Inspection on 18/05/05 for 42a-b Lowther Park

This inspection was carried out on 18th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

42a-b Lowther Park 17/07/07

42a-b Lowther Park 19/06/06

42a-b Lowther Park 14/09/05

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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Clover House

Dystlegh Grange

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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/42b Lowther Park Kendal Cumbria LA9 6RS Lead Inspector Ray Mowat Unannounced 18 May 2005 16:00 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/42b Lowther Park F58-F10 s22686 42a & b lowther park v216852 180405 ui stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service 42a/42b 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 Vacant Care Home 7 Category(ies) of Learning disability; Physical disability registration, with number of places 42a/42b Lowther Park F58-F10 s22686 42a & b lowther park v216852 180405 ui stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 7 people with learning disabilities 1 of whom may also have a physical disability Date of last inspection 06 December 2004 Brief Description of the Service: 42A/42B Lowther park is situated on a residential housing estate on the outskirts of Kendal, Cumbria. The premioses are two halves of a semidetached property, which has been knocked through to create one dwelling. is owned by Impact Housing Association and operated by the Oaklea Trust, a not for profit charitable organisation, specialising in providing services to people with learning disabilities. Currently it provides a home for seven people with a learning disability, one of who also has 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 traditional baths, with toilets on the first floor. The communal space 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, side and rear of the home. 42a/42b Lowther Park F58-F10 s22686 42a & b lowther park v216852 180405 ui stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 4pm and 9pm on the 18th April 05. During the course of the inspection the inspector met with six of the seven residents, three permanent staff and one agency staff. At the start of the inspection time was spent with the new manager, Mr Ray Boothroyd. The requirements and recommendations from the previous inspection were discussed and outstanding actions identified. Mr Boothroyd was aware of complaints/grievances raised by Trust staff that related to the home. It was explained to Mr Boothroyd the allegations had been forwarded to Social Services and the Commission for Social Care inspection and a joint investigation was underway. What the service does well: What has improved since the last inspection? Since the last inspection five of the previous requirements have been met in full with a carpet replaced and minor repairs completed. In addition decoration of the home has started. One of the two good practice recommendations has been met in full. Guidance relating to all medication held outside of the monitored dosage system has been introduced. 42a/42b Lowther Park F58-F10 s22686 42a & b lowther park v216852 180405 ui stage 4.doc Version 1.20 Page 6 Permanent staff were clear about their role and the need to encourage and support independence. There was evidence some new activities had been introduced based on individual needs and preferences. What they could do better: The home must ensure all residents are issued with an up to date contract of terms and conditions, preferably in a format that is meaningful to them. The home must improve the recruitment and retention of permanent staff as recently turnover has been high. In addition they must improve the induction of new staff, ensuring they are familiar with residents and their individual needs and the systems in the home, therefore ensuring a continuity of care. Care plans must be reviewed, also the content of the care plan files should be checked to ensure only current and relevant information is held, therefore avoiding confusion for staff. The storage of confidential information must be reviewed particularly the storage of daily care notes/diaries, which were left out in the kitchen areas of the home. Another priority for the home is the development of a detailed programme of repairs and renewal, including specific timescales for work to be completed. The poor condition of the decoration and furniture in the home has been an ongoing issue and is an outstanding requirement from two previous inspections. The Trust has completed some consultation, however the home must consult locally with residents of the home, so that their views can be incorporated into an annual development plan. The management responsibilities as set out in the Care Home Regulations, regarding the reporting of notifiable incidents and management visits to the home, have not been carried out as required. In addition the on-call management arrangements should be reviewed, as the current arrangements are inadequate, with senior support workers who were on shift in a home, responsible for the on-call service, this meant they were only able to offer telephone support. Please contact the provider for advice of actions taken in response to this 42a/42b Lowther Park F58-F10 s22686 42a & b lowther park v216852 180405 ui stage 4.doc Version 1.20 Page 7 inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 42a/42b Lowther Park F58-F10 s22686 42a & b lowther park v216852 180405 ui stage 4.doc Version 1.20 Page 8 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/42b Lowther Park F58-F10 s22686 42a & b lowther park v216852 180405 ui stage 4.doc Version 1.20 Page 9 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 and 5. All the people living at Lowther Park were placed there as a result of a care management assessment and after a gradual introduction to the home. This process ensured a detailed assessment of needs was completed and compatibility with existing residents was checked out. Not all the people living at Lowther Park had been issued with adequate up to date information regarding their terms and conditions of residence, therefore were not clear about their rights, about such issues as decoration, payment for food and replacement of furniture. EVIDENCE: The care plan files contained both care management assessments and the home’s own assessments of need. There was also evidence of specialist assessments where needs had been identified. Through this ongoing process individual needs and aspirations are recorded and responded to. Not all the residents had been issued with a statement of terms and conditions. In addition some of the contracts in place were out of date and in need of updating. In particular the timescale for re-decoration and the replacement of furniture and the responsibility for payment, must be clarified. Recordings in the communication book informed staff that the home’s food budget had been reduced from £242 to £220 and repairs and renewals and furniture budgets had also been reduced for the coming year. This is of particular concern with the current state of decoration being a poor standard. 42a/42b Lowther Park F58-F10 s22686 42a & b lowther park v216852 180405 ui stage 4.doc Version 1.20 Page 10 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, 10 The care plans were in need of review, ensuring only current and relevant information is retained on file. The ability of staff, to meet individual needs and choices of residents, has been affected by staff shortages and the use of agency and inexperienced staff. The storage of personal and confidential information needs to be improved. EVIDENCE: The home has developed detailed care plans for all the residents. On examination some of the care plan files were in need of review, which is subject to a requirement. It is also recommended that the content of care plan files be reviewed as some contained information that is no longer relevant and can be confusing to staff. Residents were involved in the development of care plans and were consulted regarding issues within the home. Care plans described family members and representatives supporting residents with decision making as appropriate. Staff were seen to support residents by taking on an enabling role, which promotes and encourages independence and choice. Diary recordings containing personal and confidential information were not securely stored. 42a/42b Lowther Park F58-F10 s22686 42a & b lowther park v216852 180405 ui stage 4.doc Version 1.20 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, 14,16. The home continues to encourage and provide opportunities for personal development and access to community facilities and activities. Opportunities were sometimes limited because of the shortage of staff. In addition when agency staff, or new staff, not properly inducted to the home, were covering shifts, the quality of service being received was poor. EVIDENCE: Five people attend the day service full time and two people attend part time. This provides people with a range of educational, vocational and leisure opportunities, both in the day service and in the community. On the day of the inspection two people returned from their first horse riding session of the season, which they clearly enjoyed and spoke enthusiastically about. There were diary recordings relating to community activities either not taking place or being cut short, due to inexperienced and unfamiliar staff, not being able to provide appropriate support. On the night of the inspection care staff had to spend time in the office, away from residents, whilst trying to cover the early morning shift for the next day. If cover could not be found then the waking night staff would have been left on a one to seven ratio with residents. 42a/42b Lowther Park F58-F10 s22686 42a & b lowther park v216852 180405 ui stage 4.doc Version 1.20 Page 12 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) 18, 19, 20 The systems for the administration of medication have improved with written guidance in place for all medication managed outside of the monitored dosage system. Good recording systems were in place to monitor that personal and healthcare needs were being met. The staffing issues described previously were having a detrimental impact on the consistency of personal support and meeting individual’s emotional needs. EVIDENCE: Healthcare needs of residents were recorded in care plans, with key workers taking a lead role in monitoring individual needs. Staff spoken to on the whole had a good awareness of individual needs. However training in the use of an Epipen is required. Care notes described how a new member of staff, supported a resident of a different gender, with bathing and personal care when meeting them for the first time. This was poor practice and does not respect the privacy and dignity of individuals. Diary notes also documented events where staff had made inappropriate judgements resulting in very undignified incidents occurring. Permanent staff also spoke of residents exhibiting an increase in agitated behaviour, when staff, who were unfamiliar to them, were on shift. Staff rosters showed vacant shifts and an increased use of different agency staff and new staff with very little induction, being on duty in the home. 42a/42b Lowther Park F58-F10 s22686 42a & b lowther park v216852 180405 ui stage 4.doc Version 1.20 Page 13 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, 23. Policies and procedures for dealing with staff grievances, whistleblowing allegations and allegations of abuse, have not been followed satisfactorily. EVIDENCE: There were no recorded complaints within the home since the last inspection. The Commission has received written statements from staff alleging poor management practice and allegations of abusive behaviour. A meeting has been held with the responsible individual for the Trust, Sue Green, to make her aware of the concerns. A full joint investigation is now ongoing, with Social Services, the Integrated Commissioning team and the Commission for Social Care Inspection. Many of these issues were initially raised with the Trust senior managers but the staff that raised them felt they have not been investigated fully. Therefore the Trust has been asked to provide evidence of internal investigations of the allegations, which were handed to them in January 05. 42a/42b Lowther Park F58-F10 s22686 42a & b lowther park v216852 180405 ui stage 4.doc Version 1.20 Page 14 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, 25, 26, 27, 28, 29, 30. The décor within the home is poor, with little evidence of improvement through maintenance or future planning. EVIDENCE: The state of the environment is an outstanding requirement from the previous two inspections. The new manager acknowledged the décor within the home is a poor standard and not a pleasant environment for residents. There was evidence that some decorating has been started, therefore timescales will be extended. The home must produce a detailed programme of repairs and renewal including timescales for action. There was evidence that the budgets for decoration and furniture for the home were being reduced. This was detailed in the staff communication book by a brief note written by a temporary manager. This is a major concern when considering the current condition of the home. Resident’s rooms were personalised and provide a comfortable and safe environment in line with their needs and lifestyles. The toilets and bathrooms were appropriate to meet the varied needs of the current residents. Suitable adaptations have been made to the home as a result of specialist assessments. 42a/42b Lowther Park F58-F10 s22686 42a & b lowther park v216852 180405 ui stage 4.doc Version 1.20 Page 15 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, 34, 35, 36. The staffing situation in the home and temporary management arrangements, have had a detrimental impact on resident’s lives and put increasing pressure on the permanent staff within the home. Recruitment of permanent staff must be a priority, alongside improvements in the induction and training of new and temporary staff. EVIDENCE: On the night of the inspection it was evident the next days early shift was not covered, this meant staff on shift spending time away from residents whilst they tried to cover the shifts. Based on discussions with staff there was evidence of agency staff and Trust staff working in the home, with little or no induction, to the residents, or the safe working practices of the home. This resulted in residents needs not being appropriately met and a poor continuity of care. Communication books and staff rosters, document examples of inadequate cover and the delivery of a “disjointed service” at times only meeting basic care needs. The new manager described the actions taken since his appointment, which were encouraging. This included holding of a staff meeting to identify staff concerns and what was working well within the home and to set some initial targets. 42a/42b Lowther Park F58-F10 s22686 42a & b lowther park v216852 180405 ui stage 4.doc Version 1.20 Page 16 Staff felt unsure with the appointment of another “temporary manager” but were keen to work with him to create a stable home environment for the residents. 42a/42b Lowther Park F58-F10 s22686 42a & b lowther park v216852 180405 ui stage 4.doc Version 1.20 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, 40, 41, 42, 43. The new manager has a good understanding of the areas in which the home needs to improve. Plans need to be put in place outlining how these improvements will be made. There are concerns regarding recent management practice both within the home and in the Trust that are currently being investigated. Management visits to the home and notifications to the Commission, as required by the Care Home Regulations have not been complied with. EVIDENCE: As described previously communication books and staff rosters show that the residents have not benefited from a well run home. Based on these recordings and statements by staff, there has been major concerns raised about the leadership and management approach to the home that must be fully addressed. 42a/42b Lowther Park F58-F10 s22686 42a & b lowther park v216852 180405 ui stage 4.doc Version 1.20 Page 18 There was evidence of consultation with residents, which now needs to be strengthened with local consultation within the home culminating in the production of an annual development plan for the home. Resident’s rights have not been safeguarded by the home’s policies and procedures with evidence of incidents of major concern not being reported, as is legally required by regulation 37 of the Care Home Regulations 2001. In addition there are concerns regarding the home’s and the Trust’s response, to allegations of mistreatment and abuse and whistle blowing. Also the Trust has not been carrying out regulation 26 management visits as required. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 x 1 Standard No 22 23 ENVIRONMENT Score 2 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 42a/42b Lowther Park Score 1 3 Standard No 24 25 26 27 28 29 Score 1 3 3 3 3 3 Version 1.20 Page 19 F58-F10 s22686 42a & b lowther park v216852 180405 ui stage 4.doc 8 9 10 LIFESTYLES 3 x 1 Score 30 STAFFING 3 Standard No 11 12 13 14 15 16 17 3 2 3 2 x 2 x Standard No 31 32 33 34 35 36 Score 1 1 1 1 1 1 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 x Standard No 37 38 39 40 41 42 43 Score 1 1 2 2 2 1 1 42a/42b Lowther Park F58-F10 s22686 42a & b lowther park v216852 180405 ui stage 4.doc Version 1.20 Page 20 Yes 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 5 Regulation 5 Requirement The home must issue an up to date contract of terms and conditions to all residents in the home.(Previous timescale of 1st February not met) The decoration of the home must be maintained to a reasonable standard. (Previous timescale of 1.12.04 not met) An annual development plan for the home must be produced based on local consultation with residents. (Previous timescale of 1.3.05 not met) Care plans must be reviewed at least every six months or at the request of the resident or their representitive. Personal and confidential information must be securely stored at all times. A detailed programme of repairs and renewal, including timescales, must be developed. Approriate induction training in line with TOPSS standards must be completed by all new staff, within the required timescale. All temporary/agency staff must receive training appropriate to the work they are to perform. Timescale for action 31st July 05 2. 24 23(2)b 31st July 05 3. 39 24 1st June 05 4. 6 15(2)b 1st June 05 5. 6. 7. 7 24 35 12(4)a 23(2)b 18(1)a 1st May 05 1st June 05 1st July 05 8. 35 18(1)b, c 1st June 05 42a/42b Lowther Park F58-F10 s22686 42a & b lowther park v216852 180405 ui stage 4.doc Version 1.20 Page 21 9. 33 18(1)a 10. 11. 37 26 42 43 12. 20 13 The home must ensure at all times suitably qualified, competent and experienced persons are working in the home in such numbers as are appropriate for the health and welfare of residents. All notifiable incidents must be recorded and reported in line with this regulation(37). Management visits must take place as required and be forwarded to the appropriate parties as described in regulation 26. All staff must receive appropriate training in emergency medical procedures involving the use of an Epipen. 1st June 05 1st May 05 1st May 05 1st June 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. Refer to Standard 6 36 43 Good Practice Recommendations It is recommended care plan files are audited to ensure only current and relevant information is retained. The on-call management arrangements should be reviewed to ensure appropriate support is available when required. It is recommended the budgets for the home should be reviewed through consultation with all relevant parties. Any changes to terms and conditions of residence, should then be incorporated into individual contracts. 42a/42b Lowther Park F58-F10 s22686 42a & b lowther park v216852 180405 ui stage 4.doc Version 1.20 Page 22 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/42b Lowther Park F58-F10 s22686 42a & b lowther park v216852 180405 ui stage 4.doc Version 1.20 Page 23 - 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. 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