CQC report explained · a residential care home
What the CQC found at Haydons Lodge
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Requires improvement
- Most medicines were given safely and on time, and fire safety arrangements had improved. However, the home did not always have formal pharmacist guidance for medicines given covertly in food or drink.
- Effective?
- Good
- This question was not inspected during this focused visit. Its previous rating was used when calculating the overall rating.
- Caring?
- Good
- This question was not inspected during this focused visit. Its previous rating was used when calculating the overall rating.
- Responsive?
- Good
- This question was not inspected during this focused visit. Its previous rating was used when calculating the overall rating.
- Well-led?
- Good
- Managers had improved governance and record keeping. People, relatives, staff and health professionals gave positive feedback about how the home was managed.
What inspectors found, March 2023
Haydons Lodge rated Good; inspectors found improved fire safety and leadership, but medicines given covertly were not managed fully safely.
This was an unannounced focused inspection on 21 February 2023. The inspector spoke with three residents, the registered manager and two care workers. Feedback was also received from three community health professionals, and records about care, medicines, staffing and management were checked.
The home had improved since the previous inspection. Fire doors had been repaired, emergency evacuation plans were in place for everyone, and electronic systems had strengthened oversight. Staffing, cleanliness, infection control and safeguarding were satisfactory.
Most people received their medicines on time. However, there was not always formal pharmacist guidance about medicines given covertly in food or drink. Safe was rated Requires Improvement, while Well-led was rated Good. The overall rating changed from Requires Improvement to Good because the other areas were carried forward from the previous inspection.
Fire safety improved
Fire-resistant doors had been repaired and tested. Everyone had an up-to-date personal emergency evacuation plan.
“Fire-resistant doors we tested during this inspection all closed automatically into their doorframes when their release mechanisms were activated.” from the report
Enough suitable staff
Inspectors found enough staff on duty, and recruitment checks were thorough. Staff responded promptly to requests for help.
“There were enough staff to meet people's needs.” from the report
Positive relationships
Residents and professionals spoke positively about the care and the way the home was run. The home worked with community health and social care professionals.
“The feedback we received from people living in the care home and community health care professionals was positive about the standard of care provided at Haydon's Lodge.” from the report
Covert medicines guidance
needs fixingThe home did not always have formal guidance from a community pharmacist when medicines were given covertly. This could affect whether medicines remained effective when mixed with food or drink.
“The provider did not always support people who needed to receive their medicines covertly in a safe way.” from the report
- 01Which residents receive medicines covertly, and has formal guidance from a community pharmacist now been obtained for each person?
- 02How do you check that medicines remain effective when mixed with food or drink?
- 03What checks are now carried out on fire-resistant doors and how often are evacuation plans reviewed?
- 04How are electronic care, medicines and governance records audited and followed up when they flag a problem?
- 05What were the ratings for Effective, Caring and Responsive at the previous comprehensive inspection?
This was a focused inspection of Safe and Well-led, including infection control under Safe; the other ratings were carried forward from the previous inspection. This explanation was written from the published report of 15 March 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, July 2022
Haydons Lodge rated Requires Improvement; inspectors found caring support but weaknesses in risk management, fire safety and oversight.
Inspectors visited on 12 and 17 May 2022. The first day was unannounced. They spoke with five residents, a relative and staff, and checked care plans, medicines records, staff files and management records.
The home was rated Good for Effective, Caring and Responsive. People were treated with kindness and dignity, received suitable food and medicines, had person-centred care plans, and were supported with health care, activities and independence.
Safe and Well-led were rated Requires Improvement. Some risks were not properly recorded or managed, most residents did not have personal emergency evacuation plans, and some fire doors were faulty. The provider's checks had not led to timely action, and some serious incidents were not reported to the CQC without delay.
The overall rating means the home was not consistently meeting the expected standard. The faulty fire doors were repaired during the inspection, and the CQC asked the provider for an action plan and said it would monitor progress.
Kind and respectful care
Residents and relatives gave positive feedback about the care. Inspectors saw warm, respectful interactions and found that privacy, dignity and individual choices were respected.
“Staff interaction with people was characterised by warmth and kindness.” from the report
Enough trained staff
Inspectors found enough permanent staff on duty, with appropriate recruitment checks, training and supervision. Staff knew residents well and responded promptly to requests for help.
“There were enough staff to meet people's needs and wishes.” from the report
Personalised support
Care plans covered residents' needs, preferences and goals. People were supported to make choices, keep in touch with family and friends, and build daily living skills.
“People's care plans were up to date, personalised and contained information about their strengths, likes and dislikes” from the report
Medicines and health support
Residents received prescribed medicines as they should. Staff supported people to attend appointments and work with health and mental health professionals.
“We were assured people received their medicines as prescribed.” from the report
Risk assessments and evacuation plans
seriousCare plans did not always give staff enough guidance about managing risks. Most residents did not have personal emergency evacuation plans.
“People's care plans did not always contain all the information and guidance staff needed to help them prevent or appropriately manage identified risks people might face.” from the report
Fire safety defects
seriousSome fire-resistant doors did not close correctly and some alarm-activated release mechanisms were faulty. The provider repaired them during the inspection.
“A number of the care home's fire resistant doors were not fit for purpose.” from the report
Weak management checks
needs fixingAudits had identified faulty fire doors three months before the inspection, but action was not taken until inspectors visited. The provider's monitoring was not being analysed effectively.
“No action was taken to address these maintenance issues until we inspected three months later.” from the report
Serious incidents not reported promptly
seriousThe provider did not tell the CQC without delay about several incidents in which residents were seriously injured and admitted to hospital.
“The provider should have notified the CQC immediately about, but did not.” from the report
Visitor COVID-19 checks
minorOn the first inspection day, the home did not obtain evidence that two visitors had tested negative for COVID-19. Staff completed these checks on the second day.
“The provider failed to obtain evidence from a visiting relative and a community professional to show they had both tested negative for COVID-19” from the report
- 01What has been done to make sure every resident has a suitable personal emergency evacuation plan?
- 02How do you now check that all fire doors and alarm-activated door release mechanisms remain safe and fully working?
- 03What changes have been made to management audits so that problems are acted on promptly?
- 04How do you make sure serious injuries and hospital admissions are reported to the CQC without delay?
- 05How do you now record COVID-19 test evidence and symptoms for every visitor?
This was a planned, on-site inspection covering all five CQC questions; the first day was unannounced and the inspection took place over two days. This explanation was written from the published report of 6 July 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Haydons Lodge
5 rated inspections over 8 years: the service has improved, from Requires improvement to Good.
- March 2023Goodcurrent ratingup from Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2022Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- April 2018Goodstayed GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2016Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Good
- February 2015Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- July 2013
Report published without a new overall rating.
- April 2013
Report published without a new overall rating.
- March 2012
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 2 December 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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