CQC report explained · a nursing home
What the CQC found at The Lodge
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found enough staff were deployed, risks were assessed and medicines were managed safely. Some staff were not wearing masks correctly during the visit, but this was addressed immediately.
- Effective?
- Requires improvement
- This area was not inspected during this focused visit.
- Caring?
- Requires improvement
- This area was not inspected during this focused visit.
- Responsive?
- Requires improvement
- This area was not inspected during this focused visit.
- Well-led?
- Good
- Inspectors found effective audits and action plans, positive management and staff feedback, and a person-centred approach to care.
What inspectors found, August 2022
Rated Good; inspectors found safer staffing and sound management, but noticed some staff were not wearing masks correctly.
This was an unannounced focused inspection on 3 August 2022. Inspectors checked Safe and Well-led, including staffing, risks, medicines, infection control and management systems. They spoke with two people using the service and nine members of staff, and reviewed records and other information.
The home had improved since its previous inspection. Staffing levels had been increased, risks were assessed and monitored, medicines were managed safely, and people were protected from abuse. Inspectors also found that staff knew people well and supported their preferences.
The home was rated Good overall, with Safe and Well-led both rated Good. The previous overall rating was Requires improvement, published on 1 February 2022. The report says the provider was no longer in breach of the regulations identified at the previous inspection.
Improved staffing
The provider had increased staffing after the previous inspection. Rotas showed enough staff were deployed, and inspectors saw staff respond promptly to call bells.
“Staffing rotas evidenced there were enough staff deployed to provide people with the care and support they required.” from the report
Risk management
Risks such as weight loss, poor nutrition, dehydration and skin problems were monitored. Staff followed guidance from health professionals, including at mealtimes.
“Risks to people were assessed, and measures were taken to mitigate risk.” from the report
Safe medicines
Trained nurses and senior care staff gave medicines. Their practice was checked, and medicine records and stock levels were audited.
“Medicine was administered by trained nurses and senior care staff.” from the report
Person-centred care
Staff knew people well and understood their preferences and wishes. People were offered group and one-to-one activities.
“There was a positive, person centred approach to the planning and delivery of people's care.” from the report
Management oversight
The provider used audits, feedback, meetings and action plans to identify and address problems. Staff said they felt supported and listened to.
“The provider and manager had quality assurance systems in place which ensured all aspects of the service were regularly audited.” from the report
Masks were not always worn correctly
needs fixingInspectors saw some staff wearing masks incorrectly during the visit. The area manager addressed this immediately.
“We were somewhat assured that the provider was using PPE effectively and safely, we observed some staff not to be wearing their masks correctly through our inspection, the area manager immediately addressed this.” from the report
Care note recording needed improvement
minorA quality audit found that the detail recorded in people's care notes needed to improve. The home planned a training session for staff.
“A quality audit had identified improvements were required to the detail of recording's in people's care notes.” from the report
- 01How do you calculate and review staffing levels now, particularly on each floor and during busy periods?
- 02What checks are in place to make sure staff wear masks correctly and follow infection-control procedures?
- 03What training was provided, or is planned, to improve the detail in people's care notes?
- 04How will you continue to monitor risks such as weight loss, nutrition, hydration and skin problems?
- 05What progress has been made with the planned flooring and bedroom decoration work?
This was an unannounced focused inspection of Safe and Well-led only; the other areas were not inspected and their ratings were carried over from the previous inspection. This explanation was written from the published report of 31 August 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.
What inspectors found, February 2022
Rated Requires Improvement; inspectors found staffing, safety checks and people's choices were not always managed safely or consistently.
This was an unannounced inspection on 13 December 2021. Inspectors spoke with people, relatives and staff, observed care, and checked care, medicine, staffing and management records.
The home did not always have enough staff. People sometimes waited for help, and some were left in undignified or unsafe situations. Risk guidance, emergency plans, medicine checks and safeguarding investigations were not always complete or followed.
Training was behind the provider's own policy. People did not always get proper choices about food, drink or activities. Staff were described as kind, but they were often too busy to offer companionship or meaningful conversation.
All five ratings were Requires Improvement. The last inspection, published in December 2017, rated the home Good. The manager had been in post for five months and was working on an improvement plan, with some changes made during or after the inspection.
Kind staff
People and relatives said staff were caring. Inspectors found staff knew people well and had formed close bonds.
“Although staff were kind and caring in their approach, care staff were always busy completing tasks.” from the report
Healthcare links
Healthcare professionals gave positive feedback about referrals and staff following their advice.
“Feedback we received from professionals who regularly visited the home was that referrals were made effectively and any advice or instructions they left were always followed.” from the report
Improving leadership
The manager had an action plan and had made some immediate improvements. People, relatives and staff reported better communication and leadership.
“People, relatives and staff told us the home was well-led and they felt improvements were continuing.” from the report
Infection planning
The home had plans for preventing and managing outbreaks, and inspectors were assured about PPE, testing, social distancing and staff vaccination.
“We were assured that the provider was promoting safety through the layout and hygiene practices of the premises and had plans to effectively prevent and manage outbreaks.” from the report
Not enough staff
seriousPeople sometimes waited for care, and staff were not always available in communal areas. One person called for help for five minutes while staff were on rest breaks.
“There were not enough staff on duty to ensure people received care in a safe and timely manner.” from the report
Safety information not reliable
seriousSome risk guidance was unclear or out of date. Fire evacuation plans were wrong, exits were obstructed, and records did not always show that repositioning or weight checks had happened.
“The provider had failed to do all that was reasonably practicable to mitigate risks to people's safety.” from the report
Training gaps
needs fixingStaff had not always completed required training. This included safeguarding and training for supporting people whose behaviour could challenge others.
“12 staff members were recorded as not having completed safeguarding training.” from the report
Choice and companionship
needs fixingPeople did not always receive choices about modified food and drink, and activities were not frequent enough. Busy staff had little time for conversation or companionship.
“Staff did not have the time to offer companionship to people and at times people were left isolated because of this.” from the report
Missing legal records
seriousRecords of DoLS applications and best-interest decisions were incomplete. This meant the manager could not confirm that restrictions on people's liberty had the required legal arrangements.
“There was a lack of records to demonstrate decisions were always made in people's best interest.” from the report
Medicine safety checks
seriousSome creams were stored in unlocked bedroom cupboards, and some records had only one signature when two were required.
“This meant that required safety checks had not always been completed and could lead to an increased risk of errors.” from the report
- 01What are the current staffing levels on each shift, and how do you make sure staff cover rest breaks and all areas of the home?
- 02What evidence can you show that staff have completed safeguarding, choking and other required training?
- 03How are choking risks, weight loss, repositioning and fire evacuation now recorded and checked?
- 04How do you make sure people receive choices about food, drink and activities, including people who cannot express their preferences?
- 05Which residents have DoLS applications or authorisations, and how are best-interest decisions recorded and reviewed?
This was an unannounced comprehensive inspection covering all five questions and infection prevention; the specific alleged abuse incident that prompted the inspection was not examined because it was subject to a criminal investigation. This explanation was written from the published report of 1 February 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 The Lodge
4 rated inspections over 6 years: the service has improved, from Requires improvement to Good.
- August 2022Goodcurrent ratingup from Requires improvementSafe: GoodEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Good
- February 2022Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- January 2018Goodup from Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- December 2013
Report published without a new overall rating.
- December 2012
Report published without a new overall rating.
- May 2012
Registered with the Care Quality Commission on 10 May 2012.
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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