Nutley Lodge Care Home

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

The registered manager and provider failed to operate robust systems and processes to ensure only suitable staff were employed by the service. However staff knew people well and people spoke highly about their support from staff. Staff had received safeguarding awareness training. However, staff and leaders did not always understand their responsibilities regarding how to keep people safe. People were not always protected from the risk of harm and abuse. This was a breach of Regulation 18 (staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered manager and provider failed to ensure that risks relating to the management of people’s needs were being effectively mitigated and managed. This was a breach of Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Relatives of people using the service told us they felt confident raising concerns to the registered manager. One relative said, “I have raised concerns in the past with (registered managers name) and (registered managers name) has quickly sorted the issues”.

Staff told us they understood their responsibilities to report safeguarding concerns, following the services policy. Staff told us they had received safeguarding training. However, important information shared with the registered manager had not been acted upon in line with training and the services safeguarding policy and procedure.

The systems, processes, and practices in the service, were not always effective in identifying and reporting signs of abuse. One person informed us of a complaint they had raised with the service about possible financial abuse. At the time of this concern being raised appropriate action wasn’t taken. We raised this with the registered manager and asked them to make a referral to the local authority safeguarding team.

Relatives of people living at the service told us, they felt their relative was safe and felt involved with their care and treatment.

Staff told us information about a person’s risks could be found in their care plan and risk assessments. However, staff were not always following care plans.

We observed people being involved in making day to day decisions.

Care plans did not always contain adequate guidance for staff, on how to meet the people’s individual risks and health needs. For example, in relation to weight loss ,risk of falls, epilepsy and skin damage. Some people were not being cared for in line with their care plan For example, one person’s records showed staff were to record movement every 2 hours to ensure the person was re-positioned to prevent pressure damage to the person’s skin. Records showed gaps of between 12 hours to 20 hours. We could not be assured the people using the service were always having their care, needs met in relation to the prevention of pressure damage.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us that staff were pleasant and they were kind. However they also told us they had to wait for support and one person told us “they don’t sit and chat with you, they don’t have time”.

Staff told us they were well supported by the management team and felt confident to raise any concerns. One member of staff told us, “I love working here” . However, They went on to say “my last supervision was 4-5 months ago and I have never had an appraisal.” The registered manager told us, and records showed, staff were not being provided with regular supervision and appraisals during which shortfalls in care being provided could have been discussed.

We observed there were enough staff on shift to meet the needs of people.

The provider completed appropriate police and criminal records checks. Disclosure and Barring Service (DBS) checks provide information including details about convictions and cautions held on the Police National Computer. This information helped employers make safer recruitment decisions. However, references were not always obtained and verified. Two recently recruited staff did not have sufficient evidence of conduct in previous employment, One staff member’s recruitment record showed that references had not been received and this had not been followed up by the provider. The provider had not gathered evidence of potential staffs’ good character before they started to work at the service.

We spoke with people to learn more about their experiences of using the service. People’s feedback did not highlight any concerns they had about the cleanliness of the service.

The registered manager spoke with us about the implementation of a new Infection Prevention and Control (IPC) audit after recognising it needed to be more in-depth. The registered manager had recently appointed someone from within the service to be a team leader. This person would take responsibility for the oversight of IPC and the environment. However, this role had not yet been imbedded within the service.

Personal protective equipment (PPE) was visible around the home. Staff wore wearing appropriate PPE at the time of our visits.

The registered manager had recognised that cleaning records were not robust and had appointed a member of staff to have oversight on these records however this system had not yet been embedded. The registered manager could not always be assured scheduled cleaning had taken place.

Staff recorded when people’s medicines were administered. These records showed people received their medicines. We spoke with people to learn more about their experiences of using the service. People’s feedback did not highlight any concerns they had relating to their medicines.

Staff told us that people received their medicines when they needed them and were supported to receive them safely and in a way that suited them. Staff told us there were medicines audits in place.

Where people were prescribed medicines to be administered as and when required (PRN), guidance was not always in place to inform staff when they would be appropriate to be given to people. Some specific medicines were being administered by staff that had not been trained to administer these medicines safely. Medicines were not always stored safety. Medicines and liquids were not always dated when they were first opened. This meant that staff would not know when they required disposal or became less effective. Temperatures were not recorded in areas where medicines were stored. Systems and processes failed to ensure service users’ medicines were managed and secured safely. Audits had not identified these issues.