incidents. Improvements were being made as the registered manager had identified the current system was not capturing all information required to fully manage incidents and monitor appropriate actions effectively. Whilst falls analysis was occurring, records did not always fully demonstrate the specific actions taken to mitigate risks in relation to incidents and safeguarding concerns. Learning was shared through team meetings and staff communications.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. Pre assessments were conducted before people joined the service, to ensure their needs could be met. The registered manager and provider confirmed admissions were kept in line with their statement of purpose and aims of the service.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately. Staff received training in safeguarding adults. Safeguarding concerns were identified and reported to the local authority. However, 1 safeguarding concern had not been reported to the commission as required. A safeguarding overview monitored progress and actions taken in relation to identified safeguarding concerns. Further details on how outcomes and learning was shared within the team was needed. Safeguarding concerns were discussed at team meetings.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. The registered manager submitted applications to the local authority when a person was at risk of being deprived of their liberty, and mental capacity assessments were completed. Authorisations of DoLS were monitored for progress. Where people had conditions associated with their DoLS these had been documented and completed.

People said they felt comfortable living at the service. A person said, “I’m happy so far. The manager is lovely, things come from up top and the staff are lovely.”

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Risk assessments were completed for different areas of people’s care, specific to their needs. For example, around mobility, skin integrity and medicines. Some risk assessments required revision to ensure staff instructions were completely unambiguous, particularly where professional guidance was integrated. For example, around constipation and covert medicines. The provider had not assessed the risks to people associated with emollient cream use. The registered manager said this would be addressed.

The service had strengthened its skin integrity risk management. Staff consistently repositioned people to maintain healthy skin and completed care records demonstrated this. Improvements had also been made in supporting to move around safely. We observed staff supporting people to transfer safely in line with their risk assessment and care plan. Staff talked people calmly through the process and reassured them throughout. Where people had a sensor mat to support them in relation to risk from falls. These were in place and used appropriately. A person told us, “[The sensor mat] it is good, it makes me feel safe.”

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care. The fire risk assessment had not been reviewed since 2022. This was being completed by an external professional during our assessment. People had personal emergency evacuation plans to assist in an evacuation. Clearer information was required to ensure in an emergency situation the correct actions were taken. The registered manager took steps to address this.

A business continuity plan gave guidance of how the service would manage in unforeseen circumstances such as utility failures or extreme weather. Environmental risk assessments assessed potential risks from equipment use and different areas of the service. Risks to people had not been assessed in accessing remote and higher floors of the service which could pose risks to people and where staff were not in attendance.

Significant improvements had been made to the environment. This included refurbishments in the interior of the home. People’s rooms and communal areas were now safe and uplifting. A person said, “I have a nice room.” A staff member said, “[Name of staff member] has turned the environment around.” There was improved seating and rest points throughout the service for people who liked to walk around. People now enjoyed the garden and patio area which was enclosed and safe. A person said, “You can go outside if you want to.” A professional said, “It is so much nicer, run down before. Changes in the environment helps peoples’ moods.” Since our last assessment the provider had modified their CQC registration to exclude parts of the building not currently in use and fit for purpose. This had reduced the capacity of the home to 35 people. Other improvements had been made including hot water pipes were no longer exposed and a smoking area had been created separately from the main building.

The provider had an ongoing refurbishment and maintenance plan which outlined future upgrades. Regular checks of fire safety equipment and the premises were undertaken. Including gas, water and electrical safety checks.

 

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. Improvements had been made in recruitment procedures to ensure safe practices were completed. Recruitment procedures were followed including Disclosure and Barring Service (DBS), right to work and reference checks. Interview records demonstrated how potential new staff were assessed for the role.

New staff received an induction which included introduction to the service and shadowing of more experienced staff. Supervisions were completed alongside competency assessments. The provider had a tracker to monitor supervision; this did not include non-care staff. Staff said they were supported in their roles. Some staff fed back their last supervision was some time ago. The registered manager said these areas would be addressed. Staff completed a range of training; both face to face and e-learning. This included areas such as moving and handling, first aid and dementia awareness. Training was being monitored to increase compliance. A staff member said, “I am getting enough training.”

Feedback about staffing levels was positive. A staff dependency tool monitored staffing levels against people’s support needs. People and professionals told us staff were available. A health professional said, “Staff are always around.” The home had a consistent team of staff who demonstrated they knew people well. A person said, “It’s been the same staff for a while. They are at ease which makes a difference, they get on well, there is a difference.” Another person said, “I like all the staff they are a great bunch.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Staff receive training in infection prevention and control. A lead staff member was developing their role of oversight in this area. Handwashing guidance was displayed. A health professional said, “Environments are well presented, well maintained, and appropriately managed with regard to infection prevention and control.” Staff had access to personal protective equipment (PPE) which was stored throughout the home. Staff were observed wearing PPE as appropriate. For example, during meal services. The home was clean and tidy. People said, “It is clean, [domestic staff] are really good” and “They clean my room.” A staff member said the home was, “Kept clean, cleaning staff are in every day.”

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. People’s preferences of how they liked to take their medicines were described. One person told us how they were supported with their medicines and this had, “Worked out well.” Medicines which required additional storage due to legal requirements were stored safely and regularly checked. Protocols for as required medicines (PRNs) were completed to direct staff on how to administer these medicines. We highlighted where further details specific to the individual would benefit. For example, how the person may communicate the PRN was needed. Temperature of medicine storage areas were monitored. The registered manager said they would implement maximum and minimum temperature recording for the medicine fridge in line with best practice. The registered manager was aware that transdermal patches needed the location of administration recording and was working with their electronic system to adjust this. Topical medicines records were maintained to ensure people had their creams and lotions as prescribed. Medicine audits occurred and competency assessments were conducted for staff practice. A health professional said, “The team [at Earlfield Lodge] handles medicines safely and responsibly.”