The Lodge Care Home

Updated 24 August 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by one inspector, a specialist nursing advisor, a medicines inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

In The Lodge Care Home people receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of our inspection, there was a registered manager in post but they were on long term absence.

We were supported by senior members of staff and an area manager, who was a representative of the provider and was managing the service in the interim. The area manager worked with the nominated individual, who was not able to attend the inspection. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

Notice of inspection

The inspection was unannounced.

What we did before the inspection

We reviewed the information we already held about the service. This included the last inspection report and notifications. A notification is information about important events, which the provider is required to tell us about by law.

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

We used information gathered as part of monitoring activity that took place on 15 May 2022 to help plan the inspection and inform our judgements. We used all of this information to plan our inspection.

During the inspection

During the inspection, we spoke with the area manager, two care managers, two senior staff, six care staff, one domestic staff, one laundry staff, one maintenance staff and the kitchen manager. We carried out observations of people’s care and support and spoke with 10 people for their feedback on the home.

We reviewed documents and records that related to people’s care and the management of the service. We reviewed ten care plans, which included risk assessments. We looked at other documents such as medicine management and infection control.

After the inspection, we spoke with three relatives for their feedback about the home by telephone. We continued to seek clarification from the provider to validate evidence found.

Updated 24 August 2022

The Lodge Care Home is located in Romford, Essex and supports older people, some of whom have dementia care needs. It is registered to provide accommodation and personal care for up to 94 people. At the time of the inspection, 91 people were living in the home. The home has two floors with adapted facilities and en-suite rooms across five units.

People’s experience of using this service and what we found

The home was not safe because people’s medicines were not managed, stored and administered in a safe way. Staff were administering specialised medicines to treat diabetes but they did not have the appropriate training to do this. Staff competency in this area was not assessed which could put people at risk. We found multiple issues with medicine records and storage facilities which had not been identified through audits.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People were not always receiving care in a person-centred way. Care plans and risks to people’s health were not being regularly assessed and reviewed. Some people were not being supported effectively to maintain their nutrition and hygiene.

People had limited opportunities to take part in activities because there was a lack of activity staff. We have made a recommendation in this area. Staffing levels in the service were not sufficient to ensure people received the care they needed. Accidents and incidents in the home were not always used to learn lessons.

Quality assurance systems in the home were not robust and there was a lack of oversight to ensure people were safe and being supported with good quality care. The provider was not meeting regulatory requirements to notify us of incidents in the home.

People and relatives told us the staff were friendly and caring. There were procedures for the prevention and control of infections but we have made a recommendation to include COVID-19 outbreaks within the provider's future contingency planning.

Staff were recruited appropriately and they received an induction and training. Staff worked with health professionals and other agencies to help maintain people’s health and wellbeing. There was a complaints process and complaints were investigated. People’s communication and equality needs were understood. The provider engaged with people and relatives and obtained their feedback to drive improvements. However, more work was required to resolve the issues we found and identify them in the first instance.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 8 October 2021 and this is the first inspection. The last rating for the service under the previous provider was Good, published on 26 September 2017.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, staffing, person-centred care, meeting nutritional and hydration needs and good governance at this inspection. We also made some additional recommendations.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.