Bentley 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 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 75 (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. Lessons were learnt to continually identify and embed good practice.

The registered manager promoted an open safety culture where people and staff felt able to raise any safety issues without concern. People and relatives said, “It’s very safe and they are very good at contacting us if they need to tell us anything” and “All the time I’ve been here, they’ve always been on the ball, so I don’t have to worry.”

Staff spoken with understood what action to take if an incident occurred to ensure the person’s immediate safety and to monitor their health and welfare. Staff at all levels understood what to report, to whom and how.

The provider had processes in place to ensure safety events were investigated and any identified learning was then shared with staff, through handovers and team meetings. The registered manager informed us about the reflection, learning and additional training which took place following an incident when staff were challenged by a person’s behaviours, in order to reduce the risk of reoccurrence. Staff appreciated the importance of this process and said, “Depending on the incident, staff may need additional training. Training is so important to prevent future occurrences.”

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.

The provider had processes to ensure when new people moved in or people returned from hospital, their care records were updated and shared with staff. Heads of department, including catering, housekeeping and maintenance were informed at their daily meeting when people were moving in or out of the service and of any actions they needed to take for the person’s safety or care.

Staff were then updated at the staff handover and through the electronic care planning system. Nurses told us about their role when people were discharged from hospital in ensuring any required measures were in place ready for the person, such as medicines, updating their care plan and liaising with other services where required. A relative said, “Communication between hospital and home was very good” when their loved one had required an operation.

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.

People were provided with information in the service user guide about how to raise any concerns they had and their feedback about safety was sought through care reviews and surveys. People and relatives spoken with did not have any concerns. Their feedback included, “They [staff] have a deep respect for him [person]” and “I have no worries about that at all.”

Staff completed safeguarding training which they updated annually and safeguarding was discussed with them at their supervisions. Staff could also seek guidance from the home’s safeguarding lead and access the providers guidance. Staff understood what safeguarding was and their role in keeping people safe and how to report concerns. We saw relevant action had been taken in response to safeguarding incidents. We found 1 safeguarding incident which had been raised externally had not been notified to CQC as required, however, all others had been reported. The registered manager acted immediately and submitted this notification.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found where restrictions were in place, these were kept to a minimum and where required DoLS applications were made. Where people had an advocate appointed in relation to their DoLS, they had regular contact with them to ensure their rights were upheld.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People’s care plans documented who had been consulted in making decisions about their care, potential risks associated with their care and the measures in place to manage them. Nurses used a range of clinical tools to identify and assess risks to people and to plan how they were to be managed. People and relatives told us what risks had been identified and the measures in place to reduce them, for example, through the provision of equipment for them to mobilise safely and the application of topical creams to manage the risk of them developing sore skin.

Staff had completed training in areas related to people’s needs and understood potential risks to them and how they were managed. Staff told us how a person was at high risk of falls, but this risk had been reduced by changing the equipment used to support them. A nurse told us, “I think clinical risk is well managed. The carers are always reporting things to us.”

People said they were not restricted by staff in what they could do. The registered manager told us how staff had discussed the risks associated with specific activities a person enjoyed with them and completed relevant risk assessments. The person confirmed to us they now regularly participated in their chosen activities.

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

The provider ensured relevant safety checks were completed as required in relation to gas, electrical, water and equipment safety. Staff completed checks to ensure equipment such as call bells, air mattress settings and bed rails were safe for people’s use.

The external gates from the car park which provided access to the road were broken and arrangements were in hand to replace them shortly. We observed the home was secure, with electronic door entry and exits, therefore people who might be at risk from the road could not leave the home without staff being aware.

Staff were up to date with their fire training which was held face to face. However, we noted the recording of fire drills could be further improved, to ensure they always contained sufficient detail including the role of staff who attended and any identified areas for improvement, as it was not apparent night staff had been involved, which national guidance states is advisable. The registered manager took immediate action and held a fire drill with night staff; the record provided afterwards demonstrated the role of staff and the lessons learnt. We also noted a downstairs bathroom which although not in use was used to store hoists. There was a potential risk of people accessing it and tripping. We brought this to the attention of the registered manager who immediately arranged for it to be fitted with a bolt.

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.

Staff were recruited safely and had an induction to their role. Staff told us they received ongoing training, competency assessments and supervision. In addition, they were supported to complete professional qualifications or to pursue any particular interests such as end-of-life care or wound care. Nurses’ registration was checked when they were recruited and they were supported with their professional re-validation. Staff had received learning disability and autism training suitable for their role.

People and relatives reported staff were competent and skilled at providing their care, they told us, “They know what they are doing.” A person and a relative said on occasions it could be difficult to understand some staff. We observed a couple of staff’s verbal English limited their ability to chat with people and would benefit from further improvement. The registered manager told us a member of staff had been supported to improve their spoken English skills and that they would arrange further training for any other staff where required.

People and relatives told us overall there were enough staff, which the staffing dependency tool confirmed. Staff were allocated in pairs to work with people in one of 5 zones. We noted and some people commented that the call bells rung loudly and frequently, which gave the impression staff were constantly busy. The registered manager explained this was due to all call bells ringing throughout the building, rather than just within their specific zone. The registered manager immediately acted to reduce the volume and contacted the system provider to look into altering the system to ring only within the relevant zone.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading.

People and relatives said the service was clean, feedback included, “Cleanliness wise, it’s very good, very good cleaners.” We saw the home environment was clean and hygienic and staff were seen cleaning it across the site visits. The provider’s cleaning schedules evidenced the cleaning completed. Staff regularly audited the effectiveness of the infection control processes. The home had a food hygiene rating of 5, which was very good.

Staff had completed training in infection control and hand hygiene and had access to relevant guidance. Staff were observed to wear the personal protective equipment (PPE) provided appropriately. There was guidance displayed to prompt people for example, about the importance of hand washing.

People’s care plans detailed the staff support they required with their personal care to maintain their hygiene.

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.

People received their medicines from trained and competent staff who had access to relevant guidance. Staff told us they felt confident with the processes in place within the home to ensure safe medicines management and oversight.

Staff ensured people’s medicines, including controlled drugs were stored securely and medicines which required refrigeration were stored at the correct temperature. Staff ensured people’s medicines were ordered as needed, there were not excess stocks of medicines and any unused medicines were returned.

People told us they received their medicines on time, including where they were prescribed time specific medicines. We observed staff administer people’s medicines safely. The provider ensured where people were on high-risk medicines such as diabetes medicines, or where people were fed via a feeding tube, any associated risks had been assessed and there was sufficient training and guidance in place for staff.

Staff ensured legal requirements were met where people had to be administered their medicines covertly. Where people took their medicines as required, known as ‘PRN’, there were clear and detailed protocols for staff to follow. People’s medicines records were complete and clear.