Dawson Lodge

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• 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 assessed five quality statements within the safe key question. There was a positive culture where people and staff were encouraged and supported to raise concerns. Incidents and complaints were investigated, and lessons learned to improve safety and people’s experience in future. Staff were recruited safely. There were enough staff to make sure people received consistently safe care that met their needs. Checks were in place to monitor the safety and upkeep of the premises and equipment. Some checks had not been completed at the intended frequency and the review of general risk assessments of the service was overdue. The acting home manager was working to address these shortfalls. Improvements had been made in the management of people’s medicines following external pharmacy audits and people told us they were satisfied with the management of their medicines. We identified shortfalls in the recording and monitoring of topical medicines (creams applied to the skin) and some liquid and cream medicines were not labelled when opened. The acting home manager took prompt action to address this. However, we found some risks to people required a more detailed assessment to ensure risk management actions were fully identified and monitored. Staff we spoke with had good knowledge about people’s risk areas and how to manage them, however some records required review to ensure they were fully completed and consistent. We identified a gap the availability of safeguarding training arranged by the provider. Although safeguarding was discussed with staff at interview, on induction and in meetings, some staff had not completed formal training in this area. In other areas, staff had received training and support to enable them to deliver good quality care and to develop their practice.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they felt safe at the service and were comfortable raising any concerns. One person told us, “I slipped once in my bathroom, the staff helped me up, I didn’t need a doctor. I’ve had new non-slip flooring in there since.” This demonstrated action had been taken to minimise future risk. People were asked for their feedback about the service, and this was used to make improvements. People had shared they would like to spend more time in the garden and to reintroduce vegetable prepping and baking. In response, the garden had been revamped and there was a daily vegetable preparation session. One person told us, “The garden looks nice, we can see they’ve made a real effort, especially as the weather hasn’t been good.” In the communal lounge, suggestions and the action taken or planned was captured on a ‘you said – we did’ board.

Staff described a culture where they were encouraged to share concerns and learn from mistakes. One staff member said, “Management are very clear; if anyone makes a mistake come and inform us. They focus on teaching and improving.” Staff described how they pooled their experience of supporting people to improve their support. One said, “There is a lot of discussion among staff about people’s care needs and it does go on the care plan.” Staff shared examples of improvements that had been made in relation to medicines errors. One staff member said, “We all did more meds training, and they introduced a better system. It is working better now.” The acting home manager described how she was fostering an open culture. This included being present at staff handover to ensure she met with all the team, including the night staff, and inviting feedback and discussion both in team meetings and individually. There was also a focus on developing the team. The acting home manager said, “I like the reflective practice, I like to do the meetings. They know they can come to me. We have had outside trainers in to get to potential problem areas before it becomes a problem.”

There were processes in place to ensure incidents were captured and any learning shared. In addition to reviews within the service there was scrutiny and challenge from representatives of the provider. Weekly risk meetings brought together a group of home managers in the area to share learning and identify areas for improvement. To support staff and improve practice, additional training had been arranged. Records indicated this training had delivered results for people, including supporting staff to liaise promptly with healthcare professionals and support a person to remain at Dawson Lodge rather than being admitted to hospital. Our review of records from an incident demonstrated the service had acted in an open and transparent way, applying the duty of candour.

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.

We did not look at Safeguarding 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 Dawson Lodge. Relatives gave examples of how people had been supported to manage risks in their care needs and we saw people being supported safely during our visits. A relative said, “They are very good here if he’s had a fall or is not well. They ring me and tell me what’s happened, it’s reassuring.”

Managers and staff, we spoke with were knowledgeable about how to mitigate risks to people. For example, we discussed risks to people from falls, pressure sores and behaviours of distress and staff demonstrated an understanding of how to support people safely. Managers had identified the need for staff to support people with positive risk taking to improve their well-being.

We saw people being supported safely by staff. For example, we saw staff supporting a person who became anxious whilst walking. Staff responded to their distress with patience and encouragement, enabling the person to continue walking with their support. During lunchtime we saw people who required assistance to eat or who required a specific consistency of food were supported appropriately. This helped to manage risks to people from malnutrition and/or choking.

Whilst staff were knowledgeable about people’s risks, some risk assessments were not detailed enough. For example, when people were at risk of constipation, unexplained weight loss or were refusing care which could lead to a deterioration in their health. Some records required review to ensure they were fully completed and consistent with people’s risk management needs. The acting home manager and team leaders acted to address the examples we found. More time was required to ensure this approach was fully embedded into practice. Planned care actions meant staff were alerted to people’s care needs, such as repositioning to reduce the risk of pressure sores. We saw a person at high risk of pressure sores had not developed any and their repositioning records showed this had been completed as planned. Daily and weekly meetings were held to review and monitor incidents and people’s risk areas. Records showed staff followed the risk assessments in place. Acting management reviewed the records to ensure this was done. Staff confirmed processes such as daily shift handover meetings and the use of an electronic care plan system enabled them to keep up to date with people’s changed needs and risks. This enabled staff to give appropriate care.

People told us they were happy with the home, their rooms and garden. One person shared how they had been able to bring their own furniture and ornaments. They told us, “That [ornament] is over 70 years old, my family painted it and I’m allowed to keep it in my room, it reminds me of home.” People were happy with the maintenance of the home.

Staff told us equipment was readily available and they were supported to purchase whatever was needed. One staff member said, "Equipment with Anchor [Provider] is very good, if we need anything we can order it." Staff felt confident they understood what action to take in the event of fire. They told us there were regular alarm tests and they had carried out evacuation drills. One said, “We have regular fire drills and are improving each time on response. We all know what to do!”

The home appeared well maintained and free of hazards. Equipment was in place to support the safe evacuation of people from the building. Spot checks on equipment, including fire extinguishers and hoists showed these had been serviced. Window restrictors were in place. During our visits the home was clean and airy. People were able to move freely within the service and to access the garden. We saw people enjoying the outdoor space. Throughout the home there were areas of interest, for example a room decorated and furnished as a pub, memorabilia including sewing machines and a typewriter, bookshelves and puzzles/games.

Some people who were at risk of falls used sensor equipment to monitor their movements. This helped to alert staff so they can provide prompt assistance. Whilst this equipment was in place to support people’s safety, it was a restriction to people’s freedom of movement. The decision to use this equipment should be subject to an assessment of the person’s mental capacity to consent to its use and, if they lack capacity an assessment a record of the decision made in their best interests. This process had not been applied and the acting home manager took immediate action to remedy this. More time was required to ensure this approach was fully embedded into the service. Processes were in place to support safety in the home environment and with equipment. These included checks on fire safety equipment, fire evacuation drills and regular flushing of infrequently used water outlets. We identified some gaps in these checks and some check sheets appeared to be duplicates. The acting home manager explained they were working through the health and safety files to understand which actions were outstanding. They told us a new maintenance staff member was to join the following week and would receive support from the maintenance team at another of the provider’s services. General risk assessments for the home were overdue review. The acting home manager told us this was on their list to address. There were process in place to support staff understanding relating to safety of the environment. The induction knowledge checklist included understanding the fire panel, policies and procedures and an overview of the business continuity plan. Equipment, including the passenger lift and hoists, had been serviced. Where issues had been identified, for example a fire door not closing correctly, this had been raised as an urgent repair request with an external contractor.

People did not express any concern regarding staffing levels in the home. They told us they received support when they needed it. One person explained there were a lot of staff working in the home and said they appreciated their keyworker. They said, “I do have a named person who I’ve known since I came here, and I can talk to her.” People had confidence in the staff supporting them. One person said, “They seem to be well trained, that’s the ones I know.” Some people referenced the recent changes in management at the service. One shared, “Managers are all up in the air at the moment, the stand in manager is very nice though.”

The acting home manager and representative of the provider explained they had maintained staffing levels, despite the lower occupancy, in order to stabilise the team and to support the introduction of the digital care system. Staff told us they had time to support people and spend time with them. One said, "You get allocated time, plenty of time. We have plenty of staff, I don't feel we are understaffed.” Staff said they could draw on support from team leaders or managers if they were stretched. Staff told us they had received training and felt confident and supported in their roles. They told us additional training was provided if a person had a particular support need. Staff felt they could go to their seniors for support and had received supervision. One staff member described supervision as “regular and meaningful”. They told us it was good to get feedback. Staff described a challenging period, where there had been turnover within the team and agency staff on the rota. One staff member explained, “We went through quite a lull with staffing, all doing lots of extra hours. Much better now, getting there.” Another staff member said, "There was agency, but we have enough staff now. A lot of new staff came.” A third shared, “We are well-staffed now. I think the residents can feel the difference.”

We saw staff attending promptly to people’s needs. Staff in all roles appeared to enjoy good relationships with the people they supported. We heard them addressing people by name and stopping to chat or offer support. People were supported calmly and were not rushed by staff.

Records showed staff had received most of the training they need to perform their roles. However, there were gaps in relation to safeguarding training. The management team acknowledged this and explained how they assured themselves of staff competence in safeguarding. There was a system to monitor staff training and to ensure refresher courses were completed. The provider’s mandatory training included a course on learning disability and autism training. Since 1 July 2022, all registered health and social care providers have been required to provide training for their staff in learning disability and autism, including how to interact appropriately with autistic people and people who have a learning disability. The provider used a dependency tool to assess people’s support needs and the number of staff required to meet them. Records demonstrated this had been reviewed and updated to reflect changes in people’s needs. Rotas were provided to staff 4 weeks in advance. Rotas we reviewed indicated the home had been staffed above the level indicated by the dependency tool. Staff were recruited safely. This included checks on their suitability to work in care. When new staff joined the service, they completed a period of induction that included shadowing of experienced staff. There was a system of monthly review over the first 12 weeks of employment.

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.

People told us they were satisfied with the management of their medicines. Their comments included, “Medicine rounds are always done well here, I used to be a nurse, so I know” and, “Yes, they give them to me at the same time as breakfast, which is when I took them at home.” People confirmed they received their ‘as needed’ pain relief when required. People who wished to manage some or all of their medicines were supported to do so safely.

The management team described the improvements they had made to medicines management. These improvements had reduced medicines errors. Staff told us how they supported people with their medicines and spoke confidently about how they provided safe and person-centred medicine administration in line with current guidance.

Staff completed records to show when people had received or refused their medicines or taken an ‘as required’ medicine, such as for pain relief. However, staff did not always record topical medicines properly. Some liquid and cream medicines were not labelled when opened. Opening dates are used to prevent the risk of applying out of date medicines which could be ineffective. On our second site visit we saw the acting home manager had taken action to address these shortfalls and had reviewed all topical medicines to ensure the system was accurate, up to date and monitored. More time is needed to fully embed this into the service. Processes for the ordering, storage and disposal of medicines were in place and met current guidance. Some people were prescribed their medicines to be taken covertly. This means they can be disguised so the person does not know they are taking a medicine. Records showed the appropriate assessments and guidance were in place to ensure safe and lawful administration. Controlled drugs (medicines requiring tighter controls under the Misuse of Drugs Act 1971) were stored, administered and disposed of in line with current guidance.