Littleton Lodge

On this page

• 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

People were safely supported and were protected from the risk of harm and abuse. People's risks were managed well and staff knew people and knew how to meet people’s individual risks and needs. The culture across the service promoted this practice allowing staff to support people in the most effective way. The environment was clean and free from potential hazards. The provider had effective infection control processes in place. People were supported by enough staff who were well trained to effectively and safely meet people’s needs. The provider was working to reduce the number of agency staff to ensure people received consistent care. Staff were recruited safely. People’s care records required further information to ensure staff had up to date accurate information about people’s risks and needs. The registered manager confirmed they were in the process of updating these to include specific detail for staff to follow. We found there were some discrepancies in relation to people’s medicines, including, the recording of the clinical room temperatures and on some body maps, where people were administered pain relief patches. The registered manager took action to investigate this to ensure staff provided accurate record keeping.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People we spoke with told us they felt safe, they knew how to report any concerns and felt these would be listened to and actioned. One person told us, “I’ve never seen anything that’s not safe.”

Staff received training to provide people with safe care and treatment and they were confident they could access further training or support if required. Staff told us they had support from the management team if any additional information and guidance were needed, and the management were proactive in offering support. One staff member told us, “I would definitely be comfortable to go to [Registered Manager’s name] with any issues. They are very approachable. [Registered Manager’s name] would take action if I raised something. They have only been with us a short time and to be fair to them, you can say something to them, and they will sort it out straight away.”

The registered manager was newly appointed and had created a positive learning culture which encouraged staff to be open and honest as concerns were investigated. Staff completed training and received guidance and support to meet people’s individual needs. There was a system in place for staff to raise concerns and the registered manager reviewed these and ensured any incidents or accidents were followed up as required. The registered manager responded without delay during our inspection to review any identified shortfalls. Staff were provided with learning to help ensure accidents and incidents did not reoccur.

People had access to services as and when needed and would speak to staff or the registered manager to ensure their needs and preferences were understood and responded to.

The management team were working to build relationships with people living at Littleton Lodge. Staff shared their knowledge with other members of the staffing team to ensure people received consistent and effective care. One staff member told us, “We have staff meetings once a month. We discuss everything, the residents have a meeting the day before and then we discuss what’s going on in the home, any issues that need to be raised and if we have any problems or concerns. We can bring them up in the meeting or we can speak to the manager after.” Another staff member told us, “It has been a lot better since [Registered Manager’s name] came, everyone works as a team. [Registered Manager’s name] is really good with the residents, nothing is too much trouble for her.”

Professionals who worked in partnership with the service, provided mixed reviews about safe systems, pathways and transitions for people living at Littleton Lodge. Professionals agreed staff members sought advice and guidance when required. One professional told us, “A person with dementia came here and they [Staff] did their best to help them, they had a clear plan that they followed well, and they spent a lot of time with them. We made changes to their medication which the staff managed well.” Some professionals, however, shared concerns staff members did not always follow advice and guidance provided. The local General Practitioner (GP) confirmed although the registered manager raised concerns and acted on any deterioration, due to the high turnover in the management team in recent months, consistent communication was not always effectively achieved. They felt they repeatedly informed the management team of the process for their working relationship. The provider had a planned meeting with the GP to go through systems and processes to help ensure effective communication across the services.

The provider was working to ensure up to date records, policies and procedures were in place. This included sharing required information with people, staff and partner agencies to ensure people’s care needs were effectively met.

People felt safe living at Littleton Lodge. One person told us, “They [Staff] look after me very well really, I’m not worried at all, I feel safe and comfortable.”

Staff confirmed the process they followed when recognising and responding to potential harm or abuse. This included escalating concerns to a senior member of staff or directly to the registered manager. Staff we spoke with confirmed the required action was taken following raising any concerns. One member of staff told us, “The residents are definitely safe, I don’t think the residents are at risk.” Another staff member told us, “I would raise concerns such as bruises, unexplained cuts, people withdrawing themselves from communal areas, not eating or drinking. I would bring this up to my manager, they would definitely raise it as a safeguarding.” Staff received training in safeguarding and confirmed access to safeguarding policies and procedures if required. Staff followed the principles of the Mental Capacity Act 2005 and understood the importance of people’s consent and choice.

During the on-site inspection, we observed staff spoke with people kindly and respectfully and delivered care and support effectively and in line with their needs to keep people safe. We observed staff responding to people’s needs, including with moving and handling and ensuring people had the correct dietary requirements during meals. Staff raised concerns and these were followed up by the registered manager to ensure people received safe care and treatment.

The provider had systems and processes in place to protect people from abuse and harm. Action was taken to ensure safeguarding referrals were made to the local authority as and when required. The provider was working to embed systems and processes for identifying themes and trends and ensuring learning is shared when incidents occurred. People’s rights under the Mental Capacity Act 2005 were fully supported and understood by staff.

People’s risks were assessed and well managed. One person told us, “They [Staff] knock, they help me, and they let me be in peace if I want to rest up.” Another person told us, “I love the bath, and they [Staff] used a belt on the bath chair to keep me safe.”

Staff knew people well and knew their individual risks and needs. Staff understood their role in monitoring and managing people’s needs to help keep them safe. Staff we spoke with confirmed they supported people to be involved in their care and manage their own risks where appropriate. One staff member told us, “There are no risks to people, their needs are being met and they are safe.” Whilst staff knew people well, people’s care plans did not provide staff with enough information on specific concerns. Staff confirmed they understood people and their needs through working with them and work as a staff team. One staff member told us, “I think you are reliant on other staff a bit to tell you as the care plans don’t tell you everything.”

We observed staff supporting people in a safe way in line with their needs and preferences. For example, people were supported with moving and handling with their input during transfers.

People’s care plans required further information to provide clear guidance about specific needs in line with their choices and preferences. The registered manager had identified where care plans were lacking detail to support staff. They had put together an example care plan which included the required information for staff to follow. The registered manager planned to update each person’s care plan to ensure both permanent and agency staff had access to accurate records with information on how to support people’s specific needs. The management team had effective oversight of people’s risks to people due to effective incident reporting processes.

People living at Littleton Lodge did not have any concerns about the environment, they felt safe and well supported within the home.

Staff worked safely within the environment and used equipment and technology which were checked and maintained for safe use. The management team took required action to control risks within the environment.

There were processes in place to promote the safety of the environment. People had keys to lock their bedroom doors, and signs were located around the home to alert people to fire exists, as well as identifying areas of the home to help people safely navigate.

The environment was well maintained to ensure the safety for people living at Littleton Lodge and for staff and visitors entering the building. Records were kept up to date to show the maintenance and safety of the environment.

People provided mixed reviews about the effectiveness of the staff group within the home. People confirmed there were enough staff to meet their needs, however, they felt there was a high use of agency staff who didn’t always know them or how to support them effectively.

Staff told us they felt there were enough staff to support people safely and effectively, but there was a concern around the usage of agency care staff. One staff member told us, “The main thing would be to have more permanent staff, they are trying to get more but this would be better for the residents. We don’t have agency too much now, some of them are absolutely brilliant, it is when we get the ones who don’t know the place.” The registered manager acknowledged the use of agency care staff to provide cover and was actively recruiting permanent members of care staff. The registered manager confirmed their focus was to ensure there was a consistent care staff team.

We did not observe people waiting to receive care and support and staff were attentive and knowledgeable about people’s needs and wants. Despite people and staff concerns around agency staff skills and knowledge, we observed examples of positive interactions and delivery of care between people and agency members of staff.

The provider ensured staff were recruited safely, and fully trained before supporting people. Records evidenced staff received supervision and appraisals to provide staff with the opportunity to discuss and enhance their personal and professional development.

People were assured they were being cared for in the safest way to manage the risk of infection, as staff wore required Personal Protective Equipment (PPE), as needed. Housekeeping staff were consistently cleaning the home. People we spoke with had no concerns for the cleanliness of the environment or issues with infection prevention and control. One person told us, “It doesn’t smell here, it’s very clean.” Another person told us, “Everything is clean and tidy.” One relative told us, “It is very clean, we have never had any concerns that way at all. It never smells and it does always look clean everywhere.”

Staff told us they received training in IPC and had access to PPE supplies. Staff were aware of how to keep people safe in line with best practice guidance. One member of staff told us, “The registered manager does spot checks of the cleaning, they come round and watch us and observe. They also spot check beds”.

The home was visibly clean, well maintained and free from malodour. Staff wore PPE when required and were observed supporting people to use hand sanitizer to help promote cleanliness within the home.

The management team had effective IPC measures in place to keep people safe and to ensure staff were complying with best practice. Staff had access to policies and procedures as needed and received regular IPC training.

People received their medicines on time and as prescribed. Staff supported people in a discrete manner showing respect and patience when administering their medicine. One person managed their own medication, with support from staff of daily counts to ensure safe stock levels, this promoted the person’s independence.

Staff received medication training and had regular competency checks to ensure they had up to date skills and knowledge to safely administer people’s medication. Staff worked well together to mitigate the risks of medicine errors. One staff member told us about the medication process, and how trained staff have, “In depth competency checks” by the regional senior registered general nurse.

People received their medicines on time, as prescribed and they were stored and administered following best practice guidance. We found, however, there were some discrepancies in the recording of the clinical room temperatures and on some body maps, where people were administered pain relief patches. We raised this with the registered manager who confirmed they would review this and ensure staff followed the required process. The provider completed regular medicine audits; the registered manager confirmed they would review the audits in place to ensure they would identify the shortfalls we found. This would help ensure medicines were managed safely and to identify themes and trends.