The Lodge - Dementia Care with Nursing

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 changed to good. This meant people were safe and protected from avoidable harm.

This service scored 69 (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 learning culture. Lessons were not always learnt to continually identify and embed good practice.

Although staff knew how to record incidents, we found that some low-level incidents had not been documented, and the quality of some reports was variable. This made it difficult to review situations for themes and identify areas for improvement. However, staff recorded incident forms for medium to high level issues, and these were reviewed by the clinical leads and the registered manager.

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.

There was a robust admissions process and thorough policy in place. This meant holistic assessments were completed before people moved into The Lodge and staff had information about how to meet people’s needs. Staff made referrals and worked with other agencies to make sure different aspects of people’s health and wellbeing were considered by the appropriate health professionals.

The provider protected people’s right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

There was an appropriate safeguarding policy and staff undertook safeguarding training. The Staff knew how to raise concerns and managers worked with the local authority to make sure these safeguarding issues were investigated, and recommendations implemented and monitored.

The provider did not always work well with people to understand and manage risks. Risk assessments did not always contain accurate or detailed information to guide staff.

For example, for 1 person that was immobile, their skin integrity risk assessment and care plan did not guide staff about how to minimise the risk of skin breakdown. However, daily notes indicated that staff were completing appropriate care tasks and the person’s skin was healthy. Some people had the use of ‘safe holds’ in their care plans. Quality of care plans was inconsistent and some guidance about how to support people when they experienced distress contained limited detail. Safe holds are a physical method used by staff as a last resort to reduce the risk of people causing themselves or others harm, and other methods such as distraction should be used first. We checked records and safe holds were not being used on a regular basis, and when they were, staff supported people safely.

We fed this back to the provider who agreed to review care records straight away and amend their care plan audit schedule.

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

There was a robust maintenance management system, and health and safety checks were made on a regular basis. Compliance checks were made in relation to fire safety, gas, electric and water safety. The person responsible for maintenance completed regular environmental audits and items were replaced or fixed when required. The home was maintained to a high standard and the building and equipment were in good working order.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The provider completed staffing dependency tools and made sure there were enough staff on duty to meet people’s needs. At times agency staff were arranged to fill any gaps in rotas.

The provider recruited staff using safe processes. Managers completed safety checks such as references and Disclosure and Barring Service (DBS) checks. Managers checked nurse and clinical staff competencies.

Staff completed thorough inductions and training relevant to their role; compliance rates were high.

Some staff reported at times they were asked to cover a shift on a different unit in the home. They felt their knowledge was less well developed about people’s needs when this occurred. Relatives said overall staffing levels seemed good and staff appeared well trained.

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.

There were infection prevention and control measures in place and the home benefitted from dedicated housekeeping staff. Rooms were cleaned daily and as required. The home was clean and comfortable. Staff wore appropriate items such as gloves and aprons when required to do so. Hand gel was available for staff to use, and we observed staff washing their hands.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Medicines were stored securely and staff checked that storage areas were the right temperature. There was information for staff about medicines that were prescribed ‘as and when required’. This was an improvement following the last assessment. Medicine records indicated that staff administered people’s medicines according to their prescriptions and at appropriate time intervals. However not all staff recorded the amount of thickener added to people’s drinks. We fed this back, and the manager made changes immediately to make sure this was completed consistently.