We undertook this unannounced comprehensive inspection on 6 September 2018. We last inspected Tollington Lodge Rest Home in November 2015 and we had rated the service good. At this inspection we found the service had deteriorated and was rated as requires improvement.

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

Tollington Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a 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 for up to 25 people requiring assistance with personal care. During our inspection there were 24 people living in the home.

Accommodation is offered over two floors and consists of single bedrooms, most of the bedrooms have washing facilities and a toilet. The dining room is centrally located on the ground floor and people can sit in one of two lounges. People can access and use the front garden, there is seating available and the ground is flat, making it accessible.

There was a registered manager for the service. 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.

Medicines were not always administered safely or in line with the service’s procedures. This meant that people were at risk from not receiving the correct dose of medicine. The date that creams and ointments were opened was not always recorded on the container. This meant that people may have creams or ointments applied that had gone out-of-date.

People’s privacy was not always respected. We observed some staff entering the rooms of people without knocking on the door. We saw other staff that did knock before entering the room. People were not always treated with dignity and respect when they were being moved in wheelchairs.

There was a programme of quality audits in place and these were managed by the registered manager. There was a further ‘audit of audits’ in place and these were completed by the provider. However, these did not always identify potential risks. For example, only one radiator in the service had a radiator cover and no control measures, for example guarding the heated areas, or risk assessments were in place relating to the risk to people from hot surfaces.

Equipment was not always safe for people to use. For example, one adjustable bed posed an entrapment risk due to poorly fitting bed rails and another had bedrails that were unsafe.

People spoke positively about the registered manager and provider, saying they were approachable and they could complain if necessary.

Staff could describe the different types and indicators of abuse, including the actions that they would take if they thought abuse had occurred.

The service responded to changes in people’s needs and worked with healthcare professionals to achieve good outcomes.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of this report.

Tollington Lodge Rest Home is a care home providing accommodation for up to 25 older people, some of whom are living with dementia. During our inspection there were 23 people living in the home. The home is a detached property set out over two floors and is situated in a residential area of Weston Super Mare.

The inspection took place on 25 November 2015 and was unannounced.

There was a registered manager in post. 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 registered manager was leaving the service in December 2015 and the provider had appointed another manager who would be applying for the registered manager’s position with us.

The provider had an improvement plan that detailed areas for service improvement. The plan did not identify all of the shortfalls in the service. The director and manager had plans to introduce a system to audit the service.

A recruitment procedure was in place and staff received pre-employment checks before starting work with the service. One staff members personnel file did not contain evidence of a pre-employment check, the manager provided us with evidence confirming this was in place following our inspection.

Staff received training to understand their role and they completed training to ensure the care and support provided to people was safe. New members of staff received an induction which included shadowing experienced staff before working independently. The induction did not link into the Care Certificate Standards which are standards set by Skills for Care to ensure staff have the same skills, knowledge and behaviours to provide compassionate, safe and high quality care and support. Staff received supervision and told us they felt supported.

Where people lacked capacity to make decisions for themselves the Mental Capacity Act 2005 code of practice was not always followed.

People and their relatives told us they or their relatives felt safe at Tollington Lodge. Systems were in place to protect people from harm and abuse and staff knew how to follow them. The service had systems to ensure medicines were administered and stored correctly and securely. There were enough staff available to keep people safe and the provider had plans to recruit staff to cover activities, the laundry and assist in the kitchen.

People and their relatives told us they were happy with the care they or their relative received at Tollington Lodge. One person told us, “I have had nothing but kindness”. Staff interactions with people were positive and caring.

People were complimentary of the food provided and had access to food and drinks throughout the day. Mealtimes were a sociable experience. Where people required specialised diets these were prepared.

People and relatives were confident they could raise concerns or complaints with the manager or provider and they would be listened to.

The provider sought the views of people and relatives to gauge satisfaction and make improvements to the service.