Tomswood Lodge Limited

Tomswood Lodge Limited is a residential care home providing the regulated activity of accommodation and personal care to up to 8 people. The service provides support to people with learning disabilities or people living with autism. At the time of our inspection there were 8 people using the service. The service was an ordinary home in a residential street, which had been adapted to meet the needs of people using the service.

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

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.

Right Support: People were not always fully supported to develop independent living skills and this was not covered in care plans. Although people were able to live in an ordinary residential home, there were issues with the maintenance of the premises. Staff did not receive regular one to one supervision.

People were able to choose where they lived. The service was able to assess people's needs before they began living at the service, so they knew whether they could meet their needs. Staff were supported through training to gain knowledge and skills to help them in their role. People were supported to eat a balanced diet and were able to choose what they ate. People were supported to maintain relationships with family and friends, and to engage in meaningful activities.

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.

Right Care: Care was not always person centred. Care plans and risk assessments were not of a satisfactory standard which meant people might not get the care and support they needed in a way that was safe. Medicines were not always managed safely.

There were enough staff working at the service to meet people's needs and the provider had robust staff recruitment practices in place. Infection control and prevention systems were in place. Accidents and incidents were reviewed to see if any lessons could be learnt from them. Staff understood how to support people in a way that promoted their privacy and dignity. People had access to healthcare professionals.

Right Culture: The leadership of the service was not adequate. There was a lack of communication between senior staff. The registered manager received no formal supervision. Quality assurance and monitoring systems were not always effective in identifying areas for improvement at the service.

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 20 September 2018).

Why we inspected

The inspection was prompted in part due to concerns received about the management of the service, maintenance of the premises and staffing levels.. A decision was made for us to inspect and examine those risks.

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.

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 sections safe, effective, caring, responsive and we-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 Tomswood Lodge Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to the management of medicines, care plans and risk assessments, maintenance of the premises and leadership and governance at this inspection.

We have made recommendations about staff supervision and the implementation of Health Action Plans for people.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Tomswood Lodge is a care home. People in care homes receive accommodation and nursing or personal care as 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 and personal care to a maximum of eight people with learning disabilities or on the autistic spectrum. Three people were using the service at the time of our inspection.

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.

The service had a registered manager in place. 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.

Appropriate safeguarding procedures were in place. There were enough staff working at the service to meet people’s needs and robust staff recruitment procedures were in place. Risk assessments provided information about how to support people in a safe manner. Procedures were in place to reduce the risk of the spread of infection. Medicines were managed safely. Steps had been taken to help ensure the premises were safe.

Systems were in place to assess people’s needs before they started using the service to determine if those needs could be met. Staff received on-going training to support them in their role and new staff undertook an induction training programme. People were able to make choices for themselves and the service operated within the principles of the Mental Capacity Act 2005. People told us they enjoyed the food. People were supported to access relevant health care professionals.

People told us they were treated with respect and that staff were caring. Staff had a good understanding of how to promote people’s privacy, independence and dignity. The service protected people’s right to confidentiality and sought to meet equality and diversity needs.

Care plans were in place which set out how to meet people’s individual needs. Care plans were subject to regular review. People were supported to engage in various activities. The service had a complaints procedure in place and people knew how to make a complaint.

Staff and people spoke positively about the registered manager and the working culture at the service. Quality assurance and monitoring systems were in place which included seeking the views of people who used the service.

Tomswood Lodge is a care home that is registered to provide accommodation and support with personal care for eight people with learning disabilities and/or mental health needs. The service also offers respite care which enables carers who look after relatives in their own home, to have some time off while their loved one is placed temporarily in a care service. There were no people in respite care at the time of our inspection.

The service was split between a ground floor and a first floor with three bedrooms on the ground floor and five bedrooms on the first floor. At the time of the inspection, four people were using the service. During our last inspection on 23 April 2014, we found that the service was not fully compliant with all regulations we checked. We asked the provider what actions they would take to meet legal requirements in relation to safeguarding people from abuse and they wrote to us with an action plan. We checked that these actions were completed in September 2014.

The service had a registered manager in place at the time of our inspection. 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.

The service provided care and support to people to enable them to become more independent. We found that people were cared for by sufficient numbers of qualified and skilled staff. Staff also received one to one supervision and received regular training. People were supported to consent to care and the service operated in line with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People were given choices over what they wanted to eat and drink and they were supported to access healthcare professionals. People’s finances were managed and audited regularly by staff so that people’s money was kept securely.

People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. The care plans contained a good level of information setting out exactly how each person should be supported to ensure their needs were met.

Staff had very good relationships with people living in the service and we observed positive and caring interactions. Staff respected people’s privacy and supported people to express their views. People pursued their own individual activities and interests, with the support of staff. The environment was safe and clear of any health and safety hazards; however the service did not always label or record the dates when jars of perishable food were opened.

There was a structure in place for the management of the service. People, relatives and visitors could identify who the registered manager was. People felt comfortable sharing their views and speaking with the registered manager if they had any concerns. The registered manager demonstrated an understanding of their role and responsibilities. Staff and people told us the registered manager was supportive. There were systems to routinely monitor the safety and quality of the service provided.

We found one area where we have made a recommendation to the service, which is detailed in the report.

On 17 June 2014, we received an action plan confirming that the provider had taken action to become compliant with the Regulations.

At this inspection we found that improvements had been made. People told us they felt safe living at the home and that staff treated them well. A person who used the service told us, "I like it here, it's ok."

Safeguarding procedures were in place. Staff demonstrated an understanding of the types of abuse that could occur. They were aware of the signs they would look for and what they would do if they thought someone was at risk of abuse or harm, including who they would report any safeguarding concerns to. However, we were concerned that the manager had not been notified of a safeguarding alert, by the Local Authority, about a situation that had occurred in June 2014, as a potential safeguarding issue. They were not aware that it had been raised as a safeguarding alert with the Local Authorities responsible for placing people at the home. We have asked the provider to forward a monthly report about their progress against the care plans and risk assessments set by the respective local authorities to the Care Quality Commission.

The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLs). MCA 2005 is legislation to protect people who are unable to make decisions for themselves. We saw that when there were concerns about a person's ability to make a decision affecting their safety and welfare, a mental capacity assessment had been carried out and a formal application had been made for a DoLs to be put in place. This had been agreed by the relevant local authority and will be reviewed after a year to ensure that it was still appropriate. This meant that people's rights were protected. The provider had informed the Care Quality Commission of incidents that affected people's welfare, health and safety.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found.

Is the service caring?

We spoke with people being supported by the service. We asked them for their opinion about the staff that supported them. They told us that the staff were "nice" and "caring" and had enough time to deliver the planned care. One person said "staff are nice, they look after me. She knows what I like, I told her." Another person told us "I like living here." People's preferences and diverse needs were recorded and care and support had been provided in accordance with their wishes. A relative told us "they have very very caring assistants. We couldn't be happier, they have been absolutely marvellous with him. They take him to church and on holidays."

Is the service responsive?

The staff we spoke to were knowledgeable about the needs of people they supported and how to meet them. They told us that if they identified that people's needs had changed, they would inform the manager who would re-assess the person's needs and update their care plan and risk assessments.This meant that the planning and delivery of care was flexible and kept up to date in recognition of people's changing needs. People were supported to access health and social care professionals when required.

Is the service safe?

People told us they felt safe. Safeguarding procedures were in place and staff understood how to safeguard people they supported. Systems were in place to make sure that managers and staff learnt from events such as whistleblowing and safeguarding investigations. This reduced the risks to people and helped the service to continually improve. Appropriate risk assessments were in place. Staff knew about risk management strategies for example, how to prevent falls in order to provide safe care to people. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected. However the provider did not ensure that any control measures applied were in line with the guidelines in the Mental Capacity Act 2005 Code of Practice and include best interest assessments where people were deprived of their liberty.

Is the service effective?

People's care needs were assessed with them and they were involved in developing their plans of care which reflected their current needs. People were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives. We spoke with four people using the service and asked them for their views about the care and support they received. They were positive about their experiences. People told us the staff are "nice they look after me."

Is the service well-led?

The service had a quality assurance process. Sufficient systems were in place to monitor the quality of the service provided to ensure that people received safe, quality care. We saw questionnaires completed by people who used the service.The manager spoke with staff at staff meetings to seek their views and opinion about the service. Staff told us they were clear about their roles and responsibilities. They were supported by the manager to provide good, quality care and were encouraged to complete relevant training which enabled them to carry out their roles effectively. This helped to ensure that people received a good quality service at all times.

People knew how to make a complaint if they were unhappy. One person who used the service said "If there is a problem I tell the staff and they sort it out." Another person told us "I am happy with the food and I am happy with everything." Staff told us that people who used the service were asked at the residents meetings if they were satisfied with the care that they received and were always asked if they had any concerns.They told us that any concerns were dealt with straight away to avoid them from becoming major issues. However we found that the provider had not notified the Care Quality Commission of all incidents which had occurred in the home as required under the Care Quality Commission Regulations (2009). Informing CQC of safeguarding incidents as well as other incidents is a regulatory requirement so that appropriate action where needed could be taken.

We found risk assessments and care plans were in place. These set out how to meet people's individual needs. Records showed that people had access to other heath care professionals. We found the service had enough staff to meet people's needs and systems were in place to assess and monitor the quality of service provision.