Courtland 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. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement: This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

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.

The provider did not always have a proactive and positive culture of safety based on openness and honesty. Lessons were not always learnt to continually identify and embed good practice.

The provider’s incident forms did not always evidence sufficient action taken or identify shared learning. Staff reported incidents with details of what happened and the initial actions taken but further prompts for required follow up actions lacked the detail to help prevent the incident happening again. For example, staff had reported in an incident report a person’s footwear may have contributed to a fall, but we saw no evidence of action taken to prevent reoccurrence and during our visit, observed them in what appeared to be unsuitable footwear. The registered manager told us “[Learning is] discussed at handover and at team meetings. Staff cascade information as they come in, issues are discussed at unit meetings, every other month.”

Staff confirmed they were informed of incidents at staff handovers and were able to access information via their handheld devices where details of people’s care was stored. A staff member said, “Normally at handover when you come in on the next shift. We also have the devices, so you can check everyone’s pictures. Check device or word of mouth.”

People’s relatives were informed when incidents occurred. A relative said, “[Person] had a slight fall. We received a call from [staff] with details of what happened and what action was taken.” Another relative told us, “There have been incidents and the staff have immediately contacted me to inform me and discuss things.”

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 professional told us, “We find the staff to be approachable and happy to accommodate our nurses on their visits and are very rigorous in ensuring that they document our recommendations and advice so this can be performed by the care staff. We are confident that the staff and management team follow correct escalation processes to refer patients to us.”

The provider had not always ensured people were safe. We visited the service, having been made aware of an incident relating to poor risk management during a heatwave. We found some action had been taken in response to the concerns raised.

The provider had a safeguarding policy. Concerns were reported to the local authority and notified to CQC as required. The registered manager had a tracker to monitor safeguarding referrals; there were several in progress at the time of our visit.

Staff were trained in safeguarding and understood their responsibilities. A staff member told us, “Safeguarding is keeping people safe from harm; if I have a concern, I report it.”

People confirmed they felt safe at the service. A person said, “Safe, yes, absolutely I feel safe- because whatever happens I am only 1 of these [pointed to call bell] away and then someone is only a couple of minutes away.”

People’s relatives were informed when safeguarding concerns were identified. A relative told us, “There was a safeguarding [issue/concern] recently, we discussed this and they made some changes.”

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.

The provider had not ensured people had enough to drink to keep hydrated. We reviewed fluid monitoring records and found people were not always offered their daily target of 1500ml. For example, in a 2-week period, 1 person was not offered their target for 8 days, they drank below 1000ml on 7 days and 3 days below 500ml. This meant they were at risk of dehydration. We discussed monitoring of fluid intake with the registered manager and they told us, “It [fluid intake] shows on dashboard, seniors check who is on low fluids. I do too. We escalate to staff to make sure they push fluids.” However, the records we reviewed showed this was not always effective.

Staff we spoke with knew the signs of dehydration and action to take. A staff member said, “[Signs are] more sleep than normal, dry mouth, you can tell by their skin. [We] report to seniors if any concerns and push more fluids and monitor. At every handover they say who is at low intake and we are to push fluids.” However, they also told us “We have to assist them with their fluids. If they are up, they can do it themselves. But if they are in their rooms you have to assist them. That’s the case throughout the whole home and sometimes we are short staffed.”

People’s records did not always contain clear, consistent guidance for how to manage risks to them. We found discrepancies and inconsistencies between care plans and risk assessments. For example, a person’s care plan was updated to show they were cared for in bed and needed support of 2 staff to mobilise, but some of their risk assessments still said they were able to mobilise with a frame and received support of 1 staff. However, staff we spoke with were knowledgeable of people’s needs and feedback from most people and relatives confirmed this.

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.

We visited the service to assess risk in the environment following an incident related to poor risk management. Some action had been taken since the incident to improve the overall safety and comfort of the environment. We saw that new equipment had been introduced to communal areas and individual bedrooms to better maintain the living environment. A relative confirmed this progress, noting that management had installed new monitoring tools on residents' walls to help ensure their ongoing safety.

People were given a choice as to where they wanted to eat their meals. The dining area was quite cramped and trying to fit everyone in required some moving around. Staff told us, “It’s doable, we have the room but only just; the only saving grace is some eat in their rooms, in the past we had 15 people in there.”

The provider had a process to monitor various health and safety checks including water and fire safety, and these were audited monthly.

The provider did not always make sure there were enough staff to provide safe care. People were supported by qualified, skilled and experienced staff.

Staff told us there were not always enough staff on duty. They felt staffing levels did not impact on people’s safety but did affect wellbeing. A staff member said, “If we could have 5 [staff in] all the time that would be wonderful for us and residents. It would give you more 1-1 time with residents.” Another staff member told us, “Sometimes it’s a bit stressful, sometimes not enough staff. Not unsafe just really hard work and can put us behind on meds. When they have the numbers its ok.”

People and their relatives gave mixed feedback about staffing levels. Some people and relatives felt there were enough. A relative said, “There seems to be enough staffing. My [relative] is not able to use the call bell, but they check on [them] often.” A person told us, “Sometimes you have to wait for quite a long time to be attended to.”

During our observations we found there were mostly enough staff to meet people’s needs. However, people and relatives told us there were times when there were no staff in a particular area, possibly because staff take breaks at the same time. We were also told there were not always enough staff at night. Therefore, we were not assured there were always enough staff at different times of day to meet people’s needs in a timely way.

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.

The provider had an Infection, Prevention and Control (IPC) policy. Staff supported people to clean their hands. We observed this during our visit and found the home to be clean.

People confirmed the home was clean and staff wore Personal Protective Equipment (PPE) as required. A person told us, “They wear gloves and aprons.” A relative said, “I always think the home is clean and fresh.”

The provider had not always 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 medicines were not always administered and recorded as required. People’s records showed some people had missed several doses of their prescribed medicines, including a person prescribed thyroid medication. There was no evidence these omissions had been identified, escalated or followed up appropriately by staff at the time.

We found some protocols for medicines prescribed ‘as and when required’ (PRN) were missing, this meant staff did not always have access to clear guidance regarding when these medicines should be administered.

Staff had not always ensured medicines were stored and disposed of appropriately. We found an expired controlled drug in the cupboard and insufficient monitoring of fridge temperatures.

Following our findings, the provider took appropriate and timely action to address the concerns identified. People’s records were updated, medicines were disposed of appropriately, temperature monitoring issues were resolved, PRN protocols were implemented, and relevant clinical reviews were undertaken.