The 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 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 75 (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. There was an effective system in place to record accidents and incidents within the service. Incidents were documented appropriately by members of staff and then investigated by a member of the management team. Causes and triggers for incidents were identified to minimise the risk of recurrence and to support learning which ensured people were kept as safe as possible.

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. The provider had systems in place which ensured effective communication of people's needs when attending hospital appointments including individual ‘hospital passports’ and up to date medication information from medication administration record (MAR) charts.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way for this to be achieved. 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. People who lived in The Lodge were safe. Members of staff had received appropriate training to keep people safe and we observed safe practice when members of staff supported people. For people who could not communicate verbally, members of staff were able to clearly describe how they would monitor their facial expressions, body language and vocalisations and identify when something might not be right.

We saw evidence the provider followed the principles of the Mental Capacity Act 2005 (MCA) to review people’s capacity and understanding around receiving care and support. The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We found the service was working within the principles of the MCA and if needed, appropriate legal authorisations were in place to deprive a person of their liberty.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs which was safe, supportive and enabled people to do the things which mattered to them. Care was delivered in line with people’s care plans. People’s care plans and risk assessments clearly set out how the provider would work with people to manage risks safely and protect them from avoidable harm. Risk mitigation strategies were in place which enabled members of staff to provide safe and effective person-centred care. The provider supported and encouraged positive risk taking in line with the principles of CQC’s ‘Right support, right care, right culture’ guidance. A relative told us, “We know what's in the care plan and we help make it for [family member] so it has what they want in there.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. The care environment was clean, well maintained and adapted to meet people’s physical, sensory and emotional needs, which supported safety and wellbeing. The management team ensured regular safety and compliance checks were completed. We were assured the care environment met the needs of people with complex learning disabilities and sensory needs. The layout was clear and easy to understand with quiet areas and sensory spaces which helped people, who were non‑verbal, feel less anxious. Plans were in place to make enhancements and improvements to outside areas.

The provider made sure there were qualified, skilled and experienced staff, who received support, supervision and development. They worked together well to provide safe care which met people’s individual needs. Members of staff were recruited safely and received training, supervision and support. The provider completed checks before members of staff started work. These included identity checks, right‑to‑work checks, references and Disclosure and Barring Service (DBS) checks. This helped protect people who used the service. There was use of agency staffing throughout the service as a result of pressures on the numbers of staff available to meet people’s needs safely. Concerns around this were shared with us by members of staff. We raised the issues around staffing pressures with the registered manager and they told us about the actions in place to mitigate this risk. These actions included an active recruitment campaign to recruit more permanent staff and the development of positive working relationships with a small number of staffing agencies which ensured a consistent team of agency support and nursing staff who knew the people who lived at The Lodge and how they preferred their care to be provided. All agency members of staff were given an on-site induction and their profiles were reviewed. This ensured they were up to date with all relevant and required training. Feedback from relatives was mixed but balanced. One relative told us, “Using agency staff impacts information flow.” Another relative said, “[Person] is safe, staff know them well.” Members of staff had completed training linked to people’s needs, including learning disabilities, autism and positive behaviour support.

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 care home was clean, tidy and well-organised. A relative told us, “It feels very un‑institutionalised. It is always clean when we go.” Members of staff completed infection prevention and control (IPC) training and there was sufficient personal protective equipment (PPE) available throughout the care home. A member of staff told us, “Each person has gloves and aprons kept in stock in their bedrooms. We also have masks if needed.” IPC and PPE policies were accessible to members of staff and they were reviewed regularly by the provider.

The provider made sure medicines and treatments were safe and met people’s needs, capacities and preferences. Clinically trained members of staff supported people to take their medicines safely and in ways which met their individual needs. Health professionals reviewed medicines regularly and there were regular calls with people’s GPs to discuss medicines and any changes in their health. This helped the provider make changes quickly when needed. The provider had systems in place to support safe medicines management, including audits, GP involvement and clear records. When medicine administration errors happened, members of staff acted quickly. They reviewed the incident, informed families and identified learning to reduce the risk of it happening again. There were clear guidance and protocols in place for ‘as and when’ medicines given for pain relief. The protocols explained when to give the medicine, how much to give and what result should be expected. Members of staff monitored use of these medicines closely and tried calming and supportive approaches first to avoid unnecessary use of medicines.