Archived: Tosh Lodge

Updated 30 January 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 19 and 25 October 2017 and was unannounced. The inspection was carried out by two inspectors.

Before our inspection we looked at records that were sent to us by the provider and the local authority to inform us of significant changes and events. We also reviewed our previous inspection report, and the Provider Information Return (PIR) that the provider had completed. The PIR is a form that asks the provider to give some key information about the service, what the service does well and what improvements they plan to make.

During the inspection we spoke with people living at the service. We spoke with the provider and one member of care staff. We looked at one person’s care plan and the associated risk assessments and guidance. We looked at a range of other records including one staff recruitment file, the staff induction records, training and supervision schedules, staff rotas, medicines records and quality assurance surveys and audits.

Updated 30 January 2018

This inspection took place on the 19 and 25 October 2017.

Tosh Lodge is a service which provides accommodation and personal care for up to five people who are living with mental health conditions. There was one person living at the service when we inspected. who was also living with long term health conditions such as epilepsy.

This service is not required to have a registered manager in post. The provider had registered with the Care Quality Commission to manage the service and is therefore a 'registered person'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Tosh Lodge was last inspected in April 2017 when the service was rated inadequate in the safe, effective, caring and well-led domains and requires improvement in responsive. The service was placed into special measures. We found breaches of regulation relating to protecting people from abuse, management of risks to people and the environment, a lack of person centred care, care plans lacking detail and a lack of understanding about people’s capacity to make decisions. Other breaches related to issues with staff recruitment and training, a lack of oversight of the service and not informing the Care Quality Commission of notifiable incidents.

At this inspection there were continued breaches of regulation and little progress had been made to improve the care and support people received. People continued to be at risk of harm due to a failure to treat people with dignity and respect. Although some staff treated people kindly, people were not always protected from abuse and were spoken to in a derogatory way. Plans to manage risks to people did not give enough detail and placed restrictions on people. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

When people became unwell they were not supported to access health care treatment promptly resulting in people being in pain for periods of time with no access to pain relief. Staff did not have guidance about how to support people with long term health conditions. People were not supported to be independent and there was a culture of doing for people, rather than with them. People’s care plans contained contradictory information and lacked detail about how people liked to be supported and what they could do for themselves. People had limited access to activities and records showed they had long periods of time with no meaningful activity.

Staff were completing some checks relating to the environmental risks. However, water temperatures were not being checked regularly and were found to still be too high. Checks to the fire systems were completed and personal emergency evacuation plans were in place. People were supported by staff who had been recruited safely and who had received additional training. However, there was a lack or training and understanding about how to support people when they were distressed or agitated and staff had not attended fire safety training which was highlighted at the last inspection as a shortfall. Although there were enough staff on the day of the inspection the service did not employ enough staff to meet people’s needs in the event of illness or annual leave.

People told us they enjoyed their food, but that they had limited choice in what they could have to eat. People were not involved in preparing their meals. People’s medicines were managed safely by trained staff. The provider told us they had received no complaints since the last inspection. People had been asked to given feedback on their support via a questionnaire which they were supported to complete by staff. The provider told us no notifiable incidents had occurred since the last inspection. The provider had not completed regular audits to identify areas for improvement. There was continued evidence of restrictive practices and the provider was not always knowledgeable about the guidance they should follow or their responsibilities as a registered person. The provider had not displayed the services rating as required by regulation.

We found a number of continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.