Inspection on 01/12/05 for Tollington Lodge Care Home

This inspection was carried out on 1st December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Tollington Lodge Care Home 06/08/07

Tollington Lodge Care Home 03/10/06

Tollington Lodge Care Home 14/07/05

Tollington Lodge Care Home 14/12/04

Tollington Lodge Care Home 22/09/04

Tollington Lodge Care Home 18/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Tollington Lodge Rest Home 146 Milton Road Weston Super Mare North Somerset BS23 2UZ Lead Inspector Carolle Wise Scanlan Announced Inspection 1st December 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Tollington Lodge Rest Home DS0000008068.V259363.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tollington Lodge Rest Home DS0000008068.V259363.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Tollington Lodge Rest Home Address 146 Milton Road Weston Super Mare North Somerset BS23 2UZ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01934 620630 01934 620630 Mrs Carole Eileen Cotter Mrs Christine Neuenschwander Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places Tollington Lodge Rest Home DS0000008068.V259363.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 23 persons aged 65 years and over requiring personal care only 14th July 2005 Date of last inspection Brief Description of the Service: Tollington Lodge is a private residential care Home registered for twenty-three residents. Situated in a quiet residential area of Weston-Super-Mare within reasonably easy reach of the town centre, sea front and railway transport links. The facilities at Tollington Lodge include two lounge areas and dining room and use of the recently landscaped gardens. The resident’s rooms are accommodated over two floors, which can be accessed via a stair-lift, lift or stairs. The home operates a no smoking policy. Tollington Lodge Rest Home DS0000008068.V259363.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection, which took place over eight hours. The inspector met with six of the twenty residents currently living here. During the course of the inspection positive comments were received from three visitors to the home. The inspector reviewed several records, which must be kept by the home. What the service does well: What has improved since the last inspection? What they could do better: POVA checks must be undertaken prior to commencement of employment at the home. The garden security gate operated by staff in the reception hallway, and the keypad lockable front door must tie in with the homes fire alarm systems Further advice must be sought from Avon Fire Brigade. Any nursing intervention must be carried out with the knowledge and approval of the community nursing team when delegated to the care staff. Tollington Lodge Rest Home DS0000008068.V259363.R01.S.doc Version 5.0 Page 6 During the inspection serious concerns regarding medication practice were observed. Medicines must be securely stored at all times and an immediate requirement notice was issued. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Tollington Lodge Rest Home DS0000008068.V259363.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tollington Lodge Rest Home DS0000008068.V259363.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3 Resident’s receive sufficient information about the home to make choices about living here. Resident’s needs are assessed prior to moving into the home. EVIDENCE: The homes Statement of Purpose and service user guide is offered to all prospective residents. The Registered Manager, Mrs Christine Neuenshwander, is to review both in the next few weeks to ensure they reflect the current services offered to the resident’s. Several Tollington Lodge residents have lived at the home for many years. One recently admitted resident found that she received sufficient information about the home prior to moving in. Residents are offered terms and conditions/contracts and have a month’s trail period. Records demonstrated that residents are assessed prior to moving into the home to ensure that the facilities and staff can meet their needs. Two residents met during the inspection recalled ‘chatting’ about what they needed Tollington Lodge Rest Home DS0000008068.V259363.R01.S.doc Version 5.0 Page 9 in a care home with their families and the registered manager prior to moving in. Tollington Lodge Rest Home DS0000008068.V259363.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Care plans and risk assessments are in place for all residents, these are general in their nature and could be improved by containing more detail of the care provided. Medication administration procedures are in place, however during the inspection serious concerns regarding practice were observed. Residents are satisfied with the care they receive and staff and residents have developed a good rapport. EVIDENCE: Each resident has a care plan these were general in nature, clear and evaluated on a monthly basis. They could be more detailed which would then reflect the actual care provided by the staff team. One example was that of a resident who has a risk of falls, uses a zimmer frame but had no mention in the care plan on how to assist the resident in his mobility to reduce the identified risk of falling. Another that of a resident who had developed new symptoms, this had been followed up with a referral to the appropriate health care professional. The care plan however, did not reflect the monitoring the Tollington Lodge Rest Home DS0000008068.V259363.R01.S.doc Version 5.0 Page 11 staff were undertaking under the direction of the District Nurse. If the staff are to undertake a delegated nursing task, they must be suitably qualified and competent to do so. The registered manager must ensure that the staff receive appropriate training and that written guidance is in place from the person delegating the task to ensure safe working practice. Risk assessments had improved, however on reviewing the care records further improvements in the content and detail is needed. Residents find the staff approachable and several were singled out for praise. Several residents gave examples of how the staff are courteous and are treated with dignity and respect. One resident also noted that should ‘you need help with a bath, either a female or a male carer can assist you’. ‘Shaws’ supply medications to the home via blister packs. The medication policy was found at the front of the Medication Administration Record Folder. A list of those staff who are trained to administer medications together with their signatures is needed. During the inspection the medication cabinet was found unsupervised by staff, unlocked with the keys left unattended. One residents medication had been ‘potted out’ but not given. An immediate requirement was made regarding medication administration systems. Tollington Lodge Rest Home DS0000008068.V259363.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Resident’s likes and dislikes are made account of by the home when arranging in-house activities. Residents arrange their own daily routines exercising control over their lives. Residents enjoy the pleasant dining room facilities and the standard of the food was described as good. EVIDENCE: Residents arrange their own daily routines and day-to-day activities. Tollington Lodge also arranges some activities based on the likes and dislikes of their residents. Recently this has included ‘one off’ visiting musical entertainers, such as a harp player, which several residents commented positively on. One resident said she had really enjoyed the religious readings made by one of the entertainers who visit the home. A record is maintained of which activities residents choose to attend. More recently students at a college have assisted the staff in arranging activities on Wednesdays. Letters of recommendation and risk assessments are in place with regard to the tasks the students are able to undertake to safeguard the resident’s. Tollington Lodge Rest Home DS0000008068.V259363.R01.S.doc Version 5.0 Page 13 Visitors are made very welcome at the home, several visitors also having got to know each other, added to the relaxed atmosphere in the larger of the two lounge areas used more regularly by the residents. Residents enjoy eating in the separate dining room overlooking the front garden area. There is now a suppertime snack offered at about eight in the evening, for those residents who feel ‘peckish’ following their evening meal, however not all residents choose to have this. Food is described as good and that there is plenty of choice in practice. The kitchen caters for special diets such as diabetics and lists of the resident’s likes and dislikes are known to the kitchen staff. Tollington Lodge Rest Home DS0000008068.V259363.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 & 18 The home has a complaints procedure in place. Residents and their families felt they could approach any staff member to complain should the need arise. EVIDENCE: Tollington Lodge has a complaints and whistle blowing procedure in place. It was suggested that the homes adult protection policy reflect the ‘no secrets’ in North Somerset guidance when updated. In the previous twelve-month period two complaints were recorded. These were both acted upon within agreed timescales and dealt with appropriately. Visitors and residents met suggested that they could approach any staff member to complain should it be necessary. Staff have not received adult protection awareness training in the last twelve months however a training event has been booked for February 2006 for a few staff members. The registered manager stated that the staff during their induction training and when completing the NVQ course have some training in adult abuse awareness. Three of the residents met said that postal voting is made available to them should they wish to vote or that their families would assist then to visit the poling station locally. Tollington Lodge Rest Home DS0000008068.V259363.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24 & 25. There is an ongoing programme of refurbishment and redecoration, which helps to ensure that residents and their visitors are comfortable at Tollington Lodge. EVIDENCE: The home is arranged over two floors with access via a chair stair lift, lift or stairs. Communal areas are all on the ground floor. Hallways have grab rails. There are two lounge areas, one used more often by the residents is larger and activities are arranged in this room generally. The smaller lounge is used as a quiet room. Both are decorated in a homely style with a mixture of various lounge chairs and occasional tables. There is a separate dining room overlooking the front garden area. Resident’s rooms lead off the hallways on both floors. Rooms are in various sizes all pleasantly decorated a few with ensuite facilities. All residents had Tollington Lodge Rest Home DS0000008068.V259363.R01.S.doc Version 5.0 Page 16 personalised their rooms with their own effects. All rooms have access to the call bell system and radiators are fitted with low temperature covers in all communal areas. A loose floorboard by the stairs on the first floor landing under the recently recarpeted area poses a trip hazard. The registered manager said this would be placed for urgent attention on the maintenance list. One hallway carpet on the ground floor in two areas had evidence of wear and tear and had become a trip hazard, this needed to be replaced. The inspector was advised that this carpet would be totally replaced when the homes future refurbishment plans commence in 2006. Water temperature checks are undertaken and recorded regularly, with all ensuites fitted with fail safe valve devises fitted to reduce the risk of scalding. During the inspection several communal hall light bulbs needed replacing. The registered manager spoke to person who completes the homes ‘maintenance’ who is the proprietors’ son, in order that these are replaced as soon as possible to prevent risks of falling. Tollington Lodge Rest Home DS0000008068.V259363.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 & 29 Staff recruitment systems need to improve to ensure residents are protected. Staff training is designed to meet the needs of the current residents, however recent staff changes meant that the numbers of staff qualified to NVQ Level 2 had diminished. EVIDENCE: Staffing consists of nine carer staff, the registered manager and two ancillary staff. There are three care staff on the morning shift, two on in the afternoon with nights covered by one waking and one sleep staff member. There is also a newly appointed deputy manager. Residents find that staff are readily available to offer them assistance when they need it and developed a good rapport with the staff. The total number of care hours provided including the Registered Managers hours are 322. The registered manager felt that given the low dependency of the majority of the residents there were sufficient numbers of staff to meet their needs. Since the refurbishment of the kitchen environment the staff rest room is now located to the side rear of the property. On night duty the staff currently use either a vacant bedroom or the smaller lounge when not in use. When considering changes to the premises the registered manager must ensure that there is suitable sleeping accommodation where the provision of such accommodation is needed by the staff in connection with their work at the home. Tollington Lodge Rest Home DS0000008068.V259363.R01.S.doc Version 5.0 Page 18 Criminal Record Bureau Checks are kept separately to the recruitment files at the home. The personal files are in reasonable order however improvements must be made to ensure that POVA checks are undertaken prior to commencement of employment and that all care staff have enhanced Criminal Record Bureau checks undertaken. Although staff are supervised according to the registered manager until their Criminal Record Bureau checks are returned satisfactorily, staff should not be recruited into the home until POVA checks and references have been obtained to safeguard the residents. The registered manager maintains a spreadsheet on the training the staff have undertaken, which also assists in ensuring that staff keep up to date with mandatory training. It was suggested that a mixture of in-house and outside training would be useful to ensure that staff base their care and safe working practice on current evidence based practice. The home uses ‘Network Training’ which consists of distance learning using workbook based assessments. Staff are to attend Abuse Awareness training day offered by North Somerset PCT in January. Several staff have left the homes employ since the last inspection and as a consequence the number of staff with NVQ level 2 qualifications had diminished. New staff will be enrolled onto the next NVQ training with the University of Bristol. Tollington Lodge Rest Home DS0000008068.V259363.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 37 & 38 EVIDENCE: Residents had a clear understanding of the management and leadership of the home. The resident’s and relative’s views were very positive regarding the homes leadership and management approach. Mr Russell Cotter the proprietors’ son is now more involved in the running of the home. The inspector suggested that his involvement and role should be defined. The proprietor, Mrs Carole Cotter, undertakes regulation 26 visits to the home on a monthly basis completing these visit reports and forwarding them to the commission. The Registered Manager visits each resident whilst on duty to keep in touch with his or her views. Residents have regular meetings with the next meeting planned for pre Christmas festivities. The last survey of Tollington Lodge Rest Home DS0000008068.V259363.R01.S.doc Version 5.0 Page 20 resident’s views was undertaken in July 2005. The home act upon the residents views which is excellent practice. An example of which was following consultation with the residents the home put in place changes to the suppertime menus. Records are stored in the homes office, which is lockable. Fire safety training and drills were recorded appropriately. The front door keypad and the garden gate security lock must be reviewed to ensure they comply with fire regulations. Service contracts such as central heating and maintenance records appeared in good order. The homes general risk assessments need to be updated and contain more detail and when reviewed, signed and dated. Policies and procedures when reviewed should also be signed and dated. Residents who choose to have money safe kept by the home have access to their monies via the registered manager or proprietor. Account record keeping was clear, noting balances ‘in’ and ‘out’ dated and signed. It was suggested ensuring there were two signatures would be an improvement to their current good practice. Tollington Lodge Rest Home DS0000008068.V259363.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 Score 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 X 3 X 3 3 X STAFFING Standard No Score 27 3 28 2 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 X 3 2 Tollington Lodge Rest Home DS0000008068.V259363.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP7 OP7 Regulation 15(1) 18 Requirement Care plans must reflect the actual care provided. Nursing interventions must be carried out with the knowledge and approval of the community nursing team when delegated to the care staff. Medicines must be securely stored at all times. An immediate requirement notice was issued. There must be a clear audit trail of medicines received into the home, administered to residents, or returned to the pharmacy. Carpet to be replaced in hallway areas as identified during the inspection. Floorboard repair or replace as poses trip hazard on first floor landing area by stair chair lift. The registered manager must ensure that there is suitable sleeping accommodation where the provision of such accommodation is needed by the staff in connection with their work at the home. DS0000008068.V259363.R01.S.doc Timescale for action 01/02/06 01/02/06 3 OP9 13(2) 01/12/05 4 OP9 13(2) 01/12/05 5 OP19 23(2)(b) 01/02/06 6 OP27 23(3)(b) 01/03/06 Tollington Lodge Rest Home Version 5.0 Page 23 7 OP38 23(4) Front door security keypad 01/02/06 should link into the homes fire alarm system. The front garden gate security should be checked with Avon Fire Brigade to ensure that in the event of a fire residents would not be placed at risk. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP1 OP8 Good Practice Recommendations Statement of Purpose and Service User guide to be reviewed at least annually to reflect the facilities and services offered. Residents risk assessments should be translated into a care plan action to mitigate the risk. Areas of specific risk must be assessed. Adult abuse awareness training to be made available to all staff. Policies and procedures when updated to be signed and dated. Resident account records to contain two signatures. 3 4 5 OP18 OP33 OP35 Tollington Lodge Rest Home DS0000008068.V259363.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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