Elm Lodge Nursing and Residential 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 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.

The service was in breach of legal regulation in relation to safeguarding and people’s safe care and treatment.

This service scored 53 (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. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.
During our inspection we identified that the provider had not investigated incidents and complaints. For example, when concerns were raised by family members regarding medication. This meant they had missed opportunities to learn and make improvements.
The provider recorded if people living in the service had an injury. However, there was a lack of evidence that investigations or analysis had been completed to identify the cause of the injuries.
We identified safeguarding incidents that had not been shared with other agencies in a timely way for independent review to determine how these concerns should be investigated. For example, when a person developed a serious skin injury.
The provider was updating processes and had put additional staffing hours in place to review documentation. The provider had invested in a new system to improve medication management and were engaging with support from external auditors.
 

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.
Some people’s care plans did not contain important information about people’s care systems including details of wound care management, equipment in place, external clinical team input, professional recommendations and guidance.
Care plans did not always include updates following referrals to services.
Two staff members were unsure about the handover process. This meant that there was a risk that staff were not aware of changes to people’s needs and people did not receive the appropriate support. Some people wanted more involvement in decisions regarding their health conditions.
However, we saw evidence of appropriate referrals, for example, to the memory clinic and tissue viability nurse team where this was required.
Staff told us they worked with other professionals including the pharmacist, dietician and district nurses.
The provider talked about the improved, thorough pre-admission assessment process and sharing of information when people transferred to and from the home. We saw evidence that the provider was making improvements to people’s continuity of care. For example, meetings were held to look at trend analysis and discuss hospital admissions and discharges. We observed a clinical meeting where the manager reminded staff of all the important actions to take following a person returning to the home from hospital. The service had also implemented a dedicated care plan coordinator role to manage the care plan audits.
 

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

During the inspection we looked at documentation relating to the oversight of safeguarding concerns, medication errors, accidents and incidents, injuries and complaints. We found these documents did not demonstrate that robust procedures and processes had been implemented. We found there was insufficient scrutiny and oversight of safeguarding concerns and systems were not established or operated effectively to prevent abuse of people. For example, following medication errors there was no evidence that investigations had been conducted and appropriate action had been taken to minimise reoccurrence. The Care Quality Commission (CQC) and local authority were not always notified of safeguarding concerns which raised concerns about a lack of transparency.

However, people told us they felt safe. One person said, “I do feel safe -it’s because of care we have -it feels good not to worry about many things and let carers help us.”

One relative told us, “Regarding care, I think my relative is in the right place and we know [they] are safe."

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.

Care plans did not always contain suitable and sufficient risk assessments to effectively manage risks. For example, one person did not have a risk assessment in place for their progressive health condition. Choking risk assessments did not always detail the food consistency required or involvement from specialists. Pressure sore risk assessments did not always include how often to support someone with repositioning and the equipment in place. Risk assessments were not always individual or included generic statements.

Daily care records did not always evidence how staff had responded to risk. For example, we reviewed records where staff recorded a person had been distressed but there was no information about how staff had provided reassurance or identified the cause. However, we saw evidence that concerns were shared in handover notes.

During the inspection visits we observed staff responding to risk, for example when someone needed support to sit more comfortably and safely. Staff could give examples of restrictive practice and depriving people of their liberty. They told us that if they had any concerns around restrictions, they would raise them with management.

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

Staff told us that everyone had access to their call bell, and all equipment was regularly checked and maintained including hoists. We saw evidence of this during our inspection.

We observed the home to be accessible with no hazards identified and equipment was stored in designated areas.

We observed staff safely using equipment to support people to change position and pressure relieving equipment was in place when required.

Documents viewed showed that there was a good system in place to identify maintenance jobs that needed doing in the home with a timeframe for actions to be completed.

However, some furnishings were dated and items were worn. The provider had included items that needed replacing on their service improvement plan.

The provider did not always make sure there were enough qualified, skilled and experienced staff.

Leaders had identified that nursing and senior staff needed support to improve their reporting and confidence. However, this support was not yet being provided. There was a lack of evidence about what actions had been taken to address poor practice, for example, following medication mismanagement and concerns raised by people about staff conduct.

The induction policy was not robust and did not include enough detail on identifying and managing concerns, who staff report to, or roles and responsibilities.

Two staff members were unsure about the handover process, and one member of staff raised concerns about the induction process. Leaders acknowledged this feedback and advised that the handover process and induction schedule had recently changed but these were yet to be embedded.

Leaders told us there had been a focus on mentoring and coaching staff, in-person training and supervisions. Staff told us they received effective support, supervision and development. We observed staff working together well to provide safe care that met people’s individual needs.

Staff felt their team was diverse, skilled and experienced and there was enough staff to keep people safe. They felt they had the support and training required.

One person told us, “What I like about staff is that they work well together, each one of them know their roles and that is good starting point.”

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.

Staff had training and were clear in their responsibilities in relation to infection prevention and control (IPC). We observed staff practising good hygiene, wearing appropriate personal protective equipment (PPE) and cleaning surfaces before and after food was served. However, some PPE stations and hand sanitiser dispensers required replenishing.

People were happy with the cleanliness of the home. One person told us, “My room is very nice, and other areas are also nice”.

A relative told us, “What we see when we come for visits is that [family member] is safe and their room looks clean”.

There was a malodour throughout one unit in the home. The provider was addressing this and carpets were being replaced.

The provider did not always make sure that medicines and treatments were safe.

There was no effective oversight of medication incidents and when errors occurred the provider could not demonstrate these had been responded to appropriately. For example, when medication had not been re-ordered by staff when required so someone missed their medication.

However, staff who administered medication told us they felt confident with the processes and procedures. We observed staff administering medicines as prescribed and medicines were stored safely.

The provider had recently implemented a new electronic medication administration recording system which was providing more accurate and efficient medicines management. The home had been engaging with external pharmacists and health teams who were completing audits and providing support in relation to medication.