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Inspection on 14/07/05 for Tollington Lodge Care Home

Also see our care home review for Tollington Lodge Care Home for more information

This inspection was carried out on 14th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The environment for the residents continues to improve with the garden landscaping now fully enjoyed in the good weather by the residents. Its homely ambience and relaxed atmosphere continues, with staff promoting and developing this further.

What has improved since the last inspection?

Staff recruitment files have improved significantly since the last inspection in which requirements were made. The matron has worked hard to ensure that all staff have Criminal Record Bureau checks completed. However there are still some improvements to be made regarding POVA checks. 50% of the staff have achieved either NVQ Level 2 or 3 with this benefiting the residents by ensuring up to date care practices are observed.

What the care home could do better:

Medication administration and recording on the Medication Administration Records needs to improve to further protect the residents. Night staffing levels need to increase to 2 waking staff members to meet the needs of the current resident group safely. Risk assessments and care plans to be more detailed, enabling staff to provide specific, individualised care to each resident. Resident`s attendance at individual activities and events was not clearly documented in their care plans or communication diary. The staff personnel files and training files could be improved further, to more readily demonstrate how many days training each staff member has completed in a year, its content and course length. This would also act as an easy prompt for the matron to ensure that each staff member has the opportunity to complete mandatory training and updates as well as specialist care courses.

CARE HOMES FOR OLDER PEOPLE Tollington Lodge Rest Home 146 Milton Road Weston Super Mare North Somerset BS23 2UZ Lead Inspector Carolle Wise-Scanlon Unannounced 14th July 2005 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 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 DD53-DO2 S8068 Tollington V235569 140705 Stage 4 1.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Tollington Lodge Rest Home Address 146 Milton Road Weston Super Mare North Somerset BS23 2UZ 01934 620630 01934 620630 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Carole Eileen Cotter Mrs Christine Neuenschwander Care Home 23 Category(ies) of OP Old Age (Gender - Both) (23) registration, with number of places Tollington Lodge Rest Home DD53-DO2 S8068 Tollington V235569 140705 Stage 4 1.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: May accommodate up to 23 persons aged 65 years and over requiring personal care only. Date of last inspection 14th December 2004 Brief Description of the Service: Tollington Lodge is a private residential care home registered for 23 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, a dining room and use of the recently landscaped garden. The residents room 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 DD53-DO2 S8068 Tollington V235569 140705 Stage 4 1.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 6 hours. Of the eighteen residents the inspector met and spoke with five. The resident’s views regarding the homes care and services were very positive and several staff were singled out for praise. The inspector looked at and reviewed a number of records that need to be kept in the home. The inspector focused on the staff recruitment and training which has developed and improved over time. What the service does well: What has improved since the last inspection? What they could do better: Medication administration and recording on the Medication Administration Records needs to improve to further protect the residents. Night staffing levels need to increase to 2 waking staff members to meet the needs of the current resident group safely. Risk assessments and care plans to be more detailed, enabling staff to provide specific, individualised care to each resident. Resident’s attendance at individual activities and events was not clearly documented in their care plans or communication diary. The staff personnel files and training files could be improved further, to more readily demonstrate how many days training each staff member has completed in a year, its content and course length. This would also act as an easy prompt for the matron to ensure that each staff member has the opportunity to complete mandatory training and updates as well as specialist care courses. Tollington Lodge Rest Home DD53-DO2 S8068 Tollington V235569 140705 Stage 4 1.doc Version 1.40 Page 6 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 DD53-DO2 S8068 Tollington V235569 140705 Stage 4 1.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Tollington Lodge Rest Home DD53-DO2 S8068 Tollington V235569 140705 Stage 4 1.doc Version 1.40 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 standard(s) 3, 4 & 5 Residents have their needs assessed prior to moving into the home to ensure that the home can meet their specific needs safely. Visits are welcomed and a trial period is offered to resident’s giving them an opportunity to assess the homes suitability further. (The statement of purpose and service user guide was not reviewed at this inspection). EVIDENCE: Residents suggested that they or their families had looked around the home prior to taking up accommodation. Several said they had left it to their families to decide which home would suit them best as they were in hospital and not able to look for themselves. They were not sure if they had received any written brochures or information but felt that they had received enough feedback to make a choice by visiting the home and talking to the staff and matron. A resident suggested that the trial period had been a good idea and that at his review together with his social worker he had been able to put suggestions forward regarding his future stay. The matron visits the residents either at their home with their family/friends or hospital in order to assess whether the home can meet their needs. She suggested that the opportunity is Tollington Lodge Rest Home DD53-DO2 S8068 Tollington V235569 140705 Stage 4 1.doc Version 1.40 Page 9 taken at this stage to ensure that the prospective resident and their families are fully aware of the homes facilities, staffing and the activities offered. Several resident’s suggested that the locality and proximity to their family and friends had a large part to play in their decision making too. It was noted that resident’s had visitors popping in to see them and that the staff checked that the resident’s were happy to meet with them either in their own room or in the communal areas. Tollington Lodge Rest Home DD53-DO2 S8068 Tollington V235569 140705 Stage 4 1.doc Version 1.40 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 standard(s) 7, 8, & 9 Care plans, although improved, need to provide more information on how residents needs should be met by staff with further resident involvement where able. Resident’s risk assessments need to be regularly undertaken to provide clear guidance on how to mitigate identified risks safely. Medication administration needs to be improved further to safeguard the residents. EVIDENCE: Care plans were evident on those residents files randomly selected. One care plan contained specific, detailed and individualised care, which is good practice. Two others seen however lacked the detail needed to safely care for the residents with risk assessments not translated into care plan actions. The resident’s met did not know if they had care plans so did not appear to be involved in drawing them up. The lack of resident involvement could lead to specific information needed to offer individualised care being missed. Tollington Lodge Rest Home DD53-DO2 S8068 Tollington V235569 140705 Stage 4 1.doc Version 1.40 Page 11 Staff awareness of resident’s care needs was well demonstrated during the inspection. Residents said they are encouraged to remain as independent as they are able and retain responsibility for many of their personal care tasks. Medications at the home are supplied by Lloyds Pharmacy currently in the form of blister packs. Only those staff trained by the local pharmacy to do so administer medications and the list of these staff members was made available to the inspector. One medication had been signed for but not given. A further review of its medication policy and procedure was already planned as the home is changing its pharmacy supplier. At the time of the inspection no residents had chosen to self medicate. Tollington Lodge Rest Home DD53-DO2 S8068 Tollington V235569 140705 Stage 4 1.doc Version 1.40 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 standard(s) 12, 13, 14 & 15. Residents have choice and control over their day-to-day lives with the choice of attending activities offered by the home. EVIDENCE: The activities on offer at the home forms only part of the residents day-to-day lives. The activities included reminiscence therapy, music afternoons and weekly visits from the hairdresser for those who wish it. The inspector spent time with five of the residents, talking to them about their experiences of living at the home. One gentleman suggested that the locality meant he could keep in contact with loved ones, friends and local community events more readily. Another resident suggested that sitting chatting in the nice weather in the homes garden although ‘not hectic’ kept her ‘busy enough’. It was evident from comments made that they have good relationships with the staff with easy, light, banter developing, as the staff and residents get to know each other better. The social events documentation could be improved to reflect the activities preferred and those undertaken. The matron and staff were observed negotiating a solution with a resident who wanted to help out in an activity involving the practical side of the home. This was done in a manner that promoted the residents control. Other examples of listening to the resident’s requests and promoting independence were seen during the inspection. Tollington Lodge Rest Home DD53-DO2 S8068 Tollington V235569 140705 Stage 4 1.doc Version 1.40 Page 13 The home has completed its redesigned kitchen layout making the kitchen area larger. The staff room moved to towards the rear and side of the property. The homes menus are produced on a four-week basis with the menus posted on the dining room notice board. The residents described the food as ‘good, simple, fare’ and a variety of seasonal fresh vegetables and fruit were noted on the menus seen and in the kitchen. If residents don’t want the menu of the day a hot or cold alternative is available so a choice is offered in practice. The dining room is pleasant and light with the majority of the residents choosing to take their meals there. It was suggested that records are kept of the meals taken by the residents who did not have the menu of the day. Tollington Lodge Rest Home DD53-DO2 S8068 Tollington V235569 140705 Stage 4 1.doc Version 1.40 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 standard(s) These standards were not assessed during this inspection. EVIDENCE: Tollington Lodge Rest Home DD53-DO2 S8068 Tollington V235569 140705 Stage 4 1.doc Version 1.40 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 standard(s) 19, 20, 21, 25, & 26. Resident’s benefit from a pleasant and comfortable environment. EVIDENCE: The home is arranged over two floors. The ground floor houses the communal areas as well as the kitchen, laundry, matron’s office and several bedrooms. There is a chair lift to the first floor. The spacious reception hallway leads to two separate lounges and the dining room. The home is decorated and furnished to a standard that creates a comfortable and homely ambience. The proprietors are considering future refurbishment and improvement to the home, which is at the planning and development stage currently. A loose floorboard by the stairs on the first floor landing under the recently re-carpeted area poses a trip hazard. The matron said this would be placed for urgent attention on the maintenance list. There are sufficient toilets and bathrooms to meet the current resident’s needs with the extractor fan to the ground floor bathroom recently repaired. The first floor windows have restrictors fitted and low temperature radiator covers were in place. The home smelled pleasant and clean. Tollington Lodge Rest Home DD53-DO2 S8068 Tollington V235569 140705 Stage 4 1.doc Version 1.40 Page 16 The garden to the side of the property has been landscaped in order that the residents who wish to use the garden can mobilise easily. Garden areas are arranged with seating and shade with potted planting as well as shrubs. The matron advised the inspector that the garden refurbishment has been very successful with the residents. They now hope to further extend the private garden area to the front of the property. Security to the garden is now via that of an intercom buzzer in which a staff member needs to release the lock from the reception hallway following enquiry. Tollington Lodge Rest Home DD53-DO2 S8068 Tollington V235569 140705 Stage 4 1.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30 Resident’s benefit from well-trained staff, but which according to resident dependencies, in numbers which need to be reviewed. Staff recruitment systems have improved but need to develop further to ensure residents are protected. EVIDENCE: Staff files should contain information on recruitment, training, appraisals and supervision. Those files reviewed showed improvement however several remained incomplete. One staff member needed POVA checks and another a reference. Although staff are supervised according to the matron 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. All staff have induction training. A plan of training needs is something the matron is looking at currently in order to meet the changing needs of the residents. Mandatory training such as first aid, food hygiene and health and safety is also undertaken and completed in full with the exception of two staff members so far. ‘Protocol’ training and outside assessors are used for several courses completed by the staff. Staff attend NVQ training with currently 4 out of the 8 staff with NVQ Level 2 or 3 qualifications. The inspector suggested that a note is also kept of the duration of each course, so that the manager can monitor that each person is getting the required amount of training each year. Tollington Lodge Rest Home DD53-DO2 S8068 Tollington V235569 140705 Stage 4 1.doc Version 1.40 Page 18 The inspector recommended that the matron review the homes staffing levels to ensure that they are in line with the guidance offered by the Department of Health’s ‘Residential Forum’. The total care hour’s needs to be 323 at least with the resident dependencies discussed at the inspection. Night duty consists of one staff on a waking shift and the other a ‘sleep in’. The matron and proprietor were advised by the inspector that the current residents needs would suggest that 2 waking staff members would best meet their needs. Residents suggested that staff are helpful and they did not feel that they were ever rushed. They noticed that the staff are busy but it was at times they expected they would be, such as first thing in the morning and last thing at night ‘when we all seem to want to get off to bed at once’. Tollington Lodge Rest Home DD53-DO2 S8068 Tollington V235569 140705 Stage 4 1.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 36 & 38 The home is being well managed and continues to develop an open culture in the best interests of the residents. EVIDENCE: Residents met had high regard for the matron Mrs Christine Neuschwander. She is currently extending her knowledge base and has enrolled on a Mental Health Nursing Course. The residents find matron approachable willing to help and an easy person to discus ‘things’ with. The staff enjoy her clear leadership and feel they take part in the decision making within the home together with the residents. Residents now have their own newsletter. The staff meetings are held on a reasonably regular basis dependant on staffing levels. The residents are aware of the management structure of the home and also enjoy the company of the proprietor Mrs Carole Cotter and her son Russell. Matron currently does not have any staff member in the position of deputy manager and is looking towards developing senior staff to manage the home in the case of her annual leave or sickness. Tollington Lodge Rest Home DD53-DO2 S8068 Tollington V235569 140705 Stage 4 1.doc Version 1.40 Page 20 Staff supervision records were not seen during this inspection. The staff met said that they receive regular informal supervision in their practice. Fire drills and fire safety training are undertaken with the last drill on 11/7/05. Regulation 26, auditing of service provision visits, which are completed by the proprietor, are currently not as frequent as one each month. They provide valuable quality assurance information from the residents and staff about the services the home provides. Tollington Lodge Rest Home DD53-DO2 S8068 Tollington V235569 140705 Stage 4 1.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 x x x 3 3 STAFFING Standard No Score 27 2 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 3 x x x 3 x 3 Tollington Lodge Rest Home DD53-DO2 S8068 Tollington V235569 140705 Stage 4 1.doc Version 1.40 Page 22 Yes Are there any outstanding requirements from the last inspection? 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 OP29 OP27 Regulation Sch 2 18 Requirement POVA checks and referencing is required prior to staff appointment. Suitably qualified, competent and experienced staff are working in such numbers as are appropriate for the health and welfare of the residents. Timescale for action 14/09/05 14/09/05 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. 3. 4. 5. Refer to Standard OP7 OP8 OP12 OP15 OP33 Good Practice Recommendations Care plans to contain more detail to enable staff to safely care for residents. Residents risks are undertaken regularly reviewed and translated into care plan actions to mitigate the risks when necessary. Social activity recording to be improved to readily demonstrate residents preferences and attendances. Residents who do not have the menu of the day have a record made of the alternative meal taken. Monthly regulation 26 visits by the proprietor as part of the homes quality assurance to be undertaken and copies fowarded to the CSCI. DD53-DO2 S8068 Tollington V235569 140705 Stage 4 1.doc Version 1.40 Page 23 Tollington Lodge Rest Home Commission for Social Care Inspection Riverside Chambers Castle Street Tangier 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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