George Davis Lodge improved from Requires Improvement to Good following a focused inspection on 1–2 February 2023, with previous breaches of Regulations 12, 17 and 18 fully remediated. Safe medicines management, updated governance processes, staff training and regular supervision were all evidenced as successfully addressed since the 2021 inspection.
Strengths
· Medicines management improved: MAR sheets audited regularly with complementary checklists; staff trained in medicine administration
· All staff trained in safeguarding; concerns logged and referred to social workers promptly
· Robust staff recruitment including DBS, employment history, references and ID checks extended to agency staff
· Staff training up to date including agency staff; regular supervision evidenced via matrix and supervision notes
· Quality assurance improved with regular spot checks capturing staff interactions and medicine administration
Quality-Statement breakdown (17)
safe: Using medicines safelyGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Staff support: induction, training, skills and experienceGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood
George Davis Lodge deteriorated from Good to Requires Improvement following a focused inspection of safe, effective and well-led domains, with warning notices issued for breaches of Regulations 12, 17 and 18 relating to unsafe medicines management, inadequate governance, and insufficient staff training and supervision. Strengths were noted in recruitment, infection control, inter-agency working and person-centred practice, but systemic failures in quality assurance and a failure to notify CQC of a safeguarding allegation posed significant risks to people's safety.
Concerns (8)
criticalMedication management: “Systems for managing medicines were unsafe. We looked at 6 people's MAR charts and found four contained gaps. This meant it was unclear whether people had taken their medicines as prescribed.”
criticalRecord keeping: “There was no system in place to pick up these gaps in people's medicines administration as MAR charts were not audited.”
criticalStaff training: “No care staff member had completed all the training. Some training was overdue for refreshing and some had not been completed at any point.”
criticalSupervision / appraisal: “The registered manager informed us that they had not held supervision with at least eight care staff in the year preceding our inspection.”
criticalGovernance: “There were no governance systems in place to identify spot checks were not being completed. Similarly, governance processes had not identified the lack of quality assurance for medicines administration.”
criticalSafeguarding: “The registered manager had not notified CQC about an allegation of abuse which had been reported to the local authority in January 2021, which they were required to do without delay.”
moderateStaff competency: “There were no medicine administration competency assessments and spot checks were not being completed regularly.”
moderateCare planning: “There were no risk assessments specific to people's medicines. There was little if any mention about people's medicines and the risks associated with them within risk assessments.”
Strengths
· Recruitment practices were robust with criminal records checks, employment history, employer references and proof of identification completed before staff started working.
· Sufficient staffing levels were maintained with all care calls covered and agency staff available to cover absences.
· Infection prevention measures were in place; staff wore PPE, completed infection control training and followed Covid-19 national guidance.
· Accidents and incidents were recorded, followed up by management, and discussed in team meetings so staff could learn lessons.
· People's needs were assessed before they began using the service and care plans were based on needs assessments aligned with legal requirements.
Quality-Statement breakdown (15)
safe: Using medicines safelyRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff working with other agencies to provide consistent, effective, timely care; Supporting people to live healthier lives
George Davis Lodge, a local authority extra care domiciliary service, received Good ratings across all five key questions at its December 2014 announced inspection. No regulatory concerns were identified; the service demonstrated robust safeguarding, person-centred care, well-supported staff, and effective governance.
Strengths
· People felt safe and staff demonstrated strong awareness of safeguarding responsibilities and reporting procedures
· Effective medication management with individual MAR records, trained staff, and regular GP reviews
· Comprehensive staff training programme including mandatory topics, NVQ qualifications, regular supervision and yearly appraisals
· Person-centred care plans reviewed regularly, with copies held by service users in their own flats
· Positive staff-people relationships with consistent care teams and continuity of care through stable rotas
George Davis Lodge, an extra care housing service for 27 people in Barkingside, was rated Good across all five key questions at its February 2018 inspection, maintaining the rating from its previous 2014 inspection. The service demonstrated safe care, kind and respectful staff, responsive individualised support, and strong leadership, with only a minor gap identified around staff training currency during the transition to online learning.
Concerns (1)
minorStaff training: “staff training was not always up to date. The registered manager told us this was partly due to a move from the local authority providing face-to-face training to online training.”
Strengths
· People felt safe and staff were aware of safeguarding responsibilities; a health and social care practitioner noted the registered manager is 'very good at managing safeguarding'.
· Sufficient staffing levels with no missed visits reported; regular agency staff covered rota gaps using familiar staff.
· Medicines were administered safely with training and competency assessments in place.
· Staff received relevant training including safeguarding, moving and handling, and end of life care, with good supervision from the registered manager.
· People were treated with dignity and respect; privacy maintained and independence encouraged.
Good
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
well-led: Promoting a positive culture; Continuous learning and improving care; Quality assuranceRequires improvement
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staffGood