Inspection on 17/08/07 for 81 Lowther Street

This inspection was carried out on 17th August 2007.

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

81 Lowther Street 14/03/07

81 Lowther Street 23/11/05

81 Lowther Street 27/06/05

81 Lowther Street 21/02/05

81 Lowther Street 28/06/04

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

CARE HOME ADULTS 18-65 81 Lowther Street Whitehaven Cumbria CA28 7RB Lead Inspector Liz Kelley Unannounced Inspection 17 August 2007 09:30 th 81 Lowther Street DS0000029268.V345446.R01.S.doc Version 5.2 Page 1 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 81 Lowther Street DS0000029268.V345446.R01.S.doc Version 5.2 Page 2 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 Stationery 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. 81 Lowther Street DS0000029268.V345446.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 81 Lowther Street Address Whitehaven Cumbria CA28 7RB Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01946 691234 The Croftlands Trust Mr Mark Barrett Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (3) 81 Lowther Street DS0000029268.V345446.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The home is registered for a maximum of 6 service users to include: up to 6 service users in the category of MD (Mental disorder under 65 years of age) up to 3 service users in the category of MD(E) (Mental disorder over 65 years of age) 14th March 2007 Date of last inspection Brief Description of the Service: The home is operated by The Croftlands Trust; a non-profit making organisation, which runs a number of residential and community based services in the County for people with mental heath problems. Six places are available to respond to people with severe and enduring mental health illness, living in the community who are in need of short-term crisis intervention and to reduce the need for a hospital admission. The average length of stay is around three weeks and the home takes over 100 admissions every year. 81 Lowther Street is a large Georgian property situated in the town centre of Whitehaven. It is therefore, central for all amenities, transport links and is convenient for both service users and visitors. Each person is given a bedroom of their own and use of a communal lounge, dining room, no smoking lounge and kitchens. Service users are not charged for the service as the Health Authority fund the project. The home is managed by Mark Barrett, two staff are on duty and an aftercare 24 hours telephone support line is also available. 81 Lowther Street DS0000029268.V345446.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an inspection where all the key areas of the National Minimum Standards were checked. Service users were spoken to and they gave their opinions regarding the service and care to the inspector. These comments, and the observations made by the inspector, have informed the judgements made in this report. The inspector also: • Received questionnaires from professionals and other people working with the home • Interviewed the supervisor and staff • Visited the home, which included examining files and paperwork • Received a self-assessment report/questionnaire from the manager. The overall picture gained by the inspector was that 81 Lowther Street offers a unique non-hospital based service that is highly valued by service users and their families. What the service does well: What has improved since the last inspection? At the last inspection a number of areas were identified for improvement and since then the service has reviewed and overhauled many of its practices and procedures. This has led to significant improvements in numerous areas resulting in a more consistent and efficiently run establishment. The most positive feature being a greater focus on care planning which increases the likelihood of positive outcomes for people using the service. 81 Lowther Street DS0000029268.V345446.R01.S.doc Version 5.2 Page 6 Another significant improvement has been the increased support to staff both in one to one supervision and in more training, particularly on listening and counselling skills. What they could do better: 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. The summary of this inspection report can be made available in other formats on request. 81 Lowther Street DS0000029268.V345446.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection 81 Lowther Street DS0000029268.V345446.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service continues to be a unique facility in the area and, therefore real choice is limited. However people using the service are given good information and support to help them make a decision. EVIDENCE: The admission criterion is well-developed and ensures appropriate placements. A recent development has been the introduction of a more in depth assessment carried out by the home in the first few days of a persons placement. This has been a positive move as it allows people to make a connection with their keyworker early on in their stay, and to examine the key issues of their mental health that led to their admission. Staff described the use of further tools to assist in this process, namely a “spider diagram” which visually charts a person’s progress in key areas that affect their mental health, graphically displaying this information at admission and then plotting progress throughout their stay in the home. There was evidence that these were being completed to good standards and involved face-to-face sessions with service users to ensure they were clear on the reasons for their admission and the outcome hoped for. 81 Lowther Street DS0000029268.V345446.R01.S.doc Version 5.2 Page 9 Another positive development is the recent change in emphasis in referrals to crisis and responsive services and a move away from planned regular stays. The home has reviewed its effectiveness in the continuum of care for people with mental health problems in light of other community developments. To this end it has expanded its geographical intake for referrals to include North and East Cumbria. And in line with meeting equal opportunity legislation the project now takes service users over the age of 65 where there is a clear mental health need. In order to minimise any negative impact of recent community changes the management team at Lowther Street have instigated a meeting with Cumbria Partnership For Mental Health on a monthly basis. 81 Lowther Street DS0000029268.V345446.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The individual needs and choice of people using the service have been greatly improved by the recent introduction of a more efficient care planning system. EVIDENCE: The approach of the home is in line with the Care Programme Approach recommended for mental health service users. Service users are mostly knowledgeable of their care plans and goals which leads to a good compliance and success rate. The project is currently working to improve its care planning system. This has included making people who use the service more aware of the role of the staff and what is expected of each person during their stay. Staff have had training in using different ways of working with people to ensure that people gain maximum benefit from their stay. For example staff are using skills developed from training in Motivational Counselling. 81 Lowther Street DS0000029268.V345446.R01.S.doc Version 5.2 Page 11 The staff team has also been re-organised into two teams that are responsible for ensuring that paperwork essential for a successful placement have been carried out. For example these include a detailed needs assessment, care plan and a comprehensive outcome measure are conducted within 72 hours of admission to the service. People using the service were all aware of these documents and were clear on why they had been referred and on their goals, and the role staff had to play in helping them. One person described in detail how they had been helped by staff over the weeks of their stay. From initially being given space and time to moving onto receiving a great deal of emotional support. This person was particularly appreciative of the time staff spent with them individually in talking and listening to their issues. 81 Lowther Street DS0000029268.V345446.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal development and making informed decisions is a key feature for individuals while at Lowther Street and the staff team are skilled at supporting service users to make these choices. EVIDENCE: The service is successful at providing a safe and therapeutic environment where residents can explore the nature of their current illness and personal circumstances. To aid this process the service has strengthened links that promote social inclusion and are aware of good practice models in the mental health field, for example Community Bridge Building. To assist in this, service users are encouraged to have a range of interests and are encouraged to maintain and develop appropriate relationships within the community. Care plans indicated that they are in contact with relevant 81 Lowther Street DS0000029268.V345446.R01.S.doc Version 5.2 Page 13 professionals, such as community psychiatric nurses, to assist in developing their life skills and coping strategies. The home has developed a good balance between risk-taking and a duty of care, and much of the dialogue with service users is around rights, choices and developing positive coping strategies. Service users are treated as individuals and their rights and needs respected and addressed. A good quality and healthy diet is identified as a key feature in promoting a persons well-being whilst staying a the Home. Menus are planned with service users on a weekly basis and a communal evening meal is encouraged. Service users spoke of very much enjoying the food and appreciated having a cooked meal in the evenings and are encouraged to make snacks and light meals across the day and to carry out shopping for the house. Staff are given training on the importance of healthy diets and the role in promoting good mental health. 81 Lowther Street DS0000029268.V345446.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s healthcare is well monitored and they are supported to stay well during their stay. EVIDENCE: Records seen by the inspector confirmed that service users have access to a full range of general health care services and more specialised services, such as psychiatrists, community psychiatric nurses (CPN) and behaviour specialists. Service users spoken to felt staff are approachable and are helping them to achieve greater stability and promote their mental well-being, and felt this support was offered at the right levels, without being too intrusive. Medication handling has under gone a review with a view to making the procedures as safe and robust as possible. An Inspection was carried out by the CSCI pharmacist and recommendations from this visit have now been implemented. This included strengthening the checking in and out of medications brought into the home, this is now carried out by two members of staff who counter sign each other’s recordings. 81 Lowther Street DS0000029268.V345446.R01.S.doc Version 5.2 Page 15 The service is reviewing its policy on self-medication, and will be involving the crisis resolution team to ensure the appropriateness and the safety of people who may benefit from self medication as part of their recovery programme. 81 Lowther Street DS0000029268.V345446.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has improved and strengthened both its complaints and protection procedures to ensure that people using the service are listened to and are safeguarded from harm. EVIDENCE: Croftlands has reviewed its Complaints Policy to separate the investigation of alleged abuse issues from the management of the Project, in line with the most recent good practice guidance as a result of the National inquiries. This is also in line with local multi-disciplinary guidance. The senior team are now clear that they have to refer allegations of abuse to social services for consideration. Staff have received training from the project manager on the revised policy, and the project manager has enrolled on the next available course for senior managers run by social services. The Project Information Brochure has also been reviewed to include the new Complaints Policy, and a copy of the Complaints Procedure is now included in the information pack. This pack will be placed in each resident’s room for easy user access. A complaints register and investigation file has been set up and held in the Project Office to record and monitor all formal and informal complaints and concerns. All these revisions ensure that the protection and welfare of people using the service is paramount. 81 Lowther Street DS0000029268.V345446.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are provided with a homely, comfortable, clean house which they feel is far preferable to the institutional feel of a hospital setting. EVIDENCE: People spoken to thought the location of the home was very convenient for local facilities and the town centre, and had enjoyed going out for walks around the town centre and harbour. They said they appreciated having a key to their bedrooms and having a smoking area outside that was covered. Service users have joint responsibility with staff to keep the house and their rooms clean and tidy and this is handled well by staff who support service users to carry out these tasks. The deputy is responsible for the maintenance and upkeep of the property and this is managed well ensuring the house is safe and comfortable. Two bedrooms had just been refurbished as part of this programme. The lounge had been redecorated with new curtains and cushions and service users said it was much more homely. 81 Lowther Street DS0000029268.V345446.R01.S.doc Version 5.2 Page 18 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff team have become remotivated after a period of being unsettled due to staff frictions and they are now taking on new courses and ways of working that benefit people using the service. EVIDENCE: The project manager and the Croftlands Trust have now resolved a long standing staff issue and the team is now working together and a more positive atmosphere is clearly evident in the project. Service users spoken to were very complimentary about all the staff, saying they were good at listening and offering the right amount of support to help them get better. The project manager and team are having an overhaul in reviewing working practice with people. The intention is for the project team to complete the newly published final Ten Essential Capabilities workbook standards. The Training Matrix, as recommended at the last inspection has been completed. Croftlands Trust’s Human Resource Manager and Training 81 Lowther Street DS0000029268.V345446.R01.S.doc Version 5.2 Page 19 Coordinator are working to link core objectives to NVQ and Mental Health Certificate standards to make training as relevant as possible for this setting. Croftlands is piloting the new Creating Capable Teams Approach (CCTA) for the Lowther Street Team. This workshop has been devised by the New Ways of Working (DOH 2007) The CCTA is intended to help teams review their skill mix, refine their ways of learning and developing on the basis of service user and carer needs. A revised Annual Supervision and Appraisal schedule for all employees has been set up for the project. This will ensure that the supervisions and appraisal are preplanned, places responsibility on both parties to attend and participate and provides a monitoring tool for managers on the quality of service being delivered. Croftlands is implementing a new programme of training for all managers. This is an accredited national standard programme delivered by an external trainer. It is a six day course on ‘supportive supervision’ and ‘managing blocked performance’. It also includes completion of the NVQ Level 3 in Supervision Staff training levels in NVQs are also improving with 9 out of 11 permanent staff having either completed an NVQ or being part way through. To promote professional development each team member has an additional role to a support worker, for example is a Fire Warden or the key First aid person, Health and safety co-coordinator. The service has robust recruitment procedures that include all staff having enhanced level CRB disclosure checks. Upon appointment staff are issued with a handbook, which includes job descriptions and terms and conditions. Appointments are subject to a six-month probationary period. The Croftlands Trust has a code of conduct and all members of staff have a statement of terms and conditions. The organisation is further developing this procedure by including service users as part of the selection procedure for new staff. This will be enabled through a newly appointed Service users Participation coordinator. All these measures are creating a more professional and skilled work force that are better able to support and promote peoples well- being. 81 Lowther Street DS0000029268.V345446.R01.S.doc Version 5.2 Page 20 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39, and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Management of the home has improved with greater clarity of roles providing a much more targeted approach to support for people using the service. EVIDENCE: The Service Manager has undertaken a review of Lowther Street Quality Assurance system with the aim of evaluating the consistency and quality of the following: 1. 2. 3. 4. 5. 6. Individual Needs Assessment Mungo Star Assessment Care Plan completion End of Placement Reports Daily Reports Health and Safety Reports DS0000029268.V345446.R01.S.doc Version 5.2 Page 21 81 Lowther Street To assist in seeking service user views, the newly appointed Service User Participation Coordinator will: 1. 2. 3. engage with users. identify a method of collating user views assist in the review of the documentation process for the project. All support staff now have a set of core objectives covering their role. These are used as a basis for assessing training and development needs, which will be included in the project training matrix. They are also used during supervision and appraisal, and will be part of the Quality Assurance Plan. The deputy manger is now given extra hours to spend on management areas, and on his own professional development. These changes have all led to service users benefiting from a well-run service where their views and needs underpin the purpose of the project. 81 Lowther Street DS0000029268.V345446.R01.S.doc Version 5.2 Page 22 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 Standard No Score 1 3 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 3 32 3 33 x 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 3 3 x x 3 x 81 Lowther Street DS0000029268.V345446.R01.S.doc Version 5.2 Page 23 No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 81 Lowther Street DS0000029268.V345446.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 81 Lowther Street DS0000029268.V345446.R01.S.doc Version 5.2 Page 25 - 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!