Inspection on 13/08/08 for Katherine Lowe House

This inspection was carried out on 13th August 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Katherine Lowe House 04/08/09

Katherine Lowe House 27/09/06

Katherine Lowe House 02/02/06

Katherine Lowe House 17/05/05

Katherine Lowe House 24/02/05

Katherine Lowe House 20/07/04

Katherine Lowe House 28/10/03

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Katherine Lowe House Barton Road Urmston Manchester M41 7NL Lead Inspector Sylvia Brown Unannounced Inspection 08:00 13 August 2008 th X10015.doc Version 1.40 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 Katherine Lowe House DS0000032577.V369936.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 Older People. 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. Katherine Lowe House DS0000032577.V369936.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Katherine Lowe House Address Barton Road Urmston Manchester M41 7NL 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) 0161 748 2844 0161 747 5377 Rose.hargreaves@trafford.gov.uk Trafford Metropolitan Borough Council Mrs Rosemarie Hargreaves Care Home 45 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (0) of places Katherine Lowe House DS0000032577.V369936.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home provides accommodation for a maximum of 45 service users, 24 of whom require care by reason of old age (OP) and 21 of whom are older people who require care by reason of dementia (DE(E)). Separate lounge and dining space must be provided to meet the needs of the service users who require care by reason of dementia (DE(E)). There are currently 3 named older service users who require care primarily by reason of mental ill health (MD(E)) and 1 named service user who requires care primarily by reason of physical disability (PD(E)). Should any of these service users no longer require accommodation at the home, these places will revert to the service user category (DE(E)). The Statement of Purpose must be maintained in line with the requirements of Schedule 1, of Regulation 4(1) of the Care Homes Regulations. The Statement must be kept under review and updated. Any changes to the home’s purpose must be agreed with the Commission for Social Care Inspection prior to implementation. The staffing arrangements at the home must be maintained in line with the minimum levels set out in the guidance published by the Residential Forum, `Care Staffing in Care Homes for Older People`. This must be reflected in the Statement of Purpose. The home must be managed at all times in accordance with the guidance and regulations issued in respect of older peoples` homes by the Secretary of State for Health under Sections 22 and 23(1) of the Care Standards Act 2000. The authority must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 2. 3. 4. 5. 6. Katherine Lowe House DS0000032577.V369936.R01.S.doc Version 5.2 Page 5 Date of last inspection 27th September 2006 Brief Description of the Service: Katherine Lowe House is a purpose built local authority residential home, which provides accommodation and personal care to 45 older people. Accommodation is set on three levels, with a number of small lounge dining areas located throughout the building near bedroom areas. Sufficient communal space, bathrooms and toilets are available to meet residents needs. The home is equipped with a passenger lift and stairways, which enable people to access all floors easily. Service users have access to garden areas that are used in fine weather. Katherine Lowe House is situated of Davyhulme Circle, Barton Road and is close to a residential area and local shops. The weekly fees are £397.60. Each service user is financially individually assessed and contribute to this amount depending on their income. Katherine Lowe House DS0000032577.V369936.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service would experience adequate quality outcomes. The inspection report is based on information and evidence gathered by the Commission for Social Care Inspection (CSCI) since the last key inspection, which was completed on the 27th September 2006. This was a key inspection which included a site visit to the service. The site visit was unannounced, which means the registered manager and staff were not told that we would be visiting. The registered manager was on duty throughout the site visit. We gathered information from a number of people, which included talking with and seeking the views of service users. We also sent out surveys to service users, relatives and members of staff. This gave them an opportunity to talk with us about their opinions on the services provided at Katherine Lowe House. Comments received are, where appropriate and applicable included within the report. We looked in depth at the care support of two people living at the home which included looking at their records in detail. We also spent time sitting with service users and observing their day-to-day routines as they received care support from care staff. This helped us get a better view about how people living at home are looked after and supported. In July 2008 the registered manager of Katherine Lowe House completed a self-assessment form, which is called an Annual Quality Assessment Audit (AQAA). This should tell us what the home had been doing since the last key inspection to meet and maintain the National Minimum Standards. It should also tell us what they felt they were doing well, how they had improved within the past 12 months and their plans to develop in the next 12 months. Though there was a lot of information provided, the AQAA did not contain enough information. The information provided was confusing and did not relate to what was being asked for. We could not tell what actions had been taken meet and maintaining standards, neither did it indicate how requirements issued at the last inspection had been complied with. Two of which we have found were not met and have been repeated. We also gathered information through general contact with the home; through their reporting procedures, which are called ‘Notifications’, and through information we received from other people, such as the general public, Katherine Lowe House DS0000032577.V369936.R01.S.doc Version 5.2 Page 7 including concerns and complaints procedures. We have not received two complaints about this service within the last twelve months, however we are not confident one directly related to the home, rather it appears more related to the Local Authority. We advised the second complainant to access the homes formal complaints procedure. This provided the registered manager the opportunity to look into any dissatisfaction about the service and complete an her own investigations into matters raised. What the service does well: Prospective service users are given up to date information about the home prior to admission, this makes sure they can make an informed choices about their future. The registered manager makes sure prospective service users are assessed and that she can meet their individual needs before any decisions are made to move in. Service users and relatives spoke highly of the staff team and of the support services provided. One relative told us “I have never worried about the care she receives at Katherine Lowe House , which I believe is excellent.” Others have said “The staff respect my mother and show real care and consideration towards her.” “Staff are always there to help support relatives and the resident” and “They are very good, nothing is to much trouble.” One service user told us “I am sure this is the right place for me. I feel staff give me all the support and help I need. “ It is evident that the staff provide a caring environment and that they enjoy and feel proud of the work they do. When asked what the home did well, staff said, “We create a family atmosphere and try to meet the needs of all clients and relatives as best we can.” and “our home is one of the best run and I have worked at a few. Staff clients and relatives get on well together.” It also appears that staff work together with one staff pointing out “The best thing about Katherine Lowe House is, we have great management and staff team.” Service users have fairly well written care plans that mostly identify their individual preferences for care support. They are consulted about their care packages and sign their own care plans once they have agreed to what is recorded. Complaints and adult protection procedures are in place which, as far as possible, ensures that service users are able to raise concerns without fear. Service users are also protected by good recruitment and selection procedures being carried out. Staff have appropriate induction programmes and continued training ensures service users receive support from staff who have the appropriate skills. The AQAA stated that 66 of staff have achieved a National Katherine Lowe House DS0000032577.V369936.R01.S.doc Version 5.2 Page 8 Vocational Qualification (NVQ) at level 2 or above. This exceeds the required minimum standard. What has improved since the last inspection? What they could do better: Even though we have identified a number of good practices as stated above, there remains a number of areas within the service which must be developed to ensure the safety, comfort and enjoyment of service users. The building appears shabby and uncared for. Service users are living in rooms that have ripped and torn wallpaper. Bare plaster is evident where rewiring has taken place, and many areas need repainting including ceilings. The quality assurance procedure carried out by the registered manager identifies that service users living accommodation needs upgrading, however the report only refers to communal areas. We found that service users bedrooms were as poorly decorated as the communal areas and should also be included within the upgrading programme. Poor infection control procedure carried out by staff increased risk of spread of infection for service users. On one occasion, one staff was observed carrying soiled items of clothing through the home without wearing appropriate protective gloves or sealing the clothes up. We also observed a number of staff wearing protective gloves as they supported service users around the home after personal care support had been given. Whilst this ensures that staff were protected, it was highly likely they were increasing the risk of spread of infection instead of reducing it. Katherine Lowe House DS0000032577.V369936.R01.S.doc Version 5.2 Page 9 We observed that staff left unclean commode bowls in corridors and used commodes were left in service users rooms without a lids in the mornings. This meant that the living accommodation had strong odours of incontinence and was not nice for service users to observe. We also saw that some service users clothing were left in small piles in corridors, some of which were wet. Later we saw a number of commode bowls soaking in a bath which was designated for use by service users. Not all fires safety doors fitted into the doorframe correctly. We also observed the wedging of fire safety doors. Both of these issues placed service users at risk of harm in the event of a fire emergency. Medication administration procedures were not followed correctly. We saw that medication was handled by staff without hand washing procedures being carried out or protective gloves being worn. We were able to sit with service users during the morning as they waited for their breakfast. We observed at that time that staffing numbers were insufficient to meet the needs of service users in a timely manner. Furthermore we could find no evidence to support the registered managers statement that staff routines ensured that service users were served early morning hot drinks if they were awake and as they rose. Most of the service users we spoke with stated they had not received a hot drink. Some service users received their first hot drink of the day at approximately 9:15am even though they had been sat at a dining table before 8am. We have issued a number of requirements regarding the above areas which ensures that improvements will be made. We have also made a number of good practice recommendations for example activities and improved record keeping. In addition laundry routines need improving to make sure service users clothes are handled correctly and laundered appropriately. We received several comments prior to the site visit about laundry procedures. We observed agency staff completing laundry duties which included having bedding, day wear and towels being washed together. Furthermore the management of service users clothes could also be improved. One service user informed us that another service users was wearing her skirt and another service user said she was wearing someone else’s trousers, which were uncomfortable. Katherine Lowe House DS0000032577.V369936.R01.S.doc Version 5.2 Page 10 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. Katherine Lowe House DS0000032577.V369936.R01.S.doc Version 5.2 Page 11 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Katherine Lowe House DS0000032577.V369936.R01.S.doc Version 5.2 Page 12 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3. Standard 6 does not related to this service. Quality in this outcome area is good. Pre admission procedures are carried out appropriately, which makes sure the needs of service users are known and can be met by the registered manager before any decisions about moving into the home are made. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Prospective and current service users are provided with up to date information about the home. We observed each service user had a copy of the current statement of purpose and service users guides within their own room. Pre assessment procedures were recorded, and identified that the registered manager met with service users in their own home. This gave them the Katherine Lowe House DS0000032577.V369936.R01.S.doc Version 5.2 Page 13 opportunity to meet with someone from the home and discuss any matters of concern before making any decisions about their future. Katherine Lowe House DS0000032577.V369936.R01.S.doc Version 5.2 Page 14 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is adequate. Service users health care needs are met, however inappropriate medication administration practices place service users at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each service user has an individual care record and care plan. We looked at a number of care plans and specifically two were looked at in depth. We found that generally care plans identified most of the service users individual needs and personal preferences for how care support should be provided. Some care plans had very good details which reflected service users required and preferred individual routines. Discussions were held with the registered manager on ways that records could be further developed to consistently and fully reflect service users individuality and preferences for their care support packages and daily routines Katherine Lowe House DS0000032577.V369936.R01.S.doc Version 5.2 Page 15 Care plans recorded some service users as requiring ‘toileting programmes,’ however their specific programme was not recorded and or monitored. Senior officers told us that service users who required support to maintain continence were routinely toileted every two hours and only when issues arise, are records of support recorded. We think that such routines are not best practice for all service users. Toileting programmes should be individually planned for after assessment. Such routines should be monitored and adjusted dependant on the service users ability to maintain continence. Specific reasons should be in place if service users are receiving such support and detailed records of staffs daily/evening/ night practice should be maintained. Health care records and information provided by service users confirmed that they received appropriate support to maintain as far as possible good health. All doctors, district nurse and hospital appointments were recorded. We enquired about chiropody treatments for one service users who’s key worker had identified in March 08 that chiropody treatment was required. We could find no recorded information to confirm that the service user had received this treatment. After looking at various records, senior staff could confirm that the chiropodist had been in attendance at the home but not who they treated. Bathing records indicated that routines were based around the home rather than individual routines of service user. Each service user is offered a weekly bath unless required for other reasons. Bathing should be like every other aspect of care support, they should be individual to the service user. Daily records were maintained, however they did not reflect the care support provided by care staff or the service users daily routines and or achievements, rather they gave an overview of the service users behaviour for example statements such as ‘has been walking around the home’ or ‘ has been sat in their room’ were used. Records did not reflect rising and retiring times or staffs interactions with the service user. One service users was identified as losing weight. Because of this the registered manager had implemented food intake record which we were told should be completed by staff and monitored by senior care staff. One record looked at, which had been in place for six days was only correctly completed for one day. One day no food intake was recorded at all, on other days various meals were not recorded. There was nothing to confirm the monitoring procedures had been carried out by senior staff to make sure they were completed correctly or to confirm the service users was receiving enough nutritional intake. Furthermore the food intake record did not include any nutritional snacks served throughout the day or suppertime meal/snacks. Katherine Lowe House DS0000032577.V369936.R01.S.doc Version 5.2 Page 16 We observed two medication administration rounds during the site visit. On both occassions staff were seen to directly handling medication. No hand washing procedures were carried out or protective gloves worn. Such practice increases the risk of spread of infection for service users. We have advised the registered manager to review when medication is administered. It is not best practice to disrupt service users whilst eating their meal, it may minimises their pleasure and spoil their taste of food when medication is administered whilst they are eating, particularly when medication is in liquid form. A sample of the medication records was looked at and were found to be completed correctly. Throughout the inspection we observed service users interaction with staff. They appeared to have formed trusting relationships and in the main were treated respectfully. One service user told us “Staff listen to what I want all the time” whilst two relatives stated, “Staff always pleasant the care of residents is excellent.” And “The staff respect my mother and show real care and consideration towards her”. Katherine Lowe House DS0000032577.V369936.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is adequate. Morning routines do not ensure service users received sufficient drinks and breakfasts in a timely manner, and routines compromise service users independence and minimised choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users views were mixed regarding their daily life experiences at Katherine Lowe House. Some were contented with the amount of activities provided whilst others “wished they had a bit more” One service users social care plan identified that the service user preferred to isolate themselves in their room, but after being encouraged by staff they had started to slowly gain the confidence to mix occasionally with others. We looked at the service users activities programme and their preferences for social support. Their plan stated that the service user enjoyed walking outside and manicures, however there was no individual support plan in place to ensure that manicures were done frequently as an activity, rather than “when nails required it” the records Katherine Lowe House DS0000032577.V369936.R01.S.doc Version 5.2 Page 18 identified that the service user had enjoyed a walk several weeks prior to the site visit. Both of these activities could be offered weekly and walking even more frequently for the health benefit and enjoyment of the service user. Another service users care records identified that they had an occupational therapy assessment in place which had been completed by a professional assessor from the services to Older People with Mental Health. The assessment identified the various activities the service user could benefit from ,which included going out for walks, simple crafts and pampering type activities. We looked at the activities record for this service user and could find no recordings to confirm such activities taking place on a routine basis. Such and activities programme may support the service user to maintain a general sense of well-being and promote better mental health. Although the registered manager has organised a planned activities programme, which includes reading news papers to service users and playing games and activities, staff told us that the quality of activities vary and are sometimes not conducted because of other demands on staff . When asked how the home could improve, one relative told us “ Talking to some of the residents, I feel they are missing out on the arts and crafts, which has been cancelled. “ another relative said “a manicurist would help low moral”. On the morning of the site visit we observed that staff were not in sufficient number to support service users individual rising routines and provide them with their breakfasts and morning drinks in a timely manner. The registered manager told us that all service users awake received early morning drinks, however we spoke with at least eight service users before 9am they told us they had not received a drink at all that morning. Some were observed receiving their first hot drink at 9.30am even though they had been dressed and waiting in dining rooms from 8am. Whilst the registered manager stated that nighttime staff routines included providing service users with drinks before they leaving at 8am and that morning staff provided service users with a hot drink and their breakfast when they were individually ready, staff stated that this was not always possible due to the demands placed upon them. We had the opportunity of sitting with service users from 8.20am as they waited for their breakfast and first drink of the day. Two of the service users had been waiting from 8am for breakfast support, one of whom had been supported to sit at a table. The delay appeared to be causing some distress, one service user was heard to say why do they make you sit at the table when we are not going to get any breakfast when they were asked if they knew why the delay was, another service user said you just get different stories every time you ask a member of staff something, theres nothing we can do, we will just have to sit and wait. At 8:45 a.m. a service user said Do you think anyone is aware we are here ? continuing they then stated “ I Katherine Lowe House DS0000032577.V369936.R01.S.doc Version 5.2 Page 19 will go and tell them we are here at this point service user left of room to go and speak the staff. A number of service users were supported to the dining room and or arrived alone all confirmed that they had not received any drinks that morning and did not receive their breakfast as they arrived. One service user arrived and preceded to make their own hot drink, and had almost completed the task when a member of the care staff observed this and stopped the service user from continuing. The staff stated it was to “dangerous” for them to pour their own because the tea pot leaked. The service user clearly had the capacity to attend to their own breakfast, however they had to wait until cereals were provided and tea poured. This practice severely reduced the service users independence and did not promote a sense of self worth for the service user. The lunch time meal service was observed in a different lounge. Routines were fairly good, but again one member of staff appeared very busy serving meals and attending to at least service users. At times the staff member had to leave the room, to support another dining room and or attend to a service user. When we asked what the home could do better, relatives stated that staffing could improve, one said “Maybe more staff would give an even better service” One member of staff told us “We run short on occasions but we pull through as a team” Because service users were left unattended for long periods of time and because they did not receive their breakfasts and drinks in a timely manner, we are requiring that staffing levels are reviewed and staff appropriately deployed in numbers to meet the needs of service users and the demands of the home at all times. We were able to share two meal times with service users. They appeared to enjoy their meal and feedback about food served was positive. We were informed that service users have a choice of cooked breakfast at least two days a week and that alternative options are always available at each mealtime. One service user told us the food is very good and I have no complaints at all.” Another said it’s “Lovely food.” Katherine Lowe House operated an open visiting policy and service users are able to meet with family and friends in private. Without exception all service users spoken with, talked positively about the support they received from staff, confirming the were treated with dignity and respect. However we found that routines within the home disrespected the service users clothing and environment. For further information please refer to standards 19-22 (The environment). Katherine Lowe House DS0000032577.V369936.R01.S.doc Version 5.2 Page 20 . Katherine Lowe House DS0000032577.V369936.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. Service users are protected by good complaint and safeguarding procedures This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager continues to ensure service users and relatives are aware of the complaints procedure and records all complaints received at the home. The AQAA stated that the registered manager has received five complaints within the last 12 months all of which were investigated and resolved within twenty-eight days. We looked at the record of complaints and can confirm that they were recorded as required. When asked if they if they were confident their complaints would be taken seriously and that they had someone to talk should they have any dissatisfaction, service users stated they thought their complaints would be listened to. One service user told us “If I had a complaint I would make one. I would tell Rose.”(The registered manager) Another told us “I would ask to speak to Rose. I don’t need to complain.” During the site we observed the registered manager walking around the home talking to service users, who told us “she’s lovely” The interactions we observed gives us confident that service Katherine Lowe House DS0000032577.V369936.R01.S.doc Version 5.2 Page 22 users would feel safe to speak their minds and raise any matters of concern with the registered manager. Katherine Lowe House is run by the Local Authority, who operate adult protection procedures. Staff have all received mandatory training in safeguarding of vulnerable adults. Training records looked at confirmed that staff receive up dated training on a rolling programme which is set by the Local Authority. Information is provided to service users and relative about safeguarding procedures and other information is included in the service users folder which is held in their private room. Katherine Lowe House DS0000032577.V369936.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,23,24,25 & 26. Quality in this outcome area is adequate. Service users do not live in a home that is well maintained and safe. Poor infection control and fire safety places them at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users do not live in a well maintained home. Prior to arriving at the home we were informed by some relatives that “It would be nice for the staffresidents if the house was now decorated to brighten the place up, but there are improvements being made.” Another person told us “It would be nice if the home was redecorated” Katherine Lowe House DS0000032577.V369936.R01.S.doc Version 5.2 Page 24 When we looked around the home we saw that a high proportion of service users bedrooms were poorly decorated. Some ceilings had been re plastered where lighting fixtures had been changed but not been repainted. Many bedroom walls had ripped and torn wallpaper where new electrical wiring systems had been put into place but redecoration had not taken place. We were invited by several service users to visit their room. One service users stated “ I am a bit embarrassed about the condition, but I am unable to do anything about it. Another service user told me though they thought their room was nice because it contained fixtures and fittings from their own home, though they said the room looked “a mess”. The previous inspection in September 06 identified similar findings about the home and a requirement for decoration was issued. This requirement has not been complained with. The registered manager told us that plans were underway to redecorate the main parts of the home in December 2008. Staff confirmed it was not service users rooms. We think extensive redecoration in all parts of the home should be undertaken and completed by December 2008. We also recommend that service users are individually consulted about their choice of colour schemes and wallpaper /decoration for their private rooms. The main hallways and corridors appeared to be equally poorly decorated, with wallpaper and borders had been ripped/ pulled off in part. Plastering was evident where rewiring had taken place and many parts of the paintwork was scratched and chipped. The home had a general air of being uncared for , externally the home also looked tatty. Windows require repainting, the public car park had weeds growing around the edges of the building, and there was an extensive amount of cigarette butts near the rear door which had spread onto the car parking area. Because fire safety issues have been identified we have issued a requirement to make sure all doors close affectively into their frames in order to ensure they protect service users and minimised the spread of smoke and or fire in the event of a fire emergency. We looked at a number of doors and tested their closures. We observed a number of fire safety doors continue to required attention to make sure they are fit for purpose. The registered manager stated that she had informed the local Authority on a number of occassions about outstanding work, but had not received the support to rectify problems. This was confirmed through fire safety records, where it identified where faulty fire doors were. Katherine Lowe House DS0000032577.V369936.R01.S.doc Version 5.2 Page 25 The wedging of open of fire doors also compromised service users safety in the event of a fire emergency. When we walked around the building we observed two doors being wedged open by commode chairs and one with a linen trolley. We looked around most parts of the home and found that routines were poor regarding infection control and that some routines in the mornings did not respect service uses clothes or their home. On arriving at 8am, we observed commode bowls in some corridors, we later observed five commode bowls “soaking” in a bath which is used for service users. We also observed clothing left on the floor in corridors, some of which were there for over two hours. Many bedrooms contained used commodes without lids and created strong odours around the home. Bathrooms and toilets smelt strongly of incontinence. We observe that the incontinence bins were over full with lids failing to close, one had a broken lid , meaning used incontinence aids were on view within the bin. One staff was observed carrying some incontinence aids and what appeared soiled clothing though the home ,in their hands by holding them by a white plastic apron. The staff did not wear gloves. When we looked round the building we inspected the laundry area. We found that laundry was piled on the floor in a cupboard like unit which contained stepladders. When we asked the registered manager about laundry procedures she told us the laundry cupboard observed was the bottom of a laundry chute. She could give no explanation as to why stepladders were stored in this area, or why there was no laundry bin in place to collect the laundry coming down the chute. There was no formal recording of laundry cleaning routines and the registered manager could not demonstrate how often the laundry collection area was cleaned. Although it did not appear to be dirty we have concerns about how clothes are managed and infection controls within this service. Relatives made a number of comments about laundry procedures which included “More hand washing by laundry staff” was needed and “Laundry problems, clothes washed at to high a temp and named clothes go missing” during the inspection one service user informed the inspector that another service user was wearing her skirts, and another service users stated they were wearing someone else’s trousers. Katherine Lowe House has a dedicated smoking area for use by service user, this room was furnished in a basic manner and offered no comfort. There were numerous metal waste paper bins in place filled with water, where service users disposed of their cigarette butts when finished. The room Katherine Lowe House DS0000032577.V369936.R01.S.doc Version 5.2 Page 26 appeared shabby and uncared for and did not promote a warm caring environments for service users to relax in whilst enjoying their cigarettes. Katherine Lowe House DS0000032577.V369936.R01.S.doc Version 5.2 Page 27 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30. Quality in this outcome area is adequate . Though service users receive support from staff who are appropriately recruited and trained, they are not always in sufficient numbers to ensure service users get the care and attention they require in a timely manner. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All comments received from service users and relatives about care staff were good. One service user said “I feel staff give me all the support and help I need” and relatives told us “They are very good nothing is to much trouble” and “Staff are always pleasant the care of residents is excellent.” The AQAA identified that 66 of staff have achieved NVQ training at level 2 or above, this exceeds the National Minimum Standards. Training records identified that within the last twelve months a wide verity of training has been provided to staff as they individually require it. Training includes protection of vulnerable adults, first aid, mental capacity act, moving and handling, managing challenging behaviour, food hygiene and equality and diversity. Katherine Lowe House DS0000032577.V369936.R01.S.doc Version 5.2 Page 28 We looked at two staff files and found them to contain all the required information. The home follows robust recruitment and selection procedures set down by the Local Authority which are designed to protect service users from receiving care from people who may do them harm. Staff surveys identified that staff feel they do a good job and that they are dedicated to supporting older people. They confirmed they received good support from their managers and that they work well together as a team. When we asked what they felt they did well they told us “Care of the elderly and vulnerable in a relaxed friendly environment when enough staff on.” “I think the service works well and takes good care of the people we look after.” “We have regular staff meetings and one to ones. We also have training.” Another said “We create a family atmosphere and try to meet the needs of all clients and relatives as best we can.” When asked what they could do better they also told us “Because of holidays and sickness we sometimes need agency staff and this can be very stressful to us because who we are working with maybe some one we have not met before and they do not know the service users or the lay out of the home.” “We could do with more permanent staff as this would cause less pressure when people are off.” “Sometimes we are short staffed because of sickness.” and “We are always short staffed due to sickness” As stated within section 12-15( Daily Life) of this report, we noticed that there were insufficient numbers of staff on duty in the mornings to support the varying needs of service users in a timely manner. From comments received from staff this issue may also occur in the evenings as one staff told us improvements could be made by “Making sure we are fully staffed would be an improvement. If clients requested something to eat and drink they would not have to wait so long as sometimes we are busy putting people to bed.” The staffing rota of the home employs care staff, senor care staff and officers, but the rota does not state where people are deployed to. Because of the layout of the home, the staffing rota should be in sufficient detail to enable an accurate assessments about staffing numbers to be undertaken and identify where they are deployed to at any given time. Staff told us that on one floor one staff “comes up” to get two service users up and then goes back down. There was no specific time for this support as it took place when the staff had finished their work on their own floor. Furthermore the registered manager explained that one staff on afternoons is dedicated to providing laundry services. The staffing rota did not identify this and the staffs hours were recorded as ‘care staffing’ hours on the rota. We also noted that when the dedicated laundry support person in the mornings is on days off, care staff and or domestics do the laundry. Katherine Lowe House accommodates forty five service users and complete all laundry duties which includes bedding and towels in additional to clothes and other items. Because of the demands on this part of the service and because of comments made and the outcome of our own observations about laundry procedures, we Katherine Lowe House DS0000032577.V369936.R01.S.doc Version 5.2 Page 29 think consideration should be given to having dedicated laundry personnel who are specifically employed and trained to do such valuable and important work. We are requiring that a full audit of staffing levels is undertaken to ensure there are sufficient numbers of staff on duty day, evening and night time to meet the individual needs and dependency of service users and the demands of the home. “ Katherine Lowe House DS0000032577.V369936.R01.S.doc Version 5.2 Page 30 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 & 38. Quality in this outcome area is adequate. Katherine Lowe House makes sure service users feel supported and happy. However failing health and safety issues place service users at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no changes in the registered managers position. The registered manager has the qualifications and skills necessary to run a care home, and training records confirmed that she continues with her leaning and personal development. Katherine Lowe House DS0000032577.V369936.R01.S.doc Version 5.2 Page 31 We received positive feedback from staff about the management of the home which included confirmation that they received support and supervision and were kept informed of relevant information. Staff told us “We have supervision once a month to discuss problems and ongoing training. Officers and managers informed.” “We have regular staff meetings, which our manager and other officers hold. We also have supervision on a regular basis, which means your work and issues can be discussed and I am helped.” “we have a daily report with senior carers and they write information down” and “The best thing about Katherine Lowe House is we have great management and staff. Everything is put passed us straight away and we talk through things.” All of which reflects a positive staff team who feel they are well supported. Service users are consulted about their satisfactions with the service and we have been provided with the outcome of the last quality audit completed in April 2008. The report details service users feedback and what actions the home has taken to improve and develop were gaps in the service are apparent. Service users and relatives are invited to attend focus group meetings which keeps them informed of developments within the home and give them an opportunity to influence changes to be made. Service users are supported to manage their own finances through family and nominated people involved with their life. The home only manages small balances which is used for small expenditures for those people who require additional support. Where service users receive support to manage their finances, records are maintained and audited. We looked at health and safety records and found that routines servicing of equipment and services was in place. As a consequence of finding a number of doors not fitting correctly into their frames as mentioned within the environment section of this report, we have consulted with the fire safety department. They confirm that a fire inspection was undertaken in on the 3/6/08 by fire safety officers and a sample of fire safety doors were looked at and found to require some attention to ensure the safety of service users. We have talked about poor infection control issues within the environment section of this report. We were notified in January of one out break of diarrhoea, which culminated in restricted visiting to the home in order to prevent spread of infection. We were also informed that one service user has C-Difficile. Katherine Lowe House DS0000032577.V369936.R01.S.doc Version 5.2 Page 32 Katherine Lowe House DS0000032577.V369936.R01.S.doc Version 5.2 Page 33 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 x x x 2 2 1 1 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 x 1 Katherine Lowe House DS0000032577.V369936.R01.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? Yes 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 OP9 Regulation 13 (1) (2) Requirement To ensure service users receive their medication safely, the registered manager must ensure that staff cease handling medication during administration. To make sure service users live in a home which offers a comfortable, pleasant environment the registered manager must complete a full assessment of the building regarding refurbishment and redecoration and provide us with a planned programme for upgrading the home. The plan should detail timescales for completion. (Timescale 22/11/06 was not met) 3. OP19 23 The Registered Persons must ensure that all fire safety doors operate correctly and fit in to their frames appropriately in order to safeguard service users in the event of a fire emergency. (Timescale 22/11/06 was not met) DS0000032577.V369936.R01.S.doc Timescale for action 14/08/08 2. OP19 23 30/09/08 30/09/08 Katherine Lowe House Version 5.2 Page 35 4 OP19 23 5 OP26 13 (1) (2) 6 OP27 18 To protect service users in the 14/08/08 event of a fire emergency, the registered Manager must ensure that the practice of wedging doors open ceases. To protect service users the 01/09/08 registered manager must ensure that infection control procedures are maintained at all times.. A full assessment of the staffing 01/09/08 ratios should be completed by the registered manager, who must make sure staff are deployed in sufficient numbers at all times to meet the needs and dependency of service users in a timely manner. 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 Refer to Standard OP7 Good Practice Recommendations To ensure the care and support of service users can be identified and monitored, record keeping should be developed and monitoring systems maintained to ensure that they reflect the individual support provided to service users, for example chiropody treatments, food intake, continence programmes, individual preferred bathing routines. Daily records should reflect the actual care support provided and service users individual routines and achievements. In order to ensure service users social needs and preferences are recognised and supported group and individual and activities should be routinely planned for and carried out. Service users individual records should detailed activities provided. Service users should be encouraged to make choices and decisions for themselves and their independence should be DS0000032577.V369936.R01.S.doc Version 5.2 Page 36 2. OP7 3 OP12 4 OP14 Katherine Lowe House 5 OP14 6 OP19 promoted at all time including mealtimes. Routines should be in place which ensures that service users are offered hot drinks on rising, and whenever they individually require throughout the day, evening and nighttime. Such routines will minimise the risk of dehydration. Service users should be individually consulted at about their preferred colours and redecoration of their private room, and group consultation processes should be completed to find out their views on redecoration of other rooms used by them. Systems should be put into place, which ensures that service users clothes are treated with respect, ensuring that they receive and wear their own clothing at all times. To ensure laundry routines are improved consideration should be given to providing dedicated laundry staff who are specifically trained, experienced and skilled to provide such a service. 7 8 OP10 OP26 OP27 Katherine Lowe House DS0000032577.V369936.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 Katherine Lowe House DS0000032577.V369936.R01.S.doc Version 5.2 Page 38 - 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!