Inspection on 04/08/09 for Katherine Lowe House

This inspection was carried out on 4th August 2009.

CQC 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 CQC 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

Katherine Lowe House 13/08/08

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 15/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Katherine Lowe House Barton Road Urmston Manchester M41 7NL Lead Inspector Sylvia Brown Key Unannounced Inspection 4th August 2009 09:00 DS0000032577.V377361.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Katherine Lowe House DS0000032577.V377361.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Katherine Lowe House DS0000032577.V377361.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.V377361.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th August 2008 Brief Description of the Service: Katherine Lowe House is a purpose built local authority residential home, which provides accommodation and personal care for up to 45 older people. Accommodation is set on three levels, with a number of small lounge and dining areas which can be located throughout the home and which are near bedroom areas. Sufficient communal space, bathrooms and toilets are available to meet residents needs and 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. A financial assessment is completed by the Local Authority who make the final decision regarding funding contributions dependant on the service user’s ability to pay. Katherine Lowe House DS0000032577.V377361.R01.S.doc Version 5.2 Page 5 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 report is written on behalf of the Care Quality Commission (CQC) therefore throughout the report the terms we and us are used when referring to the CQC or representatives working on their behalf. . For reporting purposes the preferred term to be used for people living and receiving a service at Katherine Lowe House is service users. The registered manager was unavailable at the time of the inspection site visits, however two officers acting as persons with responsibility for the running of the home in her absence were present. The officers competently supported the inspection process and made themselves available to answer questions on behalf of the registered manager and provide all requested information. We also had the opportunity of meeting with and talking to the service manager who, as part of her overall organisational responsibilities for monitoring care provision for older people within the Local Authority, monitors their residential care provision which includes Katherine Lowe House. The inspection report is based on information and evidence gathered by the Care Quality Commission (CQC) since the last key inspection, which was completed in August 2008. This was a key inspection which included three site visits to the service. The site visits were unannounced which means the registered manager and staff were not told that we would be visiting. As part of the inspection process we gathered information from a number of people which included talking with and seeking the views of service users. Prior to the site visits we also sent out surveys to service users, their relatives, advocates or friends and members of staff. This gave them an opportunity to tell us in writing about their opinions on the services provided at the home. Some of the comments received are included within the report. We case tracked two service users which means we looked in depth at their records, observed them as they went about their daily routines and evaluated the support they received from members of staff. In July 2009 the registered manager completed a self assessment form, which is called an Annual Quality Assessment Audit(AQAA).This document should tell us in detail what they and the registered provider have done 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 plans to develop in the next 12 months. The AQAA Katherine Lowe House DS0000032577.V377361.R01.S.doc Version 5.2 Page 6 received was not very well filled in; parts were incorrectly completed and gave us confusing basic information about the service. It did not tell us ways in which they could improve the service and how over the next 12 months. There was no clear reference to how the service had developed, addressed their requirements or good practice recommendations. It was evident that the registered manager had not referred to or understood the guidance we make available when she completed the document. We also gathered information from general contact with the home through their reporting procedures which are called Notifications and information we may have received from other people, such as the general public and professional visitors. We have not received any formal complaints about this service within the previous 12 months, but we have received some information from one person about concerns they have about the service. We have also been informed of one safeguarding concern which was not dealt with under the Local Authority Safeguarding procedures, rather the Local Authority used equally important procedures which mean the best interests of the service user were addressed. The AQAA identifies that two safeguarding referrals have been made at the home and investigated under Local Authority procedures. An expert by experience supported the inspection process and spent time talking with service users about their experiences whilst living at the home. An ‘expert by experience’ is a person who, because of their shared experience of using services and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. This report is a public document and should be on display within the home and can be made available for reading upon request. What the service does well: When we talked with service users we found that whilst they identified where areas of improvements could be made they were generally contented living at the home. We saw many occasions when service users and staff interacted well with each other indicating that some positive relationships had formed. 3 of the 4 returned service user surveys said the registered manager and staff team communicate well with them, relatives told us they generally received up to date information about the home and were kept informed about their relative’s health and important matters. The registered manager has been able to maintain a relatively stable work force, with the AQAA identified that only 4 members of staff have left the service within the previous 12 months. This indicated that service users are more likely receiving care and support from people they know and trust. Katherine Lowe House DS0000032577.V377361.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: The ill fitting of some doors meant that they may not close correctly in the event of a fire emergency. One lounge door identified as faulty weeks prior to the inspection had not been repaired, furthermore we saw one fire safety door did not close when the fire alarm was activated. This means that service users are placed at increased risk in the event of a fire emergency. 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. This should make sure the risk of the spread of fire and/or smoke inhalation is reduced in the event of a fire emergency. We must be notified of all significant events at the home relating to its running and service users. This will make sure we are aware of all significant events relating to the health, wellbeing and safety of service users. The registered provider must make sure that the home is kept in a good state of repair and be reasonably decorated. Although attempts by staff members have been made to improve some areas, the Local Authority acting as the registered provider has not made sure that all parts of the home used by service users hare comfortable and well decorated. We have made a number of good practice recommendations relating to the improving of recorded information, consistency from care staff when Katherine Lowe House DS0000032577.V377361.R01.S.doc Version 5.2 Page 8 supporting service users, improved social activities for service users, and the updating of the homes fire risk assessment If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Katherine Lowe House DS0000032577.V377361.R01.S.doc Version 5.2 Page 9 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.V377361.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 is not applicable to this service. People using the service experience Good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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. EVIDENCE: There have been no changes to the way the registered manager gathers information about service users before they move in. Most service users are Local Authority funded and have up to date assessments completed by the Katherine Lowe House DS0000032577.V377361.R01.S.doc Version 5.2 Page 11 referring social worker as part of their preparation for moving into full time care. Once a referral is received the registered manager makes arrangements to visit the service user in their own home or placement. This enables the registered manager to discuss any concerns the service user may have, find out about their needs and any preferences for how they would like their care to be provided. Once the pre assessment process is complete and the registered manager has assured herself that the service can meet the needs of the service user, they are invited to look around the home, view vacant rooms and meet with others who live at the home. The records we looked at confirmed the pre assessment process. One service user told us “my family had a look around for me; it’s nice here I have made friends.” Feedback from service users and relatives identified that they received enough information about the home. Katherine Lowe House DS0000032577.V377361.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service user’s health and care needs are generally met. The home has a plan of care that the person or someone close to them has been involved in making. The care home supports service users to take their medication as prescribed. Most staff were respectful to service users but some staff were not so service users received an inconsistent level of support. EVIDENCE: Katherine Lowe House DS0000032577.V377361.R01.S.doc Version 5.2 Page 13 Each service user had their needs assessed prior to moving into the home which were kept under review so members of staff were always aware of the service user’s current needs and how they should be met. Their care needs were recorded and a care plan was in place which the service users or someone close to them had been involved in making. The care plans indicated how service users would individually like to receive support. We looked in depth at two care files and found that the care plans were fairly well written, however supporting records were not. One service user had been on a food intake chart, however the charts shown to us were poorly maintained, did not demonstrate that they were being supported sufficiently and that they were receiving enough nutrition. Notwithstanding that the weight chart for the service user did identify that weight gain was evident and maintained. It is important to make sure that such records are always completed correctly and that monitoring systems are in place to ensure standards are met. Although nail care plans were in place, one service user had unclean nails which were overly long, whilst the other had a nail which was partially cut; one in particular was broken and sharp. The officers could give reasonable explanations about these matters however records failed to identify why the service user’s nails were in the condition and what risks apply as a consequence. Daily records kept by members of staff failed to identify the condition of the nails. Another care plan recorded that a service user could shave themselves with assistance. However it was evident that the resident had not shaved on the day of one site visit though the checklist indicated that they had and there were no comments to indicate that the service user had refused assistance. Service users care needs are kept under review, with monthly updates and half yearly reviews being completed by the staff team and annual reviews being conducted by the Local Authority. The registered manager stated within the AQAA that within the past twelve month the services of a domiciliary dentist have been secured so service users receive dental checks when required but we could not consistently see where last dental checks had been completed or future ones planned for. The registered manager also stated that a chiropodist visited the home every eight weeks. The officers stated that not all service users were referred to the chiropodist every eight weeks, rather members of staff reported any service user who required treatment. When we looked at records we could not always tell when foot care observations were made or if service users always received their treatments in a timely manner. Formal recording of foot care support Katherine Lowe House DS0000032577.V377361.R01.S.doc Version 5.2 Page 14 should be in place with planned chiropodist treatments or general appointments in place for each service user. Records were in place which detailed professional health care visits from district nurses and general practitioners and service user’s attendance at hospitals. We looked at a sample of medication administration records and observed a member of staff administering medication to service users. We found that practices were being met to standard and medication was being handled, recorded and administered appropriately and safely. When asked “does the home make sure you get the medical attention you need” five relatives surveys stated yes their relatives needs were always met. When asked “what does the home do well” one person wrote “the staff are always very attentive, there is always someone available to talk to if required.....the home has a very relaxed atmosphere and is obviously a very caring place.......the staff feel more like friends that workers.” During the course of the inspection we saw mixed practice regarding how service users were supported and spoken to by members of staff. We found some staff on occasions were disrespectful and dismissive for example we heard one staff member speaking abruptly on two occasions to one service user, we also noted they did not follow through a request from a senior member of staff to provide a service user with a light snack. We also heard a staff member say to a resident “it’s time to get up now”. Whilst we know it was after 11am in the morning when this interaction took place, the tone of the staff member was one of disapproval rather than gentle encouragement for the service user to get up and join in the routines of the home. Another service user was heard asking a member of staff for a cup of tea, however the staff member stated “you have just had one .... hang on for a bit”. The case record for this service did not indicate that fluids should be restricted therefore there was no reason this service users should have been prevented from drinking. Not all staff were heard to be abrupt and we saw on many occasions members of staff being extremely polite and cheerful when supporting and speaking to service users Katherine Lowe House DS0000032577.V377361.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some service users do not always have the opportunities to make their own decisions and choices or have sufficient daytime activities available to them. Because of this some service users become bored and isolated. EVIDENCE: Relative surveys identified that they felt service users were generally supported to live as they wished and that activities were sufficiently provided. During the course of the site visit we were able to sit with service users during the day and observe their day to day routines. Some service users had very Katherine Lowe House DS0000032577.V377361.R01.S.doc Version 5.2 Page 16 specific daily routines which they were supported in keeping; others had a flexible approach to each day. When asked about the routines for getting up in a morning a number of service users said they were “woken up”, two service users told us they would like a “lie in”. A number of service users told us they felt they were not given any choice about when they could get up. One service user spoke of their displeasure about being woken up. Some service users said they had no objection to being ‘got up’ if they were already awake. One service user told us they had to be out of bed at a certain time for breakfast or “you lose it.” We saw that many service users rose when they wished and that specific instructions were recorded for some service users who preferred to get up late. Care files did not specifically identify service user’s individual wishes regarding if they would be preferred to be woken in the morning or if they preferred to get up when they naturally woke. We looked at a number of service users bedrooms as part of the inspection process and did not see that any service users had their own alarm clocks which would support them to wake when they wished whilst at the same time promote their independence. Since the last inspection daily activity plans have been put on display in each lounge. Our observations were that the activity notices were not in a convenient place for service users to see and were not designed to attract and engage service users. The care files did not contain social care plans for individual service users rather they stated some of their preferred hobbies and interests. Activity records are kept which record when service users join in a social event. We looked at the activity records for five service users, two of whom were described as having a learning disability and two who were described being alcohol dependant. We could not see any additional risk assessments relating to the service users due to their conditions or any specific considerations which may apply. The activities record identified that the ‘drinks trolley’ was offered to all service users each week, but it was not clear if this was appropriate or not for those with alcohol dependency, furthermore we could not see any records to identify that the registered manager or staff team had consulted with professionals relating to the social development or provision for those with a learning disability. Rather one activities programme was in place for all service users regardless of their general or mental health conditions. The records routinely recorded the media group, movement to music, manicures and bingo. From the records we looked at a number of service users rarely joined in such activities, there was no evidence to support that they had been consulted about their preferences or offers of alternative activities. Katherine Lowe House DS0000032577.V377361.R01.S.doc Version 5.2 Page 17 We were able to speak with a service user who preferred to remain in their room. They said the reason for staying in their room was because they found the lounge “too boring” with others “asleep and the TV on most of the time” which we also observed on the days we were at the home. Another service user also spoke of being “very bored” and to break the boredom they go to their room for short periods. The service user mentioned that they used to enjoy swimming but was never offered an opportunity to go swimming. The entrance of the home looks out on to a main road and we saw that a small group of service users used this area well to socialise with each other. Virtually all service users agreed that the only regular external activity available was to sit in the garden when the weather is good. Whilst walking around the home we heard very loud music coming from one lounge, when we visited the area we found one service user with their hands over their ears and another complaining it was “to loud, turn it down”. There were no members of staff in the room. We were told by the officer that a quiz should have been in progress in that particular lounge and had no idea why the music was playing so loud and service users left alone. A number of service users had enjoyed the most recent trip outside of the home to a local place of interest. They stated their pleasure at going out with one person saying they had really enjoyed their day and being out. One service user did inform us that they were supported to go for walks with a member of staff most days. We had the opportunity of sitting with service users for a number of meals, including breakfast and lunchtime. At breakfast on the first day there was a wide variety of choice for breakfast which included cereal, fresh fruit, cooked breakfast, toast, tea, milk and fruit juice with extra helpings being offered. When we spoke with service users they complained that they had been sat at the table waiting for breakfast at 9am but was not served until after 10am. Some remarked that they would have “preferred to have tea and toast instead of this long wait.” We observed similar delays in two lounges at lunchtime. When we enquired what they delay was, some staff stated “staff shortages” whilst others seemed unaware that there was a delay. Service users later told us that despite the long wait for meals they were generally very enjoyable with fresh fruit available at every meal time. We observed one service user requesting a drink of tea at 11.45am however they were told by a staff member that lunch would soon be served. Lunch was not served until 1pm on that day. This means service users were sat at dining tables for some considerable time. Katherine Lowe House DS0000032577.V377361.R01.S.doc Version 5.2 Page 18 During meal service staff members were observed to be attentive to those who required additional support. Many service users receive frequent visits from their friends and families. Some service users are taken out by their family and are able to visit their family home for periods of time. All visitors are asked to sign the visitors record which we checked and found correct. This means the registered manager and staff team know when additional people are in the home and their whereabouts. Katherine Lowe House DS0000032577.V377361.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is Good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are protected by complaint and safeguarding procedures. EVIDENCE: The AQAA identified that one complaint had been received at the service within the last twelve months. When asked if they knew about the complaints system, all returned service users surveys recorded that they did know how to complain and that they had someone they knew and trusted to talk with if they had any concerns. Three relatives stated that their complaints had been dealt with appropriately by the registered manager and staff team. During discussion with the officers it became apparent that complaints dealt with quickly are not recorded rather it is only formal complaints received which are recorded. Because of this we could not tell how many people have been dissatisfied with the service or the action taken by the home to minimise Katherine Lowe House DS0000032577.V377361.R01.S.doc Version 5.2 Page 20 further issues, although we are satisfied that people are listened to and concerns acted upon. In order to protect service users the registered manager makes sure all new staff members have a Criminal Record Bureau (CRB) check completed prior to being offered employment at the home. Induction procedures include information on the Protection of Vulnerable Adults (POVA) and mandatory safeguarding training is completed by all members of staff. We have been contacted on two occasions about concerns of service users, both of which have been investigated and dealt with by the local authority. One matter brought to our attention was a concern regarding the home’s difficulty to manage and support a service user. The registered manager did not inform us of this through the required notification system, neither have we received any information from the registered manager about the two safeguarding matters which were recorded within the AQAA. The manager needs to make sure that we are kept fully informed of all safeguarding referrals. Katherine Lowe House DS0000032577.V377361.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,23,24,25 & 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users do not live in a home that is well maintained and safe. Insufficient maintenance of some fire safety doors potentially places people at increased risk. EVIDENCE: At the last key inspection we identified that the environment of the home fell below the required standards and as a consequence we made a number of requirements relating to redecoration, upgrading and fire safety. Katherine Lowe House DS0000032577.V377361.R01.S.doc Version 5.2 Page 22 The registered manager wrote within the AQAA that she and her staff team have been spending time improving some areas of the home themselves. During the course of our site visits we looked around the home and found the registered managers comments to be accurate. Some communal rooms had been repainted, looked brighter and cleaner with new curtaining and upgraded televisions. However we observed that for the most part the rest of the home needed some significant investment. Some service user’s families had redecorated some bedrooms but we found that bare plaster was still evident, wallpaper was ripped or missing and paintwork was scratched and shabby in most bedrooms. There was still clear evidence of the electrical re wiring which took place at the home several years ago and some carpets remain stained and unsuitable. We spoke with the service manager who informed us that the upgrading of the home has been delayed as a consequence of the residential review currently being undertaken by the Local Authority. Assurances were given that following the completed review in September 2009 a plan for the Local Authority residential care provision will be put into place and provided to us alongside any upgrading programmes. During the course of the inspection we again found that some bedroom and lounge doors did not fit into their rebates correctly. During the inspection process the fire alarm was activated and a full fire procedure was carried out that was later determined to be a false alarm. When we checked fire safety doors and bedroom doors we found at least one bedroom door had failed to close properly. This could have increased the risk of smoke inhalation and the spread of fire in the event of a real fire emergency. The record of fire safety checks identified that a faulty lounge door had been identified by the person checking and reported their findings to the registered manager however several months later the door had not been repaired. The officers explained that all the appropriate requests had been made to the Local Authority to no avail. The failing to maintain appropriate fire safety in respect of fire doors was identified at the last two key inspections and needs to be addressed. Katherine Lowe House DS0000032577.V377361.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27.28.29 & 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users receive support from staff that are recruited correctly and trained to fulfil their employment roles and responsibilities. EVIDENCE: The registered manager wrote within the AQAA that all staff have achieved a “National Vocational Qualification (NVQ) at level 2 to 4 depending on their role” and we also know that that officers have achieved an NVQ at level 4 which is required for managers of care services . This exceeds the National Minimum Standard to have 50 of staff trained at NVQ level 2 or above. Feedback from service users was in the main positive with all returned surveys indicating that staff members always listen to service users and act on what they are saying. Katherine Lowe House DS0000032577.V377361.R01.S.doc Version 5.2 Page 24 We looked at two staff files in depth and evaluated training records for six members of staff. The registered manager had followed the Local Authorities robust recruitment and selection procedures which are designed to protect service users from receiving care from people who may do them harm. Applications forms were on file as were statutory checks and references which are essential when making a judgement regarding a person’s suitability. Training records identified that training has continued to be provided throughout the year. Members of staff had training and development records on file which confirmed that their future training needs had been identified and systems put into place to make sure they received the training they needed. When we consulted with members of staff about how they were supported five out of six stated they had received a very good induction. We were also told that they usually received the information they required to support service users in a timely manner. The records we looked at confirm that new staff members receive good inductions which met the Skills for Care Common Induction Standards. We also had the opportunity of observing the handover system which is completed between one shift finishing and a new one commencing. During this time good information was passed from one staff team to another about the service users and routines for the day. When we asked staff members if there were always enough staff on duty we received mixed views. Of the six surveys’ received one said usually, three said sometimes and two stated never. One staff member stated “we are sometimes so short of staff and agencies do not always pull their weight”. The AQAA identified that 252 shifts had been covered by temporary members of care staff or by agency members. At the time of one of our site visits we noted that three agency staff were on duty which is proportionally high, however we were told that this was due to annual leave and sickness absence. In an attempt to reduce sickness absence the registered manager operated sickness monitoring and those returning from sick leave completed a return to work interview. When a staff member had a high level of sickness absence we saw that a health review meeting had been held to support the member of staff to remain in work and reduce sickness levels. During the course of the inspection, we were aware that the top floor level of the home had reduced staffing levels due to the reduced occupancy of service users; as a consequence we found that in the main staff were observed to be in appropriate numbers on other floors. We looked at staff meeting minutes where we could see that action had been taken by the registered manager to ensure that staff break times were more structured and did not leave the home understaffed. Katherine Lowe House DS0000032577.V377361.R01.S.doc Version 5.2 Page 25 Katherine Lowe House DS0000032577.V377361.R01.S.doc Version 5.2 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Katherine Lowe House makes sure service users feel supported and happy. However failing health and safety issues place service users at risk. EVIDENCE: There have been no changes in the management structure of the service in that the registered manager continues to be in place as are the officers who Katherine Lowe House DS0000032577.V377361.R01.S.doc Version 5.2 Page 27 support the running of the home. The registered manager continues with her training and holds the relevant qualifications to run a care home. The home is visited by a service manager each month to complete an audit of the home to make sure it is operating to the correct standard. In 2008 the registered manager completed a quality assurance procedure which included consulting with service users, staff members, relatives and friends. Of the 30 surveys sent out 15 were returned. A report of the outcome of the consultation has been provided to us and is made public and available upon request at the home. We advise the registered manager to give future consideration to how the report is written and to fully address how the shortfalls in the service are to be met. Currently the report is slightly dismissive of negative feedback and does not provide the reader with a sense that the service may be developed as a consequence of the feedback given. All accidents are recorded. The records we looked at were generally completed well and systems in place for monitoring service users for 24 hours after an accident could be seen. From reading the accident records were noted that a number of service users had received medical attention as a consequence of their accidents and some admitted to hospital. There were also records of relating to where one service user had caused the accident of another indicating this was on purpose and the service user’s behaviour was becoming an issue for the home. We had not been notified of any of these events as required within Regulation 37. Fire safety records looked at indicated that there were sufficient routines in place for the checking of fire safety equipment. As mentioned earlier in the report, not all doors closed appropriately into their rebates which placed service users at increased risk in the event of a fire emergency. During the course of the site visit the fire alarm was activated and a full fire procedure was carried out. It was identified that three agency staff were not aware of the procedure to be followed, with one indicating their confusion and asking directions whilst two others did not arrive at the collection point. The agency staff did not appear to have been missed by contracted staff members and were not reported as missing to the officer. Following the fire procedure the Officer was observed showing the three agency members of staff the procedure to be followed in the event of a fire emergency. Notwithstanding the action taken by the officer, there was no clear system in place to support officers in charge to know if agency members had received up to date fire safety training and systems were not in place for members of staff to recognise when staff were missing or report their absence when congregating at the fire safety point. Katherine Lowe House DS0000032577.V377361.R01.S.doc Version 5.2 Page 28 Officers from the fire safety department inspected the home in June 2008 and found the premises satisfactory. Inspection of fire training records identified that all but one member of staff had been trained in fire safety procedures. There are concerns that the registered manager and the Local Authority as the registered provider of the service have continually failed to ensure that fire safety procedures are of the highest standard to ensure the safety of both service users and members of staff in a fire emergency. Infection control procedures have improved since the last inspection. Members of staff had signed to say they had read infection control procedures and training records identified they had received appropriate training. During the course of the site visits, members of staff were discreet when providing personal care and using protective clothing. Notices were on display to advise visitors to be vigilant in washing their hands in a effort to reduce the risk of the spread of infection. Health and safety records identified that routine servicing of equipment had been completed by external professionals and that equipment was fit for purpose. Service users and relatives continue to attend focus group meetings which keeps them informed of developments within the home. Service users are supported to manage their own finances through family and nominated people involved with their life. The home continues to only manage small balances which are 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. Katherine Lowe House DS0000032577.V377361.R01.S.doc Version 5.2 Page 29 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 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 2 2 2 X X X 2 1 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 3 X 2 Katherine Lowe House DS0000032577.V377361.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No 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 OP19 Regulation 23 Requirement 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. (Timescales from 22/11/06 not met) This should make sure the risk of the spread of fire and/or smoke inhalation is reduced in the event of a fire emergency. 2 OP18 37 The registered manager must keep us notified of all significant events as identified within Regulation 37. 15/08/09 Timescale for action 15/08/09 3 OP19 23 This will make sure we are aware of all significant events relating to service users. The registered provider must 15/10/09 make sure that the home is kept in a good state of repair and be reasonably decorated. A plan full detailed plan for the Katherine Lowe House DS0000032577.V377361.R01.S.doc Version 5.2 Page 31 upgrading of the home should be provided to us so that we can monitor that upgrading is being completed in a timely manner for the benefit and comfort of service users. 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 Formal recording of future appointments such as chiropody, dental, optical and hearing tests and checks should be in place so each service user has their care needs evaluated by an appropriately trained person To make sure service users receive the daily care support required, and to ensure that records identify areas of change and difficulty in providing support, daily records should contain details of the care support provided and record where the care plan has not been followed and the reasons why. All members of staff should be trained treat and support service users in a respectful and dignified manner. Their practice should be monitored and addressed if identified falling below the required standard. All service users should have the opportunity of joining in meaningful activity and social events which are of interest to them. Individual social care plans should be developed and an activities programme developed to meet the needs of those who wish to meet as a group and for those who prefer to remain alone. Service users should be encouraged to make choices and decisions for themselves and their independence should be promoted at all times including rising times. Systems should be in place to make sure service users request for drinks are met at all times. DS0000032577.V377361.R01.S.doc Version 5.2 Page 32 2. OP8 3 OP10 4 OP12 5 OP14 6. OP14 Katherine Lowe House 7 OP15 8 OP16 9 OP37 10 OP37 Systems should be put into place which makes sure members of staff know the actual time for food being delivered to the units at each mealtime. Members of staff should only encourage and support service users to be seated at dining tables when they know that food has been or is about to be delivered and served. Systems should be in place for the recording of all complaints received at the home. Complaints records should detail the nature of the complaint, the action taken to investigate and the outcome. The registered manager should ensure that the homes fire risk assessment is updates. Where risks are identified staff should be informed of the action to be taken to minimise risk. Systems should be in place which makes sure the whereabouts of staff failing to reach the emergency call evaluation point are known at the time of a fire emergency. Katherine Lowe House DS0000032577.V377361.R01.S.doc Version 5.2 Page 33 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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