Totteridge House

Updated 4 November 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by one inspector on site over two days. An expert by experience carried out calls to relatives after the inspection.

An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Totteridge House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Totteridge House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

During the inspection we walked around the home to review the environment people lived in. We spoke with one person who used the service and used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with the registered manager, deputy manager, one team leader and two support workers. We reviewed a number of records relating to individual's care and the running of the service. These included fire safety, health and safety, recruitment, staff competency assessments and medicine records.

We asked the provider to send further documents after the inspection for review, which included support plans for three people, fire safety records, training, supervision, audits and meeting minutes. We spoke with four relatives and sought feedback from professionals involved with the service.

Updated 4 November 2022

Totteridge House is a residential care home providing the regulated activity accommodation and personal care to up to seven people. Whilst registered for seven people it can currently only accommodate six people, as one of the bedrooms has been converted into a dining room and communal space. The service accommodates six people in one adapted building and provides support to people with a learning disability, including people with autism. At the time of our inspection there were five people using the service.

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

Relatives were happy with the care their family members received. They felt confident they got safe care. They commented “I am extremely happy with the care my son receives, he has at times distressed behaviours and they manage it well,” “Compared to where my son lived before I couldn’t be happier, they understand him better so get the best from him,” “The staff have a very good attitude to my son, they are kind, supportive and friendly,” and “The staff are friendly and professional, my son really enjoys time spent with a couple of his main carers.”

Some records were not accurate and complete. Auditing and monitoring of the service was taking place however, the audits had not identified the shortfalls we found in record management or that sufficient staff were not provided at night-time to provide people with the level of support outlined in their PEEP’s.

Some risks to people were identified and mitigated. Staff were aware of people's risks and how best to support them. Sufficient staff were provided during the day which enabled people to have the support they required and access to community activities. 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. The PEEP’s were reviewed in response to our feedback and we have made a referral to the local fire service.

Safe medicine practices were promoted, and systems were in place to safeguard people from abuse. Staff were clear of their responsibilities in recognising and reporting potential safeguarding incidents. Accident and incidents were recorded and showed a debrief of incidents and a review of positive behaviour management plans to prevent reoccurrence.

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.

Staff felt suitably inducted, trained and supported in their roles. Staff were suitably recruited, although some records relating to recruitment were not on electronic staff files to demonstrate the checks they had carried out. These were added to the file after the inspection.

The service had an experienced manager who was committed to providing a person-centred service for people. They acted as a positive role model to staff and had built positive relationships with health professionals and families. Relatives were complimentary of the registered manager and the stability they had brought to the service. Health professionals told us they worked collaboratively with them. A health professional told us the service supports people with very high complex needs. They commented “The registered manager is always available, leads from the front, is hands on, person centred and see what is important for a person. She puts the people they support at the centre of everything they do.”

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.

The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

Right Support: 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.

Right Care: Person centred care was provided which promoted positive outcomes for people. There was a reduction in distress for people and people were treated with compassion. This promoted their well-being and enabled them to achieve their goals and aspirations which included access to community activities such as swimming, driving experience, holidays and college.

Right Culture: The registered manager promoted a positive, open culture within the service, where staff felt supported, trained and able to raise concerns to enable them to support people to lead inclusive and empowered lives.

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 22 May 2018).

Why we inspected

The inspection was prompted in part due to feedback and concerns around the providers fire safety systems. A decision was made for us to inspect and examine those risks.

As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

We have found evidence that the provider needs to make improvements in the safe and well-led domains.

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 Totteridge House on our website at www.cqc.org.uk.

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.