Elderly residents at The Lodge 'went 28 days without a bath' says report after inspectors visited the Hemel Hempstead care home

A care home in Hemel Hempstead has been rated as 'requires improvement' after inspectors found some residents went 28 days without a bath or shower.

Care Quality Commission (CQC) inspectors found that The Lodge Care Home had 'insufficient' staffing levels, with one member of staff saying it was 'woefully inadequate' and some staff have worked nine days in succession without a day off.

And the report says that this sometimes meant residents were not receiving their medicines as intended by the prescriber, in addition to the concerns over hygiene.

But the inspectors also found that residents liked living in the care home, and relatives felt the staff team provided care and support to people in a safe way.

The Lodge, which at the time of the inspection in February had 34 residents, 10 of whom had dementia, had recently been the subject of an investigation by the local safeguarding authority, the CQC found.

This had looked at medicine management, record-keeping and meeting people's personal hygiene needs, but the CQC said the home, on Broad Street, had failed to improve practices since.

During the inspection inspectors spoke with two people who used the service and three relatives about their experience of the care provided. They also spoke with seven members of staff and the registered manager.

Lessons were not always learnt

The CQC report says: "Staff used risk assessment tools to assess if people were at risk of pressure ulcers, falls, malnutrition and skin integrity. Care plans were developed to ensure measures were in place to mitigate these risks.

"Risk assessment tools were not always completed correctly, therefore there was a risk that measures in place were not always as effective as they could have been. Governance systems, audits and analysis of accidents and incidents had not led to improvements.

"The information recorded by staff was not always consistent, in enough detail and not always submitted to the registered manager. As a result, some safeguarding incidents were not reported to the local safeguarding authority for investigation.

"Medicine administration and management was not always done safely or following best practice guidance. People were not always receiving their medicines as intended by the prescriber.

"When things went wrong, lessons were not always learnt and staff practices were not changed to improve the quality and safety of the care provided. Staff told us they were aware of people's needs, however there was not enough staff to meet people's needs safely and effectively. We observed people left waiting for staff, sitting in wheelchairs without pressure relieving cushions in place, although care plans detailed they had to sit on those.

"This increased the risk of people's skin breaking down. People felt safe in the home and told us they liked living there. Relatives were complimentary about staff and management and told us they felt the staff team provided care and support to people in a safe way.

"We received concerns in relation to the management of medicines, people's personal hygiene needs not being met and lack of accurate records kept about people's care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service.

"No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

"We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme."

The two areas that were inspected 'Is the service safe?' and 'Is the service well-led?' were both rated as 'requires improvement'.

Personal hygiene needs not met safely

The report says: "People's personal hygiene needs were not met safely. People did not receive bath or showers and staff had no guidance to follow in how and whom they had to report if people consistently refused.

"We found that from 21 January 2021 to 17 February 2021, five people had no bath or showers, nine people had one bath/shower recorded and the remaining had two or more. Staff told us they were not enough staff during the day or night to offer people daily bath or showers. One staff member said, "I wish we could offer people a bath/shower every day, but we just don't have enough staff to do this." Staff told us people received a wash every day, however there was a risk for people to develop skin integrity issues due to poor personal hygiene.

"Staff told us they shared hoist slings between people as there were insufficient slings in the home. This was not in line with infection prevention and control guidance and put people at risk of harm The provider failed to ensure the care and support people received was safe and fully met their needs.

"All staff we spoke with told us there was insufficient staff to ensure people received care and support safely and in a personalised way. One staff member told us, staffing was 'woefully inadequate' and some staff have worked nine days in succession without a day off."

In the 'Is the service well-led?' section of the report it says: "At the last inspection this key question was rated as good. At this inspection this key question has now deteriorated to requires improvement. This meant the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care

"The provider had failed monitor staffing levels to ensure people's needs could be met and therefore missed opportunities to improve the quality of the care.

"Staff told us they had not had regular supervisions; they did not feel supported by management and in some instances had not received training relevant to their roles. They told us they have not received COVID19 training and they could not describe donning and doffing of personal protective equipment (PPE) correctly.

Relatives felt confident raising concerns

"People told us they were happy with how the home was managed. We observed the registered manager and staff talking to people and this gave people an opportunity to feedback about their care.

"Residents meetings were a regular occurrence in the home and minutes of these meetings with actions resulting displayed for everyone to read.

"Relatives told us, staff and the registered manager were approachable and they felt confident in raising concerns or giving feedback about the service."

The CQC is carrying out a review of quality at The Lodge Care Home and will publish a report when our review is complete.

A spokesperson for B&M Investments Ltd, of Hemel Hempstead, which runs The Lodge, said: "As a provider, we are actively working with both CQC and Hertfordshire County Council to improve our service.

"Following the CQC inspection, the home has had two positive visits from Hertfordshire County Council. We will continue to work closely with both regulators."

You can view the full report on the CQC website.