- Care home
Buckler's Lodge Care Home
We served a warning notice for Greensleeves Homes Trust on 12 August 2025 for failing to meet the regulation related to management and oversight of governance and quality assurance systems at Buckler’s Lodge Care Home.
Report from 21 May 2025 assessment
Contents
Ratings
Our view of the service
Date of Assessment: 9 and 11 June 2025.The service is a care home without nursing providing support to older people, people with dementia, physical disabilities and sensory impairments. This assessment took place due to concerns received about people’s safety, management of medicine, care and risks, and governance oversight at the service.
At our last inspection, the service was rated requires improvement and was in breach of 3 legalregulationsin relation to safeguarding, good governance, and fit and proper persons employed.
At this assessment, we found continued breaches of legal regulations in relation to safeguarding, fit and proper persons employed, and good governance. We found new breaches of legal regulations relating to medicine management, staffing, and duty of candour.
The provider and the registered manager did not always demonstrate they had robust quality assurance systems and governance processes which operated across all levels of the service. The provider and the registered manager did not always ensure there was a good learning culture.The provider and the registered manager did not always ensure safeguarding procedures were followed and any allegations or incidents were reported to external agencies accordingly.The registered manager did not always ensure they and the staff team consistently managed and recorded risks to people’s health and welfare.The registered manager did not always ensure there was effective staff deployment as they did not always have full oversight of staff training and people’s support needs.The staff did not always receive consistent training, supervisions and regular appraisals.Management of medicines was not always safe and not supported with consistent clear records.Effective recruitment processes were not in place to ensure, as far as possible, that people were protected from unsuitable staff being employed.People and relatives could raise concerns or complaints and provide feedback. However, staff were not always encouraged to be actively involved in the development and continuous improvement of the service.
Staff ensured people were protected from the risk of acquiring an infection during the provision of their care. The facilities and equipment were clean and well-maintained for infection risks to be mitigated. Staff supported people to access different services and support from health and social care professionals to promote and achieve positive outcomes for people.
In instances where CQC has begun a process of regulatory action, we may publish this information on our website after any representations and/or appeals have been concluded, if the action has been taken forward.
People's experience of this service
We spoke to people using the service and relatives during our site visit.While the people and relatives expressed that they were generally happy with their care, our assessment found some elements of care did not meet the expected standards.People were mostly supported to have choice and control of their lives and in their best interests; but the policies and systems in the service did not support the practice and oversight of people’s care and treatment.People were not always supported to engage in meaningful activities to ensure stimulation and reduce the risk of social isolation.
We observed staff’s practice and support provided. Staff did not always demonstrate they knew people’s individual needs. Staff were not always able to support people effectively to ensure good outcomes for them. People felt they could speak to staff and management team but not everyone has met or knew who the registered manager was.The staff andthe registered manager did not always ensure people’s views or wishes were taken into account. A few people told us they were not sure if they had meetings to review their care, support and risks.People did not always have clear or detailed plans of care and risk assessments. This did not always ensure people would receive personalised care which should be responsive to their needs.
People were supported to eat and drink sufficiently for their needs and they were mostly complimentary of that experience.Staff supported people to see healthcare professionals in order to maintain good health and wellbeing.People reported to us they were treated mostly in a caring and kind manner by staff. A few people added, “I was upset at the beginning, but [staff] were kind and tried to find out what was wrong. It’s just all the change” and “If the staff realise I’m upset, they are very kind.”People agreed staff ensured people's privacy and dignity were upheld and independence promoted during the provision of their personal care.People told us they did not feel they experienced any discrimination or inequalities while staying at the service.