Archived: Holly 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 reviewed 3 quality statements for this key question relating to safeguarding and risk management. We found staff understood their role in keeping people safe. Staff assessed and mitigated risks and the provider had enough staff to ensure people’s safety and meet their needs.

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.

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 and their relatives told us they felt safe at Holly Lodge. If they had any concerns, they found the staff approachable and knew who to contact.

Staff told us they had received training and understood their responsibilities to keep people safe from avoidable harm. Staff knew how to report any concerns about abuse. Staff comments included, “It [safeguarding] is about safety of individuals. We're keeping people safe from harm. All types of abuse are avoidable” and, “If I saw bruising, I would record it and do a skin integrity check. I would inform the nurse, and the nurse would tell us what to do. We would monitor it.”

We observed staff supporting people safely. Staff were quick to recognise a new agency member of staff was not who they were expecting. They appropriately challenged the person’s identity and took steps to report to the relevant staff agency.

Safeguarding notifications were made appropriately. Any incidents, accidents and new care protocols were reviewed by the management team and any learning cascaded to the staff team. Deprivation of Liberty Safeguards (DoLS) had been applied for appropriately and the information was held within the electronic care planning system. We have not made any other amendments to the report or the scoring, so the Quality statement score will remain 3.

One relative said, “There’s always someone with him.” Another relative told us staff were aware of people’s behaviours, they observed and acted quickly.

Staff told us they encouraged people with positive risk-taking. One staff member said they were helping one person try different bikes before buying one, and another staff member described how they supported people with different needs on days out. We discussed the shortfalls found in record-keeping with the management team during the inspection. They quickly developed an ‘at-risk skin management plan checklist’ to be undertaken for all individuals who had an identified risk. This will ensure that the support delivered clearly reflects the position changes required and which interactions will evidence this, it will also form an integral part of the ‘my skin’ support plan.

Staff were observed putting on gloves and applying sun cream to a person’s skin before they went outside. Staff were observed supporting people safely. We saw that equipment used to move people was checked regularly.

Staff recorded daily to confirm if mattresses were set correctly. However, on occasions staff had documented it had not been set correctly, but there was nothing documented to show they had raised this. When we checked a person’s mattress with a member of staff, it was set incorrectly. The staff member then corrected this. Plans in relation to wound care were difficult to locate. It was also difficult to see if regular photographs had been taken and therefore difficult to assess if wounds were improving or deteriorating. Photographs of wounds that we saw did not have a measuring tool used, although a staff member told us the service did have these in stock. Following feedback, the management team had sought additional training and guidance from an external source to increase staff knowledge on wound care and accurate monitoring. They had also introduced a new monitoring and assessing tool to identify risks to people’s skin, required position changes and frequency. People had been assessed for risks such as skin damage, choking and malnutrition. Assessments had been regularly reviewed. Some people had been assessed as being at risk of choking. Plans informed staff how to position people when eating or drinking and any recommendations made by the speech and language team (SALT). We looked at the plans for one person who sometimes experienced episodes of distress due to their health condition. The plan was detailed and included information for staff on any known triggers and actions to be taken.

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

Relatives told us, “There always seems to be enough [staff]” another said, “I’ve never had a problem. There were loads of staff at the home, no problem.” However, one relative told us there were times when it appeared there was a shortage of permanent staff.

Staff told us that aside from unexpected absences, generally the service was fully staffed. Staff comments included, “Most days there are enough staff. We do use agency but they [agency staff] are all very good and know people really well. There are usually four staff for six people” and, “Weekends can be tricky for agency cover, so staff do pick up extra shifts. If we're really short, the nurses will help out.” The management team told us they had a varied and multi-cultural full staff team and a reliable consistent agency staff team.

There were enough staff on duty to meet people’s needs.

Staff had been recruited safely and there was a dedicated agency team for consistency of care. The service was staffed in line with the providers own dependency tool. The staff turnover rate was very low, some staff had been working at Holly Lodge for a number of years.

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.