Herts care home residents ‘went 28 days without bath’ due to inadequate staffing

A number of elderly residents in a Herts care home went 28 days without a bath or shower because of “woefully inadequate” staffing levels, according to a new report.

A damning report by the Care Quality Commission (CGC) into the Lodge Care Home in Hemel Hempstead, Hertfordshire, found that five people had no bath or showers between January 21, 2021 and February 17, 2021, while nine had just one bath or shower recorded.

During this period, workers there told the CGC that that there were not enough staff during the day or night to offer people daily bath or showers.

One staff member told the CQG: “I wish we could offer people a bath/shower every day, but we just don’t have enough staff to do this.”

And staff say residents received a wash every day, but there was a risk of residents developing skin integrity issues due to poor personal hygiene, according to the report.

Hoist slings were also shared between people as there were insufficient slings in the home, but this wasn’t in line with infection prevention and control guidance and put people at risk of harm, the report said.

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There were 34 residents living at the care home on Broad Street, Hemel Hempstead, at the time of the inspection, including 10 who had dementia.

The CQC says the staff they spoke with told them there was insufficient staff to ensure residents received care and support safely and in a personalised way. One staff member told inspectors that staffing was “woefully inadequate” and some of their colleagues had worked nine consecutive days without a day off.

There were also concerns by inspectors around medicine management and record-keeping.

The care home has been told it requires improvement.

People ‘at risk of harm’ and ‘lessons not learnt’

The report found that staff hadn’t always reported safeguarding incidents and concerns to the registered manager. These were then not reviewed which meant protection plans were not developed for people to help keep them safe.

For example, the report states that staff recorded an incident between two people where one person pushed another which resulted in a fall. This had not been investigated or reported to the local safeguarding authority.

There were other incidents where a person had displayed behaviours that challenged others on a number of occasions and this had not been reported, investigated or a care plan developed for staff to know how to prevent these from happening or manage them effectively. This meant that the person themselves, as well as others, were at risk of harm.

The report found there were three safeguarding concerns raised with the local safeguarding authority for people by the registered manager and/or people’s family members recently.

And, following the investigation carried out by the local safeguarding authority and the registered manager, there were further actions and improvements needed to ensure staff practices were improved in regard to medicine management, record keeping and meeting people’s personal hygiene needs.

But the CQC says it found in this inspection that lessons were not learnt and staff practices had not improved. As a result, the inspection concluded that the systems and processes in place didn’t protect people from the risk of abuse.

The lack of response to safeguarding incidents and failing to develop protection plans and learn from previous incidents was considered a breach of regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Relatives of residents ‘happy’ with standard of care

The CQC report says that residents told inspectors they felt safe living in the home. One resident said: “I do feel safe. Staff help me when I need it.”

Relatives were also said to be happy with the care and support their family members received in the home.

And although inspectors found that not all safeguarding concerns were reported, care staff told them they had safeguarding training and they knew how to report their concerns. Staff the CQC spoke with told them they reported concerns to their seniors.

‘People were at risk of not receiving their medicines as intended’

The comprehensive report went on to add that medicine administration and management “was not always done safely or following best practice guidance”.

As a result, residents were not always receiving their medicines as intended by the prescriber and, 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 reportedly told inspectors they were aware of individual needs but claimed there weren’t enough staff to meet people’s needs “safely and effectively”.

Some residents were also not getting the medication they were prescribed.

The report said: “People were at risk of not receiving their medicines as intended by the prescriber. We checked individual medicine administration records (MAR) against the tablets remaining in the blister packs and found that the MAR had been signed to indicate the medicines had been given, when it remained in the blister. This meant some people had not received their medicine as prescribed.”

There were also issues over the way medicine was stored at the care home.

“Medicines were not always stored safely,” the report continued.

“We found stocks of medicines stored in the medicine cabinet for the previous three months. Most of these were not labelled, therefore we could not establish who they belonged to or what medicines these were.

“Daily temperature checks of the medicines room had not been consistently completed for the previous two months. Controlled medicines were removed from the controlled drugs cabinet and stored in the medicines trolley whilst staff administered other people’s medicine.”

And, due to staff shortages, some patients were put at risk of developing pressure ulsers and skin conditions.

The report states that CQC were told by one staff member that on the unit where people lived with dementia there were two care staff allocated for 10 people. Five of those people needed assistance of two staff for their personal care and mobility, meaning that communal areas had no staff member to support people while the two staff were assisting people in their bedrooms or bathrooms.

As a result, residents were not receiving baths or showers and they had to wait for both staff to be free to transfer them from their wheelchair to a comfortable chair.

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“This put people at risk of developing pressure ulcers and skin conditions,” the report continued.

The registered manager and the provider also “failed to ensure” staff were knowledgeable and followed best practice guidance when administering people’s medicines and government guidance on infection control and PPE, the report said.

The CQC added that it needed an action plan from The Lodge, detailing how it would improve standards as a result of the inspection.

The report can be read in full here.

B&M Investments Ltd, of Hemel Hempstead, which runs The Lodge, were approached for comment by HertsLive.

A spokesperson 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.”

HertsLive – Hemel Hempstead