Inspection on 03/10/06 for Tollington Lodge Care 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

Prospective residents are encouraged to visit the home and spend time there before they make a decision about moving in. Their needs are assessed before admission to make sure that the home is able to meet their health, social and care needs. All residents have a care plan that sets out their basic care, health and social needs so that staff are able to undertake this care. Residents have access to health, medical and social care professionals as and when they need to. Residents confirmed that staff were courteous and respected their privacy and dignity in the way they undertook care interventions and carried out their daily tasks. The routines of the home are flexible to suit the needs and choices of residents; visitors are made welcome in the home at any time. One comment made by a relative/visitors to the home was that the home was ` excellent`. The majority of residents spoken to said that the home provided suitable activities within the home The home has a complaints policy and residents surveyed and spoken to were clear about whom to tell if they had a concern or complaint. The majority of the care staff are qualified to provide the level of care that the residents need.A resident commented that they `were very happy here, it is lovely`. One resident commented that they don`t have any problems, all the staff are pleasant and helpful`. The home is generally well maintained and the residents are satisfied with the standard of the environment. The overall comments from professionals who returned surveys was that they were satisfied with the level of care provided by the home.

What has improved since the last inspection?

The front lounge has been redecorated and a new mantelpiece fitted. Two more bedrooms have been fitted with ensuite facilities. The front garden has been made safer with paving slabs replacing the old covering. A loose floorboard by the stairs on the first floor landing under the recently recarpeted area posed a trip hazard during the last inspection and this had been addressed. The adult protection policy has been updated to make clear that abuse must be reported and gives the local Care Connect telephone number. The complaints policy has been updated to make clear that complainants can contact the CSCI at any stage of a complaint. A policy to make clear to staff that they must not accept gifts or assist with residents wills and bequests has been developed.

What the care home could do better:

Efforts need to be made to involve residents, their relatives and representatives in the care planning and review process so that they are able to discuss and agree to the care provided by the home. Care plans and daily records need to cover all the recommended topics and should contain more detail and specific instructions to staff on how to meet identified needs, particularly in relation to risk assessments. Risk assessments should be undertaken on admission and reviewed as necessary when a service user has a known history of falls. Risk assessments in relation to moving and handling of service users with mobility problems and /or those who use equipment such as hoists must be undertaken and reviewed as necessary. A nutritional risk assessment tool should be obtained and used as necessary when a risk has been identified.Tollington Lodge Rest Home DS0000008068.V312014.R01.S.doc Version 5.2 Page 7One comment received was that there was usually staff available to confer with, but that staff were not always co operative with advice given relating to residents care. Residents would welcome more activities and trips outside the home. The staff responsible for cooking must have access to training on the nutritional need of older people and how to provide special diets. More care should be taken to ensure that any residents that are vegetarian are offered only suitable foodstuffs. Serious consideration must be given to staffing levels at mealtimes to ensure that there is sufficient staff to assist residents if necessary. It would useful for the cook to talk to residents about the menus to ensure that they met with their approval. All staff should undertake training in the protection of vulnerable adults. The complaints log should record the details of any investigation, outcome and any action taken as a result of a complaint. All complaints, their investigation, findings and any action taken as a result should be recorded. The managing physical and verbal aggression policy should be reviewed to make it clear to staff the reasons for involuntary aggression due to physical and mental health problems. All policies and procedures should be reviewed regularly and updated if necessary, these should also be signed and dated. A copy of the report of the home should be freely available to residents without having to ask to see it. Continued refurbishment of the building must include appropriate arrangements for staff that sleep in the home during night shifts. The broken window catch in the lounge should be repaired. The carpet in the entrance hall and stairs should be deep cleaned as soon as practicable. All areas of the home must be free from offensive odours. More care should be taken with the laundering of clothes to ensure that they are returned to residents in a good condition. Staff recruitment procedures must be improved to protect residents from the risk of abuse. Due to the increasing dependency of residents accommodated at the home the staffing levels should be reviewed to make sure that they are sufficient to meet residents` needs. The current practice of not having waking night staff on every day should be reviewed and looked at in relation to the dependency levels and number of residents. If the current practice continues then the home must make it clear in the statement of purpose and service guide that there may be nights where staff are asleep but wake up when the call system is used by residents.A comprehensive fire risk assessment must be completed. Work identified as necessary during the checking of the hard wiring must be completed and the system verified by a suitably qualified person as safe. An up to date clinical waste contract should be in place. All risk assessments relating to the environment should be updated to ensure they are relevant. There were several areas where management practice needed to be improved, in recruitment and selection of staff, management of medicines and maintaining the home to make sure it is safe for the people who live and work there.