Field 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 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 providers 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.

Accidents and incidents were audited each month. Findings and any issues identified were shared with the staff for learning and to improve practice.

People, relatives and staff felt able to raise concerns and most felt that the senior team responded constructively.

The providers 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.

Information was gathered before people moved into the service. Staff worked with external professionals including District nurses and GPs to support the move and have ongoing monitoring. Observations confirmed staff understood people’s assessed needs and supported them appropriately. One relative told us, “The process to get him in here was excellent. They were in hospital and the [family member] couldn’t cope with them at home anymore. I came to have a look round and talk to them about their needs. The next day they sent someone to the hospital and after seeing them, they agreed to take them. Staff sorted out physically getting them here, settled them down and made them welcome. It was a great weight off our minds.”

The providers 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 providers shared concerns quickly and appropriately.

People said they felt safe from harm and abuse and relatives agreed. One person told us, “Yes, I do feel safe. The staff come and check on me. People can’t just wander into the home which is good. It is easy to get around the home.” Another person said, “I do feel safe here. Staff pop in to see if I am okay. I like to keep my door shut so it is quieter. I trust all the staff that come in and I know they care about me.” A relative told us, “I know staff check on them at night. It gives me peace of mind that I know people are here all the time to take care of them.”

Staff received training in safeguarding and were aware of their responsibility to safeguard people and knew who to contact in the event of any safeguarding concerns. One staff member told us, “I would complete an online form, report to management and raise a safeguarding with the local authority.”

The providers was proactive in raising safeguarding concerns with the local authority and CQC. They worked with the relevant professionals to investigate concerns when incidents occurred.

The providers understood their responsibilities under the Mental Capacity Act 2005 in ensuring Deprivation of Liberty safeguards (DoLS) applications were submitted as required.

The providers 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.

We observed staff involving people in their care, especially when supporting people to move around the service. Staff supported people to ensure their footwear was fastened correctly. Staff also spoke how they checked people’s skin regularly and reported and recorded any redness or changes. This was to help in taking action to prevent the condition worsening and/or seek further advice from the nurses.

One relative told us, “Staff have spoken to [family member] about asking for help when they need to go to the bathroom and they try and make sure they use their walker when they are going around the home. I don’t think there is much more they can do about their falls. There aren’t any trip factors in the home as far as I can see.”

Regular audits took place to ensure risks were managed well, these included pressure relieving equipment, diabetes management and nutritional monitoring.

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

Staff had undertaken training in health safety and fire safety. Cleaning chemicals and medicines were securely stored.

The providers carried out and organised safety checks, which included, gas safety, portable electrical appliances and water safety to ensure the risk of legionella disease was well managed.

Equipment used to support people was suitable, well maintained and stored securely. The providers had an up-to-date plan in place to help ensure people were supported in the event of an emergency. Staff told us they made checks on items such as slings as part of their daily checks.

All these checks helped to ensure that people lived in a safe environment.

The providers 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.

There were mixed responses to whether people, staff and family members felt that staffing levels were adequate. Comments included: “There are always staff around when needed.” “No there aren’t enough staff. I don’t believe the ratio are high enough.” “There are times when they are short staffed. You see the staff rushing around quite a bit. They have always attended to [family member] as soon as they can but you can just see they are rushing.” “Staffing is enough to meet people’s needs.”

However, the providers assessed staffing levels required using a dependency tool. Overall, during our visits, we found staff were able to respond effectively to people’s needs.

The providers carried out checks on the suitability of staff before they started working at the service. Systems in place included checks on new staff’s identity, eligibility to work in the United Kingdom, Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. This information helps employers make safer recruitment decisions.

New staff received a thorough induction to help ensure they were well prepared and felt confident to care for people. The induction program included a welcome and introduction to the service and people who lived there. All staff received training that the providers identified as mandatory. Additional training was in place which covered things such as Parkinson’s, diabetes and dementia care.

The providers assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The service was free of odours and housekeeping staff made sure areas were sanitised, clean, hygienic and fresh. One person said, “Staff come in and hoover every day. They seem to change my bed a lot. My room always seems clean.” Another person said, “The domestic staff are really helpful. They keep my room lovely and clean and they change the sheets at least once a week.”

Staff had sufficient supplies of PPE. They received training to help them maintain good standards of infection control. Staff told us they followed procedures for the use and disposal of their PPE. People and relatives also confirmed staff followed safe infection control practices.

The providers 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.

Qualified nurses were responsible for medicines administration, and their competencies were checked regularly with the registered manager. Weekly medication audits were completed with follow up meetings held to discuss any identified errors and appropriate action plans were in place when required.

The recording system in use is eMAR (electronic medicines administration records) which displays when medication is not administered in a timely way or if medication was missed.

Medicines were stored appropriately. Fridge temperatures are recorded regularly and are within safe limits. Medication storage rooms were clean and tidy and there was evidence to show that they are cleaned and checked regularly.

The inspection team observed the administration of medicines where staff followed safe procedures and displayed a confident and professional manner. Consent was obtained from people prior to medication being given. Communication with people was respectful and information was provided prior to the administration of medication. We observed one person refusing their morning medication and staff then returning later using a different approach which was then successful.

Where people were prescribed ‘as required (PRN) medicines, we observed that there were PRN protocols in place. We observed evidence that the option of self-medication had been discussed with one person and the care plan had been updated to reflect the discussion and record their preferences.