Carmel 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 assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant people were not safe and protected from avoidable harm.

We have also determined a breach in regulation 18 staffing.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Whilst the provider had a proactive and positive culture of safety based on openness and honesty and they investigated and reported safety events, actions to reduce the risk of future incidents were identified but not always fully embedded. For example, safety incidents were not routinely analysed for themes or trends. The registered manager explained although incidents were discussed during staff ‘flash meetings’, regular audits of incidents were not part of the provider’s current policy. However, a new system was being implemented to allow management to have oversight of incidents.

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. People told us the process of moving into the home was supportive, and welcoming. They told us the provider asked the right questions, taking time to answer their questions and prepare them for the move. One relative we spoke with said, “We looked at different care homes and we felt this one was the most appropriate, as we felt we were being listened to. So far things have been good.”

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 any avoidable harm and neglect. Although the provider shared concerns quickly and appropriately with relevant organisations, we found an incident which required a safeguarding referral and notifying to CQC and the local authority had not been done. We spoke with management who admitted it was an oversight and promptly referred this to the local authority and notified the CQC. Staff had completed mandatory safeguarding training. Staff told us they would have no issue with raising safeguarding concerns with the registered manager or the external partners if they needed to.

The provider did not always work effectively with people to understand and manage risks. Staff did not consistently deliver care that was safe, supportive, or aligned with people's individual needs and preferences. Additionally, we found people’s safety had not always been reviewed to ensure they accurately reflected people’s current needs. For example, a person who received their meals and drinks in bed, potential risks such as risk of scalding from hot drinks or choking due to eating while lying down flat had not been assessed. In response to our findings managers assured us these risks would be promptly reviewed to support people safely. However, the provider had other risk assessments in place to support people safely, such as mobility, and moving and handling people risk assessments.

Overall, we found the home to be clean and well-maintained. However, some areas required attention. For example, one person’s bathroom was missing a skirting board, and the surface around the sink was worn, this was an issue the provider had identified during internal audits. Additionally, a hoist used on the ground floor bathroom, had been out of order for nearly a year and had not yet been repaired.

The provider confirmed these issues had been identified through their own audits, and repairs had been requested. Routine checks and servicing of utilities and equipment were in place. A business continuity plan was in place, designed to keep people safe in the event of an emergency, such as a loss of utilities or an environmental hazard.

The provider did not always make sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Although staff had the right skills to support people, we observed staff were generally busy with some staff such as domestic staff and administration staff assisting to support people to eat at mealtimes and support with people’s personal care needs. One person told us, “Sometimes the food is cold. It’s not the chef’s fault, its just it takes time to get to us, as there isn’t enough staff to serve the food while hot, so it gets to us cold.” Staff told us whilst they worked well as a team, there were not always enough staff to meet people’s needs. One staff said, “We have some issues with the number of staff at the moment, as we have fewer residents. They tend to cut staff numbers if we are not full capacity. We have 4 residents who need 2 staff to support with their needs, 3 require equipment such as hoist due to their mobility. We have to wait for the nurse to come and help us. We are struggling.” The management team told us they used a dependency tool to calculate how many staff were required for the people supported however feedback from people, relatives and staff indicated a need for more staff to support people effectively. One person told us, “I couldn’t ask for better staff, they treat me well. They’ve been smashing with me.”

We found the provider to be in legal breach of regulation 18, staffing.

The provider had systems in place to control the risk of infection spreading and shared concerns with appropriate agencies promptly. The provider had personal protective equipment [PPE] available for staff and visitors to use throughout the building. However, we observed a staff member handling soiled items without wearing PPE as required. We raised this with the manager who assured us they would address this immediately. Moreover, some areas within people’s bedrooms contained materials around the sink basins which were not conducive to effective infection control. We raised this with the provider, who confirmed they were aware of the issue and were in the process of addressing it.The provider had regular cleaning schedules in place to help keep the environment clean and tidy. Staff had training in infection, prevention and control, and Control of Substances Hazardous to Health (CoSHH) and in health and safety.

The provider did not always make sure medicines and treatments were safe and met people’s needs, capacities, and preferences. Whilst people generally received their medicines as prescribed, we identified some areas for improvement with medicines management. Although there was no impact to the person, there was an instance where medicines which should not be taken together was administered to the person at the same time, and in another case, a person’s allergy information was not recorded on their medication administration record (MAR). These issues had not been identified by the provider’s own audit processes. Despite this, there were several areas of good practice. Body maps were in place for people who required topical creams, and individuals’ preferences in relation to their medicines were clearly documented. For medicines prescribed ’as required’ (PRN), such as those used for pain relief or managing distressed behaviours, clear guidance was available for staff. The issues we found were dealt with quickly, advice from other healthcare professionals was sort and information updated.