Princess Lodge Care Centre

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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

We assessed 6 quality statements in relation to assessing needs, delivering evidence-based care and treatment, how staff and teams work together, supporting people to live healthier lives, monitoring and improving outcomes and consent to care and treatment. People’s needs were assessed before they moved to the service and people and their relatives were involved in this. There were processes to ensure staff were up to date with people changing needs. We found evidence-based tools were used to assess people’s care needs and staff were aware of these. Relatives gave examples of where people achieved good outcomes, and felt staff monitored people’s needs well. There were processes in place to ensure people were checked regularly, however this did not always take place hourly in line with what the manager told us should happen. Staff, teams and services worked together, however some people felt staff did not always have time to support people with outlined guidance from other health professionals, such as supporting people with exercises suggested from a physiotherapist. Staff asked for people’s consent before supporting them, however, we saw many people had their bedroom doors open which meant that people could see into their rooms. It had not been assessed or recorded whether this was people’s choice or whether this decision was made in people’s best interest, however, people we spoke with did not express this as a concern.

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’s needs were assessed before they came to the service, and we saw this information was transferred to people’s care and support plans. People and relatives told us they were involved in this process. Staff knew how to keep up to date with people’s changing needs. People’s care needs were reviewed regularly, through a process called the resident of the day, and we were informed relatives were contacted to provide their views as part of this process. However, we received mixed feedback from relatives about their involvement in this process. We raised this with the manager, who explained sometimes relatives did not answer the attempts of contact, but that messages were left asking for relatives to call back, however we did not see any recorded evidence of this contact made.

The service had evidence-based tools embedded into their care planning, for example, tools to determine whether people were at risk of developing pressure areas. Staff did not always have a good understanding of these tools and what they were used for, however staff had a good understanding of people’s needs and knew how to manage any risks.

There were processes in place to support effective team working. For example, there were regular team meetings which all staff were invited to. Additionally, the manager told us they used an online system to ensure all relevant staff were kept informed of people’s needs, including hospital admissions. Staff told us they worked well together and with external services, such as the GP. The manager provided examples of how they worked well with other professionals, and we saw referrals were made to external teams where necessary. We also saw evidence of the manager contacting a social worker about people’s changing needs. Relatives told us that staff worked well with other professionals. One relative told us, “[Person] goes for her hospital appointments, they get the Doctor when [person] needs it.” However, some people told us staff did not always have time to support people with exercises outlined by the physiotherapist team and one staff member also supported this. We raised this with the manager, who explained, they have reviewed this and found staff were finding it difficult to manage this due to time constraints, and have made changes to the way this is managed. Additionally, we found staff did not always record information from healthcare professionals clearly in people’s care plans, although this information was recorded in the review and update part of the document. This meant information may not have been easily accessible to staff. The provider acted proactively following this feedback, telling us, “Following your visit, our Director of Operational Quality has arranged for a member of the Quality Support Team to spend a week in our home, meet with the staff and show them how to use the care planning system better and also the expectation on how care plans and supporting documentation must be completed.” We saw evidence of these improvements made.

People were supported to live healthy lives. The manager explained how they had oversight of people’s health needs. They told us, “We have clinical governance meetings every week, where changes to people’s health, or any concerns which I need to know about. We analyse information to help the person improve. Every week when we have the GP visit, I ask the nurses if there is anything I should know. I can access our online system to review things like accidents, hospital admissions and handovers. Activities were offered to people such as light exercises and games which encouraged movement. Staff told us about how they encouraged people to live healthier lives. One staff member told us, “It’s like everything, diet and going in the garden in the summertime for fresh air. Some [people] do exercise activities too.”

Relatives told us the service supported people to achieve good outcomes. One relative told us, “[Relative’s] weight is so much better here, she had ballooned up… but since she has been here, she is her proper weight again and her legs are right and a good colour now… her skin has healed up and she is so much better now.” The manager explained how they were able to effectively monitor people’s outcomes. They told us, “The system we have in place makes this easy. The nurses call me to let me know about anything I need to. When I come to work, I am always told by the nurses about things that have happened.” The service routinely monitored people’s care and treatment to continuously improve it. For example, reviews took place when things changed for a person and information was updated in people’s care and support plans. Staff told us how they used a device to record people’s care needs, and this also alerted staff when people should be offered a drink.

People had assessments in place to determine whether people had capacity to make some decisions, and best interest decisions in place where appropriate, which included relevant people. Staff had completed training in the Mental Capacity Act and understood how to apply this within their roles. Staff asked for people’s consent before supporting them, however, we observed many people had their bedroom doors open, meaning people walking along the corridor could see into people’s bedrooms. We raised this with the provider who told us, “Before moving into Princess Lodge, a thorough pre-admission assessment is carried out to identify the needs and choices including their capacity. A key to the room is also offered where the individual has capacity to make use of it. This is also documented in the service user guide placed in every bedroom. The staff offer residents choice of having the door closed or open and as a general practice the door would be kept closed only when specifically requested by the individual to avoid social isolation. There are also hourly checks and other regular checks throughout the day and night as risk assessed for each individual within the service. During the night, some individuals have specifically requested to keep their doors shut. This has been recorded in their care planning. In some scenarios this would be based on individual risk assessments or identified care needs.” The manager sent us evidence of an example of where this was recorded.