Umika 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

We looked at all quality statements for Safe at this assessment. The service was safe. The service followed recruitment procedures, and enough staff were employed. Care staff completed appropriate training, and their competency was regularly checked. People had care plans and risk assessments in place. The provider had made improvements since our last inspection in 2022.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

When incidents happened, they were investigated, and further actions identified and shared with staff in team meetings and one to one supervision. There were processes in place to record incidents, complaints, and compliments. We read a complaint that a relative had made and we could see a formal process was followed to address the concerns. The provider also completed monthly analyses of incidents such as falls and safeguarding. The registered manager said, “we don’t need to wait for a trend to be identified to learn from an incident, we always look for where we can learn.”

The provider had a formal assessment process in place that was used for new referrals and to assess people for short stays. People’s care plans were detailed and could be shared easily and securely with other professionals if required. The manager makes referrals and works in partnership with other professionals for example, district nurses and GP’s.

There were systems in place to record safeguarding concerns. The management team investigated concerns and had good internal records of actions taken, follow up discussions with staff and acknowledgement letters to families in response to complaints. However, we found one complaint that was investigated by management internally and action taken to address the concerns but a safeguarding alert and CQC statutory notification were not made. The manager told us they were not aware the incident met the threshold for reporting. The manager immediately reported this concern in retrospect. Statutory notifications are notifications the provider must make to the CQC for certain issues such as safeguarding concerns, allegations or serious injuries. Staff explained safeguarding as, “It is about safeguarding people and us from abuse. Signs might be shying away, changes in person’s behaviour or mood, bruises. I would report to manager, and if my concerns were about the manager I would report to someone more senior.” Another said,” Safeguarding is a way of protecting people in our care and recognising signs of abuse and who to report to.” A family member said, “I feel people are safe.”

Care plans had good detail within them to reduce risks, particularly around personal care and maintaining the persons dignity. There was good detail around communication and how best to offer choices. A lot of detail to ensure the correct manual handling equipment is used around hoist and slings. We observed staff with manual handling and supporting people to transfer from wheelchair to armchair using equipment, this was done safely. We also observed staff being mindful of each other’s limitations and changing sides of the bed when providing personal care. This was to reduce the impact on the staff member’s posture. Throughout the observations of manual handling, it was explained to the person what staff were going to do next so that the person was informed. There were processes in place to communicate changes with families however, one relative said, “I feel that more information could be shared in regard to health changes and risks.” Some people had gates on their bedroom doors. When asked how they felt about this people said they were happy with the gates. One person said, “This prevented people from accessing their room and moving things.”

Environments were safe and potential risks were known and assessed. The home was cluttered in some areas such as the main lounge where people spent a lot of their time. Despite lounge layout the home has a relaxed and homely feel. Staff told us they do their best within the environment they have. One relative said, “I am not worried about the décor because I know my [relative] is well looked after and that is what matters most.” People’s rooms were clean, and some were personalised. Some of the rooms were shared occupancy rooms. The people we spoke to about sharing rooms were happy with the arrangements. The registered manager ensured health and safety, and maintenance checks were regularly completed, and appropriate certification was in place. Personal emergency evacuation plans, and fire safety measures were in place. The registered manager told us there were some limitations on what can be done externally to the footpaths because they are not owned by the provider.

Staffing levels were monitored by the manager and there were clear systems in place to ensure safe staffing in the event of any emergencies. Staff training was reviewed and up to date. New staff were recruited safely. Staff told us they felt supported. Family’s repeatably said, “I have no complaints.” Another family member said, “I phone on a regular basis, and they do not mind if you phone anytime day or night and they are thorough.” A stakeholder said,” I feel the staff are given adequate training to meet the needs of the care they are providing.” The provider does not use agency staff and has enough staff to meet people’s needs. Staff were able to explain people’s needs and preferences. One staff member said, “I ask people what they want, I give them choices, and sometimes it is about observing their body language for communication.” Another said, “This place is my second family home, it's full of love, joy, laughter and sometimes tears, but we are all there for each other, whether that be staff or service users, if I can make someone smile or laugh, by making a cup of tea, having a chat, or singing their favourite songs then I know I've done a good job.”

Staff knew how to protect people from the risk of infections. Staff were observed to wear personal protective equipment when required, hand sanitiser was available. The manager completed regular IPC audits. Staff used PPE appropriately during personal care tasks. The home was in good repair and the kitchen has a hygiene level of 5 from the environment foods agency.

Despite there being good systems in place to safely administer medicines, the practise we observed was not always safe. We observed a drink that had covert medicines in it being left with a person who has dementia. The person and drink were left unsupervised, the person then moved to a different chair and left the drink with medicine in it at the first chair. This meant there was a risk someone else might accidentally drink the drink and consume the medicine unknowingly. The manager was made aware of our findings and took action to address the concerns. There was good documentation in place to ensure that when medicines were given covertly, it was an agreed protocol and, in the persons, best interests and with the authorisation of a GP.