Kings 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 good. At this assessment the rating has remained good.

This meant people were safe and protected from avoidable harm.

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. Lessons were learnt to continually identify and embed good practice.

People told us they were happy living at the home and felt safe and well cared for. Their comments included, “I feel safe living here” and “Yes I feel safe. The carers know what they are doing.” A relative added, “Definitely safe, yes. The home always phones up and keeps us updated.”

Staff knew how to report and document any incidents or accidents. Lessons were learned when things went wrong. The provider analysed all incidents and accidents that occurred at the service to find out what went wrong and how to prevent these from happening again in the future.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed and monitored. They made sure there was continuity of care, including when people moved between different services.

People told us they felt safe living at Kings Lodge. They told us the staff were always available if they needed support. Relatives stated they were informed when their loved ones required support or treatment from different services.

The staff team and managers told us they worked well with other professionals to ensure continuity of care, including when people moved between different services or required temporary stays in hospital. Healthcare professionals told us relationships with the service and communication were good.

The tissue viability nurse, diabetes nurse and podiatrist provided short training sessions for all relevant staff. This included best practices in wound management or insulin administration. Staff were then equipped to put this learning into practice. External professionals told us they followed up with feedback during the next visit, reinforcing a collaborative culture of learning.

The service had up to date policies and procedures in place. Staff were required to read and sign these to evidence they understood and agreed to follow these.

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 who were able to tell us said they felt safe from harm and abuse. Most relatives agreed and one said, “Yes, I think my [family member] is totally safe. They are looking after [them] so well. It can be manic here sometimes, but they are always looking in on [them].” However, one relative stated they were concerned that their family member had sustained several falls in a short period of time, and did not always feel involved and properly informed. We fed this back to the provider who told us they were reviewing the person’s needs and would address any concerns with their family.

Staff were aware of their responsibility to safeguard people and who to contact in the event of any safeguarding concerns. One staff member told us, “I would go to my team, leader and unit manager.” Another said, “If I suspected a safeguarding concern, I would go to my unit manager. If my concerns were with my unit manager, I would go to my home manager or report it to the local authority or to CQC to explain my concerns.”

On the day of our visit, we observed a member of staff addressing a person in a disrespectful manner. This was quickly noticed by the unit manager who discussed this with the registered manager. They took appropriate action without delay.

The provider was proactive in raising safeguarding concerns with the local authority and CQC. They worked with the relevant professionals to investigate concerns when incidents occurred. We saw evidence of this in the documents we viewed during our visit.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Processes to help ensure risks to people were assessed and mitigated had not always been effective. There had been a number of unwitnessed falls, some resulting in injuries to people. Following these, we saw the provider had carried out internal investigations and had put measures in place to help prevent further incidents. Overall, we observed safe care being delivered to people. However, we saw a member of staff balancing a mug of tea on the arm of a chair between two people while they fetched a small table. This posed a risk of scalding. We fed this back to the registered manager who assured us they would take appropriate action. Following our feedback, the provider told us they had reviewed CCTV camera footage, which showed the care worker to be within reach of the mug at all times. They also assured us that drinks temperatures are always below scalding temperatures.

Care plans were sufficiently detailed to inform staff how best to support people with complex health conditions. For example, one person was living with diabetes and their care plan detailed how to recognise signs they were becoming unwell. We saw evidence the person was involved and supported to manage their condition with the hope that in time they could administer their own insulin. When people could become distressed, there was clear guidance to inform staff how to support them to de-escalate or reduce their anxiety. There were effective systems to review care plans and ensure they were sufficiently detailed and contained key information and guidance for staff. Personal emergency evacuation plans were in place for each person. These contained detailed information about each person and the support they required to safely evacuate the building in the event of a fire or other emergency.

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

People were supported in a safe and well-maintained environment that met their needs. People and relatives told us they liked the home and felt it was homely and well decorated.

There were effective systems in place to monitor and regularly check the safety and upkeep of the premises. The management team and staff worked together to help ensure any potential risks were identified and addressed promptly such as faulty equipment or trip hazards. The maintenance person completed daily and weekly checks of all areas of the home to ensure safe systems were in place. These included water temperatures, fire safety checks and kitchen equipment. They also responded promptly to any reports from the staff where repairs were required.

Equipment used to support people was suitable, well maintained and stored securely. The provider had an up-to-date emergency plan in place to help ensure people were supported in the event of an adverse event.

The home was clean and well-maintained with good quality fixtures and furnishings. Communal areas were light and airy which allowed people to mobilise easily. There were areas available for people to rest, enjoy activities and spend time following personal interests or have visitors.

People’s bedrooms were personalised with photographs and items belonging to them. There was signage around the home, and objects and pictures to help people with reminiscence.

The provider made sure there were enough qualified, skilled and experienced staff. They ensured staff received effective support, supervision and development. However, the staff did not always work together well to provide safe care that met people’s individual needs. People who could tell us thought there were enough staff available to meet their needs. However, some relatives reported there were not enough staff at times, and this could put people at risk. They said, “You do not always see the same levels (of staff). They would benefit from having a few more”, “They could do with an extra person on each floor. They are always under pressure and running about” and “I think there are just enough. Sometimes it is… just.” One relative praised the home for not needing agency staff, saying, “The home is better off not using any agency staff, and the stability this brings is commendable.” Staff told us they were happy working at the home, felt supported and listened to. They said they received training that equipped them to do their job well and care for people who used the service. A staff member stated, “We regularly receive training. [Trainer] delivers first aid training, fire safety training, safeguarding training and moving and handling training. The provider used a dependency tool to calculate the staffing levels based on people’s individual needs. The staff rota indicated the staffing levels recommended were consistent. However, we did observe that on one of the units, where people’s needs were high, the staff were rushed and did not have time to spend quality time with people. The provider carried out checks on the suitability of staff before they started working at the service. Systems in place included checks on new staff’s identity, eligibility to work in the United Kingdom, Disclosure and Barring Service (DBS) checks.

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 told us they felt safe from the risk of infection because premises and equipment were kept clean and hygienic, and relatives confirmed they did not have any issues with cleanliness of the service.

We observed a dedicated staff team ensured the service was kept clean, tidy and well maintained. Cleaning staff followed a cleaning schedule and used appropriate personal protective equipment (PPE). Care staff wore PPE when supporting people to help protect people from cross infection. A member of staff told us, “We have had training online and in the care home. I know that PPE is important and hand hygiene. Also making sure that there is no cross contamination between units and residents.”

Appropriate systems were in place in relation to infection control. The provider ensured staff had access to PPE and were trained in the use of this. The provider’s infection prevention and control policy were up to date. Information about the risk of infection was shared appropriately with people using the service and visitors. The managers and senior staff carried out audits to ensure standards of cleanliness were good.

The equipment used to monitor and administer medicines was not always fit for purpose. We found an unsecured oxygen cylinder stored in a person’s room. We found out-of-date blood glucose monitoring test strips were in use. This meant the readings taken using these test strips may not have been accurate.For another person, the syringe driver used to administer palliative care medicines was not serviced as per the manufacturer's instructions. However, the provider showed evidence that there had been clinical oversight and approval from multiple healthcare professionals prior to the device’s arrival at the home, and the device had functioned as expected. Furthermore, the provider told us they had put a protocol in place to verify servicing dates on all equipment accompanying discharged people, further strengthening their quality assurance practices. Records were not always accurate. The nursing staff administered insulin and recorded this on the medicines administration record. However, the care staff on several occasions had recorded the administration of the same medicine on the electronic system. Guidance in relation to ‘as required’ medicines was not always in place to help staff give these consistently. Medicines care plans did not always have the necessary information. For example, one person’s care plan did not include information on how to monitor or manage the side effects of their high-risk medicine.Staff carried out medicine audits to identify gaps and make improvements. However, these audits did not identify some of the concerns we found during the inspection. Medicines reviews were carried out by the local GP and a clinical pharmacist. There was a process to report and investigate errors and incidents.