Argentum 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 78 (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 strong proactive and positive culture of safety, based on openness and complete honesty. Staff actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt to continually identify and embed good practice.

Staff reported and recorded accidents and incidents. The manager reviewed accidents and incidents and completed monthly analysis to identify any themes and required actions to prevent recurrence.

The manager completed root cause analysis reports where injuries had occurred. They shared lessons learnt and duty of candour reports for safeguarding concerns. Group supervisions were held regularly, for example around supporting people after they had experienced a fall. This enabled staff to share and discuss learning with the aim of improving the support they provide to people.

Staff explained how they learnt from accidents and incidents, and they felt comfortable to raise any concerns they had. Comments included, “The manager comes to the floor and communicates clearly with us, we are free to communicate with her” and “I do feel confident to raise any concerns I can tell the nurses anything I'm concerned about.”

Health professionals were positive about the service’s learning culture. Comments included: “We have had several learning events which we have discussed together, Argentum staff and management have been engaged and keen to learn through these incidents, putting in change when required” and “The home are open to criticism and don’t appear to operate with defensive practice. They accept our feedback and generally implement our suggestions.”

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 manager completed preadmission assessments for people before they moved into the service to ensure they could fully meet their needs. People and their relatives shared information about the person and how they would like to be cared for as part of this assessment. One relative told us, “The manager listened to information about my relative.”

When people moved into the service, they were provided with a welcome pack which contained information on the home and its services. The manager completed admission checklists for people to ensure all required actions were completed.

The service regularly supported people to stay at the home for short respite stays. People were able to extend the length of their planned stay or move into the home permanently if they wished. Several people had decided to do this. Some people had returned home to live independently after staying in the home for respite visits. When people were admitted to or discharged from hospital, information was shared with staff during daily handover meetings.

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 manager investigated safeguarding incidents and shared concerns appropriately with the relevant authorities. Outcomes were shared with the person and their family as appropriate. A health professional told us, “I have seen multiple time where staff have managed difficult safeguarding and mental capacity issues with professionalism and diligence.”

Staff had received safeguarding training and were clear on how to report concerns. One staff member said, “I report any concerns to the senior nurse or the manager. We have policies we follow, and we have access to these on our work phone.”

People’s legal status around Deprivation of Liberty Safeguards (DoLS) was included in care plan information. A tracker monitored current authorisations and when people’s DoLS expired. Staff we spoke with understood the principles of the Mental Capacity Act and we saw they applied this in their support of people.

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.

Care plans contained best practice guidance for staff to follow. Risk assessments supported positive risk taking, they aimed to mitigate risks where possible while enabling people to maintain their independence, wellbeing and dignity. Where people received 1:1 care, they had a detailed care plan which covered how to support them to remain safe while respecting their choices. Where people displayed behaviour which communicated a need, emotion or anxiety, they had a positive behaviour support (PBS) plan which gave clear information to staff on how to support them.

Care plans for people with risks associated to their health conditions such as diabetes, catheter care and Parkinson’s Disease contained clear, individualised instructions, reflecting safe and effective systems of work. Identified risks to people in areas such as weight loss and pressure damage were discussed in weekly clinical meetings.

Staff were informed about any changes in risk for people in daily handovers and had access to this information. One staff member said, “The nurses share information with us about the residents, for example if they are at risk of falls or if they have their fluid monitored it is shared with us in handover, their care plans are updated regularly.”

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

Each person had a care plan around maintaining a safe environment for them, this included information about how to minimise any risks in the environment.

The provider employed a maintenance person, who completed regular internal safety checks and ensured any environmental issues reported to them were rectified promptly.

People were able to move safely around the environment. There was specialist equipment available to support people who needed it. People were provided with specialist beds, hoists, and other equipment. Equipment was regularly serviced to maintain safety.

Checks and reviews of essential services including gas, electricity and water were completed regularly. The service had an up-to-date fire risk assessment, and each person had a personal evacuation plan, in case of emergency.

Staff took part in regular fire drills. Some staff had also completed training to become fire wardens. Staff had also recently completed additional training to assist them in being able to evacuate people with reduced mobility safely.

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 provider upskilled staff by supporting them to advance in their careers. For example, some staff had trained to become moving and handling trainers. This meant the provider kept up to date with best practice and was able to share this with their staff in a way which was individual to the people they supported.

Safe recruitment practices were followed before new staff were employed.

The manager ensured staff were supported and received regular supervision and annual appraisals. Staff told us they had the training they needed to be able to do their jobs well. Nursing and staff competency checks were also completed in various areas, including observations of care practice. The provider had a training matrix to ensure staff compliance with training. This showed most staff and nurses were up to date with their required training.

The manager used a dependency tool to calculate the numbers of staff they needed; this was reviewed regularly. There were sufficient staff available, with the right skills and experience to keep people safe and provide high quality care.

We received very positive feedback about the levels and quality of staff. People said, “I can’t fault the staff, they are always available to help” and “If I was to fall, I could call out, and they would be here in 2 seconds.” Relative’s comments included, “The staff are wonderful, and nothing is too much trouble for them” and “Staff interaction is good. The resident to staff ratio is better here.”

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.

The service was very clean and tidy. The service employed a team of housekeeping staff who followed cleaning schedules to ensure the home’s cleanliness was maintained.

Staff had a good understanding of when to use personal protective equipment (PPE), to prevent the spread of infection and received regular training in infection control practices. The manager completed daily quality checks of staff’s practice in this area and regular competency checks were also completed. We saw staff wearing PPE appropriately when providing care and support to people. Audits and checks were used to monitor the cleanliness of the service and the effectiveness of the IPC measures used.

People and relatives were complementary of the level of cleanliness in the home. One person told us, “The cleanliness is very good.” Relatives’ comments included, “The home is immaculately clean and well maintained” and “Their room is spotless.”

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.

Records demonstrated people received their medicines as prescribed. Electronic medicines administration records (EMARs) were completed accurately, with no unexplained gaps or omissions identified. Nursing staff ordered, stored and disposed of medicines safely. Time specific medicines were administered to people as prescribed.

Where people were prescribed medicines to be administered ‘when required’ (PRN), the service had person centred protocols to explain how and when these medicines should be given. Managers investigated medicines errors and medical advice was sought for the person where needed. A health professional told us, “Staff are competent at managing medications and raising concerns when there are difficulties with patients taking medications.”

Nurses and specific staff were trained to safely administer people’s medicines and their competency to do this was regularly checked. The management team completed regular audits to make sure medicines were being administered safely.

People did not raise any concerns regarding their medicines. Two people had been supported to successfully reduce some of their prescribed medicines since moving into the service which had a positive effect for them. A care professional told us of one person, “They are no longer sedated, and their joy, laughter, and relaxed demeanour are a huge improvement compared to just a month ago.”