CQC report explained · a residential care home
What the CQC found at Totteridge House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Inspectors found weaknesses in fire safety records, fire training and night-time staffing for emergency evacuation. They found medicines, safeguarding, infection control and everyday risk assessments were generally managed safely.
- Effective?
- Good
- This question was not inspected during this focused visit. The report says ratings for questions not inspected were carried over from the previous inspection.
- Caring?
- Good
- This question was not inspected during this focused visit. The report describes person-centred care, compassion and positive outcomes, but does not give a current rating for Caring.
- Responsive?
- Good
- This question was not inspected during this focused visit. The report describes support for communication, independence, hobbies, college and community activities, but does not give a current rating for Responsive.
- Well-led?
- Requires improvement
- The manager and staff were described as committed and supportive, but records were not always accurate or complete. Audits had failed to identify important safety and record-keeping problems.
What inspectors found, November 2022
Rated Requires Improvement; inspectors found caring, person-centred support but concerns about fire safety, night staffing and management records.
This was an unannounced, focused inspection on 20 and 21 September 2022. Inspectors looked mainly at whether the home was safe and well-led. They spoke with people, relatives, staff and health professionals, and checked care, fire safety, medicines, recruitment and management records.
The home provided support for five people with learning disabilities, including autism. Relatives and professionals described kind, person-centred care. People were supported with communication, independence, community activities and life skills.
Inspectors found important weaknesses in fire safety arrangements. Night staffing did not match the support people needed in their emergency evacuation plans. Fire drill records and fire training records were also incomplete. Some other records were inaccurate or missing, and audits had not found these problems.
The overall rating changed from Good in 2018 to Requires Improvement. Safe was rated Requires Improvement, and well-led remained Requires Improvement. The provider was asked for an action plan, and CQC said it would monitor progress.
Person-centred support
People received support based on their individual communication needs, goals and interests. Inspectors found that this helped improve wellbeing and independence.
“Person centred care was provided which promoted positive outcomes for people.” from the report
Kind and trusted staff
Relatives said staff understood their family members well and managed distressing behaviours appropriately. Staff were described as kind, supportive and professional.
“The staff have a very good attitude to my son, they are kind, supportive and friendly,” from the report
Support for independence
People were supported to take part in community activities and develop skills. Examples included college, swimming, holidays and a driving experience.
“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.” from the report
Safeguarding and medicines
Staff understood how to report safeguarding concerns. Medicines were stored, recorded and administered using established systems.
“Systems were in place to safeguard people. The provider had safeguarding policies in place and staff were trained in safeguarding.” from the report
Positive working relationships
The home worked with families and health professionals to support people. Professionals said the management team responded to advice and worked collaboratively.
“The manager works collaboratively with health professionals, including the GP,” from the report
Night-time evacuation risk
seriousThe staffing available at night did not match the level of help people needed in their emergency evacuation plans. This could have put people at risk during a fire.
“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.” from the report
Weak records and audits
seriousSome care, fire safety, cleaning, training and recruitment records were incomplete or inaccurate. Audits had not identified these problems or the overdue legionella testing.
“Records were not suitably maintained, accurate and auditing was not effective to assess, monitor and improve the quality and safety of the service.” from the report
Fire training and drill records
needs fixingFace-to-face fire training was overdue for some staff, and fire drill records did not always show who took part or how people responded.
“The training records viewed showed face to face fire safety training was overdue for seven out of the 16 staff, and not completed by three new staff.” from the report
- 01What is the current night staffing level, and how does it meet each person's emergency evacuation plan?
- 02When were all outstanding fire safety training updates completed, and how often are they now checked?
- 03How do you test that fire drills are completed properly and that people's responses are recorded?
- 04What changes have been made to the audit system so inaccurate care, cleaning and fire records are found promptly?
- 05Has legionella testing taken place since the inspection, and how is the testing schedule recorded?
This was a focused inspection of Safe and Well-led only; the other questions were not inspected and their previous ratings were used to calculate the overall rating. This explanation was written from the published report of 4 November 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, May 2018
Rated Good overall, but inspectors found the home needed to improve its records, audits and quality checks.
This was an unannounced inspection on 23 and 24 April 2018. The inspector visited the home, observed care, spoke with people, relatives and staff, and reviewed care plans, medicines, staff files, training and other records.
The home was rated Good for Safe, Effective, Caring and Responsive. Inspectors found enough staff, suitable medicines systems, improved staff training, kind care, personalised support and activities. People were supported with communication, health needs, choices and independence.
The home was rated Requires Improvement for Well-led. Records were still difficult to use in places, and audits and feedback systems were not yet strong enough to show that the service was being fully monitored and improved. Some areas also needed redecorating and a deep clean.
The provider had improved since the previous inspection, when it breached three regulations. The report says the home was no longer in breach of those areas, but further work was needed, especially under the new manager.
Safer support
Risks were identified and managed, and staff understood how to support people whose behaviour could become distressed or challenging.
“People were protected from potential abuse and risks to people were identified and managed.” from the report
Kind staff
Inspectors saw staff giving people time, explanations, reassurance and appropriate support.
“Staff were friendly and welcoming. They were gentle, kind, caring and encouraging in their engagement with people.” from the report
Communication support
The home used pictures, signs, social stories and other tools to help people understand information and make choices.
“People were provided with written information in an easy read format and pictures to promote their understanding of procedures such as fire safety and hazards in the kitchen.” from the report
Personalised activities
People had individual activity programmes and were supported with interests, education, community activities and daily living skills.
“Throughout the inspection we saw community access was encouraged and some people got involved in cooking.” from the report
Improved management
The new manager had identified areas for improvement, and staff said teamwork, support and communication had improved.
“Staff felt the change in management had resulted in better team working.” from the report
Incomplete training records
needs fixingThe home could not show clearly which staff had completed or were completing the Care Certificate. One workbook had not been assessed or signed off.
“There was no record available or certificates in staff files to show who was working through the Care Certificate induction and who had completed it.” from the report
Records were hard to follow
needs fixingCare files contained repeated information and several progress sheets, making it difficult to identify the most up-to-date information. Some hospital passports were also overdue for review.
“People's care plan files were cumbersome in that there was a duplication of information across all the files and a number of multi-disciplinary progress sheets were in use which made it difficult to establish which was the most up to date.” from the report
Weak quality checks
needs fixingSome temperature and medicines audit records were missing. The new quality system had not yet become an effective way to monitor the home.
“Whilst we recognise a new quality assessment framework was being implemented this was not yet established to provide an effective monitoring tool.” from the report
Environment needed cleaning and repair
needs fixingInspectors found stained carpets, marked walls and damaged fittings. Some areas needed a deep clean to reduce the risk of cross infection.
“There was a build-up of dirt on the floor around the cookers, fridges and washing machine.” from the report
Feedback was not fully used
needs fixingSome surveys were not dated, no surveys had been sent to relatives or other stakeholders, and there was no evidence that feedback had been analysed or acted on.
“Feedback from the surveys that were completed were not analysed and there was no evidence action was taken to address the feedback received.” from the report
- 01Has the planned deep clean been completed, and have the stained carpets, marked walls and damaged fittings been repaired or replaced?
- 02How do you now track Care Certificate completion and staff competency assessments?
- 03How do you make sure care files are streamlined, accurate and easy for staff and families to use?
- 04How are best-interest decisions about medical, dental and screening interventions recorded and reviewed?
- 05How do you collect feedback from relatives and show what action was taken as a result?
This was an unannounced inspection covering all five key questions, including the home, the care provided and records about people's support and the running of the service. This explanation was written from the published report of 22 May 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Totteridge House
3 rated inspections over 5 years: the service has held its Requires improvement rating throughout.
- November 2022Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- May 2018Goodup from Requires improvementSafe: GoodWell-led: Requires improvement
- June 2017Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: GoodWell-led: Requires improvement
- November 2015
Registered with the Care Quality Commission on 10 November 2015.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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89 live-in carers within about an hour of Buckinghamshire
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Most charge £1,020 to £1,300 a week. 79 can care for a couple. 13 years' experience on average.
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