The Lodge Residential 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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 69 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Incidents and concerns were investigated, so lessons learnt were identified to prevent reoccurrence and improve the quality of care. Management and staff meeting records confirmed incidents and lessons learnt had been discussed with staff. Relatives told us they were confident in raising safety concerns as they were listened to and acted upon. For example, changes had been made to the locks of bedrooms doors following an incident where staff were unable to gain access to a person’s room when the person had locked their door.

External agencies told us the provider was prompt in responding to and investigating concerns, and taking the appropriate action where required.

Staff were knowledgeable about their role in reporting accidents and incidents on the care system and informing the senior staff member on duty. Staff told us where incidents had occurred, they were alerted to these by the messaging system, for example where a person had fallen and the person’s care plan had been updated. Practical workshops incorporating role play were used to support staff within a controlled environment on how to respond to incidents and events.

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.

A thorough assessment was undertaken of people’s needs. This was in consultation with the person, family members and any professionals involved in their care. A person told us, “I looked at several homes. I chose this one, I also chose this room.” A relative told us, “We had a very detailed discussion about his needs when he first came.” A second relative told us, “I was involved with the initial assessment with social services.”

Processes were in place to share information when people transferred temporarily, or permanently into another home or hospital.

People had access to the healthcare they required. The GP visited the service to carry out reviews. Staff recognised people’s changing health needs and referred people appropriately. A health care professional told us, “Staff at The Lodge make referrals promptly and appropriately. On ward round days, they escalate non-urgent concerns to the GP team, and they contact the surgery directly in the morning for any acute or urgent needs. They also highlight when medication reviews are overdue and report weight loss concerns to enable appropriate referrals. Our team has found their referral processes to be timely and thorough.”

Staff were informed when someone new moved into the home. A staff member told us, “If somebody new was moving in we would be told at handover and asked to read their care plans.”

The registered manager told us a pre-admission assessment was carried out, and where people moved into other services, documentation was shared to support a smooth and safe transition.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Systems and processes were in place to document and monitor safeguarding concerns and Deprivation of Liberty Safeguards (DoLS), which were underpinned by policies and procedures. The provider shared concerns quickly and appropriately with statutory agencies in line with their responsibilities.

Evidence demonstrated any conditions linked to people’s DoLS had been actioned. In the absence of a relative or other appropriate person, people who had been deprived of their liberty under a DoLS, were visited by a Paid Relevant Person’s Representative (PRPR), who had been appointed to support and represent those individuals.

Staff had undertaken training on safeguarding, mental capacity and DoLS. Staff understood their responsibilities to protect people from abuse and harm and were aware of how to support people in their best interests where people did not have the capacity to make an informed decision. A staff member told us, “The safeguarding training was good, I know that if I see any risks of abuse I can speak to the manager at any time and raise a concern.” Another staff member told us, “Mental capacity and best interests decision making was part of my training. If a new person moves in, the manager will have put on their care plan if a mental capacity assessment has been completed and what decisions we have to make in their best interest. “

People and their families spoke positively about safety and care. A person told us, “The staff treat me very well, never rough or rude. They never ignore me; they go over the top the other way.” A relative told us, “I’m very happy with the staff and how they’ve looked after her, they know her well.”

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risks associated with people’s individual care and treatment needs had been assessed and were regularly reviewed. This included the risk of developing pressure sores, swallowing difficulties, catheter care and falls. Where risks were identified, a care plan and risk assessment were developed so staff knew what action to take to reduce any risk of harm.

Where people were at risk of falls, assistive technology was used such as sensor mats to alert staff when people were moving independently. Where risks were associated with people’s health, such as diabetes, care records provided clear guidance for staff, which included signs and symptoms a person maybe experiencing a hyper or hypoglycaemic episode.

Family members were knowledgeable about the measures put in place to mitigate risk, and told us they were kept informed of any incidents, including falls. A family member told us, “At night they do 2 hourly bed checks, and there’s a pressure mat on the floor. She’s had a couple of falls; we were told straight away.”

Staff were knowledgeable about people’s identified risks. Records showed where people required positional changes to prevent pressure sores and maintain skin integrity, these were accurate and up to date. A member of staff told us, “We are informed of changes to people’s planned care at handover meetings and encouraged to read care plans to understand the changes. Care plans are easy to access on the system and we are encouraged to read them.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Health and safety audits and checks were completed regularly on the environment, premises and equipment. The management team also completed daily walk arounds to check the environment was safe. Fire risks were assessed, and staff had completed fire safety training and participated in regular fire drills. Personal emergency evacuation plans had been completed and these informed staff and emergency services of how to support people to safely evacuate the building. Systems and processes were in place to regularly test the water supply from the risk of legionella a water bacterium that can cause serious ill health.

The provider had a refurbishment plan which outlined the improvements planned for and documented the progress of the plan. Some improvements had already taken place which included decoration to the exterior of the building, the installation of new windows, improvements to the garden and decoration to some bedrooms and communal rooms.

We observed equipment used had been serviced and to be in good working order. The environment, including layout of the building, supported people’s safety. Adaptations and equipment were appropriate to meet the needs of people, such as adapted baths, handrails and ramps. The garden was accessible, and included areas of seating to enable people to relax and enjoy sitting amongst the trees, plants and flowers.

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.

The provider used a dependency tool to assess people’s individual care and support needs and was used in determining staffing levels. People were supported by sufficient numbers of staff. The staff rota confirmed staffing numbers had been consistent, and any shortfalls due to staff short terms absence were covered by bank staff.

We noted at lunchtime some people chose to eat in 1 of the 3 lounges, whilst others ate in the dining room. The 4 areas were interconnected; however, we observed there was not always a member of staff present. We did not identify this had any negative impact on people, as people were able to eat without assistance. Throughout the day we observed staff respond in a timely manner to call bells and people’s verbal requests for assistance. Most staff stated there were sufficient staff to meet people’s needs.

People’s and family members views about staffing numbers were mixed. Whilst a majority felt there were sufficient staff, others said they believed staffing levels could be improved. A person told us, “I would say there’s always enough staff.” Whilst a second person told us, “I don’t think there’s enough staff, they want a few more. They are very pushed at times.” A relative told us, “There’s always staff around.” Whilst a second relative told us, “Staffing levels are an issue, they are short sometimes, but it doesn’t affect [person’s] care.”

Staff views regarding staffing numbers were mixed as to whether there were sufficient staff to meet people’s needs. A member of staff told us, “More staff, and more stable numbers would be good so that staff can take more time with people, spend time with them and relax.” Some staff spoke of the delays in securing agency or bank staff in response staff absence. A staff member said, "People have their own opinions about staffing, the actual level is okay, it's just the absence management."

Staff were recruited in a safe way. Appropriate checks were carried out before employment was offered so that as far as possible, only suitable staff with the rights skills and experience were employed. Induction training was provided to new staff. A staff member told us, “Induction was about 1 week; I was asked if I felt ready to work independently. During induction I observed senior staff, I had lots of different training; moving and handling, fire hazard training, safeguarding, personal care, lots more, it was online and in person. I thought it was good and prepared me well for the role.”

Staff completed training in key areas linked to people’s health, safety and welfare. Staff training data confirmed good compliance. People and family members expressed confidence in staff’s knowledge. A relative told us, “I think all the staff are pretty well trained.”

Staff were supported through regular appraisals, observed practice and one to one supervision.

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.

All areas of the service were visibly clean. Staff had access to personal protective equipment (PPE), and we saw staff wearing gloves and aprons where required. There were enough housekeeping staff on duty, who followed cleaning schedules in line with best practice guidance. Audits and checks confirmed health and safety assessments and ongoing monitoring procedures were in place and working well.

Staff had received Infection prevention and control training, and they had access to relevant policies. IPC was discussed routinely at staff meetings. A member of staff told us, “We have had IPC training and we have enough PPE when needed. The management team let us know about infection or outbreak concerns and we would be updated in team meetings, and the message system if there are any new concerns.”

Processes were in place to inform people using the service and their relatives of concerns relating to infectious outbreaks, which included notices, minutes of meeting and newsletters. A family member told us, “They told me about the shingles 2 weeks ago, I was asked to keep out of the home for 48 hours.”

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.

Systems were in place for staff to safely administer and store medicines. Records we checked showed people were having their regular medicines administered safely and on time. Medicine audits and checks were regularly completed and these confirmed where shortfalls had been identified, actions had been taken to make improvements.

People had individual medicine care plans that provided staff with important information such as any allergies, when and how to administer people’s medicine safely. However, we found information about medicines which were to be taken as and when required, for example for pain or in response to periods of anxiety or distress required improvement. Care plans lacked guidance as to how people may express pain or anxiety when they were unable to verbally express themselves. We also found records did not indicate whether the medication once administered had had the desired effect. The registered manager told us they would improve record keeping, promoting a person centred approach, which would include recording whether taking the medication had improved the person’s wellbeing.

People were supported to have their medicines reviewed regularly by healthcare professionals. For example, a person’s medicines had been reviewed by the GP and the number of medicines they were prescribed had been reduced. The review of the person’s medicine was in response to them declining to take their medicines, as in their view they were not doing them any good.

Staff had received training in medicines management, administration and had access to the provider’s policy and their competency had been assessed. A member of staff told us, “The medication management training was good and there’s good support for medication administration. The arrangements with the pharmacies work well.”