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Inspection on 27/06/05 for 81 Lowther Street

Also see our care home review for 81 Lowther Street for more information

This inspection was carried out on 27th June 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

All service users interviewed were very appreciative of the service, in particular the value of stabilising their mental health and support at times of crisis. This comment sums up the feelings expressed across the day "Staff always have time and understanding and patience with the clients problems and worries. I cannot find any faults in the home." Particularly emphasised by service users was the central role that listening and spending time with each person played and the importance of offering people a non-hospital setting in which to recover. "200% better than being in hospital" one person commented. Another strength of the Home was the good working relationships developed with other mental health professionals which enabled the service to play a vital role in providing support at times when it is most needed. The staff team was well established and stable leading to high levels of satisfaction being reported by service users.

What has improved since the last inspection?

The home was looking well maintained through the deputy effectively managing a programme of maintenance and redecoration. A number of bedrooms had new bedding, carpets and had been redecorated. Staff said they had more time to spend with clients since the manager no longer did shifts. This meant that usually there were two staff plus the manager and staff could now attend meetings with clients and take them out more. A number of staff had attended a fire wardens course as part of the organisation wanting to ensure that the home was a safe place to live.

What the care home could do better:

The home has a policy of not allowing any clients to administer their own medication during their stay. However on return home this responsibility is handed back. The organisation should consider whether a gradual handover ofmedications might play a part in some individuals` rehabilitation. Staff training in medications should be up-dated.

CARE HOME ADULTS 18-65 81 Lowther Street Whitehaven Cumbria CA28 7RB Lead Inspector Liz Kelley Unannounced 27 June 2005 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. 81 Lowther Street F58 F10 s29268 81 lowther street v229276 230605 ui stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service 81 Lowther Street Address Whitehaven Cumbria CA28 7RB 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) 01946 691234 The Croftlands Trust Mark Barratt Care Home 6 Category(ies) of MD - Mental Disorder registration, with number of places 81 Lowther Street F58 F10 s29268 81 lowther street v229276 230605 ui stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 2. The home is registered for a maximum of 6 service users in the category of MD (Mental Disorder). Date of last inspection 21 February 2005 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 was around three weeks and the home had taken 140 admissions in the last 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 and kitchens with outside seating to the rear. Service users are not charged for the service as the Health Authority funded the scheme. The admission criteria states that individuals must be under the care of a mental health team in either the Allerdale or Copeland area. The home was managed by Mark Barrett and two staff were on duty with a after care 24 hours telephone support line. 81 Lowther Street F58 F10 s29268 81 lowther street v229276 230605 ui stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over 3 hours. Three service users were in across the day and spoken to. Two staff members were on duty and interviewed. Feedback cards had been received from visiting professionals earlier in the year. A partial tour of the premises took place, as some bedrooms were locked and the occupants were not available to seek permission to enter. Administration records and service users files were examined. What the service does well: What has improved since the last inspection? What they could do better: The home has a policy of not allowing any clients to administer their own medication during their stay. However on return home this responsibility is handed back. The organisation should consider whether a gradual handover of 81 Lowther Street F58 F10 s29268 81 lowther street v229276 230605 ui stage 4.doc Version 1.30 Page 6 medications might play a part in some individuals’ rehabilitation. Staff training in medications should be up-dated. 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. 81 Lowther Street F58 F10 s29268 81 lowther street v229276 230605 ui stage 4.doc Version 1.30 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 81 Lowther Street F58 F10 s29268 81 lowther street v229276 230605 ui stage 4.doc Version 1.30 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) 1,2,5 This is a unique service in the area and therefore real choice is limited. However all residents stated they would chose this service over a hospital setting and good quality information is available prior to moving in. EVIDENCE: The Home had a comprehensive statement of purpose and service users brochure setting out the aims and objectives and house rules. Residents said these were useful documents that helped make a decision about using the service. The admission criterion was well-developed and ensured appropriate placements. A positive development was the recent change in emphasis in referrals to crisis and responsive services and a move away from planned regular stays. All clients said that they had signed a licence agreement which stated the rules to respect the building and fellow residents. Thorough assessments and detailed information gained prior to moving in ensures that only those that can be helped, and needs can be met by the service are accepted. All these process described indicate a well-managed service. 81 Lowther Street F58 F10 s29268 81 lowther street v229276 230605 ui stage 4.doc Version 1.30 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 Service users were being offered individualised support reducing the need for hospitalisation, and speeding up a successful return back to their homes. EVIDENCE: The Home had a very comprehensive care planning system, with reviews and up-dates on a daily, weekly, and monthly basis. Care Plans were well structured and developed by service users and keyworkers, and were in line with the Care Programme Approach recommended for mental health service users. Service users were knowledgeable of their care plans and goals which led to a good compliance and success rate. An end of placement report also ensures successful continuity to living in the community and up-dating other professionals. Service users were treated very much as individuals and their rights and needs respected and addressed. Any restrictions to individuals rights to ensure wellbeing or safety of the Home and the individual were appropriately consulted upon and consent given by the individual. Contingency Care Plans were identified as an example of good practice in ensuring appropriate response in emergencies and at times of crisis. 81 Lowther Street F58 F10 s29268 81 lowther street v229276 230605 ui stage 4.doc Version 1.30 Page 10 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) 11,12,13,16 Personal development and making informed decisions is a key feature for individuals while at Lowther Street and the staff team are skilled at enabling 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 assist in this, service users are encouraged to have a range of interests and encouraged to maintain and develop appropriate relationships within the community. Care plans indicated that they are in contact with relevant professionals, such as community psychiatric nurses, to assist in developing their life skills and coping strategies. 81 Lowther Street F58 F10 s29268 81 lowther street v229276 230605 ui stage 4.doc Version 1.30 Page 11 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 Health care issues are well managed while living at Lowther Street and service users wishes are respected. However, service users have no control over their medications and this limits opportunities for monitoring compliance. Also training for staff to dispense medications has been internal and this needs to be more formal to ensure that staff are up-to-date. EVIDENCE: Care plans demonstrated how service users were supported and encouraged to maintain their independence. Records seen by the inspector confirmed that service users had a full range of access to general health care services and more specialised services, such as psychiatrists, community psychiatric nurses (CPN) and behaviour specials. Service users spoken to felt staff were approachable and were 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. Service users were not given the opportunity to self-medicate but this responsibility was handed over on return to their own homes. Staff stated that training for medication had been given to them by the Deputy but they had no formal accredited training in this area. 81 Lowther Street F58 F10 s29268 81 lowther street v229276 230605 ui stage 4.doc Version 1.30 Page 12 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 The home has a satisfactory complaints system with evidence of service users using this method, and others to express their views on the home, and these being acted upon. EVIDENCE: Service users were observed freely expressing opinions on the home to staff and other ways of expressing views more formally via the complaints procedure were seen. Service users said that they had been given a brochure with ways to make complaints in it and also they were aware of a complaints book which is kept in the hallway. The manager was in the process of responding to a complaint and was within the 28 day period as stipulated by the home’s policy. 81 Lowther Street F58 F10 s29268 81 lowther street v229276 230605 ui stage 4.doc Version 1.30 Page 13 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) 24,30 Service users are provided with a homely, comfortable, clean house which they feel is far preferable to the institutional feel of a hospital setting. EVIDENCE: 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. 81 Lowther Street F58 F10 s29268 81 lowther street v229276 230605 ui stage 4.doc Version 1.30 Page 14 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) 33,34,35 Service users are appropriately supported by an established staff team who are well trained and supervised to carry out their duties. EVIDENCE: All staff had either an NVQ 2/3 or were studying towards the Community Mental Health Diploma. Staff spoke of their induction which they felt equipped them well for their role, and this included shadowing until they felt comfortable to work on shift. Supervision is shared out by the manager and deputy and staff feel they are well supported by the organisation. The home has low turnover rates of staff and report good team work which is verified by service users who spoke very highly of the team. 81 Lowther Street F58 F10 s29268 81 lowther street v229276 230605 ui stage 4.doc Version 1.30 Page 15 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) 37,39, Service users benefit from a service that is well run by the manager and by the systems of the organisation, which ensure that service users are central, and their views are valued and acted upon. EVIDENCE: The organisation has a very thorough Quality Assurance system which covers all aspects of the running of a quality service that meets service users needs. Part of this was periodic questionnaires to service users, and professionals. The organisations operations manager carries out monthly audits and reports these to the Commission for Social Care Inspection. 81 Lowther Street F58 F10 s29268 81 lowther street v229276 230605 ui stage 4.doc Version 1.30 Page 16 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 3 3 x x 3 Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 3 3 3 x x 3 x Standard No 31 32 33 34 35 36 Score x x 3 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 81 Lowther Street Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 x 3 x x x x F58 F10 s29268 81 lowther street v229276 230605 ui stage 4.doc Version 1.30 Page 17 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 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. 1. 2. Refer to Standard 20 20 Good Practice Recommendations Self-medication should be considered for some individuals as part of a rehabilitation programme. Staff should receive formal medication training 81 Lowther Street F58 F10 s29268 81 lowther street v229276 230605 ui stage 4.doc Version 1.30 Page 18 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 81 Lowther Street F58 F10 s29268 81 lowther street v229276 230605 ui stage 4.doc Version 1.30 Page 19 - 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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