Holm 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 safe, protected from avoidable harm. Staff were aware of risks to people and these were documented and reviewed within care plans. Accidents and incidents were recorded and any lessons learned, shared with all staff. People’s ability to make independent decisions about their care had been assessed and systems were in place to support those who needed help. Staff were recruited safely and had received training in all relevant areas. The home was described as ‘homely’ and was clean and free from hazards. Staff wore personal protective equipment (PPE) appropriately. Medicines were stored, administered and recorded safely.

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 and their loved ones told us they had a good relationship with the manager and staff at the service and that any important updates or information would be passed to them in a timely way. This included where mistakes had been made and there were lessons to be learned. A relative said, “(Registered manager) keeps us informed using a messaging service. She is honest and open and has told us about recent staff changes.” Another added, “They keep us informed of anything that happens, they contact all of us.” Another relative told us “On the ball with incidents and I can call anytime and then call me when I need to know something."

Similarly staff told us about the process that is followed following an accident or incident. A staff member said, “We have meetings following accidents to look at how to prevent it happening again. With falls might be call bell use or manual handling learning.” Another staff member confirmed that other professionals were involved following incidents where additional support was needed. They said, “We follow advice of others like GP’s, sometimes might need to get OT to review. It’s all written in care plans.”

The registered manager and senior staff held meetings following incidents to capture learning. A running log was kept of lessons learned from incidents which described fully the accident or incident, the lessons learned, outcomes and how learning was shared with staff and others if needed. The registered manager confirmed that meetings were held with staff following accidents and incidents to capture learning and ensure there were no ongoing safety or welfare concerns.

People and their relatives told us that their transition to living at the service was well managed. A relative said, “She went there from hospital and has been there now for three months. The transition was difficult for her (relative) however the process was smooth and the staff at Holm Lodge were very supportive during the move. It’s the little touches that make the difference.” People told us that appointments and visits with other professionals were arranged by the staff, one told us, “If I needed a doctor or dentist they sort things out for me.” Another added, “They sort out my appointments for me.”

The registered manager and staff told us of working relationships with other professionals that resulted in positive outcomes for people. The registered manager said, “There are no issues now. We had a meeting and all professionals came which was very productive. Community nurse attended also working with representatives from local authority. No handover from outgoing manager so a few issues but back on track.” A senior staff member said, “We call direct to arrange appointments for people.”

We spoke with health and social care professionals who similarly told us of positive relationships with staff at the service and clear and effective pathways for people. One professional made comment about the service hospital passports, “Hospital passport – good clear info about health and social care issues. Very independent.” Another said, “The patient I was dealing with at Holm Lodge received regular liaison with GP who was visiting on a weekly basis and in between the weekly GP visits liaison was also made for the patient with the surgery as her presentation progressed.” Professionals also regularly reviewed people and we saw review documents completed by social workers and the medicines optimisation team.

People had been given the opportunity to complete ReSPECT (Recommended Summary Plan for Emergency Care and Treatment ) forms and record advanced decisions about their support in the future. Hospital passports, containing key information about people, to be used if taken to hospital, were in place. Care plans contained regular reviews from other professionals for example, occupational therapists, GP’s, mental health professionals and community nurses.

People told us they felt safe living at the service. Comments included, “I feel safe. They know who I am and my daughter-in-law speaks up if needed” and “I do feel safe here.” These views were confirmed by relatives who told us, “She is safe and well looked after. No concerns about her despite recent events.” Another added, “No concerns with safety and risk. She pushes the button when she needs anything. We (family) are all greatly relieved she is no longer at home.”

Staff had a good understanding of safeguarding and were able to tell us the situations that would amount to a safeguarding incident. They then described the actions they would take, one telling us, “Safety of resident first then record and report. If managers involved can call 999 or CQC.” Staff understood the whistleblowing process and told us they were confident to use it, “I am aware of whistleblowing and am happy to use.’

Staff were attentive to people’s needs. Call bells were answered promptly and anyone either requesting support, help or otherwise in need, were seen by staff immediately. People needing support with mobility were attended to by staff and similarly those needing help with their medicines or eating and drinking were supported.

Safeguarding and whistleblowing policies were in place and were kept under regular review. Systems were in place to keep relatives informed of incidents and the registered manager knew the processes to follow to report safeguarding concerns. The service had a positive relationship with the local authority who were responsible for investigating safeguarding issues.

People and their loved ones told us that risks were managed well at the service. People were encouraged to be as independent as possible without compromising their safety. A person told us, “Staff are very good, seem to be enough of them and they come when I ring my bell.” A relative said, “No concerns with safety and risk. She pushes the button when she needs anything. We (family) are all greatly relieved she is no longer at home.”

Staff knew people well and were aware of the risks that each person lived with. For example, risks associated with mobility and falls and those related to eating and drinking and any potential choking risks. Comments from staff included, “We know people well. Person I support needs re-positioning every two hours. Another has regular catheter checks” and “I’ve got to know the residents well and am aware of the risks they have. I’ll update care plans when I need to and I make sure new staff are kept up to date.”

Call bells were answered promptly. There were enough staff in communal areas of home to ensure everyone got the attention and support that they needed. People that were at risk of choking were given one to one support during mealtimes and those at risk of fall were supported when moving around the service.

The folder containing details of mental capacity assessments, best interest meetings and Deprivation of Liberty Safeguards (DoLS) was missing. This had been identified by the registered manager 2 months previously when several senior staff left the service. The registered manager had notified the local authority and a process was in place to review and replace all of the missing documentation. We were shown some documents that had been completed however there were others that were still in the process of being updated. Care plans contained risk assessment that were relevant to each person. These included for example, people at risk of falls, those at risk of developing pressure sores and any risks associated with medicines or nutrition. Risks had been discussed with people, relatives and where needed, other professionals.

People and their relatives were positive about the physical environment of the service. We saw several bedrooms which were personalised but safe with no obvious trip or other hazards. Similarly, communal areas were kept free of any clutter and any equipment needed for example, walking aids or screens, were kept out of the areas where people moved around. A relative commenting on the maintenance of the property told us, “Ongoing repairs are done as well.”

The service employed a member of maintenance staff to carry out ongoing repairs and keep records of safety certificates and checks on equipment. A staff member said, “I have called the maintenance man about leak in medicines room. I noticed some damp on the ceiling in this room.” Staff were aware of the steps to take in an emergency and there were dedicated fire marshals on duty each shift. A staff member told us, “We have fire alarms every Tuesday and practice how we would evacuate every month. We have fire marshal training this week and I feel confident to act.”

The kitchen was small but well equipped. People’s dietary needs were clearly displayed on a chart on the wall showing if people required a diabetic diet, mashable food and if they had any allergies. All required temperature checks of equipment and food had been carried out and was recorded. We had been notified of an issue involving rodents but there was no evidence of this during our site visit. The service appeared clean throughout and staff told us that steps had been taken to eliminate the previous rodent issue.

Gas, electricity and legionella certificates were all in place and in date. Safety checks were regularly carried out and all fire safety equipment had been checked regularly. There were actions required from the most recent fire safety inspection in 2022 and these had been completed. Personal emergency evacuation plans (PEEPs) were in place for people and was easily accessible in the event of an emergency.

People told us that staff were attentive and that there were enough of them to meet their needs. Comments included, “There are enough staff and they look after me,” “Staff are first class. There seems to be enough. Sometimes have to wait but that’s fine” and “Very happy, the care is excellent.” A relative told us, “Day staff when I visit, always plenty of them and I visit every week.’ Another said, “It’s well staffed here.”

New staff and agency staff working at the service for the first time went through an induction process. A staff member said, “Worked here for just over a year and remember induction. Covered fire and safety things and met all residents and staff. It lasts two weeks and we covered a lot of training. Also shadowed until confident to work alone." The staff member added, “We have ongoing training which give me the skills I need.” Despite some dependence on agency staff to cover leave and unexpected absences, the regular staff told us that there were enough staff and all shifts were covered. A staff member told us, “We have enough staff to support people safely. We have two at night and have a twilight shift that covers till 9pm which helps with the busy time.”

During our site visit there were enough staff to meet people’s needs. There were always staff members in communal areas and in addition, supervisors and managers frequently passed through and spoke with people and supported where needed. The introduction of a ‘twilight’ shift which provides an additional staff member working till 9pm each day, ensured that the busy times of the day had additional staff support.

Staff had been recruited safely. We looked at 4 staff files and all contained the required documents for example, application forms, references, photographic identification and in-date, Disclosure and Barring Service records (DBS). DBS help managers to make safe recruitment decisions. Staff received regular training updates and supervisions were held in line with the provider's policy. There were many opportunities for staff to speak with the registered manager or senior staff members if needed.

People acknowledged that the cleaning of the home had improved in recent months one saying, “Cleaning has improved.” Relatives told us that they had seen improvements also and that staff adhered to policies relating to wearing personal protective equipment (PPE). A relative said, “Can smell now that the place is clean. I walk around the home and it’s not an issue.” Another said, “It’s clean and staff wear masks and aprons and are aware of security.”

Staff told us that the home was clean. A staff member said, “As soon as they (the registered manager) was told about the rodent issue, she did everything possible to immediately sort the problem. There are now no hygiene or cleanliness concerns. Staff reported plentiful supplies of PPE being available and were able to tell us that they wore PPE during personal care and if appropriate, at mealtimes. A staff member said, “We have enough PPE and given training how to use.”

Domestic cleaners were working during our visit and staff rotas confirmed their attendance 7 days a week. There were PPE stations throughout the service and on every floor. We were shown donning and doffing training records and posters around the service provided reminders and instructions to staff. We saw staff wearing PPE appropriately.

Infection prevention and control and covid-19 policies were in place. We saw minutes from team meetings where reminders had been given to staff about the continued need to where PPE and how to safely dispose of used items.

Some people were able to support themselves with their medicines but most required the support of staff. A person said, “They help me with my medicines, never had issues.” A relative told us about their loved one who had been struggling to manage their own medicines before moving to the service, “They are on track now with their meds, they are managed well by Holm Lodge. They have weekly injections and they are supported now which was not before.”

Staff told us that they had been given training and competency checks for their provision of medicines. Staff were able to describe the process they carried out on medicine rounds including recording medicines given, locking the medicines trolley between each person and staying with people until their medicines had been taken. Staff were able to describe the protocols relating to ‘’as and when required’ (PRN) medicines. A staff member said, “There are separate instructions for every PRN medicine we use.” Another staff member told us, “We have protected time when giving meds.” We saw process and staff wear a red tabard to indicate they are on a meds round.”

Medicines were stored, administered, recorded and disposed of safely. Medicine administration records (MAR) had been completed correctly showing date, time, running number count of remaining medicines and whether the medicines had been successfully administered. PRN medicines each had their own protocol to guide staff in administration, for example, any issues when taken with other medicines, how often and when to be reviewed by the GP. Regular medicines audits took place overseen by the registered manager. Risk assessments were in place for people, describing the actions they can take themselves and the levels of support needed by staff.