Tollington Lodge Rest Home

People’s experience of using this service and what we found

People were at risk of harm because the service had not always assessed and mitigated the risks people faced.

Medicines were not managed safely. Records were not accurate so we could not be assured people always received their medicines as prescribed.

The service was not always clean meaning people were not always protected from the risk of the spread of infection.

Staff were not always recruited safely to ensure they were safe to work in the caring profession.

The provider’s checks of the quality of care delivery did not highlight all the issues we found and did not always drive improvement in care quality.

People told us they felt safe at the service. Comments included, “Oh yes, I’m safe” and, “Yes we’re all safe here.” Staff understood how to report concerns.

People said they enjoyed living at the service. Comments included, “It's good here”, “I don’t see the staff often, but when I do, they chat a lot with me” and, “The staff are very good, they do their jobs.”

Staff enjoyed working at the service and spoke highly of the management team.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 25 October 2019).

Why we inspected

We received concerns in relation to the governance of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Tollington Lodge Rest Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, recruitment, and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Staff we spoke with confirmed they had received training about infection prevention control (IPC) and using and wearing personal protective equipment (PPE). We observed staff wearing PPE correctly.

An enhanced cleaning programme had been implemented to help prevent the spread of infection. For example, increased frequency of cleaning and cleaning frequently touched points and high traffic areas. The home was visibly clean and free from malodours.

The registered manager had a contingency plan in the event the service experienced a COVID-19 outbreak; staff, including the registered manager, would move into the service and provide care to people who were COVID-19 positive. Additional staff would support people unaffected by COVID-19.

The registered manager was proud the service had not relied on agency staff to ensure safe staffing levels. The registered manager said existing staff had worked increased hours, additional shifts, and had assumed various roles. One staff member said, “Care staff have all pulled together.”

Tollington Lodge Rest Home is a residential care home providing personal and nursing care to 25 people aged 65 and over at the time of the inspection. The service can support up to 25 people. The home is laid out over two floors of a former large domestic residence. To the ground floor there are bedrooms, two communal lounges, a dining room and the registered manager’s office. The first floor accommodates further bedrooms, all of which are ensuite. Both the ground and first floor offer communal toilet and shower or bathroom facilities and are accessible to people via the lift. There is level access to a garden.

People’s experience of using this service and what we found

At the last inspection staff did not always knock on the doors of people’s bedrooms before entering, and interactions between staff and people had not always been caring. Since the last inspection, improvements were made to how staff treated people. Staff knocked on people’s bedroom doors and interacted with people in a kind and caring way. People confirmed they were supported by staff who were kind and caring.

The provider had improved how they were assessing people’s mental capacity and how staff recorded capacity assessments and best interest decisions. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Care plans reflected people’s preferences and needs, including guidance for staff about how they could support people to meet these needs. The premises were designed to meet the needs of people. People were supported to eat and drink. Staff were supported to carry out their roles through supervision and training.

Sufficient improvements had been made to quality assurance systems since the last inspection. Audits and checks were now being used effectively to identify concerns, shortfalls and omissions. There was a clear staffing structure in place and staff spoke about people in a person-centred way. The provider ensured people and staff were engaged with through questionnaires, a suggestions box and staff meetings. The provider was in the process of working to improve people’s experiences of care.

The service was responsive to people’s needs. Complaints and concerns were dealt with appropriately and within an acceptable timeframe. People felt able to raise concerns and complaints. Care planning reflected the needs and choices of people. People were supported to access meaningful activities and avoid social isolation. End of Life care planning was identified as an area for development, although, the provider ensured people were supported to have a dignified and comfortable death.

We identified the provider was not always working in line with published guidance about best practice. Risks to people were identified and associated guidance was available for staff. People were protected from the risk of potential harm and abuse, staff were confident about actions they would take if abuse was suspected or witnessed. Overall, people were protected from the spread of infection, however the laundry was disorganised and required cleaning in some areas, the registered manager told us this had been contributed to by a broken washing machine. Staff were recruited safely; relevant background checks were completed by the provider.

We have made a recommendation about the management of some medicines.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update) The last rating for this service was requires improvement (published 25 October 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the 'All reports' link for Tollington Lodge, on our website at www.cqc.org.uk

Tollington Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is registered to provide accommodation for up to 25 people requiring assistance with personal care. During our inspection there were 24 people living in the home.

Accommodation is offered over two floors and consists of single bedrooms, most of the bedrooms have washing facilities and a toilet. The dining room is centrally located on the ground floor and people can sit in one of two lounges. People can access and use the front garden, there is seating available and the ground is flat, making it accessible.

There was a registered manager for the service. 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.

Medicines were not always administered safely or in line with the service’s procedures. This meant that people were at risk from not receiving the correct dose of medicine. The date that creams and ointments were opened was not always recorded on the container. This meant that people may have creams or ointments applied that had gone out-of-date.

People’s privacy was not always respected. We observed some staff entering the rooms of people without knocking on the door. We saw other staff that did knock before entering the room. People were not always treated with dignity and respect when they were being moved in wheelchairs.

There was a programme of quality audits in place and these were managed by the registered manager. There was a further ‘audit of audits’ in place and these were completed by the provider. However, these did not always identify potential risks. For example, only one radiator in the service had a radiator cover and no control measures, for example guarding the heated areas, or risk assessments were in place relating to the risk to people from hot surfaces.

Equipment was not always safe for people to use. For example, one adjustable bed posed an entrapment risk due to poorly fitting bed rails and another had bedrails that were unsafe.

People spoke positively about the registered manager and provider, saying they were approachable and they could complain if necessary.

Staff could describe the different types and indicators of abuse, including the actions that they would take if they thought abuse had occurred.

The service responded to changes in people’s needs and worked with healthcare professionals to achieve good outcomes.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of this report.