Inspection on 06/08/07 for Tollington Lodge Care Home

This inspection was carried out on 6th August 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Tollington Lodge Care Home 03/10/06

Tollington Lodge Care Home 01/12/05

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 Catherine Hill Key Unannounced Inspection 09:45 6th August 2007 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.V341500.R01.S.doc Version 5.2 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.V341500.R01.S.doc Version 5.2 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.V341500.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 23 persons aged 65 years and over requiring personal care only 3rd October 2006 Date of last inspection Brief Description of the Service: Tollington Lodge is a private residential care home registered for twenty-three residents. It is situated in a quiet residential area of Weston-Super-Mare within reasonably easy reach of the town centre, sea front and local shops. The facilities at Tollington Lodge include two lounges. all bedrooms are single, and all except two have ensuite facilities. Residents’ bedrooms are on two floors, which can be accessed via a stair-lift, passenger lift or stairs. The home operates a no smoking policy. Tollington Lodge Rest Home DS0000008068.V341500.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was done over the course of two days, the first of which was unannounced. Prior to visiting the home, the inspector sent a number of surveys out to residents, relatives, GPs, and health care professionals. Eight responses were received, all of which were very positive. The homes manager submitted a self-assessment form to CSCI prior to this inspection. The inspector spent a total of 12 hours in the home. The first visit was mainly spent talking with residents and staff, and looking at the environment. The inspector spoke with 14 of the residents in depth and with most of the staff on duty. The second visit was mainly spent looking at the homes records and administrative systems. The inspector sampled a number of records, including: • the Statement of Purpose and Service User Guide • residents contracts • care plans • medications • activities and entertainments • the homes procedures • the staff rota • staff recruitment checks • staff training and supervision • health and safety checks • the Fire Risk Assessment. What the service does well: Residents and their relatives were very positive about the quality of service and the atmosphere in the home. People described very nice caring staff, always ready to help with advice. One resident said that staff do a very difficult job and they do it well. Another said that you can please yourself but the helps there if you need it. Residents felt comfortable complaining if necessary. One person said you can say what you think. Residents comments included its a very nice place - Im very happy here and theyve been very good to me. A relative commented that I cannot ask for anywhere better. Tollington Lodge Rest Home DS0000008068.V341500.R01.S.doc Version 5.2 Page 6 Residents who responded to questionnaires felt that meals are very, very good, and this was echoed by many of the residents the inspector met in person. Residents said that they are offered a choice and that staff see them individually every day to ask about their preferences. A relative also said that the food is excellent and varied, and plenty of it. A health care professional felt that the home provides very good care and seeks expert advice appropriately. What has improved since the last inspection? What they could do better: Guidance about individual residents manual handling needs should include clear instructions for staff. Although comments about the food were generally very positive, several residents said that it is only adequate. It appeared that some residents feel the meals lack interest, and this may be due to presentation rather than content. Even those people who were not entirely satisfied with the meals acknowledged that the manager really puts a lot of effort into this and meets with residents regularly to discuss the subject. The manager and owner were Tollington Lodge Rest Home DS0000008068.V341500.R01.S.doc Version 5.2 Page 7 already aware that some people feel this way, and are taking steps to remedy the situation. Many residents are very independent and make their own social and leisure lives. Some people felt that more organized activities are needed. Staffing levels dont allow time for activities, but residents appreciated the fact that staff will sit and chat with them. Residents acknowledged that the home has tried to set up a number of different activities, but these have fallen through due to lack of interest. The home is now looking at setting up a programme of one-off events rather than regularly repeated activities. The inspector recommended that a couple of hours extra staff are provided in the afternoons to support informal, in-house activities. The carpet in the ground floor bedroom with an unpleasant smell should be changed and the floor beneath treated if necessary. Frequent shampooing has not been able to completely eradicate this problem, and the smell may create a false impression about the homes overall standard of cleanliness. Suitable sleeping-in facilities for staff need to be provided. The home hopes to do this by building a new extension but may need to seek other solutions if this does not prove possible. People who use the home’s cleaning chemicals need to be made aware of the manufacturers safety information. This will help to promote safe use and ensure people know what to do if there is an accident. Staff must have all the necessary training, including in first aid. A record of staff training should be kept as this will help to show the training each person has had and what training is due. Staff must have regular formal supervision. This will help to ensure that everyone is clear what is expected of them, and is able to give residents the best possible service. Written guidance to staff should be dated, and any old versions that are no longer in use should be removed from the file so that staff are clear what is expected of them. This will help to ensure that residents are treated consistently and in line with current good practice. Health and safety checks need to be recorded so that the home can show they are being carried out properly. The homes risk assessment on the environment should be expanded to include all relevant information. Any potentially unsafe practices - such as providing a resident with a hot water bottle - should be risk assessed and the person asked to sign a disclaimer. Tollington Lodge Rest Home DS0000008068.V341500.R01.S.doc Version 5.2 Page 8 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. The summary of this inspection report can be made available in other formats on request. Tollington Lodge Rest Home DS0000008068.V341500.R01.S.doc Version 5.2 Page 9 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.V341500.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives get good information about the home. Prior to admission, the home makes reasonably sure that it can offer the person a suitable service. EVIDENCE: The Statement of Purpose and Service User Guide have been reviewed and updated. This helps to ensure that residents and their representatives get complete and up-to-date information about the home. The manager usually visits prospective residents to carry out a pre-admission assessment, then writes to confirm that the home can offer a placement. The pre-admission assessment covers a range of issues and needs. Tollington Lodge Rest Home DS0000008068.V341500.R01.S.doc Version 5.2 Page 11 Each resident has a contract, which includes detailed information on terms and conditions. Contracts also specify the persons room number. Copies of any local authority contracts are also kept on file. Newer residents said they were made very welcome. One person had only come for a fortnight but stayed. The home does not provide intermediate care. Tollington Lodge Rest Home DS0000008068.V341500.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents care needs are much better documented than previously but there are still some significant gaps in the written guidance to staff. Residents care needs are, however, being well met and the home liaises well with external professionals. EVIDENCE: Residents care records were much more informative and detailed than at the last inspection. Care plans are being reviewed every month and clearly show any updates. Some care plans would benefit from being expanded further to provide more depth of information about particular needs and the actions required from staff to address these. This is particularly so with some of the manual handling assessments. Some of these assessments give information about factors that need to be considered and equipment that should be used but do not give clear guidance about exactly what staff need to do. Tollington Lodge Rest Home DS0000008068.V341500.R01.S.doc Version 5.2 Page 13 The manager is looking at new formats to create more person-centred care plans. The inspector advised that care plans need to include clear evidence of the persons involvement in planning their own care, and how they or their relatives had been consulted. The health care professionals who responded to the CSCI survey felt that the home works with them well and that the standard of care is good. Residents and relatives comments echoed this, as did the inspectors observations during the visit. The self-medicating policy includes how the continued success of each persons self-medication will be monitored and reviewed. It also addresses issues around consent. The inspector suggested that the policy is rephrased for greater clarity when it is next reviewed. GPs are sometimes making a note on repeat prescriptions that medications have been reviewed, but the home does not keep any record of this at present. The inspector recommended that a note of this is kept on the individual resident’s file, and that the home asks the GP to review medications regularly if no note is made on the prescriptions. The home is moving to a new monitored dosage system soon, and will then have photographs of each resident and a description of each medication on the doset boxes. Tollington Lodge Rest Home DS0000008068.V341500.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Many aspects of residents daily lives are very good but the leisure needs of a few people are not yet being fully met. EVIDENCE: Residents described flexible routines and a helpful attitude from the staff. They said that staff respond quickly to the call bell and make time to chat with them. There are some male staff, and residents and staff said that residents are offered a choice about which gender they receive personal care from. Many residents are very independent and make their own social and leisure lives but some people felt that more organized activities are needed. Residents acknowledged that the home has tried to set up a number of different activities, but these have fallen through due to lack of interest. As one of the residents said, the manager really puts a lot of effort into this. The home is now looking at setting up a programme of one-off events rather than regularly repeated activities. An activities profile has been drawn up on each resident. The inspector recommended that a record is kept of all Tollington Lodge Rest Home DS0000008068.V341500.R01.S.doc Version 5.2 Page 15 activities, who participated in them and who declined, as this will help to identify which activities residents enjoy and will also provide a record of the efforts made to meet their needs in this area. Notices on the chalk boards in the dining room give information about the day’s planned activities. An aromatherapist visits every six weeks to massage residents hands. The home is exploring the possibility of starting a twinning programme with other homes abroad. Many residents said how nice the food is. A couple of people felt that meals are excellent, and residents generally described plenty of variety. However, a few people felt that meals are only adequate and lack interest. Menus were varied and well-balanced, and the ingredients are of a good-quality and mainly fresh. The inspector, owner and manager discussed ways of ensuring that meals are always presented in the best possible way to stimulate residents appetite. There was a peaceful atmosphere in the dining room during lunch. Residents like the fact that they can have breakfast in bed as this allows a more leisurely start to the day. Tollington Lodge Rest Home DS0000008068.V341500.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents concerns are taken seriously and responded to promptly. Their wellbeing is generally well protected but staff training in abuse awareness has not yet taken place. EVIDENCE: The home has a very welcoming complaint procedure, which reinforces that people will not get into trouble for complaining and in fact have the right to do this. The procedure also invites people to contribute their ideas for improvement. People are encouraged to talk to senior staff first, if they have any grumbles. If these cannot be resolved, the person is given a copy of the formal complaint procedure. This procedure is also posted in the hall and in the homes Service User Guide, and includes CSCIs contact details. Residents said that they could talk to any of the senior staff if something was worrying them, and felt free to say what they really think. A CSCI inspector and Police Community Support Officer visited the home recently as part of the joint CSCI-Police Day of Action, which was to raise awareness of abuse issues. Staff on duty were aware that they had a contact number they could ring if they had concerns, but otherwise demonstrated a lack of understanding of abuse issues. This was discussed with the manager Tollington Lodge Rest Home DS0000008068.V341500.R01.S.doc Version 5.2 Page 17 during this inspection. The manager confirmed in the homes self-assessment form that abuse training is now ongoing and that staff have a clear written policy to follow. Safeguarding adults training has been arranged for this September. Staff the inspector spoke with during this inspection were well aware of the correct procedure to follow if they had any concerns. Tollington Lodge Rest Home DS0000008068.V341500.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 23, 25, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from a pleasant and well maintained environment but the lack of proper sleeping-in facilities and the unpleasant smell in one downstairs area detracts from the overall quality. EVIDENCE: The home is on two floors with access via a chair stair lift, passenger lift or stairs. Communal areas are all on the ground floor. There are two lounges, the smaller of which is used as a quiet room. The dining room overlooks the front garden, which is paved and has a variety of seating. Resident’s rooms are various sizes and all decorated to a good standard. All but two have ensuite facilities. Tollington Lodge Rest Home DS0000008068.V341500.R01.S.doc Version 5.2 Page 19 An area of the ground floor corridor and one nearby bedroom have an unpleasant odour. This was raised at the last inspection, and the carpet in this area is now being shampooed twice a week. Special mats have been placed in the bedroom, which can be removed and put through the washing machine. Despite these efforts, there is still a lingering smell. The inspector recommended that the carpet in this area is changed and that the floor beneath is treated if necessary. It may also be useful to have an automatic odour neutraliser for this area, once the underlying smell has been dealt with. Bathrooms and toilets are within easy reach of all bedrooms. A thorough and common sense bathing procedure is posted in the bathrooms, along with a thermometer. The thermometer in the bathroom opposite room 19 was missing. The manager said that she will locate or replace this. Staff on sleeping-in duty still sleep in the lounges. This is not a satisfactory arrangement as it may affect residents freedom to use these rooms. The owner hoped to build a new extension, which would include staff sleeping-in accommodation, but is still seeking planning permission. Some residents at the last inspection felt that the laundry service was not always adequate but everyone the inspector asked at todays visit was satisfied. The inspector suggested that the dishwasher is acquired. This will help to ensure that infection is not spread, and will free up staff time for other tasks. Domestic staff had been shown how to use cleaning chemicals safely but did not know about the manufacturers safety data sheets that are kept in the office. It is very important that people using these chemicals are aware of this information, so the inspector recommended that safety data sheets are mentioned in the homes written guidance to staff. Tollington Lodge Rest Home DS0000008068.V341500.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are generally protected by good staffing practices but staff are not currently receiving sufficient training. EVIDENCE: The inspector looked at the staff rota for July this year. This showed that two care staff are on duty between 9 a.m. and 9 p.m., supported by one cleaner and a cook. The manager also works between 8 a.m. and 4 p.m. on weekdays. Two staff sleep-in at night, and the manager confirmed that the success of this arrangement is kept under regular review. The newly appointed deputy manager is likely to become a third carer, additional to basic staff levels on her shifts. Information on residents files, their comments, and discussion with staff indicates that these staffing levels are satisfactory at present. The manager confirmed that they will be increased if the level of needs changes. Given residents comments about activities, the inspector recommended that the manager considers providing an extra staff member for a couple of hours in the afternoons. No new staff have been appointed since the last inspection but the manager confirmed that practice has being amended to ensure that a satisfactory PoVA First check and all other pre-employment checks have been completed before Tollington Lodge Rest Home DS0000008068.V341500.R01.S.doc Version 5.2 Page 21 new staff start work in the home. A checklist is now in use at the front of new staff files, and this will help to ensure that all necessary checks and actions have been carried out. The rota is being changed so that each staff member has alternate weekends off. The deputy manager and another staff member hold NVQ 3, and five care staff hold NVQ 2. Staff pay for their own NVQ training. Moving and handling training was arranged after the last inspection and six staff have now had this training. The remaining four staff are having training this week. The cook and manager have had training in the nutritional needs of older people, since the last inspection. The inspector looked at most of the staff training records, all of which contained a number of certificates. However, the certificates on their own were not sufficient to demonstrate that the training standard is being met. It may help to keep a record on the training file of each training session held, its date, and which staff attended. This will ensure that some record is available in case no certificates have been received. The manager has set up a new format for recording statutory training. The inspector recommended that this be expanded to show the dates that refresher training is due, and that a similar record is also set up for other non-statutory training. This will help the manager to ensure that refresher training courses can be booked in good time and that each member of staff has the required level of training. Tollington Lodge Rest Home DS0000008068.V341500.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from a happy and homely atmosphere. Staff described a supportive working atmosphere but this needs to be augmented by more effective formal systems. Records of health and safety checks are lacking in some regards, so it is not possible to evidence that all checks are being carried out properly. Insufficient staff have first aid training to ensure residents wellbeing. EVIDENCE: The home has been owned by the same family for over 20 years. The manager has been in post for several years and holds relevant qualifications. Tollington Lodge Rest Home DS0000008068.V341500.R01.S.doc Version 5.2 Page 23 Staff described a friendly working atmosphere and a supportive team. Management staff are approachable and always make time to talk any issues through. Staff meet as a team every few months, and people are encouraged to contribute ideas. The home does not hold cash on residents behalf any more. Invoices for any expenses, such as the hairdresser, are now forwarded to relatives. The manager does not keep a record of supervision dates at present, so the only evidence that staff supervision takes place is the records of individual one-to-one sessions. The supervision contract is very clear, and is signed by the manager and the member of staff. This says that each person will have one-to-one supervision every two months, but the seven staff records checked showed that this is often actually every six months. Supervision records from previous years were also very infrequent. The newly appointed deputy will be taking over supervision of some staff in the near future. The inspector suggested that keeping a record of staff supervision dates will help the manager to ensure that each person gets the necessary one-to-one support. The homes policies file begins with information on person-centred working, reinforcing the impression that the residents are at the centre of the way the service is delivered. The policies seen provided clear and commonsense guidance, and reinforced that residents needs and wishes are paramount. Policies had all been dated but none was signed. It is good practice design policies, and to include the names and roles of whoever contributed to drawing them up. This will help to demonstrate that the home has consulted relevant experts about how best to deliver its service. At present, there are three versions of the complaint procedure in use, one of which is not dated and which gives incorrect information about the name of the registered provider. When policies are updated, the manager needs to ensure that all previous versions are taken out of circulation. There is a fourth, abbreviated, version of the complaint procedure which is given out to residents, and gives information in a very low-key and welcoming way. The manager and all four senior staff hold a current first aid certificate but this does not guarantee that a first aider will be available to the residents at all times. Enough staff need to hold a current first aid certificate to ensure that residents always have prompt access to first aid. The manager said that she and the owners son carry out an in-depth health and safety check of the premises every two months. Records of these checks were not available. The inspector suggested that they are kept on site as they will help the home to demonstrate how effectively it is monitoring safety issues. Hot water temperature regulators were fitted throughout the home two years ago, and hot water temperatures are checked every month. The system is tested for legionella on a yearly basis. Tollington Lodge Rest Home DS0000008068.V341500.R01.S.doc Version 5.2 Page 24 One resident occasionally likes a hot water bottle, which staff provide. As there can be a high level of risk associated with hot water bottles, the inspector advised that this should be risk assessed and that the resident should be asked to sign a disclaimer. There is a basic risk assessment of the premises, which was drawn up in August last year and reviewed in January this year. This includes information such as low surface temperature radiator covers being fitted, but does not mention that hot water regulators and window restrictors have been fitted. This sort of information should be included on the next review. Contractors certificates showed that the passenger lift has been serviced every six months, and that gas and electric tests have been carried out within the past year. The electric wiring check carried out by contractor in June 2006 highlighted areas of concern. The home has had the wiring checked again since then, and it has been passed as satisfactory. Emergency lighting and call bells have also been checked by external contractors since the last inspection. A Fire Risk Assessment has been drawn up. This contains very detailed but concise and easily accessible information on both the premises and individual people. The manager reviews this is every month to ensure that information remains up-to-date. Several fire doors have been fitted with safe hold-open devices which will allow the doors to shut if the fire alarm sounds. The fire precautions log book shows that staff receive regular fire instructions. The weekly fire alarm test is done at irregular times and is unannounced. It is treated as a drill but this is not made clear in the homes record. The inspector suggested that this is made more explicit in the record so that the home can demonstrate it is holding the required number of drills. Emergency lighting was checked by the contractor in October last year but has not been checked by the home every month, as advised by the Fire Officer. The manager said that she does a visual check of the fire extinguishers every month but does not record this. Tollington Lodge Rest Home DS0000008068.V341500.R01.S.doc Version 5.2 Page 25 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 Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 x 3 X 3 X 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 3 2 Tollington Lodge Rest Home DS0000008068.V341500.R01.S.doc Version 5.2 Page 26 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. Standard OP27 Regulation 23(3)(b) Requirement 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. (Previous timescale of 1/3/06 not met). As the owner is still seeking planning permission for an extension, which will include staff sleeping-in facilities, it was agreed that this requirement will be reviewed again within the next six months. Staff must receive all statutory training and each staff member must have at least three days training per year. This will help to ensure that staff are kept upto-date with good practice and are best able to meet residents needs. Staff must be adequately supervised. This will help to ensure that practice is of a consistently high standard. DS0000008068.V341500.R01.S.doc Timescale for action 06/02/08 2. OP30 18.(1)(c) (i) 06/10/07 3. OP36 18.(2) 06/09/07 Tollington Lodge Rest Home Version 5.2 Page 27 4. OP38 13.(4) 5. OP38 23.(4)(c) (iv) Enough staff must hold a current first aid certificate to ensure that residents always have access to a first aider. Emergency lighting and fire extinguishers must be checked by the home on a monthly basis, and these checks recorded. This will help to ensure that any faults can be rectified promptly, which will promote the safety of all using the home. 06/11/07 06/08/07 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 OP7 OP12 Good Practice Recommendations Manual handling assessments should give clear guidance about exactly what staff need to do to meet residents’ needs. A record should be kept of all activities, who participated in them and who declined, as this will help to identify which activities residents enjoy and will also provide a record of the efforts made to meet their needs in this area. The carpet in the ground floor room with an unpleasant smell should be changed and the floor beneath treated if necessary. The provider needs to make people who use the cleaning chemicals aware of the manufacturers safety data information. The home should consider providing an extra staff member for a couple of hours in the afternoons. This will help to ensure that there are adequate staff available for informal, in-house activities with the residents. The manager should keep a record of staff training to enable her to monitor that each person is getting the required input and to help her plan future training courses in good time. This will help to ensure that staff are kept up-to-date and best able to meet residents needs. The homes policies and procedures should be signed and dated. Old guidance that is no longer in use should be DS0000008068.V341500.R01.S.doc Version 5.2 Page 28 3. 4. 5. OP26 OP26 OP27 6. OP30 7. OP37 Tollington Lodge Rest Home 8. 9. OP38 OP38 removed from the file so that it does not give misleading information to staff. This should help to ensure that residents are treated consistently and in line with current good practice. Potentially unsafe practices, such as supplying a resident with a hot water bottle, should be risk assessed and the resident should be asked to sign a disclaimer. The homes risk assessment of the premises should include all relevant information, such as window restrictors and hot water temperature regulators. Tollington Lodge Rest Home DS0000008068.V341500.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. Extracts may not be used or reproduced without the express permission of CSCI Tollington Lodge Rest Home DS0000008068.V341500.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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