The Lodge

People’s experience of the service and what we found:

The registered manager and provider had not put in place effective systems to protect people from risk. Improvements were needed to formal systems throughout the service, particularly in the oversight of risk and people’s safety.

Information relating to people's individual risks was not always recorded or did not provide enough assurance that people were safe.

Systems were in place for accidents and incident recording however lessons were not learned, and improvements were not always made when things went wrong. People were not protected by the prevention and control of infection.

Staff had built positive relationships with people living in the service. However, not all care plans contained enough information to ensure staff knew the persons history and life story to deliver appropriate person-centred care.

The leadership, management and governance arrangements did not provide assurance the service was well-led, that people were safe, and their care and support needs could be met.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests.

Staff were recruited in line with requirements and there was a consistent staff team. People had enough food and drink to meet their nutritional needs. The service worked with other organisations to ensure they delivered joined-up care and support and people had access to healthcare services when needed.

There was a homely and relaxed atmosphere between people and staff. People and their relatives told us they were treated with care and kindness. One family member said, “All the staff really care about the residents. There is lots of stimulating activities. Food is very good. It has a lovely warm and homely feel. As a family we are very happy with the level of care [relative] receives at The Lodge.” Another family member said, “My [relative] has been treated with kindness and compassion from the staff.”

Medicines were well managed, and staff received training to help ensure they were sufficiently skilled.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The last rating for this service was Good when last inspected in March 2019. The report was published 4 April 2019.

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk and peoples safety of people. This inspection examined those risks. A decision was made for us to carry out a responsive inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

Enforcement and Recommendations

At this inspection we have identified breaches in relation to safe care and treatment, need for consent and governance arrangements. Please see the action we have told the provider to take at the end of this report.

Follow up

We have requested an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for The Lodge on our website at www.cqc.org.uk.

We found the following examples of good practice.

Risk assessments had been carried out on people using services and staff belonging to higher risk groups and actions had been taken to reduce the risks.

The service used isolation, cohorting and zoning effectively.

Infection Prevention and Control Policy and procedures were regularly updated, including a COVID-19 Policy.

Staff had all completed infection prevention and control training, and this included the correct procedures for using personal protective equipment (PPE).

The service was clean throughout. There were appropriate procedures to ensure infection control risks were minimised. The provider took swift action to address changes needed when identified.

The registered manager had contingency plans in place to prepare for an outbreak and manage any staff absences effectively.

People’s experience of using this service:

People told us they felt safe living at The Lodge. Risks were managed safely and safe processes were in place. People were supported with their medicines in a safe way.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were supported to maintain good diet and access the health services they needed.

Staff were skilled, competent and able to fulfil their role. Staff told us they received supervisions and appraisals to enable them to review their performance. A complaints procedure was in place and people knew what to do if they had a concern of any kind.

Staff had built positive relationships with people living in the service. There was a relaxed atmosphere between people and staff. Care plans were person centred and included guidance for staff in how people wanted to be supported. A range of activities were available for people to take part in.

Staff said the service was well-run and the registered manager was supportive. There was evidence of effective checks being carried out to assess and monitor the quality of the service provided..

Rating at last inspection: Good (report published 06 August 2016).

For more details please see the full report which is on the CQC website at www.cqc.org.uk

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained rated Good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The Lodge is a residential home in Maldon providing care and support to up to older 24 people, some of whom were living with dementia.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were safeguarded from avoidable risk of harm and staff understood the process to follow to report concerns regarding people’s safety. There were risk assessments in place which detailed how people could be supported safely. People’s care plans were detailed, person-centred and included information regarding their backgrounds, preferences and how they could be supported effectively. These were subject to regular review with involvement from people and their relatives where possible. There was a key worker system in place for each person to have a point of contact within the staff team.

People’s healthcare needs were identified and met by the service and there was evidence of good links with healthcare professionals. The service took a proactive approach to managing people’s healthcare needs and had recently won an award for the prevention of urinary tract infections. People had enough to eat and drink and the food and drink on offer took into account their individual needs and choices. There was a programme of activities on offer for people. People were treated with dignity and respect and had opportunities to have their opinions and views heard. People gave their consent to receiving care and treatment.

Staff received a variety of training to enable them to carry out their duties effectively including some specialised training. They completed a thorough induction programme when they first joined the service and were subject to regular supervision and appraisal. The recruitment processes used to employ new staff were safe and ensured that staff employed had the skills, character and experience to meet people’s needs. There were enough staff to keep people safe and protocols in place in case of severe shortages or staffing issues. The manager held team meetings and sent out staff surveys to provide staff with an opportunity to provide their feedback and contribute to the development of the service. Staff understood the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards (DoLS) and these were applied correctly in practice.

There was a robust quality monitoring system in place for identifying improvements that needed to be made across the service. People, staff and relatives were positive about the management of the service and felt that the registered manager was supportive and approachable.

We found that staff were well supported as there was a system of supervision and appraisals in place. An ongoing programme of training assisted staff in increasing their knowledge and undertaking their roles effectively. The staff knew about their responsibilities in relation to the safeguarding of vulnerable adults and the reporting of abuse so that people were kept safe from harm.

We found that the service had made improvements in assessing and monitoring the quality of the service in all aspects of the service. Records of people who used the service and staff were kept securely and were located promptly as requested.

One relative told us: 'We looked at three homes before this one and this was by far the nicest, not in terms of d'cor, but the feeling you got when you were here.'

The provider did not protect service users against the risks associated with the unsafe use and management of medicines, by means of the making of appropriate arrangements for the recording, administration and safe keeping of medicines.

The provider did not have an effective system to regularly assess and monitor the quality of service that people received.

Some improvements had been made to the management of medicines. However, we found some discrepancies in the medicine audits that had been completed and found that systems for the effective assessment and monitoring of quality and safety at The Lodge were inadequate. Improvements were needed.

We saw that people were provided with care and treatment that met their individual needs. We identified that food and fluid charts were not completed with detailed information required. For example one entry was listed as, 'Main meal.' There was no reference to what that main meal was. Therefore did not provide enough information to support care needs of people.

We identified concerns in relation to the management and administration of medication. We found medication in the controlled drug cupboard that had not been returned to the pharmacy.

We found that staff had been appropriately recruited to their roles; they received induction to work in the service and received ongoing training and supervision.

People were aware of the complaints system in the service. Complaints and compliments information was clearly displayed in the public areas. People were encouraged to feedback about the service. We identified that the service has not reported incidents in accordance with the regulations to notify the Care Quality Commission of routine or unexpected events.