White 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 inspection we rated this key question Requires improvement. At this inspection the rating has changed to Good. This meant people were safe and protected from avoidable harm. At our last inspection we identified the provider was in breach of regulations related to staffing, recruitment and safe care and treatment. At this inspection we found the provider had made sufficient improvement in these areas. However, there remained an on-going breach for good governance which included records for people’s medicines, care plans and how learning was shared with staff.

This service scored 62 (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 openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. However, processes to ensure lessons learnt were shared were not always effective to continually identify and embed good practice. Incidents and accidents were reported. Actions arising from incidents were transferred into care plans to inform staff how to reduce the risk of an incident happening again. Incidents were investigated and we saw examples in records. However, there was not always clear evidence of how lessons learned were shared with staff. Although discussed at meetings, and during daily handovers, minutes of discussions were not always recorded. We discussed this with the registered manager during the inspection and they told us they would review the process.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. There was a weekly GP review. One staff member said, “The GP comes every Friday or does a phone review. Any issues we can call them.” People’s relatives told us people were supported to attend appointments. Comments included, “The doctor is local; just down the road, and comes in regularly” and “[Name] has a Parkinson’s nurse and sees the neurologist annually.”

Staff told us they worked well with health and social care professionals and had developed good working relationships. There were clear processes to ensure people’s current information was safely shared and we saw records of this during the inspection. People had been seen by health professionals when required. For example, records showed people were reviewed by a speech and language therapist (SALT) if staff noted swallowing concerns.

We spoke with health professionals who worked with the service. They said they had a good relationship with the staff. One professional said, “We have recently completed a number of reviews of care plans and provided clear feedback on these. I have since reviewed the feedback that was given and can see the home have implemented the recommendations I gave.”

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. The provider shared concerns quickly and appropriately.

All the people we spoke with told us they felt safe. Relatives said, “[Name] is very safe, and I am happy and can’t praise some of the staff enough”, “We are so pleased we chose White Lodge for [name]. [They] are safe and comfortable, and we are very happy” and “[Name] is very safe there.”

Staff had been trained and understood their responsibilities to keep people safe from avoidable harm and abuse. One staff member said, “If someone has some bruising, we report it and do a body map. The bruising might be down to bad handling, or skin tears. I would look in the records to see how often the bruising happens. I would report it to see if something was going on.”

There was a safeguarding and whistleblowing policy in place. The provider shared concerns quickly and appropriately. The provider ensured referrals and notifications were made to both the local authority and safeguarding teams in a timely manner. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). In care services, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. All legal applications had been made in accordance with DoLS. This meant people’s rights were fully respected. When conditions were imposed as part of an authorisation, there was clear guidance in people’s care plans to inform staff how to endure conditions were met.

The provider did not always ensure people’s care records included information on how staff should mitigate risks to people that were identified in risk assessments.

Potential risks to people’s health and welfare had been assessed and risk assessments had been reviewed regularly. However, when risks had been identified, care plans did not always inform staff how to reduce the risks of harm to people. For example, one person had a pressure wound but the skin integrity plan did not inform staff how often to reposition the person or how to monitor the person’s skin. Despite this, position change charts showed people had their position changed regularly and pressure relieving equipment we looked at was set correctly.

Some people had been assessed as being at risk of malnutrition. In these instances, care plans included information for staff such as food preferences, frequency of monitoring people’s weight and any specialist advice that had been sought. When people were having their food and fluid intake monitored, records showed people were provided with enough to eat and drink, although no target intakes were documented.

Staff knew which people were at risk of choking and how to monitor and manage this. One staff member said, “[Name] should be sat upright, preferably in a chair. I wait until [they] swallow between mouthfuls and always use a small teaspoon. If someone did choke, I would whack them on the back and ring the emergency bell.”

Bruises and skin tears had been reported and appropriate action taken in response.

People’s relatives said they felt confident risks were managed. Comments included, “The staff phone me if there is anything. [Name] has really frail skin, so bruises easily. But they [staff] always let me know” and “Following the fall they decided not to leave [name] in [their] bedroom for long periods. Staff put a sensor mat in the room.”

The provider did not always detect and control potential risks in the care environment. The personal emergency evacuation plan (PEEP) folder was inconsistent with individual PEEP’s and did not always match up with information on the PEEP summary form. The names of people and the rooms they were living in did not always correspond. There was a fire grab bag in place, but this contained minimal equipment and again, the PEEPs in the bag did not match up with the information on the PEEP summary sheet. We discussed this with the registered manager who advised that some people had very recently moved rooms due to refurbishment or changing needs and that these would be updated with immediate effect. Fire equipment was in date and regular checks were in place for fire alarms and fire equipment.

Safety measures were in place throughout the home including window restrictors and radiator covers. All moving and handling equipment was in date of service as per certificates issued and the equipment we saw was in good condition. Areas which were unsafe for people including the boiler room, kitchen and laundry room were secured using a keypad, although the laundry room was not always locked during the inspection. We discussed this with the registered manager who advised they would remind staff of the importance of keeping the door locked.

Although we saw some areas of the environment which were worn or required attention, we were informed, and we saw on both days of the inspection, that refurbishment plans were underway. For example, we saw some rooms being redecorated whilst we were on site.

We reviewed records of checks carried out to ensure the premises were safe. This included gas, electrical and water safety checks A maintenance log sheet was being used by staff to report any maintenance issues and records showed these were addressed in a timely manner.

People and their relatives raised no concerns about the environment. Comments included, “[Name] has a beautiful room which overlooks the garden; there is a lift for wheelchairs. The garden is lovely and so well-tended” and “It’s very clean and it’s very homely.”

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 service had made improvements since our last inspection. There were enough staff to ensure people’s safety and needs were met, the service used a dependency tool to calculate staffing requirements and safe recruitment processes were followed.

People’s relatives said, “There are always enough staff around, they help the residents and chat to them and when we go and visit and within minutes staff will pop in and ask us if we would like a cup of tea, they are so attentive” and, “The staffing is very good; a big improvement on the previous management. I can always find someone and there is always a carer on the corridor for anyone who needs help.”

Staff told us they had no concerns about staffing levels. Comments included, “There are always enough staff. If someone goes off sick, the manager, deputy or activities lady will stay on. We can call agency if needed” and “Yes, there's enough staff. We cover each other. [Registered manager] helps if we need her, with repositioning or supporting with food and drinks. Even [nominated individual] will work the floor and help us.”

We observed staff throughout the inspection supporting people in a relaxed manner. Staff did not appear rushed, and call bells were answered in a timely manner. Staff were able to spend time engaging with people and doing activities.

Staff had been trained to carry out their roles. One staff member said, “We do online and practical face to face training. For moving and handling we were shown how to use the hoist and slings and stand aids. I have been in the hoist, so I know how it feels. So, I try and reassure people, tell them it won't take long. I tell them I will keep them safe.”

Staff had their competencies assessed and received regular supervision sessions.

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. People using the service, and their relatives did not share any concerns about this quality statement. Staff had been trained in infection prevention and control. Staff knew how to manage infection outbreaks at the service. One staff member said, “We wear gloves and aprons a lot. One person has an infection and is in isolation and there is a yellow [clinical waste] bin in [their] room. We put an apron, gloves and mask on before we go in and take them off and throw them in the bin in the room just before we leave.” We observed staff wearing aprons when supporting people with meals. We saw stocks of PPE around the building for staff to use. There were effective processes to prevent and control infection. Housekeeping staff were on duty seven days a week. We saw cleaning schedules were in place. Records showed equipment was cleaned regularly. When people needed staff to use slings or slide sheets to support them to move, these were single person use. One member of staff said, “We’ve got everything we need to do our job. There are normally two housekeeping staff on each day. Sometimes at weekends there will only be one of us. The equipment is good and it’s what we need.”

Regular infection prevention control audits had been carried out. These included audits of the environment, equipment, and staff spot checks. The environment looked visibly clean, and people’s relatives told us, “It’s very clean.”

Food safety was maintained. Kitchen monitoring checks were in place.

The provider did not always make sure that medicines and treatments were safe and met people’s needs. Protocols for people who were prescribed additional medicines for anxiety or agitation did not inform staff of steps to take before resorting to the use of medicines. Additionally, care plans referred to the use of these medicines but also did not consistently inform staff of any known ways to reduce people’s anxiety. We discussed this with the registered manager during the inspection and they advised they would review these records.

Records of transdermal patch applications did not show that manufacturer guidance had been followed. Guidance is for patch sites to be rotated every 3-4 weeks, but the records we saw showed patches were rotated weekly between two sites. We raised this with the registered manager who advised they would update the recording chart accordingly.

Topical creams and lotions were not safely managed. Although staff had written on containers the opening and expiry dates, we saw creams that had passed the expiry date but had not been disposed of. This was addressed by day 2 of the inspection.

Medicines were stored safely and when no longer required, were disposed of safely.

The service used an electronic medicines system. The system allowed for clear oversight of when medicines were administered and the system highlighted if medicines were overdue. Records we looked at showed that medicines had been administered as prescribed.

Staff who administered medicines had received up to date medicine training and had their competencies checked.

People’s relatives had no concerns about this quality statement. Comments included “I asked what medication [name] was on and they [staff] shared the information straight away,” “They [staff] phone us if there are any changes” and “They are good at communicating about medication.”