Archived: Tollington Lodge Rest Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Accidents and incidents were recorded and reviewed. Managers encouraged staff to raise concerns when things went wrong. Staff felt confident to report any concerns and had opportunities to discuss and learn from incidents. One staff member said, “We go through everything and see where we can do better next time."

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. The service had systems to support people being admitted to the service safely. The registered manager completed preadmission assessments. People’s changing needs were clarified and communicated between the team following any hospital admission. A professional told us how a person had moved into the service and had settled well. They said, “It is my belief that the Tollington team have been instrumental in the success of this."

The provider had procedures to help safeguard people from abuse and shared concerns quickly and appropriately.

Where people were being deprived of their liberty, referrals had been made to the local authority. The registered manager monitored people’s DoLS referrals, and any conditions attached to a person’s authorised DoLS. However, the registered manager had not notified CQC when DoLs applications had been authorised. The registered manager told us they were not aware they needed to do this. Some care plans we reviewed contained incorrect information about whether people had an authorised DoLs application. We fed this back to the registered manager to address.

People were protected from the risk of abuse and processes were followed if safeguarding concerns were identified. Investigations were completed where required and actions were taken to mitigate risks to people.

Staff understood safeguarding and whistleblowing and were clear on how to report any concerns they had. One staff member said, “I know I could always go to senior staff or the manager if I had any concerns."

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. The service had now assessed the risks of harm to people, including where people were at risk of skin breakdown or at a high risk of choking.

Care plans contained information to support people to manage risks, this included for risks of falls and risks associated with specific health conditions. The registered manager promoted positive risk taking, listening to people’s preferences and respecting their decisions. Risk assessments were person centred and detailed, they gave specific information on how to support people and recorded people’s communication preferences.

Staff understood risks to people and told us they had access to this information and were informed of any changes. However, there were some improvements required around updating records where risks had reduced, the registered manager was aware and planned to update the information as part of people’s monthly care plan reviews.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

People lived in a safe, well maintained and personalised environment. Staff conducted regular safety checks on fire, electric and water safety systems. People had their own moving and handling equipment where they required it, which was in a good condition.

The provider held fire drills to ensure people could be evacuated safely in the event of a fire. Staff used Personal Emergency Evacuation Plans (PEEPs) to assess the level of support people required. However, some PEEPs did not contain enough information around how to support people to evacuate the home or personal information for example, a list of their prescribed medicines. The registered manager had a plan to address this, following feedback they received in a recent quality assurance visit by the local authority.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Senior staff followed safe recruitment processes to ensure staff employed were suitable for the role. The provider had systems to implement and monitor new staff inductions, ongoing training, competency checks, staff supervisions and appraisals.

Staff had received the training they needed to support people well. Staff felt they had good support from the management team who always made sure they were comfortable in how they support people. Comments included, “The manager and deputy will support if I’m unsure” and “They watch me to make sure I’m doing everything right, then they tell me all the things I was good at and things I need to improve.”

We observed people were well supported by staff, for example when people asked for assistance. People felt there were enough staff and told us they received a timely response when they used their call bells. They told us, “I don’t feel they leave you for too long” and “It takes a few minutes for them to come, but they are pretty quick with the emergency bell.”

Staffing levels were met in line with the service’s dependency tool. We saw staffing levels had been increased in the mornings to ensure people had adequate support. We heard mixed views from staff around whether staffing levels were sufficient. We fed this back to the registered manager.

In this section we found improvements had been made following the inspection in July 2023. The provider now assessed and managed the risk of infection and detected and controlled the risk of infection spreading and shared concerns with appropriate agencies promptly.

The service was clean and tidy with no malodours and cleaning schedules and records were followed and effective. One person told us of their bedroom, “It’s always clean, they clean when I am here, we have a good laugh.”

A process was followed for laundry which aimed to ensure people’s items were not mixed. One person told us, “They wash our clothes, get our own back, we put them in a bag, and they are labelled.” Protective personal equipment (PPE) was readily available for staff throughout the service and staff wore PPE as appropriate, this was regularly checked as part of staff spot checks.

In this section we found improvements had been made following the inspection in July 2023, however we did identify where further improvements were required during this assessment.

Medicines audits were completed regularly but we were not assured they were always effective. Some audits were not signed to record who had completed them. The audits did not record which people’s medicines records had been audited and had not identified some shortfalls we found. For example, we found some people who were prescribed creams did not have body maps to inform staff where they should be applied. Immediate action was taken by the senior carer to ensure these people had body maps.

Staff we spoke with knew people well, particularly for pain management and medicines that were administered only when people required them. However, staff had not documented this in the care records to support new staff or staff from an agency. We fed this back to the registered manager to address so individual protocols could be provided for people.

The provider made sure medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes in their medicines occurred. People's preferences for how they liked to take their medicines were clearly documented. Record keeping in relation to medicines administration was good and we were assured people were receiving their medicines as prescribed. The controlled medicine log was fully completed by staff administering controlled medicines. People told us medicines administration worked well for them. One person said, “They bring medicine round, they put it out and wait to check I have taken it.” Where people were prescribed time critical medicines they were administered consistently. One person confirmed their medicines were administered, ‘always at the right time’. Medicines errors were investigated, and medical advice was sought for people where needed. A professional told us, “They manage patients well, mistakes (which are normal) are minimal and acted on and learnt from.”

Senior staff conducted regular competency checks of staff practice, so staff felt safe and confident to continue with medicine administration.