Doulton Court 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. This is the first assessment for this service. This key question has been rated good. This meant people were safe and protected from avoidable harm.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a proactive and open safety culture. Safety events were investigated and learning was shared in a timely way. The registered manager reviewed incidents and complaints and used the findings to improve practice. Staff knew how to report concerns and said they were supported to speak up. People were informed when things went wrong and duty of candour was applied. Action plans showed how risks were addressed and how improvements were monitored. Staff took part in debriefs after incidents and understood the changes made as a result. External professionals such as the local safeguarding team were kept informed of reportable incidents and worked with the service to reduce the risk of reoccurrence. One professional told us, “[Staffs’] responsiveness and willingness to learn from feedback is a clear strength.”

The service had safe systems in place to support people through all stages of their care. Staff worked with people and other professionals to plan moves between services. Pre assessments were completed and shared so staff knew about people’s needs, wishes and risks before care started. Information was passed on when people moved between services which helped to keep care consistent. People experienced smooth referrals because staff worked with health and social care partners in a timely way. Staff received clear information when people returned from hospital which helped them to deliver safe care. The registered manager monitored transitions and made sure actions were taken to reduce any risks linked to moves between services.

The service had clear safeguarding systems that protected people from harm. Staff understood how to recognise abuse and how to report concerns. Staff told us they felt confident any concerns raised would be addressed without delay. The registered manager monitored and reviewed safeguarding incidents and took timely action. Information was shared with CQC and the local authority when needed which helped to keep people safe. The registered manager and the provider had good oversight of safeguarding and investigations were completed with clear actions and learning recorded. Duty of candour was followed when concerns were raised and people and their relatives were kept informed.

People told us they felt safe. Some people had roles as ‘resident representatives’. In this role they met with a local charity who offered advice on understanding what being safe meant to them and who they could speak to if they felt unsafe. The representatives then shared this information with other people living at the service. There were also posters explaining about safeguarding processes and abuse awareness. Relatives told us how they saw their family members treated with respect and were considered a priority by staff. One relative said, “I would not leave my [family member] anywhere that isn’t safe but at Doulton Lodge, I know they are going to be well looked after and safe from harm.”

Staff followed the principles of the Mental Capacity Act 2005 (MCA). They supported people to make their own decisions and involved relatives and advocates in best interest decisions. Restrictions were kept under review and Deprivation of Liberty Safeguards (DoLS) applications were made and approved when needed. Staff promoted people’s rights and supported them in a way that protected dignity and reduced risks of discrimination or harassment.

The service worked with people to understand their individual risks and how to manage them in a safe and supportive way. Staff used person-centred risk assessments that were reviewed with people or their representatives so they understood decisions about safety. People were supported to make choices and take proportionate risks that helped them live fulfilling lives. One person told us, “Beautiful [staff]. I have had no falls whilst here, put on weight and I have been saved.”

Staff recognised when people were communicating a need or emotion and used positive approaches to reduce distress such as distraction or calmly speaking with people to find out the problem and help. Restrictive interventions such as limited access to the outside and medicines were only used as a last resort and were recorded and reviewed. Staff had clear guidance to follow which helped them respond safely to clinical risks and emergencies. The registered manager monitored risks and staff practice, ensuring best practice guidance was shared to maintain consistent support.

The service provided a safe environment that met people’s needs and supported staff to deliver safe care. Premises and equipment were maintained and safety checks were completed in line with required schedules. We observed some areas would benefit from re-painting where parts of the wall were scuffed. Any concerns raised about the environment action was taken quickly. For example, a professional told us how they had found sensor mats were not in place correctly. They said the registered manager acted to rectify this as soon as they told them.

Adaptations and signage supported people to remain safe and to move around independently. The registered manager audited the environment to ensure it met the needs of people living with dementia. Fire safety arrangements were in place and staff understood evacuation procedures. Equipment was available, used correctly and stored safely.

The service had safe and effective staffing arrangements that supported people to receive timely and consistent care. Recruitment checks were completed which helped ensure staff were suitable and had the right experience. People in their role as a resident representative were included in the interview process as a valued member of the panel. This gave people a voice in who supported them. Staff received induction, training and supervision which helped them carry out their roles safely and develop their skills. The registered manager monitored performance and supported staff to improve when needed.

Staffing levels and skill mix met people’s needs and rotas showed this was maintained across the week. People experienced continuity of care because they were supported by a regular staff team who knew their needs well. One person told us, “The staff are my little angels.” Staff told us they had access to support when required and felt confident raising concerns about workload or training needs. A professional said, “Staffing levels are always good and the staff always seem happy working in the home. Positive feedback is always given from the staff team.”

The service had effective systems to prevent and control infection. Staff followed national guidance and understood their responsibilities. Premises and equipment were kept clean and cleaning schedules showed regular and deep cleaning took place. However, some areas such as the inside of kitchen cupboards required a deep clean. Staff used Personal Protective Equipment (PPE) correctly and they told us they had plenty of supplies. Food was stored and prepared safely. The registered manager monitored cleanliness and took action when issues were identified. Information about infection risks was shared with people, visitors and partners when needed, and staff understood what to do in the event of an outbreak.

The service had systems to store, administer and record medicines safely, although thickeners used for people with swallowing problems were not recorded when used. This posed a risk to safety because without recording when thickeners were used staff could not be sure people with swallowing problems always received the correct thickness needed to prevent choking or harm.

Some people were prescribed patches for pain relief and there was a process to show where patches had been applied so the same site was not used too often. The service did not have individual fire risk assessments for people using paraffin-based skin products, but the registered manager acted quickly when this was highlighted.

The medicines policy at Doulton Court Lodge Care Home stated topical products must be stored safely and used with clear guidance. Staff recorded when they used these products but there were no body maps to show where they should be applied. The items were also left in bedrooms without risk assessments. This meant people were not fully protected from mistakes or unsafe storage.

Checks on stock were accurate and instructions for time specific medicines were clear. Guidance for as and when required medicines (PRN) was detailed and variable doses were recorded. Staff had guidance to safely give medicines through a stomach tube (Percutaneous endoscopic gastronomy, also known as (PEG) and medicines disguised in food or drink (covert medicines), were given only after the correct assessments. People with diabetes were monitored daily and had management plans in place. Controlled drugs were managed safely and balance checks were completed. Temperature records for medicines storage were not always completed in line with guidance. Medicines incidents were recorded and staff had completed training and competency checks.

Audits were carried out regularly, although they had not identified the issues found during this inspection. Despite the shortfalls found, people were happy with how their medicines were being managed. A relative told us, “Medicine is regular and distributed and checked that it has been swallowed safely and ointment is applied as well if needed.”