Saxby Lodge Residential Care Home

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Medicines were not stored safely because the medicine room was not locked. This meant there was a risk medicines could be accessed inappropriately. This was brought to the attention of the manager who took action to address the risk. Risks to people were not consistently identified, assessed and managed. There was a failure to assess risks of falls for a person who was able to access the stairs independently. Environmental risks, including fire safety and emergency evacuation procedures were not managed effectively. Recruitment systems were not robust, and staff support, including induction training and supervision, was not consistent. This meant the provider could not be assured that staff were suitable for their role or that they had the skills and experience they needed to meet people’s needs. Staff understood their responsibilities for safeguarding people. People told us they felt safe, one person said, “I know I’m perfectly safe here.” There were enough staff to care for people safely. People told us, and we observed, they did not have to wait for their care needs to be met. Staff were administering medicines to people safely and Medicine Administration Record (MAR) charts were completed consistently. Staff used safe techniques in line with infection prevention and control measures to keep people safe and reduce risks of infection.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they had confidence in staff. However, our assessment found shortfalls in some aspects of care. Lessons were not always learned following incidents, this meant people continued to be exposed to risks of harm. A relative spoke positively about changes the manager had made and described improvement in the learning culture. They said, “The new manager is definitely more open and honest. I have been kept informed when incidents have happened, including falls and I have confidence they are putting things in place now.”

The nominated individual was managing the service at the time of the inspection. They were open about challenges they had faced and spoke positively about the work they had undertaken to make improvements since becoming the manager. They described an open and honest culture where incidents were investigated and discussed to identify learning. Despite these positive changes, learning from incidents had not always been consistent and effective. Staff did not always identify and implement changes that would reduce risks to people. Staff understood the importance of recording incidents. One staff member described how staff learned from incidents saying, “We discuss in staff meetings, for example loud noise can be a trigger for one person, we talked about how to calm them down.” A staff member described improvements the manager had made. They explained how staff now had a clearer understanding of the importance of documentation and understood their responsibilities. They told us, “The documentation has improved. It is discussed at team meetings so staff are aware and clear.” Staff described receiving the training they needed to be effective in their roles.

The provider used a system to analyse incidents, including a route cause analysis, to support staff to understand why things went wrong. This identified patterns and trends that enabled changes in care plans to better support people’s needs. However, lessons were not always learned when things went wrong and not all incidents had been effectively addressed to ensure people were safe. Records of incidents and accidents showed a person had fallen when descending the stairs independently. Despite a history of falls, there was a failure to reassess the risks or to put in place suitable measures to ensure their safety after this incident.

One person told us they had come to Saxby Lodge directly from hospital and had not been prepared or given a choice. They told us the first they saw of the care home was from the taxi that dropped them off. A staff member had supported them to return to their home to collect some personal items and this had supported their transition. They described this positively saying, “Being able to go back home for an hour, it made a wonderful change.” A relative described how staff had been proactive in getting to know their relations when they first came to the home. They said, “When they came out of hospital, staff got to know them well, they were very kind and caring.”

The manager told us staff worked effectively with health and social care professionals to ensure people received continuity of care when they moved to or from Saxby Lodge. Staff described having the information they needed to provide care safely. One staff member said, “The manager and deputy usually deal with all the paperwork, we use the care plans to get to know people.”

The provider had worked with the local authority and health and social care partners to make improvements in the safety and well-being of people. The local authority told us the provider had taken appropriate steps to address concerns.

Initial assessments were undertaken when people first came to Saxby Lodge. The information was used to determine people’s needs and to develop risk assessments and care plans.

People told us they felt safe living at Saxby Lodge. One person said, “I know I’m perfectly safe here.” A person described their observations of how staff supported a person when they became distressed or agitated, and how this helped them to feel safe, they told us, “The trained ones know what to do.” One person described a recent incident when a staff member had been rude and unkind, we passed this information to the manager who said they would take immediate action to investigate these concerns.

Staff understood their responsibilities for safeguarding people and knew how to report any concerns. Some staff were not aware of strategies within a care plan to support a person when they became distressed. This meant there was a risk that they would not be able to provide effective support to keep all service users safe if an incident escalated.

Staff had developed positive relationships with people and knew them well. People appeared relaxed and comfortable in the presence of staff.

The provider had worked with the local authority to ensure appropriate actions were taken to address safeguarding concerns and to ensure people were safe. We noted an incident had not been considered under the provider's safeguarding policy. Following the inspection the manager confirmed that appropriate actions had been taken to ensure the person's safety.

People were not always involved and supported to manage risks. One person told us, “We’ve not seen any plans or anything about our care”. Another person described how they liked the garden but due to risks with other people living at the home they were not able to access the garden when they wanted to. They told us, “I would like to go out more often to get fresh air, but it causes problems in case people follow me.” Some people were at risk of social isolation and told us they rarely left their bedrooms because there were no activities for them to take part in. One person told us, “I don’t go to the lounge, nobody talks to you.” However, a relative spoke positively about their involvement and described how they had been involved in risk management discussions following a safeguarding incident. They said there had been improvements with the current manager who had listened to their views. They told us, “They (manager) have tried to balance the wishes of my relatives against the risks of them remaining together in the same room.”

Staff described how they used care plans to provide care and support to people safely. One staff member said, “We use the care plans on our phones (hand set) to make sure we know what to do.” Not all staff were clear and confident about how to support a person with dementia who sometimes expressed feelings of frustration. The manager described a behaviour support plan which provided staff with guidance to support the person when they became distressed. One staff member said they offer to make the person a cup of tea, another said they would seek advise from other staff on duty. Staff were not all familiar with the plan which included strategies and techniques to prevent an escalation in the person’s distressed behaviour which could present a risk to themselves or others.

We saw that a sensor mat to alert staff when a person was moving around was inappropriately placed at the top of a flight of stairs. Staff had not identified that this was a potential trip hazzard and this was ineffective in supporting them to manage the risk of falls. This increased the likelihood of a trip or fall on the stairs. This was brought to the attention of the manager. Following the inspection the manager confirmed additional measures were put in place to reduce the risk. We observed two sensor mats were left in a door way to an emergency exit and staff had not noticed that this could cause a trip hazzard and increase the risk of falls. We observed the medicines rooms was left unlocked on more then one occasion during the inspection, which increased risks of inappropriate access to medicines. We observed that people were spending most of their time in their bedrooms and there were limited opportunities for social interaction which increased the risk of social isolation. We observed that staff were accessing care plans for people and recording their actions on hand-held devices.

Systems for managing risks to people were not always effective. A person was assessed as being at high risk of developing an infection due to having a permanent catheter in place. The care plan included signs and symptoms of infection. Staff had recorded changes and contacted the GP appropriately and antibiotics were prescribed. The person did not have access to this medicine for 6 days and staff had not attempted to obtain the medicine sooner. During this time the person’s condition deteriorated and staff had to contact the district nurse for support with the catheter. The person was not being effectively supported to manage risks associated with their health condition. A person with dementia was assessed as being at high risk of falls. They were able to move around independently and this included ascending and descending the stairs, but their safety on the stairs had not been assessed. A sensor mat was not effective in alerting staff when the person was moving around but no other measures had been put in place. This was brought to the attention of the manager who took action to to ensure the person’s safety. Records showed bed rails had been put in place to prevent a person from falling out of bed. However, there was a failure to compete a risk assessment for the use of the bedrails. The manager said this was an oversight. Risks of social isolation had not been assessed .

People said they felt the environment was safe and comfortable. One person told us, “I like my room, it is particularly homely.” Another person was sitting in the conservatory and told us, “It’s very comfortable here.” However, people were not always able to access areas of the home safely. One person told us they were prevented from accessing the garden independently because the conservatory doors were kept locked. Unused sensor mats had been left in front of another exit which caused a potential trip hazzard.

A staff member said a person with dementia was at high risk of leaving the building without assistance so the door to a fire exit was kept locked and the key was removed because the person would be able to unlock the door. Not all staff were aware of where the key was kept. This meant there was a risk that the fire exit could not be opened during an emergency.

A door between the conservatory and the garden was identified as a fire exit for evacuating the building in case of an emergency. The door was locked and the key was not kept nearby. A second fire exit on the ground floor was not kept clear, two sensor mats had been left in front of the exit. This meant there was a risk that people could not be safely evacuated in the event of an emergency. Following the inspection the manager confirmed actions had been taken to ensure evacuation routes were safe and accessible. The premises were in a poor state of repair in some areas. A leak from the roof had left stains on the walls and ceiling on the first floor. A staff member said there was a plan to redecorate this part of the building.

Systems for monitoring environmental risks were not consistently effective. Fire safety audits were not effective and had failed to identify a locked fire exit door and trip hazards in front of another fire exit. Following this inspection the fire and rescue service issued an enforcement notice requiring the provider to take urgent action to ensure the safety of the premises.

People told us the staff were kind and caring. Their comments included, “Staff are very nice,” and, “The staff are marvellous. If I want anything, I just ring the bell and they come”. Another person told us, “Nothing seems too much trouble for the staff.” People said there were enough staff on duty to meet their physical needs. One person said, “There’s usually enough staff, unless someone is off sick, but usually there’s plenty.”

Staff told us there were enough staff employed to cover all the shifts. One staff member explained how staff pulled together to cover absences such as sickness at short notice. Another staff member described improvements in staffing levels and said this had improved morale and meant that call bells were answered in a more timely way. Not all staff were receiving the support they needed to be effective in the roles. Staff had not always received a consistent and comprehensive induction when they started work. English was not the first language for some staff and this meant they were not able to access all the information they needed to support people.

There were enough staff to support people with their personal care needs. We saw people were being supported in a timely way with personal care, and support with food and drinks. We observed there was little social interaction between staff and people who mostly stayed in their rooms.

Systems for the safe recruitment and induction of staff were not robust. The work history of one staff member was not complete and the provider had failed to obtain an explanation for periods of non-employment. A reference had not been obtained from their previous employer, and there was no record of an induction having taken place or any assessment to confirm they were able to properly perform their role. A risk assessment had been completed as part of the recruitment process of another staff member. This included additional supervision meetings and an extended probation period to mitigate identified risks. There was no record of these supervision meetings having taken place and no assessment of their probationary period before confirming them as a permanent staff member. Staff were receiving training but systems to confirm staff competency, including regular supervision meetings, were not completed consistently. The manager said they were aware this was an area of practice that needed to improve.

People said they were confident that staff maintained the cleanliness of the home. One person told us their room was “cleaned every day”.

Staff told us they had completed Infection Prevention and Control training. Staff said there were plentiful supplies of cleaning products and personal protective equipment.

There was plenty of Personal Protective Equipment and this was being worn and used by staff appropriately. There was hand gel and hand wash available in bathrooms. The service was clean and did not smell of mal odours.

Shortfalls in infection prevention and control identified at the last inspection had been addressed. Regular IPC audits identified any concerns and included what actions should be taken.

People usually received their medicines on time and in line with their prescription. However, one person did not have access to their prescribed medicine for 6 days after it was prescribed due to a delay in receiving the medicine. The person’s condition had deteriorated during this time.

Staff who were responsible for medicine administration were aware that the keys to the medicine room were missing and the room was sometimes left unlocked. When this was brought to the attention of the manager, they took steps to ensure the medicine room was secured. Staff who administered medicines demonstrated a good knowledge of people and their needs. One staff member was knowledgeable about recent change in medicines for one person and what their medicines were. They knew why the medicines were prescribed and what the desired affect was. Staff told us they had received training in medicine administration and were confident in the task. One staff member said, “We have to wear a red tabard so people know not to interrupt use when we are concentrating on the medicines.” Another staff member said, “I have no issue with the medicines, I administer them regularly, I am quite comfortable with doing that.”

Medicines were not stored safely. Audits of medicine management had not identified the failure to store medicines safely. The medicines room and cupboards within the room, were not kept locked. Some medicines and cleaning fluids were stored in an open cupboard within the medicine room. Other medicines were kept in locked cabinets, however the keys were kept in an unlocked key cupboard within the medicines room. This meant medicines were not being stored safely and there was a risk that people with dementia could come to harm from accessing medicines inappropriately or that medicines could be lost or misappropriated. However, staff were administering medicines in a calm and efficient manner. They were aware of people’s individual needs and preferences and supported them with a kind and gentle approach. Medicine Administration Record (MAR) charts were completed consistently and accurately.