Inspection on 14/09/05 for 42a-b Lowther Park

This inspection was carried out on 14th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

42a-b Lowther Park 17/07/07

42a-b Lowther Park 19/06/06

42a-b Lowther Park 18/05/05

42a-b Lowther Park 06/12/04

42a-b Lowther Park 17/08/04

42a-b Lowther Park 09/03/04

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Ruskin Lodge

Clover House

Dystlegh Grange

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Springfield Cottage

Cuerden Grange Rest Home

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Park Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 42A & B Lowther Park Kendal Cumbria LA9 6RS Lead Inspector Ray Mowat Unannounced 14 September 2005 17:45 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 42A & B Lowther Park F58 F10 s22686 42a&b lowther park v242365 140905 ui stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service 42A & B Lowther Park Address Kendal Cumbria LA9 6RS Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01539 731159 The Oaklea Trust Carol Mary Lucas Care Home 7 Category(ies) of 7 LD - Learning Disability registration, with number 1 PD - Physical Disability of places 42A & B Lowther Park F58 F10 s22686 42a&b lowther park v242365 140905 ui stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. 7 people with a learning disability 1 of whom may also have a physica disability Date of last inspection 18 April 2005 Brief Description of the Service: 42A/42B Lowther Park is situated on a residential housing estate on the outskirts of Kendal, Cumbria. The premises are two halves of a semi-detached property, which has been adapted to create one dwelling. The home is owned by Impact Housing Association and operated bt the Oaklea Trust, a not for profit charitable organisation, specialising in providing services to people with a learning disability. It can provide a home for up to seven people with a learning disability, one of whom may have a physical disability. It is approximately two miles from the amenities of Kendal town centre, with local shops and amenities within walking distance. There are two ground floor bedrooms and six upstairs rooms, one of which is a staff sleep-in room, which doubles as an office. There are adequate bathing and toilet facilities on both floors, including two toilets and a fully accessible walk-in shower on the ground floor and two bathrooms with traditional baths and a toilet on the first floor. The communal space in each side of the home is identical,comprising a lounge, kitchen/diner and small laundry room. There is ramped access to the front door and accessible garden and patio areas to the front and rear of the home. 42A & B Lowther Park F58 F10 s22686 42a&b lowther park v242365 140905 ui stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 5.45pm and 8.45pm. During the course of the inspection the inspector met with six residents and two staff members. Resident’s files were examined in detail, also personal information and records required for inspection and the efficient running of the home. What the service does well: What has improved since the last inspection? What they could do better: The staffing levels within the home continues to be a priority, although improvements have been made the new manager must ensure all vacant posts are filled as soon as practicable, to maintain the improved morale of the staff team. Although a new “service user agreement” has been developed it should now be agreed and signed with all residents or their representatives. Information in the medication file should be reviewed so that only current and relevant information is retained to avoid confusion. Staff were aware of the importance of a person centred approach, they now need training to support them in compiling person centred plans. 42A & B Lowther Park F58 F10 s22686 42a&b lowther park v242365 140905 ui stage 4.doc Version 1.40 Page 6 There has been a lot of uncertainty and disruption with the management of the home, this must now be resolved, so that residents and staff are clear about the management input to the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 42A & B Lowther Park F58 F10 s22686 42a&b lowther park v242365 140905 ui stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection 42A & B Lowther Park F58 F10 s22686 42a&b lowther park v242365 140905 ui stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 5. The home has a sound system for assessing the needs of current and prospective residents. Contracts examined were inconsistent and had not been agreed and signed. EVIDENCE: The home currently has one vacancy in a ground floor room. There have been no new admissions to the home since the last inspection. Recent needs assessments have been completed for all the existing residents, which has compiled detailed information from which to develop care plans. This assessment process will be completed for all new residents in addition to multi disciplinary assessments by other agencies or specialist services. Records on personal files confirmed that the home works closely with a number of specialist services to ensure needs are responded to and appropriately met. A new service user agreement was held on some personal files, however these had not been agreed and signed by residents or their representatives. Some files still had the old agreements in place. It is recommended all residents are issued with the new contract/agreement and it is agreed and signed by them or their representative. 42A & B Lowther Park F58 F10 s22686 42a&b lowther park v242365 140905 ui stage 4.doc Version 1.40 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8, 9, 10. Resident’s needs were being appropriately assessed, with individuals making meaningful choices in their lives. EVIDENCE: Individual care plans were not available for inspection as they were currently being updated and were held in a central office. However recently completed, detailed needs assessments, on which the care plans are based, were available. The information contained within the assessments was in depth and provided staff with pertinent information enabling them to identify and respond to individual’s needs and preferences. Although staff were aware of the principles of person centred planning, they had not received relevant training. It is recommended staff receive person centred planning training to support them in their role. It was evident from the inspector’s observations and from discussions with residents and staff that people were making choices and decisions in their everyday lives. This ranged from choice of food and clothes on a daily basis to choosing holidays. Residents were consulted and actively participate in all aspects of life in the home. Decisions might be made on an individual basis or alternatively at house meetings. Residents were seen to join in or undertake, routine 42A & B Lowther Park F58 F10 s22686 42a&b lowther park v242365 140905 ui stage 4.doc Version 1.40 Page 10 household chores during the inspection. One resident had been supported to get the household shopping, on there return home staff took on an enabling role to assist them to put everything away, discussing which items had been chosen by individuals and when they were to be used. Another resident was busy carrying out cleaning duties such as hovering and mopping. They described to the inspector how they enjoy doing the tasks and obviously took great pride in the fact they could do these things independently. All the residents had a range of risk assessments on their personal files that supported them to lead a safe and independent lifestyle, with staff giving discreet support as identified in the assessment. 42A & B Lowther Park F58 F10 s22686 42a&b lowther park v242365 140905 ui stage 4.doc Version 1.40 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14, 15, 16. It was evident residents were being actively supported to pursue their hobbies and interests, both in the home and in the local community. EVIDENCE: All the residents attend the local day service five days each week. Where they are involved in a range of vocational and educational activities, both at the day centre and in the local community. When the inspector arrived at the home, one member of staff was supporting a resident with the weekly shopping at the local supermarket. A remaining resident was carrying out some household cleaning in the lounge and kitchen. All of the residents were actively involved in many aspects of life in the home, some requiring one to one support, whilst others are independent needing perhaps a verbal prompt. The inspector joined a group of residents in a lounge, where they talked enthusiastically about either a holiday they had been on, or in one persons case a forthcoming trip to Kendal’s twin town in Germany, which they were looking forward to. Another resident had been working with a member of staff, gathering brochures and planning a touring holiday on the continent. The member of staff was providing discreet support and helping the resident to 42A & B Lowther Park F58 F10 s22686 42a&b lowther park v242365 140905 ui stage 4.doc Version 1.40 Page 12 put together a pictorial record of holiday choices, to discuss with her family, before making a final decision. Taking on this enabling role is good practice and encourages people to make meaningful choices in their lives. Another good example of this was two residents who had planned a helicopter ride, which came about as a result of a planning meeting to develop person centred care plans. The inspector examined individual’s daily diaries, which reflected residents enjoying full and varied lifestyles and community activities. These included day trips, visits to the pub or café, church, horse riding, social clubs, in addition to enjoying being in their home, whether it was relaxing in their own room listening to music, watching a film or on their games console or just relaxing in the garden. It was also evident that residents have frequent contact with family and friends both in the home and through visits to relatives. 42A & B Lowther Park F58 F10 s22686 42a&b lowther park v242365 140905 ui stage 4.doc Version 1.40 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20. Personal and healthcare needs were well documented, which ensures a consistent approach is maintained. Medication information needs to be reviewed and updated. EVIDENCE: Within the personal files the staff maintain a detailed record of individual healthcare needs and specialist support. Daily diaries and staff communication books are used to prompt staff, to consult personal files for detailed information relating to any health intervention. Reports relating to specialist support were also retained, ensuring a continuity of care. The home has developed PRN medication procedures for individuals in addition to collating other useful information relating to medication. It is recommended the content of the medication file is reviewed, ensuring only current information is retained and clear guidance and up to date protocols are in place. 42A & B Lowther Park F58 F10 s22686 42a&b lowther park v242365 140905 ui stage 4.doc Version 1.40 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 Through both formal and informal systems, it was evident people’s views were acknowledged and responded to. EVIDENCE: There have been no formal complaints since the last inspection on 19th June 05, when an additional visit took place, due to concerns being raised regarding the staff levels in the home, particularly at weekends and the ability of the oncall service to provide appropriate support, the most recent incident being over the weekend of 11th and 12th of June. The organisation has responded positively to these concerns and the requirements relating to them. A copy of the additional visit report is attached. Since the last inspection the home has developed a House development plan. This was developed based on feedback from resident’s questionnaires and meetings. It has been produced in an accessible format using signs and symbols to support the typed text. This is another positive step the home has made to ensure people’s views are listened to and acted upon. 42A & B Lowther Park F58 F10 s22686 42a&b lowther park v242365 140905 ui stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 27, 28, 29, 30. Routine maintenance and decoration had taken place and further improvements planned, ensuring a safe and comfortable living environment for residents. EVIDENCE: The decoration of the home and other improvements had progressed and made a real difference to the “look and feel” of the home. The lounges and kitchen diners had been painted and new carpets fitted, in addition new suites had been purchased and curtains hung, creating a pleasant homely atmosphere. More decoration was planned as required, with the hallways and bathrooms being a priority. The garden and patio looked well kept with the wooden furniture having been repaired and stained. It was obvious from discussions with residents and staff they were proud of their home and the improvements that had been made. The toilets and bathrooms were appropriate to meet the varied needs of the current residents. Suitable adaptations have been made to the home, ensuring it was safe and accessible, such as grab rails and ramps. On the day of the inspection all parts of the home were found to be clean and hygienic. 42A & B Lowther Park F58 F10 s22686 42a&b lowther park v242365 140905 ui stage 4.doc Version 1.40 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36. Staffing levels in the home are improving providing a more consistent level of care. EVIDENCE: The staffing situation in the home has improved since the last inspection, although the home is still carrying one vacant post. They have managed not to use agency staff, with permanent staff and peripatetic relief staff, covering most of the absences and the vacant post. Staff spoken to felt there had been an improvement in the staff morale, due to their being a consistent team. However there were still shifts that were not being covered, resulting in only two staff being on duty, which is restrictive for residents wanting to pursue their interests and access the community. In addition this puts the existing staff under pressure to work large amounts of overtime, which over a prolonged period has a negative impact on the staff and residents. The home is required to actively recruit to all the vacant posts on the rota. Staff supervision was taking place in the required timescales and a record maintained. Staff had access to the manager and felt they were appropriately supervised. 42A & B Lowther Park F58 F10 s22686 42a&b lowther park v242365 140905 ui stage 4.doc Version 1.40 Page 17 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39, 41, 42, 43. Despite further disruption to the management of the home, it was evident there had been minimal disruption to the lives of residents. Consultation with residents was good and their views were acknowledged and responded to regarding the management of the home. EVIDENCE: Since the last inspection the organisation has had to restructure the management staff, resulting in another change of manager for the home. Although not ideal, the disruption to the home has been minimised as the new manager is already employed by the Trust and is familiar with the home and the management systems of the organisation. The amount of time the new manager spends in the home has not been clarified and it was not reflected on the rota. It is recommended the manager’s shifts in the home are included on the staff rota. The organisation has responded positively to a requirement relating to a review of the on call service. A thorough review has taken place and a draft policy 42A & B Lowther Park F58 F10 s22686 42a&b lowther park v242365 140905 ui stage 4.doc Version 1.40 Page 18 and procedure developed that was more appropriate and would be more effective in responding to out of hours incidents. Since the last inspection a house development plan has been compiled, in a user friendly format, using signs and symbols to support the typed text. This was based on feedback from questionnaires completed by residents or their representatives. The plan incorporated a wide range of issues including, improvements to furnishings and decoration, access to rooms and the home, residents meetings, admission of new residents, key worker allocation, awareness of rights and choices and development of person centred plans. The challenge for the new manager and the staff team now is to ensure the plan is implemented and progress toward the targets is reviewed. There were no obvious hazards noted during the inspection, with routine safety checks and maintenance being completed and recorded. However recent fridge temperature recordings were consistently high, the reasons for this should be explored and remedial action taken. 42A & B Lowther Park F58 F10 s22686 42a&b lowther park v242365 140905 ui stage 4.doc Version 1.40 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x 2 Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 x Standard No 31 32 33 34 35 36 Score 2 3 3 x x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 42A & B Lowther Park Score x 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 2 3 x 3 2 3 F58 F10 s22686 42a&b lowther park v242365 140905 ui stage 4.doc Version 1.40 Page 20 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 33 Regulation 18(1)a Requirement The home must recruit staff to all the vacant posts, ensuring sufficient numbers of staff are available to meet residents needs. Timescale for action 1st November 05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard 5 20 6 42 38 Good Practice Recommendations It is recommended the new service user agreement is issued to all residents and agreed and signed by them or their representitive. It is recommended the content of the medication file is reviewed and only current information is held, with clear up to date guidance and protocols in place. It is recommended staff receive person centred planning training to support and guide their practice. Fridge temperatures were consistently high but no action had been taken. It is recommended the reasons for this should be explored and remedial action taken. It is recommended the time spent in the home by the manager is reflected on the staff rota. 42A & B Lowther Park F58 F10 s22686 42a&b lowther park v242365 140905 ui stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith, Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 42A & B Lowther Park F58 F10 s22686 42a&b lowther park v242365 140905 ui stage 4.doc Version 1.40 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!