CQC report explained · a residential care home
What the CQC found at The Lodge
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, January 2021
The Lodge was rated Requires Improvement; inspectors found risks around restraint, staffing, infection control and management oversight.
This was an unannounced inspection after concerns about safeguarding, restraint and the care provided. Inspectors visited on 04 September 2020, then spoke by telephone with staff and relatives on 07 September 2020. They saw all seven people living in the home and reviewed care, restraint, medicine, staffing and quality records.
The home was not always safe. Restraint records did not always show how long it lasted or whether it was the least restrictive option. There were times when staffing levels and deployment left people unsupported. Staff were also not initially following government guidance on protective equipment and isolation.
Medicines were given as prescribed and staff administering them had been trained and checked as competent. However, management systems did not reliably identify or correct problems with staffing, safety checks, care records, restraint monitoring, fire checks and infection control.
The overall rating fell from Good at the previous inspection to Requires Improvement. Safe and Well-led were both rated Requires Improvement. The other three areas were not inspected during this visit, so their previous ratings were used in calculating the overall rating.
Medicines
People received their daily medicines as prescribed. Staff who administered medicines had training and checks of their competence.
“We reviewed the medicine administration records which confirmed people received their daily medicines as prescribed and medicines where stored appropriately.” from the report
Risk awareness
Risk assessments were in place, and staff could explain important risks and triggers for the people they supported.
“One member of staff was able to tell us the different triggers to one person becoming anxious and how they would deal with this.” from the report
Safeguarding knowledge
Staff understood their safeguarding responsibilities and knew how to report concerns.
“Staff understood their safeguarding responsibilities, the signs to be aware of and knew how to report concerns.” from the report
Infection training
Staff had completed additional infection control and protective equipment training.
“Staff told us they had completed additional infection control and PPE training provided by Sandwell local authority and the NHS” from the report
Restraint
seriousRecords did not always show the actual duration of restraint or confirm that it was the least restrictive option for the shortest possible time. Required safety checks and debriefs were also not consistently recorded.
“The provider did not ensure restraint was implemented safely.” from the report
Staffing and support
seriousThere were not always enough staff, or staff were not deployed appropriately. People were observed being left unsupported, which contributed to agitation, harm and restraint.
“Sufficient numbers of skilled staff were not always deployed appropriately to safely meet people's needs.” from the report
Infection control
seriousStaff were not initially using protective equipment in line with guidance. There were no suitable risk assessments, staff arrangements or areas to support isolation, and people needing to isolate were mixing with others.
“People required to isolate were not being supported to isolate and were accessing the community.” from the report
Management oversight
seriousQuality systems did not consistently identify or fix problems with staffing, restraint records, safety equipment, fire checks, care records and infection control.
“The lack of governance systems and oversight meant people were at risk of receiving poor quality care.” from the report
Communication with families
needs fixingRelatives told inspectors that communication with them was poor and that the home did not involve them enough.
“Family members we spoke with told us the home did not involve them and communication with them was poor.” from the report
- 01How do you now record the length of each restraint and check that it is the least restrictive option?
- 02What staffing levels are in place at busy times, especially in the evenings, and how do you make sure people are not left unsupported?
- 03What is your current plan for supporting someone who needs to isolate, including staff arrangements and separation from other people?
- 04How often are safety equipment and fire safety checks completed, and how are missed checks followed up?
- 05How will you keep relatives informed and involved in care decisions?
This was a focused inspection of Safe and Well-led after concerns were raised; Effective, Caring and Responsive were not inspected and their previous ratings were carried forward. This explanation was written from the published report of 22 January 2021 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, January 2020
Rated Good overall; inspectors found safe, kind and personalised care, but management and communication still required improvement.
The CQC carried out an unannounced planned inspection on 09 January 2020. It spoke with people living at the home, staff and relatives, and checked care plans, medicine records, staff files, audits and action plans.
Inspectors found that people were safe, received their medicines as prescribed and were supported by trained staff. People were treated with kindness and respect. Staff understood people's needs, supported their independence and helped them take part in activities and keep in touch with family.
The overall rating was Good. Safe, Effective, Caring and Responsive were all rated Good. Well-led was rated Requires Improvement because there had been several management changes, communication with relatives had not always been consistent, and the new quality systems had not yet been fully established.
The home had improved since its previous inspection, when the overall rating was Requires Improvement and the provider breached Regulation 17. At this inspection, the provider was no longer in breach, but inspectors wanted time to see whether the improvements would last.
Safe staffing
Recruitment checks were in place, staffing levels met people's needs and staff had training in safeguarding and medicines.
“People were supported by a group of safely recruited staff who had receiving training and guidance in how to safeguard people from abuse.” from the report
Independence and choice
People were encouraged to make everyday choices, learn skills and remain as independent as possible.
“People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.” from the report
Kind relationships
Inspectors saw warm and respectful relationships between staff and people. Relatives were also positive about the care.
“We saw staff were kind and caring and had positive relationships with the people they supported.” from the report
Personalised support
Care plans described people's needs, preferences and routines in detail. Staff knew what mattered to each person and supported their activities and goals.
“People's care plans held detailed information regarding their needs, what was important to them, their likes and dislikes and how they wished to be supported.” from the report
Management changes
needs fixingThere had been a period of management instability. A new manager had recently started, and inspectors wanted more time to see whether the new arrangements would last.
“However, the service needed time to embed the systems that had been put in place and ensure the improvements introduced were sustainable.” from the report
Communication with relatives
needs fixingRelatives said they had not always been told about changes in management. The new manager had since contacted relatives to introduce themselves and discuss care needs.
“Relatives were disappointed they had not been kept informed of these management changes but welcomed the arrival of the new manager.” from the report
- 01How will you keep relatives informed about future changes to managers or senior staff?
- 02How are you checking that the new audits and action plans are still working consistently?
- 03How do you record any as-required medicines given while someone is on home leave?
- 04What formal supervision and support will staff receive now that the new manager is in post?
- 05How are you developing people's oral healthcare plans and staff training in this area?
This was an unannounced planned inspection covering all five key questions; it followed the previous Requires Improvement rating. This explanation was written from the published report of 30 January 2020 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
5 rated inspections over 5 years: the service has slipped, from Good to Requires improvement.
- January 2021Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- January 2020Goodup from Requires improvementSafe: GoodWell-led: Requires improvement
- January 2019Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- March 2018Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2013
Report published without a new overall rating.
- March 2013
Report published without a new overall rating.
- May 2011
Registered with the Care Quality Commission on 6 May 2011.
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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