The Lodge Care Home

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 inspection 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 59 (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. We found incidents were generally managed and reviewed appropriately. A staff member said, “If something doesn’t go right, we are honest about it.”

Although the provider worked well with healthcare partners, they did not always effectively manage or monitor risks to people’s safety, including those relating to health needs, medicines and environmental safety. During the inspection we identified concerns in these areas, which indicated that systems to assess and manage risks were not consistently effective. Although the provider was responsive and took, or planned, action in response to our findings, this demonstrated that existing quality assurance processes had not consistently identified or addressed these risks in a timely way.

The provider 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.

Staff had received safeguarding training and demonstrated a good understanding of their responsibilities. The provider had systems in place to identify and report concerns, and these were generally used effectively. Concerns were shared appropriately where required.
 

The provider did not always work effectively with people to understand and manage risks. Staff did not always evidence that care was delivered in a way that consistently met people’s safety needs. Following changes in people’s needs, care plans did not always contain consistent information, for example in relation to mobility. Records also did not always demonstrate that people had been repositioned in line with their assessed needs. People who require repositioning are at increased risk of developing pressure damage if care is not delivered as planned. In addition, risks relating to a person’s health condition had not always been robustly assessed or mitigated. This increased the risk of inconsistent and unsafe care delivery.

In response, the provider told us they would review care plans and had sought advice from external healthcare professionals to support management of identified health risks.
 

The provider did not always detect and control potential risks in the care environment or ensure equipment, facilities and technology supported the delivery of safe care. During the inspection, we identified environmental risks that had not always been fully recognised or addressed by the provider. These included some fire doors with excessive gaps, and window restrictors not consistently being in place, although the majority had already been fitted across the home. We also observed unsecured furniture, which could increase the risk of falls and injury where people may use furniture for support. In addition, we identified that risks relating to low staircase bannisters had not been formally assessed, although there had been no reported incidents or near misses associated with this area. CCTV was in use, but appropriate signage had not been displayed. These issues increased potential safety risks to people.
In response, the provider took prompt action during the inspection to address the identified concerns. This included fitting window restrictors and installing required signage, with further actions planned to address remaining risks.

During our visits we observed there were enough staff to maintain people’s immediate safety. However, due to staff responding to people’s needs in the moment, for example supporting people to go to the toilet during mealtimes, busy periods in the service meant staff were at times stretched. This resulted in delays in care and periods where communal areas were not always consistently supervised. Feedback from staff, relatives and people supported this judgement. Staff told us the service could benefit from an additional member of staff during busy times. A relative said, “Sometimes they are pushed for staff, at lunchtime [my relative] has to wait sometimes.” A staff member said, “Having more balanced staffing between units would make things easier.”

Staff were recruited safely, and records showed appropriate checks had been completed. Staff also received regular supervision and support to carry out their roles. The provider told us they would review staffing levels in line with people’s needs.

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 home was observed to be clean and free from malodour, and communal areas and bathrooms were maintained to a good standard. Relatives also spoke positively about the environment, with one describing the home as “clean and tidy”.

The provider did not always ensure that medicines and treatments were safe or consistently met people’s needs, capacities and preferences. We found expired and undated topical medicines, such as creams, stored in people’s bedrooms. Protocols for medicines prescribed on an ‘as required’ (PRN) basis were not always in place, and staff had not always documented why these had been administered or how effective they had been, for example when given for pain.

Medicines audits had not identified these concerns. We also found staff who applied topical medicines had not always had their competency to do so assessed. This increased the risk of people receiving unsafe or ineffective treatment.

In response to our concerns, the provider removed and replaced topical medicines and implemented PRN protocols where these had been missing. We found the medicines room was clean, and medicines were stored securely at the correct temperatures. People had person-centred medicines profiles in place, which described how they preferred to receive their medicines and the support they required.