Totteridge House

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

Relatives were happy with the care their family members received. They felt confident they got safe care. They commented “I am extremely happy with the care my son receives, he has at times distressed behaviours and they manage it well,” “Compared to where my son lived before I couldn’t be happier, they understand him better so get the best from him,” “The staff have a very good attitude to my son, they are kind, supportive and friendly,” and “The staff are friendly and professional, my son really enjoys time spent with a couple of his main carers.”

Some records were not accurate and complete. Auditing and monitoring of the service was taking place however, the audits had not identified the shortfalls we found in record management or that sufficient staff were not provided at night-time to provide people with the level of support outlined in their PEEP’s.

Some risks to people were identified and mitigated. Staff were aware of people's risks and how best to support them. Sufficient staff were provided during the day which enabled people to have the support they required and access to community activities. The night-time staffing levels did not take account of the support outlined in people’s Personal Emergency Evacuation Plans (PEEP’s) which had the potential to put people at risk. The PEEP’s were reviewed in response to our feedback and we have made a referral to the local fire service.

Safe medicine practices were promoted, and systems were in place to safeguard people from abuse. Staff were clear of their responsibilities in recognising and reporting potential safeguarding incidents. Accident and incidents were recorded and showed a debrief of incidents and a review of positive behaviour management plans to prevent reoccurrence.

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.

Staff felt suitably inducted, trained and supported in their roles. Staff were suitably recruited, although some records relating to recruitment were not on electronic staff files to demonstrate the checks they had carried out. These were added to the file after the inspection.

The service had an experienced manager who was committed to providing a person-centred service for people. They acted as a positive role model to staff and had built positive relationships with health professionals and families. Relatives were complimentary of the registered manager and the stability they had brought to the service. Health professionals told us they worked collaboratively with them. A health professional told us the service supports people with very high complex needs. They commented “The registered manager is always available, leads from the front, is hands on, person centred and see what is important for a person. She puts the people they support at the centre of everything they do.”

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

Right Support: People were provided with the right support, communication aids and equipment to enable them to be involved in making choices, promote their independence and develop life skills.

Right Care: Person centred care was provided which promoted positive outcomes for people. There was a reduction in distress for people and people were treated with compassion. This promoted their well-being and enabled them to achieve their goals and aspirations which included access to community activities such as swimming, driving experience, holidays and college.

Right Culture: The registered manager promoted a positive, open culture within the service, where staff felt supported, trained and able to raise concerns to enable them to support people to lead inclusive and empowered lives.

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 22 May 2018).

Why we inspected

The inspection was prompted in part due to feedback and concerns around the providers fire safety systems. A decision was made for us to inspect and examine those risks.

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.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements in the safe and well-led domains.

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 Totteridge House on our website at www.cqc.org.uk.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Totteridge house 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.

Totteridge house accommodates people in one adapted building. The home is registered for seven people with a learning disability and other associated conditions. At the time of this inspection six people lived there. The provider confirmed they did not intend to accommodate seven people due to the lack of sufficient communal space available to people.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy.

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.

At the previous inspection the provider was in breach of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question safe, effective and well-led to at least good.

At this inspection of the service we found improvements were made and the service was providing safe, effective, caring and responsive care. Improvements were required to records and auditing of the service to ensure it was well-led.

The majority of relatives spoken with were happy with the care provided. Relatives felt staff were better skilled to provide safe care. They described individual staff as “caring, brilliant, welcoming and friendly”. One relative was unhappy with many aspects of care and felt Totteridge house was not the right place for their family member. Relevant people involved in the person’s care were aware and it was being looked into.

People were safeguarded from abuse and risks to people were identified and managed. People had positive behaviour plans in place to support staff to manage behaviours that challenged. Accident and incidents were responded to. Debriefing meetings took place following an incident to reflect on actions and improve practices.

The required staffing levels were maintained with the rota managed flexibly to meet people’s needs. Staff were inducted, trained and supported. Person specific training had taken place to improve staff skills and their confidence in supporting people. As a result staff were kind, caring, engaging and more responsive to people. They distracted people and prevented escalation of challenging behaviours.

People’s choices, independence and involvement in their care were being developed. Staff worked to the principles of the Mental Capacity Act (MCA) 2005 but needed to be mindful that other professionals made decisions around medical interventions in line with the MCA 2005.

People’s communication needs were identified and person centred tools e.g. pictures, signing and talking mats were used to promote their understanding and communication. Information such as menus, complaints and fire procedure was provided in an accessible format to inform people. People had access to activities and the service was looking at ways to improve community access for people.

Systems were in place to promote safe medicine administration. People had care plans in place which outlined their needs and the support required. Their nutritional and health needs were identified and met. People had access to in house health professionals such as an occupational therapist, speech and language therapist and a positive behaviour support therapist. They were responsive to changes in individuals and worked alongside staff to promote their learning.

People were provided with equipment to promote their safety and independence. The equipment provided was serviced and safe. Areas of the home needed redecorating and a deep clean of some areas of the home was required to ensure the environment was kept clean and prevent cross infection.

The provider had systems in place to audit the service and get feedback to improve practice. However auditing and feedback systems were not fully established to satisfy themselves that the service was being effectively managed and that feedback was sought and acted on.

Improvements had been made to records but further improvements were required which the registered manager had identified to make records more accessible.

The registered manager was new to the service. They had identified areas for improvement and recognised further improvements were still required to develop a more person centred service. Staff and relatives were complimentary of the registered manager. Staff felt empowered and motivated. They felt team working and joint working with other professionals had improved to benefit everyone.

Totteridge House is a care home which provides accommodation and personal care for up to seven people with a learning disability and other associated conditions. At the time of our inspection there were six people living in the home.

The service is required to have 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. A manager was in post since December 2016. They had applied to the Commission to be registered and their application was being processed.

This was the first inspection of Totteridge House since the service had been registered with us. This inspection was a comprehensive inspection to enable us to rate the service.

Some relatives were happy with the care provided whilst other relatives were dissatisfied with the care provided, lack of communication and involvement. Health professionals were also dissatisfied with aspects of the service, management and the lack of partnership working. Recommendations have been made to improve those areas of practice.

Staff were suitably recruited however staff were not inducted and trained to ensure they had the specialist skills and training to meet people’s needs.

Records were not accurate, suitably maintained and up to date. Aspects of the service were audited but auditing was not effective in identifying the shortfalls in the service that we found. The home was not being effectively managed and systems were not established to seek and act on feedback on the service.

Systems were in place to safeguard people but the service was not working to local authority safeguarding procedures. The lack of effective communication between the home, other professionals, relatives, the environment and lack of suitably trained staff meant people were not adequately safeguarded.

The required staffing levels were maintained but staff were not deployed properly to ensure people got the required level of supervision they required at all times. A recommendation has been made to address this.

Risks to people were identified but risks to staff already identified were not managed. Improvements were required to medicine practices and staffs understanding of the medicine they administered to safeguard people. Recommendations have been made to address these shortfalls.

Staff were trained in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). However the feedback on their practice would suggest they were not working to the principles of the act. A recommendation has made to address this.

Some staff were kind and caring whilst other staff were less engaging with people. People privacy and dignity was promoted but not consistently maintained by all staff members. A recommendation has been made for the provider to monitor staff practice.

Systems were in place to manage complaints but all concerns were not recorded and managed in line with the organisations policy on complaints. Examples were given to the provider to enable them to follow up with staff.

The home was clean, however there was a delay in making repairs safe. The home had access to contractors to carry out remedial work and there was a 10 year warranty on the building to address any structural issues.

The home was registered for seven people but due to the nature of the challenges people presented with the home did not have sufficient communal space to enable people to have adequate space.

People were offered choices and communication care plans were in place to promote and develop people's communication.

People had care plans in place and systems were in place to review people’s needs. People had access to activities and these were being further developed.

The provider was in breach of three Regulations .of the Health and Social Care Act 2008. You can see what action we told the provider to take at the back of the full version of the report.