The Lodge

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 overall, 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 had a proactive and positive culture of safety, based on honesty and a willingness to improve.

Learning systems had improved since the last inspection where lessons were not always embedded. Systems for reviewing incidents were in place and monitored.

Staff described an open culture and ability to raise concerns. Incidents were reviewed and discussed. However, learning was not always consistently reflected in documentation, indicating further work was needed to ensure sustained improvement.

Leaders demonstrated commitment to continuous improvement. Some health professionals confirmed improvements in approach, a professional said there had been, “Significant improvements over the last six months.”
 

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.

Partnership working with external professionals had improved, and this was reflected in feedback received during the inspection. Health professionals told us staff were, “Eager to know what the plan of action is,” and “Genuinely care for patients,” with evidence that they were contacted in a timely way when people’s needs changed. This supported safer transitions between services and more effective clinical oversight. However, some feedback indicated that responsiveness could still vary at times, and there remained opportunities to further strengthen consistency in how recommendations from professionals were embedded into practice.
 

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 bullying, harassment, abuse, discrimination, avoidable harm and neglect.

Safeguarding systems were effective. Staff understood how to recognise and report abuse and described clear escalation pathways. People and relatives indicated they felt safe. Improvements in partnership working supported timely identification and escalation of concerns. While some variability in staff knowledge remained, systems ensured people were protected from harm.

One staff member told us, “Abuse to a resident you have to inform the team leader. If no action is taken, I would refer to the manager or report to the police.” This demonstrated awareness of escalation pathways and a willingness to act to protect people. A second staff member explained, “If you see unsafe practices, we all have a responsibility to report them,” reflecting a culture where safeguarding is recognised as a shared responsibility.
 

The provider generally ensured risks were identified, assessed and managed in a person-centred way.

Care plans and risk assessments were in place to guide staff in supporting people safely, and staff demonstrated a good understanding of individual risks and how these should be managed in practice. For example, a staff member told us care plans, “Explain potential risks, mobility is explained if they need a wheelchair or frame,” and described how tools such as body maps and monitoring systems were used to identify and respond to risks.

Effective communication systems supported the management of risk. Staff described how information was shared through handovers and daily meetings, with one member of staff explaining, “Each handover any concerns are given and changes updated in care plans and written on the whiteboard,” ensuring staff were aware of current risks and changes in people’s needs. This helped to promote consistency of care and reduce the risk of harm.
 

People were involved in managing risks in a way that respected their preferences and promoted independence. Although further work was needed to ensure all records consistently reflect the level of detail required, systems and staff practice supported safe care.

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

Environments were regularly cleaned and Personal Protective Equipment (PPE) was available throughout the building to support staff to maintain good infection prevention and control practices.

Fire safety systems had improved, and staff told us there were regular fire drill practices which provided assurance that staff would be able to safely evacuate people in the event of an emergency. One staff told us, “I’m confident I get the fire training I need and the regular fire drills keep us refreshed in practical terms.”

Equipment was mostly available and functioning, any equipment that was faulty or awaiting repair was not in use. Regular monthly checks were in place, including daily visual checks of equipment, such as wheelchairs and sit to stand equipment to ensure any risks were consistently identified or mitigated. The environment was managed in a way that ensured safety was consistently maintained to enable the provision of safe care.
 

The provider generally ensured there were enough suitably qualified, skilled and experienced staff to meet people’s needs. Staffing levels were flexible and responsive, with systems in place to adapt where required. One staff member told us, “We are fully staffed at the moment,” and explained that if there were any concerns, “We talk to the manager and look at the best ways to do it.” This demonstrated a proactive approach to staffing and meeting people’s changing needs. Staff also confirmed additional support was available if needed, with one stating, “There are always people that will come in and cover shifts [Name of registered manager and care manager] will come out and work on the floor.”

Staff reported they felt supported in their roles and had access to supervision and ongoing development. One staff member told us they had regular supervision where managers, “Listen to my concerns,” and another said, “I’m able to discuss any matters or concerns, they listen and give advice, and this helps to build my confidence.” This reflected a supportive management approach that encouraged staff development and promoted a positive team culture.

Training systems were in place, and staff described a range of training opportunities, including both online and face-to-face sessions. Supervision and training opportunities were in place; however, these had not always translated into consistent practice, particularly in relation to moving and handling practices and safeguarding knowledge.
 

The provider had systems in place to manage infection prevention and control (IPC). Overall, these were consistently applied.

Staff demonstrated knowledge of PPE use and procedures. One staff member explained, “We do have gloves, face masks, aprons and dispose of them in the yellow bags,” indicating understanding of processes.
 

The provider did not always make sure that systems in place were followed to ensure medicines and treatments were safe and met people’s needs, capacities and preferences.

At the last inspection, the provider was in breach of the legal regulation in relation to unsafe medicines management and failure to assess and mitigate risks. At this inspection, some improvements were evident. The service had systems in place to safely store, administer and record the use of medicines. However, these were not always followed. Practices were inconsistent and required further embedding.

Handwritten MARs were not always signed by two members of staff to confirm dosage instructions had been transcribed accurately. The use of topical creams and ointments were recorded on the medicines administration records (MARs). Body maps were in place to show staff the site of application. The service did not have individual fire risk assessments in place for people who were prescribed paraffin-based skin products.

Medicines stocks were correct. Time specific medicines were delivered in line with best practice guidance. Protocols for the administration of when required medicines were not always in place, this meant people were at risk of receiving medicines incorrectly.

There were appropriate arrangements in place for the management of controlled drugs. However, there was no evidence that regular balance checks had been completed. Temperature records to ensure the safe storage of medicines were not completed in accordance with national guidance. For ten days prior to our inspection minus fridge temperatures had been recorded and no action had been taken. This meant we could not be assured that medicines requiring refrigeration were safe to use. The provider took immediate action to resolve these issues.
There was evidence that there was a process in place to record medicines related incidents or errors. Staff told us they had completed a training and induction process for medicines management. Staff competencies were assessed regularly to make sure they had the necessary skills.

Although audits were in place, these had not identified or addressed the concerns we found during this inspection. The provider took proactive actions during this inspection to resolve the issues we had identified and therefore mitigated any risks.