Tollesby Hall Nursing Home

Tollesby Hall Nursing Home is a residential care home providing personal and nursing care to up to 55 people. Over the period of our inspection there were between 53 and 47 people using the service.

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

People and relatives gave mixed feedback about the care and support received. Some people remarked that staff supported them as requested. Whilst others told us they had lack of choices especially about personal care.

Care records were not always complete and accurate. Daily records did not always document actions taken to address gaps within people’s personal care and catheter care. Elements of the poor record keeping had been identified by the registered manager, who had started to address the failings. However, issues were still evident during the inspection. CCTV control measures were not effective. The provider’s annual review of the systems had not identified the issues we found.

Permanent staff were recruited safely. Staffing levels were calculated using a dependency tool which looked at the needs of each person. People and relatives gave mixed comments about how responsive staff were. Some people told us staff were readily available whilst others told us they had to wait. The registered manager advised that staffing levels were regularly reviewed, and staff were allocated duties daily, dependent on people’s current needs.

The home had a system to investigate and record safeguarding incidents. Staff had completed safeguarding training.

Information gathered from accidents and incidents was analysed to identify trends or patterns with actions put in place to minimise risk of further incidents.

The home was clean and tidy. Staff had completed training in infection control and followed protocols to reduce the risk of infection.

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.

The registered manager and staff were passionate about providing quality end of life care. The home had achieved the Gold Standards Framework (GSF) Accreditation Quality Hallmark Award. GSF provides effective end of life care training for the care team and promotes better working with external healthcare professionals.

The provider and registered manager understood their duty of candour. The home had developed strong partnerships with health and social care professionals to ensure people received joined up care. Feedback from healthcare professionals spoke positively about the care provided especially about end-of-life care.

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 good (published 1 December 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to review the key questions of safe, caring 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. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Tollesby Hall Nursing Home our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified a breach in relation to the failure to maintain accurate and complete records in relation to the service and people's care.

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

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.

We found the following examples of good practice.

• Systems were in place to minimise the risk of visitors catching and spreading infections.

• Staff promoted and practised social distancing. Systems were in place to keep people safe should an infection outbreak occur.

• Staff used and disposed of personal protective equipment (PPE) safely. Sufficient stocks of PPE were in place and conveniently positioned around the building.

• Clear systems were in place to admit people safely to the service.

• Regular Covid-19 testing took place.

• We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.

Tollesby Hall Nursing Home provides both personal and nursing care to a maximum of 55 people. The service supports younger adults, people who have a physical disability and older people. At the time of the inspection there were 53 people who used the service.

Tollesby Hall Nursing Home is an established service, which had been previously registered under a different provider. This is the first inspection of the service under the new provider.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

There was a strong presence of health care professional involvement at the service, which ensured people experienced a high level of care and support that promoted their health and wellbeing. People and relatives were extremely complimentary about the care and support received. It was clear from speaking with the registered manager, staff, relatives and hearing from professionals that the registered manager and provider were committed to achieving excellence in the provision of care.

End of life care was exemplary. The registered manager worked closely with other healthcare professionals to ensure people received excellent end of life care. Relatives consistently praised end of life care.

Staff understood the procedure they needed to follow if they suspected abuse might be taking place. Risks to people were identified and plans were put in place to help manage the risk and minimise them occurring. Medicines were managed safely with an effective system in place. Staff competencies, around administering medicines, were regularly checked. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety was maintained.

People and relatives told us there were enough staff on duty to meet the needs of people who used the service. In general we found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with people. We did note some gaps in employment history, however the registered manager and provider had resolved this by the second day of our inspection.

People were supported by a team of staff who were knowledgeable about people’s likes, dislikes and preferences. A training plan was in place and the registered manager monitored this to make sure all staff were up to date with their training requirements.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People received diets tailored to their specific needs and were able to choose meals of their choice. Staff supported people to maintain their health and attend routine health care appointments.

Relatives and professionals were extremely complimentary about the care provided, particularly about the care people had received at the end of their life. People’s privacy and dignity was respected.

Care plans detailed people’s needs and preferences. Care plans were reviewed on a regular basis to ensure they contained up to date information to enable staff to meet people’s care needs. People and relatives were actively involved in care planning and decision making. People who used the service had access to a range of activities and leisure opportunities. The service had a clear process for handling complaints.

Staff told us they enjoyed working at the service and felt supported by the registered manager. Quality assurance processes were in place and regularly carried out by the manager and provider, to monitor and improve the quality of the service. The service worked with various health and social care agencies and sought professional advice to ensure individual needs were being met.