Archived: Tolverth House

Updated 13 June 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 19 March 2018 and was unannounced. The inspection was carried out by one adult social care inspector. We met with care staff, people who used the service and spoke with a relative. We contacted the deputy manager and provider following this inspection to share the findings of our inspection visits.

The inspection was planned to check if the service had met specific concerns identified following previous inspections in September 2015, February 2016, September 2016, January 2017 and April 2017. Before the inspection we reviewed these inspection reports and other information we held about the service. We spoke with local commissioners about their views on the service. We had received two concerns since the last inspection in April 2017 about the service and looked at the issues raised from these concerns during the inspection. We also looked at notifications we had received from the service. A notification is information about important events, which the provider is required to tell us about by law.

During the inspection we spoke with six people who were able to express their views of living in the service. We looked around the premises in detail and spent time observing care practices.

We spoke with four care staff, domestic staff, and the administrator during our visit. We looked at three sets of records relating to the care of individuals, staff recruitment files, staff duty rosters, staff training records and records relating to the running of the home.

Updated 13 June 2018

Tolverth House provides care for primarily older people, some of whom have a form of dementia. The home can accommodate up to a maximum of 14 people. On the day of the inspection 13 people were living at the service. Some of the people at the time of our inspection had physical health needs and /or mental frailty due to a diagnosis of dementia.

An inspector carried out this unannounced comprehensive inspection on 19 March 2018. At this visit we met with the staff and people who used the service. We also spoke with a relative. Following the inspection we spoke with the deputy manager and the registered provider and checked what action had been taken in relation to concerns raised during our last inspections in September 2015, February 2016, September 2016, January 2017 and April 2017. At those inspections we found systems were not being operated effectively to assess and monitor the quality of the service provided. Due to the repeated breach of regulation 17 of the Health and Social Care Act, we issued a warning notice in September 2016. We reviewed this warning notice in January 2017 and found there continued to be no robust system of effective auditing in place meaning the provider was unable to identify or address any areas of concern. We then issued an urgent letter asking the provider to respond immediately to tell us how they would address the shortcomings of the service to ensure that people were safe. The provider responded and assured us, via their action plan, that all issues would be addressed by the 27 February 2017.

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

We received two anonymous concerns about the service prior to this inspection. Some of the concerns were in relation to staffing levels and premises.

We spoke with the provider about the management structure and our increasing concerns that since September 2015 there had been consistent failings at the service. The service was rated inadequate at the January and April 2017 inspection and remains inadequate at this inspection due to continued failings.

For the last eleven months the provider hoped that the service was going to be sold. Staff were aware of the potential sale of the service as were relatives and people who lived at the service. The provider had therefore not invested in the service, for example with the people they supported, in its staff or its environment. Following this inspection we were informed the sale was not proceeding.

There had been limited financial investment in the service. For example there continued to be no operating central heating in the older part of the home. This had been raised at the last two inspections and no action had been taken to address this. We found generic risk assessments were completed about aspects of the premises, for example the use of standalone heaters. However staff were not following them and therefore were not taking the appropriate action to ensure that potential risks were minimised.

Since the last inspection the call bell system had been updated. However staff told us that they could not hear the call bell system upstairs if a person called for assistance. This meant that it could not be relied on when people called for assistance. We found people were exposed to both inadequate heating and ineffective call bell equipment which could place people at risk of not receiving care safely or promptly.

People were complimentary about the food. Staff told us there continued to be issues with appropriate budgets being available to purchase foods, “Especially in the last three weeks.” One staff member told us they had purchased food themselves and brought it to the service as there was insufficient food stock in the home at that time. This meant that people were at risk of not receiving sufficient nutrition.

At this inspection we found that the provider continued to be in breach of a number of regulations. There remained failings in the overall management of this service. We have reissued breaches of the regulations.

We have also reissued breaches in the area of inadequate care planning and records. For example there were no care plans in place to provide guidance for staff in how to support a person when they became agitated. Therefore care plans did not provide staff with up to date guidance in how to support a person consistently.

We found there continued to be no robust system of effective auditing in place and therefore the provider was unable to identify or address any areas of concern.

The provider had delegated responsibilities to the deputy manager and administrator. However they did not have meetings as a managers group to discuss their roles and their findings. Therefore there was no audit trail of how they planned to monitor and improve the service. We found there was inadequate leadership in place to support the staff team to work to improve the delivery of care.

The service is required to have a registered manager in post. The service had not had a registered manager in post since January 2014.

Due to continuing failures since 2015 we have no confidence in the provider’s ability to address the issues raised and establish an effective and robust system of auditing to enable them to identify and address all concerns.

There had been some improvements to the service. The stair lift was now working. This meant that people who needed to use this stair lift were able to move around the service independently. Recruitment systems were now robust. Concerns that were brought to the deputy manager’s attention were being addressed and referred as appropriate to commissioners.

The overall rating for this service remains ‘Inadequate’ and the service is therefore in ‘special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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