Earlfield 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

We identified 3 breaches of the legal regulations. Risks were not adequately documented in care records which meant there was a lack of clear guidance for the staff to follow. Risk assessments did not provide accurate and up to date information relating to each person. Steps had not always been taken to ensure the risks to people had been reduced. We did not find any evidence that people had been harmed, but this was a breach of regulations relating to safe care and treatment. Safe recruitment procedures were not always followed to ensure staff were suitable to work at the service. We identified gaps in the recruitment records of staff. We did not find any evidence that people had been harmed, but this was a breach of regulations relating to fit and proper persons employed. Although improvements had been made to the building and decoration, we identified a number of new issues during this assessment. Further ongoing improvements were needed to ensure the building was safe and maintained. This was a breach of regulation relating to premises and equipment. People told us they felt safe at Earlfield Lodge and were encouraged to understand risks that may affect them. People’s capacity was assessed, and their decisions were respected whilst managing risks. The local authority told us some incidents had not been reported to them. Prior to this inspection the management team had not always take the appropriate action when there were concerns around people’s safety and changes in their needs. There were appropriate staffing levels and skill mix to make sure people received consistently safe, good quality care. The registered manager monitored staffing levels and altered these as and when people’s needs changed.

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.

People told us they felt safe living at Earlfield Lodge. They felt the staff would listen to any concerns and respond appropriately. People told us. “The staff are very kind, kindness in itself” and “I never feel that I’m an inconvenience”. People and their relatives were confident about raising any concerns with the registered manager. They were knowledgeable about contacting the Local Authority if they had any safeguarding concerns.

We spoke to the staff and found they had a good understanding of safeguarding adults from abuse. They were aware of who to report any concerns to and confirmed they had received safeguarding training. One staff member did not have a good understanding of Deprivation of Liberty Safeguards (DoLS) and the process. We gave feedback to the provider about this.

Our observations did not raise any significant concerns about safeguarding people from abuse. During the inspection process we did raise 2 safeguarding concerns about people that lived at the home. One was in relation to us observing poor moving and handling techniques. The staff and the management team knew people well, interactions were person centred and positive.

We looked through people’s records. We found people had paperwork in place in relation to the Mental Capacity Act (MCA). Best interest decisions had been made and the appropriate paperwork was in place. The provider had a process in place to manage Deprivation of Liberty Safeguards (DoLS). People’s care records confirmed that the appropriate referrals had been made, when needed. A tracker was in place so the registered manager could monitor the referrals made and to track the process. A system was in place to manage the safeguarding process. We found evidence that safeguarding referrals had been made to the local authority. Records were maintained with concerns appropriately logged within a folder.

People told us they were not always involved in updating their care plans and risk assessments. They felt the staff supported them to develop their skills and manage risks relating to medication, cooking and being independent in the local community.

Staff and managers provided examples of a positive, person-centred approach to the management of risks to people. They considered people's capacity. The staff told us people’s risk assessments contained enough up to date information to support people safely. One staff member told us, “We are made fully aware if there is a risk to a resident or member of staff”. Another staff member was unable to tell us where the risk assessments were kept.

During the inspection we observed the staff carrying out poor moving and handling practice. The staff were assisting a person who was unable to use their legs. We observed the staff transfer a person to a chair using an under the arms technique, this involved grabbing the person’s trousers. This put the person at risk of harm and was not the appropriate technique. The person’s risk assessment recorded the person was to be assisted with a frame, if they were willing to co-operate with staff, or a hoist if they refused. One person was at high risk of falls due to being unsteady on their feet. A falls risk assessment was in place. They had several falls recently. A sensor mat was introduced which notified the staff if they got out of bed. However, the person did not like this being used and would remove this. To minimise the risk the staff were to check the person every half hour to ensure their safety during the day. The risk assessment stated the person should use a walking frame. We observed the person walking around the home alone and without a walking frame. The person was at high risk of falls and the risk assessment had not been followed. The staff had not taken the appropriate action by carrying out regular checks of the person.

We reviewed a selection of care plans and risk assessments for people. We found these were not accurate and up to date with information relating to the individual people. Steps had not always been taken to ensure that risks to people were managed. An example included one person who was being supported with end-of-life care. It was written in their care plan they required 2 hourly turns in bed, due to their poor skin integrity. A skin care risk assessment was not in place, to record how the risks to the person should be reduced. Daily records relating to supporting the person with 2 hourly turns were not always in place. The person had a past history of skin breakdown. Another person was at risk of skin breakdown and required 2 hourly turns. These were not always taking place and records were not accurate. This meant people were at risk as it was not clear how the risk was being managed, or if the turns had taken place. A fall risk assessment was in place for one person as they were assessed as being at high risk of falls. It had been assessed that a sensor mat should be used to monitor when they got out of bed. A staff member told us the person avoided using the sensor mat when getting out of bed. The risk assessment recorded the person would move the mat. We found the sensor mat was not positioned near to where the person got out of bed because of where the plug socket was situated, and the lead was not long enough. The person had rolled out of bed prior to this assessment, with the sensor mat not near to alert the staff.

The people we spoke with were overall happy with the environment which they lived in. They were aware work with the environment was ongoing. They acknowledged there had been recent improvements especially with the interior decoration. One person told us, “There are always problems with the plumbing and electrics in an old building like this, it’s ongoing”. This was a theme which people gave feedback to us about, along with the lift sometimes being out of use.

We asked the staff where people and the staff smoked. One comment included, “There is a room attached to the lounge where residents smoke, they do go outside in the summer sometimes. Sometimes the staff smoke with the residents in their smoking area. Otherwise, there is a designated staff smoking area near the garage”. We spoke with staff to find out if they were concerned about any risks in the building. One staff member told us, “We had problems with the boiler and the maintenance person was off sick, so in the winter we had mobile heaters which I thought weren’t very safe. This place has been completely renovated, so much work has been done here recently”. The provider told us they planned to continue to make renovations to the building with an action plan in place.

We spent time looking around the environment of the home. It was clear that improvements had been made since the last inspection. This included some redecoration of people’s rooms and bathrooms. Further improvements were needed to the building. Hallways around the building showed signs of wear and tear. Some bedrooms required decoration including carpets and the bathrooms replacing. We observed hot water pipes were exposed to people throughout the building. These had not been boxed in to reduce harm to people and presented a risk. Part of the building remained closed and was not in used. This part of the building remained not fit for purpose and was in need of full redecoration and modernizing. People were not being admitted to this section of the building as it was not safe. The outside garden area was in need of attention to ensure it was a safe area for people to visit. The patio area was not safe, and rubbish was placed in front of the garage. The paths were not even and presented a risk. Areas of the garden were overgrown and poorly maintained. We observed that people were smoking in the conservatory area. This meant that cigarette smoke entered into the main building. The lounge area near the conservatory smelt of smoke and people were sat in the lounge. The building had a call bell system installed throughout. This was for people to use when they needed assistance or in an emergency. On checking some call bells in bathroom areas were not accessible to people. These had been tied up and out of reach. This created a risk to people.

At the time of the assessment, the service did not have a business continuity plan in place. This is a plan in relation to how the service responds to disruption or emergency and the readiness in sustaining critical functions. This was put into place and submitted during the assessment. The service had an environmental risk assessment in place. This stated that smoking was not permitted in the home and that a smoking area was provided outside for people to smoke. People were smoking inside of the home and the process in place did not follow the principles of the risk assessment. Each person that smoked had a risk assessment in place for smoking. This stated that some people smoked outside and some inside. The risk assessment was not line with current practice which we observed. The information was not consistent as the environmental risk assessment stated smoking was not permitted inside. The provider had a refurbishment plan in place for the building. This lacked essential information, which included the priority areas and clear timelines. The concerns in relation to smoking inside of the building and creating a smoking area were not highlighted as a priority. Checks were undertaken of the safety of the premises. For example, gas, fire, electricity, water and equipment. A Personal Emergency Evacuation Plan (PEEP) was in place for each person. A file was kept by the front entrance. This needed updating for the current people that lived at the home. We spoke to the provider about considering the differences in people’s needs during the day and night. The provider should be clear in its checks about what parts of the premises were not in use. Fire drills were completed regularly with the staff.

We received mixed feedback about staffing levels at Earlfield Lodge. People told us, “They come reasonably quickly when I press the bell” and, “The staff don’t always have time to change me”. Another person told us that in the past people often had to wait to be taken to the toilet. A relative said the staff do come when the call bell was pressed, however their mum needed to wait if the staff were busy.

The staff told us they felt supported in their role. One staff member told us “I would say we have a good team, well trained seniors, the managers come to the floor and want to support the carers. The managers are very aware and make sure we do all the online training”. The staff we spoke with were positive about staffing levels at the service. One staff member told us “Staffing is okay. We have 4 staff in the morning and 4 in the afternoon. We have 2 chefs and if there is no kitchen assistant we will have an extra carer come in”. The staff consistently told us they received an induction at the service. One staff member told us, “Yes, here as well as at the sister home. I had 2 days of shadowing of senior staff to get to know the residents”. The staff told us the induction included undertaking mandatory training, such as safeguarding and manual handling. The staff spent time shadowing other experienced staff until they felt competent. Where needed the staff completed the Care Certificate. This is an agreed set of standards that define the knowledge, skills and behaviours expected of specific job roles in the health and social care sectors.

We observed there were sufficient staff available to meet people’s needs. Staff knew people well and appeared competent. The service had a low occupancy of people, but the staffing levels had been maintained. Call bells were answered promptly.

Safe recruitment procedures were not always followed. We checked the recruitment records of the staff. We found that gaps in staff’s previous employment were not always evidenced. The interview records did not demonstrate fully the candidate’s suitability or skills for the role. Although criminal record checks were carried out of all the staff, these were in a different company name and not the provider’s legal entity. We found discrepancies with some staff’s references on file. One staff member worked with only one reference when two should have been obtained. Another staff member’s reference could not be verified as genuine. This was not from a company email or on official headed paper. It did not record the name of the last employer. Health questionnaires had not always resulted in risk assessment or support to the staff member. A training matrix was in place which captured the staffs’ overall training. The training was specific to people’s needs, which included mental health, autism and self harm. Although training compliance had improved, not all staff had completed their training. We looked at the supervision matrix which showed staff received regular supervision. The provider had staffing rotas in place which showed consistent staffing levels. We spoke to the provider about staffing levels at night as the fire service had made recommendations to the provider. 2-night staff worked a waking night, however the building was over 4 floors. They had mentioned this was a vulnerable time of the day with less staff around in the building in the event of a fire. We reviewed the provider’s staffing dependency tool. This assessed each person’s care needs against the staffing levels needed. We spoke to the provider as there was a discrepancy with 2 people’s needs and the number of care hours allocated to them during the day.

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

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