Archived: Totham Lodge Residential Home for the Elderly

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. 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.

People felt safe and there were systems in place to safeguard them from the possible risk of harm. Risks to each person had been assessed and managed appropriately, and there were risk assessments that gave guidance to staff on how risks to people could be minimised.

The service followed safe recruitment procedures. However, people were at risk of harm because there was not always staff to supervise them in the lounge and dining room. There were safe systems for the management of people’s medicines and they received their medicines regularly and on time.

People were supported by staff who had received the relevant training but did not demonstrate that they had the skills required to support people who were living with dementia. Individual needs were not met by the design and decoration of the building. The service was not dementia friendly. Staff received supervision and support from the management.

Staff were aware of how to support people who lacked mental capacity to make decisions for themselves and had received training in Mental Capacity Act (2005) and the associated Deprivation of Liberty Safeguards.

People’s nutritional needs were met and they were supported to have enough to eat and drink. However, choice in the menu had not been provided.

They were also supported to access other health and social care services when required.

People were treated with respect but their privacy and dignity was not always promoted. People and their relatives were involved in decisions about their care and support they received.

People had their care needs assessed, reviewed but not always delivered in a way that mattered to them. They were not supported to pursue their social interests and hobbies and to participate in activities provided at the home. There was an effective complaints procedure in place.

There were systems in place to seek the views of people, their relatives and other stakeholders. Regular checks and audits relating to the quality of service delivery were carried out. However, the systems in place were ineffective.

The provider was not meeting some of the regulations. We also recommended that the provider needed to review and act on current guidance on creating dementia friendly environment. You can see what actions we have told the provider to take at the back of the full version of the report.

We looked at some of the records held in the service including the care files for eight people. We observed the care and support people who used the service received from staff and carried out a tour of the building.

The summary below describes what people using the service, a relative and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

We found people's needs had been assessed and individual care plans drawn up to meet people's needs. These assessments and plans included consideration of risks to the person and how these could be managed to keep the person safe.

The provider had arrangements in place to deal with foreseeable emergencies. We were told by staff members we spoke with that they were able to contact a manager when they needed to.

People were protected from the risks associated with against the risks associated with medicines because the provider had appropriate arrangements in place to safely manage medicines.

We found the provider had taken steps to provide care in an environment that was suitably designed and adequately maintained. A person using the service told us, 'I love walking in the lovely garden'.

People we spoke with told us there were enough staff to meet their needs. Some staff we spoke with felt there were enough staff to meet people's needs. However, some staff and a relative we spoke with felt there were not always enough staff to meet people's needs. We found there were enough staff on duty to meet the needs of the people living at the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well.

We saw people being cared for and supported in accordance with their plans. Staff had received training to meet the needs of the people living at the home.

A relative we spoke with told us their family member had, 'Improved a lot', after being admitted to the home and that, 'The staff are lovely'.

We found the provider assessed people's capacity to make choices and decisions and ensured peoples' best interests were taken into account.

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Is the service caring?

We found people were supported by kind and attentive staff. We saw staff talking with people with kindness and in a respectful manner. We observed staff supporting people to move about the home in accordance with their needs showing patience and consideration.

Staff we spoke with were knowledgeable about the individual needs of people. Staff told us they felt it was important for people to be cared for with kindness. One staff member said, "People are well cared for".

People we spoke with told us, "The staff are friendly and caring" and, "The staff are a good lot". A relative told us they were happy with the way their relative was cared for and supported.

Is the service responsive?

We found people's needs had been assessed before they moved into the home. We found that each person's needs were regularly reviewed with care plans updated if needed. Records showed that people were supported in line with these plans.

People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

We found that quality assurance processes were in place. People's views had been

obtained by the provider along with the views of relatives and staff.

The provider made changes to improve the service people received as a result of people's views.

We found that staff received training and the provider was able to provide evidence that most of the staff held vocational qualifications relevant to their role. Staff told us they were clear about their roles and responsibilities.

On the day of our inspection, 28 people were living in Totham Lodge Residential Home for the Elderly. We spoke with seven people and six of their relatives who were visiting. We also spoke with six staff.

Many people were not able to talk to us verbally about their experience of the service but we saw that they were relaxed and comfortable. We looked at a range of records which included three people's care plans and daily records, staff training, staffing rotas, health and safety and quality checks.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

This is a summary of what we found;

Is the service safe?

All the people we spoke with told us that they felt safe in Totham Lodge Residential Home for the Elderly. The house was an old building and in need of some redecoration which was underway. People were protected from accessing areas that could be harmful to them.

Medication administration had been improved but further work was needed to bring it up to the required standard to fully ensure people were protected from harm.

We saw that people had their needs fully assessed which included all aspects of their lives. Where people were unable to make day to day or significant decisions, Mental Capacity Act (MCA) 2005 assessments had been undertaken. However, we identified that a MCA was needed for one person in relation to their medication as they had not consented to the way their medication was given. No Deprivation of Liberty Safeguards (DoLS) were needed at this time.

The provider had reviewed the dependency levels of people using the service since our last inspection. Recruitment and training for staff was underway. The required amount of staff were on duty on the day of our inspection with the appropriate skills to meet people's needs safely.

Staff knew about safeguarding people who used the service and told us what they should do if they suspected or witnessed abuse. This kept them and those around them protected from harm.

Is the service effective?

People's assessments showed that their care, support and treatment was planned and delivered in a way that ensured their safety and welfare. The records were reviewed and updated which meant that staff were provided with current information about how people's needs were to be met.

People told us that they had access to health and social services. The provider involved a range of professionals such as general practitioners and district nurses in people's care which ensured their care and treatment was planned and coordinated.

Is the service caring?

We observed the interaction between staff and people using the service. Staff were warm, kind, supportive, knowledgeable and professional with a positive attitude to their work and the people they were caring for.

One person said, 'They (the staff) are lovely.' Another said, 'I do feel that they look after me well.' A relative said, 'We looked at other homes but when we came here, we had such a lovely warm welcome. It's been the same ever since.'

Is the service responsive?

We saw in the care plans and daily records that the staff responded appropriately to people's changing needs, wishes and interests. Families were involved as appropriate in the decision making about people's care. One relative told us, 'There is always an open door here and I am included in my (relatives) care.'

The range of individual activities and entertainment had improved and the staff were getting more involved in spending one to one time with people. One person said, 'I like the peace and quiet, reading or talking with staff is enough for me. Another person told us, "It is really boring here, there is nothing to do.' One staff member said, 'We often don't get time to sit with people if we are needed elsewhere'.

Staff, residents and relative's meetings had been held after the last inspection to discuss the findings. People were able to express their views and the provider responded by drawing up a plan of changes. This meant that people felt listened to and valued.

Is the service well-led?

There had been some changes to the management at Totham Lodge Residential Home for the Elderly in the past four months. The new manager was implementing changes to care planning and delivery, training, medication and quality assurance to ensure people were cared for appropriately and to a high standard.

The staff we spoke with told us that they welcomed these changes. One staff member said, "Things are improving and it would be good to have face to face training to refresh our knowledge and not just watch DVD's.'

We found improvements in the way medicines were managed at the service but people were not fully protected against the risks associated with medicines because the provider did not have appropriate arrangements in place for the recording of the administration of medicines. There was insufficient guidance for staff on the use of some medicines.

The service had a quality assurance system in place and records seen by us showed that identified shortfalls were now being addressed. As a result the quality of the service was continuingly improving.

The new care and support records that were being put in place were much improved. They related well to the individual person's needs, abilities and preferences. However, people had long periods without staff input and stimulation, particularly in the mornings. Medicines management needed to be improved in order to fully protect people receiving the service. The manager did not have sufficiently robust systems in place to monitor the quality of the care and services provided. The manager confirmed that they were taking prompt action to address all the issues raised during our inspection.

We inspected Totham Lodge in August 2012. We found that there were areas of non-compliance with the regulations with regard to staff training, staff supervision and in relation to record keeping.

We visited again to check whether the provider was now compliant. We found that work had been done to address the shortfalls previously noted in order to become compliant. This included improvements with staff training, staff supervision and record keeping.