18 November 2021
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 Care Act 2014.
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.
The inspection was carried out by one inspector and one of our medicines team. An Expert by Experience also carried out telephone calls to some people at the home and relatives on 17 September 2021. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of service.
Service and service type
The Lodge is a 'care home'. People in care homes receive accommodation and 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.
The service had a manager registered with the Care Quality Commission. 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.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.
During the inspection
We spoke with three people and five members of staff including the registered manager, clinical lead manager and administrator. We reviewed a range of documents which included three care plans and recent feedback from three relatives. We checked six peoples’ medicines records and looked at arrangements for administering, storing and managing medicines. A variety of records relating to the management of the service, including records of meetings, incident and accident records, and policies and procedures were reviewed. We also spoke with one visiting health professional. The Expert by Experience spoke with three people who lived at the home and nine relatives on the telephone.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We also received entirely positive feedback from a further six staff members by email.
18 November 2021
About the service
The Lodge is a residential care home providing personal and nursing care to 54 people at the time of the inspection. The service can support up to 62 people living with frailty, old age, short term memory loss or needing a short time for rehabilitation following a hospital admission. The Lodge is a large adapted building near the centre of Exeter. There are bedrooms on two floors with access via passenger lifts. There are a number of communal areas on both floors. There is also a large, beautifully landscaped accessible garden/courtyard area which is enclosed.
People's experience of using this service and what we found
People and their relatives were extremely positive about their experience of living at The Lodge. People said they felt safe, well cared for and valued. Comments included, “My experience far exceeded any other respite stay, a welcoming, homely place” and “It’s not institutionalised at all. My grandfather goes out on his own in his buggy. He does what he wants to do. He does yoga and goes on minibus trips.” One relative told us the care was, “Incredible. My mother has gone from immobile to mobile. She was so fearful on arriving. Two staff greeted her at the door, freshened her up, got her tea and a menu. The fear she had, I saw it leave.”
Peoples holistic needs were very well met by a staff team who were well-trained and understood the ethos of ensuring person centred care. The provider ensured the staffing ratios remained high so the best possible care and support could be provided. This included having additional housekeeping staff and kitchen staff.
Care, meals and the cleanliness of the home continued to be exceptional in their quality and delivery. Staff received really well planned support, training and supervisions to enable them to do the best job possible.
People experienced an exceptional mealtime experience. People spoke very highly about the meals offered and the whole mealtime experience. Our observations of the lunch time experience showed staff worked hard to make the mealtime experience for people special. The restaurant was open for a two-hour lunch period. Staff were extremely attentive and supported people to choose, serve and eat their lunch in comfort. The hotel services manager often arranged special alternatives, visitors’ teas and bespoke menus.
People were valued and placed at the centre of the service. Staff promoted their privacy and dignity, enabling them to make choices and have as much control and independence as possible. The service used a variety of methods to facilitate this including supporting people with communication, assistive technology, providing information in an accessible format and a consistent staff team who knew people extremely well.
A huge range of activities were planned with people's hobbies and interests in mind.
The management team and staff genuinely cared for the people they were supporting. They advocated for them at every opportunity. They were there for them and their families at point of admission, when needing to transfer to hospital or at the end of their lives. They had achieved a national accredited training in end of life care. The service had a great reputation for achieving the best quality care for people's final days and would only accept admissions if they were able to provide this high standard of care.
They ensured people were able to maintain contact with their families, especially during the COVID-19 pandemic, even organising online birthday parties. The service had a guest room for family and friends to use when visiting if they lived far away or needed got be in close proximity due to ill health.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
The service continued to be exceptionally well led. The providers ethos was strongly promoted and modelled by the management team. They demonstrated a commitment to valuing people as individuals, supporting them to lead active and healthy lives and achieve their individual aspirations, where possible. The management team demonstrated an open and transparent management style and were fully engaged with people and staff at the service. Robust quality assurance systems ensured the continued quality and safety of the service and continued to drive improvement. This ultimately improved the outcomes for people living at The Lodge.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection The last rating for this service was outstanding in responsive and well led. (published 3 March 2020)
Why we inspected
We undertook this inspection as part of a random selection of services rated Good and Outstanding to test the reliability of our new monitoring approach. We also 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. We reviewed the information we held about the service.
We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.