CQC report explained · a nursing home
What the CQC found at Monread Lodge
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Inspectors found unexplained and explained skin tears and bruises, unsafe moving and handling, incorrectly set pressure mattresses and gaps in repositioning records. Medicines were mostly managed safely, but some records were inaccurate or difficult to reconcile.
- Effective?
- Good
- People's needs were assessed and staff had training and supervision. People were supported with food, drink, healthcare and lawful decision-making.
- Caring?
- Good
- This question was not separately rated in this inspection. Inspectors observed that staff were often kind and attentive, but this was not consistent.
- Responsive?
- Good
- This question was not separately rated in this inspection. Inspectors found that some people living with dementia were not always supported quickly or in a way that reduced distress.
- Well-led?
- Requires improvement
- Audits and action plans were in place, but they had not ensured consistent safe and personalised care. Communication with health professionals about medicines and referrals also needed improvement.
What inspectors found, February 2024
Rated Requires Improvement; inspectors found risks in pressure care, moving and handling, dementia support and management oversight.
Inspectors made an unannounced visit on 4 January 2024. They spoke with people, relatives, staff and health professionals, and checked care, medicine and management records.
The home was not always safe. There had been many skin tears and bruises. Pressure mattresses were not always set correctly, repositioning was sometimes missed, and some people living with dementia did not receive prompt, reassuring support when distressed.
Medicines were generally managed safely, but some records were difficult to reconcile. The morning medicines round was also taking too long. Staff training, food and drink support, infection control and mental capacity procedures were areas inspectors found to be effective.
The overall rating fell from Good to Requires Improvement. Safe and Well-led were rated Requires Improvement, while Effective remained Good. The provider was asked for an action plan and will be monitored by the CQC and the local authority.
Staff training
Staff received training in important areas and told inspectors they felt supported and equipped for their roles.
“We saw staff had received training in key subjects such as moving and handling, safeguarding and dementia care.” from the report
Food and drink
People were supported to eat well. Staff knew their preferences and dietary needs, and weights were monitored.
“People were supported to eat well. Weights were monitored and people had fortified food and drink if they were losing weight.” from the report
Mental capacity
The home was working within the Mental Capacity Act. Best-interest decisions were recorded and involved relevant people and professionals.
“We found the service was working within the principles of the MCA and if needed, appropriate legal authorisations were in place to deprive a person of their liberty.” from the report
Infection control
Inspectors were assured that infection prevention measures, protective equipment and outbreak arrangements were in place.
“We were assured that the provider was making sure infection outbreaks can be effectively prevented or managed.” from the report
Pressure care
seriousMattresses were not always set correctly and repositioning was sometimes missed. This could put people at risk of harm.
“People's pressure relieving mattresses were not always set correctly even though they had been recorded as being correct.” from the report
Skin tears and moving
seriousRecords showed many skin tears and bruises, some linked to unsuitable moving and handling. Inspectors saw one person pulled by the hands.
“Many of these indicated the use of inappropriate moving and handling techniques.” from the report
Dementia support
needs fixingSome people living with dementia were not supported promptly or consistently when distressed or asking for help. This sometimes increased their distress.
“While most staff were attentive and responsive to people, some staff were dismissive of this, resulting in the person becoming more distressed.” from the report
Management oversight
needs fixingThe home's audits and action plans had not found or resolved all the problems with safe, personalised care and staffing.
“However, we found that some areas relating to safe care, personalised care and staffing needed further development and improvement.” from the report
Medicine records and timing
needs fixingSome medicine records did not make stock quantities easy to reconcile. The morning medicine round was also taking an exceptionally long time.
“The medicines round was taking an exceptionally long time during the morning, and this has been a persistent issue from previous visits and reports from other agencies.” from the report
- 01What has changed since the inspection to prevent skin tears and unsafe moving and handling?
- 02How do you check that each person's pressure mattress is set correctly and that repositioning is completed and recorded?
- 03How will you support people living with dementia promptly when they are distressed or ask for help?
- 04What has been done to make the morning medicines round quicker and to keep medicine records accurate?
- 05Can we see the action plan sent to the CQC and how will you show that the improvements have been sustained?
This was an unannounced inspection covering Safe, Effective and Well-led; Caring and Responsive were not separately rated in this report. This explanation was written from the published report of 20 February 2024 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, February 2023
Monread Lodge rated Good; inspectors found safer, kinder care, but some care records still lacked enough detail.
Inspectors visited unannounced on 6 and 13 February 2023. They spoke with five people, two relatives and eight staff. They reviewed four care records, recruitment files, rotas, audits and other management records.
The home had improved since its last inspection, when it was rated Requires Improvement. People were described as safe, treated with kindness and supported by enough staff. Medicines were given as prescribed, infection control was effective and staff had suitable training.
The inspection covered Safe, Effective and Well-led. All three were rated Good. Some records did not fully explain the support people needed or decisions made on their behalf. The report says the home was no longer in breach of the regulations identified at the previous inspection.
Improved risk management
The home had developed risk assessments covering areas such as falls, skin care, weight, choking and dementia support. Staff knew how to manage these risks.
“The registered manager developed risk assessments for people to monitor risk and what actions should be taken by staff when needed.” from the report
Kind and respectful care
People were supported in a kind and compassionate way, with attention to their dignity and privacy.
“Staff supported people in a kind and compassionate way, considering their dignity and privacy.” from the report
Consistent staffing
People were supported by a consistent staff team, rather than unfamiliar agency workers. Inspectors found staffing levels were above the assessed level needed.
“People received support from a consistent staff team and the service did not rely on unfamiliar agency staff.” from the report
Good staff training
Staff received training in important areas and managers checked their skills and knowledge. New staff also received an assessed induction.
“Managers regularly checked their competency and knowledge after training had been completed and throughout the year.” from the report
Stronger management oversight
Audits covered care plans, medicines, wound care and staff training. Managers identified areas needing improvement and put plans in place.
“There had been improvements to the effectiveness of quality monitoring and assurance systems.” from the report
Care records lacked detail
needs fixingSome risk assessments and care plans did not fully explain the support people needed. The home had identified this and was providing further staff support and training.
“We found that although risk assessments and care plans had been developed, some of these lacked the detail required.” from the report
Possible pressure at night
minorSome staff said more staff might be needed during the night, and that more help was sometimes needed on particular days. Managers were reviewing this.
“Staff told us they felt more staff were needed during the night and they raised this with the registered manager who was assessing this regularly.” from the report
- 01How will you make sure every care plan and risk assessment gives staff enough detail about the person's support?
- 02How do you check whether night staffing levels are enough for the people living here?
- 03What further training is being provided to improve care records?
- 04Which ratings from the previous inspection were carried forward because they were not inspected this time?
- 05How are medicines audits and staff competency checks carried out?
This was a focused inspection of Safe, Effective and Well-led; Caring and Responsive were not inspected during this visit and their ratings were not given in this report. This explanation was written from the published report of 22 February 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.
Every inspection of Monread Lodge
9 rated inspections over 8 years: the service has held its Requires improvement rating throughout.
- February 2024Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- February 2023Goodup from Requires improvementSafe: GoodEffective: GoodWell-led: Good
- March 2022Requires improvementup from InadequateSafe: Requires improvementWell-led: Requires improvement
- December 2021Inadequatedown from GoodSafe: InadequateEffective: Requires improvementWell-led: Inadequate
- December 2018Goodup from Requires improvementSafe: GoodEffective: GoodWell-led: Good
- February 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- June 2017Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- November 2016Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- November 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- August 2013
Report published without a new overall rating.
- June 2013
Report published without a new overall rating.
- December 2012
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 13 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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