At our inspection on 11 November 2013, we found that Totham Lodge Residential Home for the Elderly was not compliant with four standards. The provider sent us an action plan on 12 December 2013 telling us what actions they would take to improve the service. Our inspection of 15 April 2014 was to check if improvements had been made.On the day of our inspection, 28 people were living in Totham Lodge Residential Home for the Elderly. We spoke with seven people and six of their relatives who were visiting. We also spoke with six staff.
Many people were not able to talk to us verbally about their experience of the service but we saw that they were relaxed and comfortable. We looked at a range of records which included three people's care plans and daily records, staff training, staffing rotas, health and safety and quality checks.
We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?
This is a summary of what we found;
Is the service safe?
All the people we spoke with told us that they felt safe in Totham Lodge Residential Home for the Elderly. The house was an old building and in need of some redecoration which was underway. People were protected from accessing areas that could be harmful to them.
Medication administration had been improved but further work was needed to bring it up to the required standard to fully ensure people were protected from harm.
We saw that people had their needs fully assessed which included all aspects of their lives. Where people were unable to make day to day or significant decisions, Mental Capacity Act (MCA) 2005 assessments had been undertaken. However, we identified that a MCA was needed for one person in relation to their medication as they had not consented to the way their medication was given. No Deprivation of Liberty Safeguards (DoLS) were needed at this time.
The provider had reviewed the dependency levels of people using the service since our last inspection. Recruitment and training for staff was underway. The required amount of staff were on duty on the day of our inspection with the appropriate skills to meet people's needs safely.
Staff knew about safeguarding people who used the service and told us what they should do if they suspected or witnessed abuse. This kept them and those around them protected from harm.
Is the service effective?
People's assessments showed that their care, support and treatment was planned and delivered in a way that ensured their safety and welfare. The records were reviewed and updated which meant that staff were provided with current information about how people's needs were to be met.
People told us that they had access to health and social services. The provider involved a range of professionals such as general practitioners and district nurses in people's care which ensured their care and treatment was planned and coordinated.
Is the service caring?
We observed the interaction between staff and people using the service. Staff were warm, kind, supportive, knowledgeable and professional with a positive attitude to their work and the people they were caring for.
One person said, 'They (the staff) are lovely.' Another said, 'I do feel that they look after me well.' A relative said, 'We looked at other homes but when we came here, we had such a lovely warm welcome. It's been the same ever since.'
Is the service responsive?
We saw in the care plans and daily records that the staff responded appropriately to people's changing needs, wishes and interests. Families were involved as appropriate in the decision making about people's care. One relative told us, 'There is always an open door here and I am included in my (relatives) care.'
The range of individual activities and entertainment had improved and the staff were getting more involved in spending one to one time with people. One person said, 'I like the peace and quiet, reading or talking with staff is enough for me. Another person told us, "It is really boring here, there is nothing to do.' One staff member said, 'We often don't get time to sit with people if we are needed elsewhere'.
Staff, residents and relative's meetings had been held after the last inspection to discuss the findings. People were able to express their views and the provider responded by drawing up a plan of changes. This meant that people felt listened to and valued.
Is the service well-led?
There had been some changes to the management at Totham Lodge Residential Home for the Elderly in the past four months. The new manager was implementing changes to care planning and delivery, training, medication and quality assurance to ensure people were cared for appropriately and to a high standard.
The staff we spoke with told us that they welcomed these changes. One staff member said, "Things are improving and it would be good to have face to face training to refresh our knowledge and not just watch DVD's.'
We found improvements in the way medicines were managed at the service but people were not fully protected against the risks associated with medicines because the provider did not have appropriate arrangements in place for the recording of the administration of medicines. There was insufficient guidance for staff on the use of some medicines.
The service had a quality assurance system in place and records seen by us showed that identified shortfalls were now being addressed. As a result the quality of the service was continuingly improving.