Saxby Lodge Residential Care Home

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

The provider had not completed assessments of people’s social needs to identify risks. People’s needs for social engagement and stimulation were not being met and this had a negative impact on their quality of life. People were spending most of their time in their bedrooms and this meant some people were at risk of social isolation. Staff told us there were not regular activities, however the manager said there were plans to make improvements. People said they could make choices, including what to have to eat, when to get up and when to go to bed. Staff sought consent from people and understood when they needed to make decisions that were in people’s best interest.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s need for social stimulation had not been assessed and considered. People told us they were not supported with meaningful activities that were relevant to them. This was having a negative impact on people’s quality of life. One person said, “There are no activities here.” Some people were at risk of social isolation and were spending most of their time in their bedroom. One person said, “Staff chat when they have time, but they don’t have much. I wouldn’t like to be on my own here, as I wouldn’t see anybody or talk to anybody”. Another person said, “We have not made any friends at the home.” A relative said, “There’s not enough to do. There’s nothing going on and people just sit around watching TV.” One person told us they had an interest in art and crafts. They said there was, “No arts and craft activity at the home.” They relied on a friend to help them get supplies for their art projects. A relative described the negative impact of people not being supported to access the garden. They said, “They are both outdoor people and they loved their garden, so not being able to go out is hard on them. I think they feel confined now.” Other needs, including communication needs, physical needs and mental health needs were assessed.

A staff member told us, “There are not regular activities. We do offer things, but people don’t always want to do things, they want to stay in their rooms.” Another staff member was not clear about what activites were available, we asked them about a personalised electronic activity listed on the activities board but they were not clear what this was. Another staff member told us there was a smart speaker in the dining room and people could ask it to play any music they liked and that sometimes they would have a music session. The manager confirmed that there were plans to improve social stimulation by providing meaningful activities that were relevant to people’s individual needs and preferences. Staff told us how people’s physical and mental health needs were assessed. For example, staff explained how a person with visual sensory loss was supported with extra lighting in the hallway and their bedroom.

Assessments and reviews of people’s health, care and well being needs were not completed consistently. Assessments were detailed in some areas but were not always holistic. One person who had dementia, had a comprehensive mental health care plan. This included that staff should encourage social interaction, stimulation, activities, events and daily chores to support their mental health needs. However, there was no care plan to guide staff in what activities would be suitable, appropriate and relevant for the person and there was no record of the person taking part in any activities. A printed timetable of activities dated February 2024 had not been updated. An activities board in the dining area showed activities were planned for each day. However, activities did not take place on the day of the inspection and people and staff told us this was not unusual. Notes from a dignity audit in April 2024 identified the need for a structured activities programme and a meeting with people included suggestions for outings and activities but this had not yet been implemented. People’s communication needs were identified. Some people had specific health conditions including diabetes. Staff were knowledgeable about people’s conditions and told us they referred to the care plans for guidance when they needed to.

People told us they were involved in planning their care and could make choices about things that were important to them. One person said, “I go to bed at 6.30pm, it’s my choice. Today, they offered me breakfast in bed.” Another person said, “When I want to get ready for bed, I just buzz, and they (staff), come and help me.” People described having choices about what food they preferred. One person said, “The food is very good, they know what I like.” Another person said, “They know what I like and what my tummy can’t take”. Staff offered people alternatives to the meal provided and alternatives were available on the menu for people to choose. People were spending much of the day in their bedrooms, some people told us this was their choice, however there was little opportunity for social engagement. Some people were at risk of social isolation, one person told us they tended to stay in their room because they were not mobile and needed hoisting into a wheelchair or bed. Another person said they would like to go out in the local community but staff could not often accommodate this, they said, "I get fed up because i never get out." Another person described how they used to enjoy knitting but didn't have enough light in their room to do this, and another person said they would like to do more artwork and social events but this did not happen often, they told us, "You can have fun here, but it’s limited”.

Staff told us people were supported with their nutritional and hydration needs. One staff member said, “Some people need support and encouragement with eating and drinking. We keep records and monitor what they are eating and drinking when necessary.” Staff understood how to monitor people following a fall. One staff member told us how additional monitoring was important for example if someone had hit their head when they fell. One staff member told us how they supported people to go out by taking them to local shops, they said sometimes they could do so during work hours but often they did this when they had finished their shift.

Care records included monitoring of food and fluids for people who were assessed as needing this. Some records lacked consistency and this meant the provider could not be assured that risks associated with dehydration were always managed effectively. A person had fallen and hit their head, records showed staff had followed the provider’s policy and additional monitoring was completed to ensure the person’s safety.

People told us they were happy with the support provided by the staff. One person said, “The staff are great.” Another person told us, “They (staff) do a good job and it should be recognised.”

Staff described effective systems for sharing information and working together. One staff member said, “It’s a good team, we all get on and help each other.” Another staff member said, “Any new information is passed to staff and included in the handover book, as well as updating the care plan.”

The local authority were satisfied that the provider had put systems in place to improve the safety of the service for some people.

Staff used hand held electronic devices to record care provided and to have access to care plans. A written handover book was used to share information and staff meetings were used to pass on information to staff.

People said they were supported to access health and care services when they needed them. One person told us, “I have to have my leg dressed every 4 weeks and staff know when it needs to be done.” Another person told us how a staff member had accompanied them to a hospital appointment. A third person said, “Staff took me into town to see the optician, I’m just waiting for my new glasses now.” People's well being was not consistently supported, some people were at risk of social isolation. One person who spent their time in their bedroom said, "There are no activities here. I would like staff to be around more." People's mental health needs were assessed but a lack of personalised detail meant that people's interests and preferences were not always considered and opportunities for social interaction were limited.

Staff described a positive working relationship with the GP surgery. One staff member said, “The district nurses support with catheter care.” The manager explained how they had been working collaboratively with the local authority to make improvements following safeguarding concerns.

The provider had been working with the local authority safeguarding team, quality assurance and market support team, contracts and commissioning team, community nurses and social work team to improve safety for some people. Records showed staff had regular contact with health and social care professionals. Guidance from a health care professional in how to support a person’s mental health needs was included within their care plan and a medicine review had taken place. One person's mental health care plan included that staff should encourage social interaction, stimulation and inclusion within the homes activities and events. However there was a lack of personalised detail about what sort of activities and events would be of most relevance and interest to the person. People's social needs were not consistently assessed and supported. Social stimulation and activities were lacking and this had a negative impact on people's well being.

People were not achieving consistently positive quality of life outcomes. People told us there was a lack of activities and opportunities for social engagement. People who needed support to go out said they rarely had an opportunity to go out because staff were too busy to go with them. People who wanted to access the garden said they were not always able to go out when they wanted to. Some people were reluctant to use the lounge and dining room area so opportunities for social engagement were limited.

Staff described positive outcomes that had been achieved. One staff member said, “We provide good care to people, we are like a family.” Another staff member described how a person had been reluctant to accept support with personal care when they first came to live at Saxby Lodge. They told us, “We had to build trust over time and it took a long time, but now it’s worth it, they are happy here.” Staff confirmed that people were not regualry supported with activities and there were limited opportunities for social interactions. One staff member told us, “People do prefer to stay in their rooms, but there is not a lot of activities going on.”

There were systems in place for monitoring care and treatment. Staff used the electronic care system and some paper documents to record monitoring activity. Some records were not consistently maintained and this made it difficult to review and assess outcomes. For example, one person needed additional fluids due to risks of dehydration, records were not consistent to provide evidence that fluid targets were consistently met.

People said staff checked with them before providing care. One person said, “They always ask me first.” A relative said staff consulted with them about decisions and described how they supported their relations. They told us, “The staff appear to understand they are independent people. They ask them, they don’t tell them.”

Staff were able to describe their responsibilities under the Mental Capacity Act and DoLS. One staff member said, “If people don’t have capacity to consent to something we may need to make a best interest decision on their behalf.” Another staff member said, “I always seek consent before providing personal care and offer people choices about what they might like to wear.”

Some people were living with dementia and lacked capacity to make some specific decisions. Records showed that, when appropriate, decisions had been made in people’s best interests. Some people were subject to Deprivation of Liberty Safeguards (DoLS) and where conditions were imposed this was recorded.