Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 15/09/09 for Loppington House

Also see our care home review for Loppington House for more information

This inspection was carried out on 15th September 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

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

What the care home does well

We do not consider that Loppington House is currently performing well however we have been consistently satisfied that the home operates a thorough recruitment process to ensure that people who come to work at Loppington are suitable for the work they are to do. We also consider that people who live at Loppington House are enabled to keep in touch with family and friends and staff know how important family contact and support is to the people living at the home.

What has improved since the last inspection?

When we visited Loppington on 21st July 2009 we found that overall improvements had been made to care and support plans because they now contain details of how to support people to manage their challenging or complex behaviour. Plans were in place to support identified behaviours and staff training to manage these behaviours had taken place. On this visit we found that care files, staff files and records are now more organised and new paperwork has been introduced that, when completed fully, will give better information to show how the home meets people’s individual care and support needs. Incident reporting has improved with all incident forms being sent to the manager for immediate review and this happens for the majority of the time. The home plans to introduce person centred care plans in the near future and training is taking place to equip staff to do this. On files reviewed we did see evidence that this process had started as staff had recorded information about people’s lives before they went to live at Loppington. Staff are enthusiastic about the appointment of an activities coordinator to develop people’s opportunities to enjoy a range of activities of their choice. Staff training is slowly improving with dates set for staff to attend mandatory training but the lack of training in areas such as adult protection may now have made people vulnerable. The organisation has implemented a new self monitoring tool that will enable them to carry out comprehensive audits of process and identify shortfalls Loppington House DS0000020698.V377613.R01.S.doc Version 5.3 within the service as part of a continuous self monitoring process that should ultimately drive improvement and make Loppington a better and safer place for people to live.

What the care home could do better:

As a result of this inspection we identified areas where improvement is needed to keep people living at Loppington House safe and free from abuse. Although a number of improvements were noted at the time of this inspection (as detailed above) the home failed to build on these improvements when it came to the admission of six new people to the home. We found that the home had failed to assess risks in relation to the safe support of the new admissions and had developed plans that, at times, were either inaccurate or were not being followed by staff. This means that people may not be receiving the support that they require or may be at risk of harm if staff do not know how to effectively support them We found that complaint investigation processes require further development as current arrangements are not satisfactory resulting in some people feeling that complaints are ignored. We are aware that the organisation has a robust process in place for managing complaints and the manager must now look to ensure procedures are followed to instil confidence in people for the future. We believe that the projects manager requires additional resources to ensure the effective monitoring of processes and staff need guidance, training and support to improve their practice and thus improve the overall quality of the service provided to people who live at Loppington House. Potentially people living at Loppington House can take part in a variety of identified leisure and social opportunities that they enjoy however staffing levels and other practices detailed within our report are having an impact on people’s opportunities and choices thus meaning that they can not live full and active lives. People living at Loppington House cannot be sure that they can live safe from abuse because not all staff have received training to ensure they are aware of processes for reporting and recognising abuse and people do not feel that they can speak out when they witness potential abuse without fear of reprisal. In relation to the environment a number of areas still require refurbishment to make them safer and more homely.

Key inspection report CARE HOME ADULTS 18-65 Loppington House Wem Shrewsbury Shropshire SY4 5NF Lead Inspector Sue Woods Key Unannounced Inspection 15th September 2009 10:00 0 Loppington House DS0000020698.V377613.R01.S.doc Version 5.3 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 home adults 18-65 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. Loppington House DS0000020698.V377613.R01.S.doc Version 5.3 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 Loppington House DS0000020698.V377613.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Loppington House Address Wem Shrewsbury Shropshire SY4 5NF 01939 233926 01939 235255 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) www.loppingtonhouse.co.ukE mail office@loppingtonhouse.co.uk Loppington House Ltd Manager post vacant Care Home 36 Category(ies) of Learning disability (36) registration, with number of places Loppington House DS0000020698.V377613.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD) 36 The maximum number of service users who can be accommodated is: 36 21st July 2009 Date of last inspection Brief Description of the Service: Loppington House is a further education unit and adult centre established in 1983.The establishment is situated in the rural North Shropshire countryside close to the small market town of Wem and just 14 miles away from the historic town of Shrewsbury. Loppington House is registered with the Care Quality Commission (CQC) to provide accommodation and care for a maximum of thirty six people with a learning disability. The accommodation comprises of a main house, which provides the education resources on the ground floor and residential accommodation on the first floor, two detached houses in the grounds and two bungalows. In addition there is a small swimming pool, an office and a separate flat that accommodates up to six visitors. In October 2007 Loppington House was purchased by Active Care Partnerships (Holdings) Limited. The home does not currently have a registered manager although the organisation’s project manager is currently overseeing management responsibilities. Ms Angela Forster is the responsible individual. Information is shared with people who live at the home in the Service User Guide. Advocacy support is promoted and a quality assurance system is in place in the form of questionnaires and regular audits. Inspection reports about this service can be obtained direct from the provider or are available on our website at www.cqc.org.uk. Loppington House DS0000020698.V377613.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means that people who use this service experience poor quality outcomes. The unannounced key inspection of Loppington House took place on 15th September 2009. The inspection was carried out by two inspectors. We started at 10.00 am and finished at 3.30 pm. We reviewed all twenty two of the key standards for care homes for younger adults and information to produce this report was gathered from the findings on the day and also by review of information received by CQC prior to the inspection date. A quality rating based on each outcome area for service users has been identified. These ratings are described as excellent/good/adequate or poor based on findings of the inspection activity. As part of the inspection we, the commission, met with a number of people who live at Loppington House. We also spoke with staff on duty at the time of the visit and spent time with the responsible individual and the projects manager who were both on site. We looked at three care files and extracts were seen from others. We also looked at a number of other records referred to within this report. We looked at three staff files, including recruitment, supervision and training records. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection that took place on 8th April 2009 and the subsequent random inspection that took place on 21st July 2009 when we looked to see if requirements made at the time of our last visit had been met. We also looked at notifications received from the home. These are reports about things that have happened in the home that they have to let us know about by law, and reviewed minutes from ongoing safeguarding meetings which we also attend. We spoke with a social care professional on the day after the visit to obtain views from people who have regular communication with the home. Loppington House DS0000020698.V377613.R01.S.doc Version 5.3 Page 6 What the service does well: What has improved since the last inspection? When we visited Loppington on 21st July 2009 we found that overall improvements had been made to care and support plans because they now contain details of how to support people to manage their challenging or complex behaviour. Plans were in place to support identified behaviours and staff training to manage these behaviours had taken place. On this visit we found that care files, staff files and records are now more organised and new paperwork has been introduced that, when completed fully, will give better information to show how the home meets people’s individual care and support needs. Incident reporting has improved with all incident forms being sent to the manager for immediate review and this happens for the majority of the time. The home plans to introduce person centred care plans in the near future and training is taking place to equip staff to do this. On files reviewed we did see evidence that this process had started as staff had recorded information about people’s lives before they went to live at Loppington. Staff are enthusiastic about the appointment of an activities coordinator to develop people’s opportunities to enjoy a range of activities of their choice. Staff training is slowly improving with dates set for staff to attend mandatory training but the lack of training in areas such as adult protection may now have made people vulnerable. The organisation has implemented a new self monitoring tool that will enable them to carry out comprehensive audits of process and identify shortfalls Loppington House DS0000020698.V377613.R01.S.doc Version 5.3 Page 7 within the service as part of a continuous self monitoring process that should ultimately drive improvement and make Loppington a better and safer place for people to live. What they could do better: If you want to know what action the person responsible for this care home is Loppington House DS0000020698.V377613.R01.S.doc Version 5.3 Page 8 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. Loppington House DS0000020698.V377613.R01.S.doc Version 5.3 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Loppington House DS0000020698.V377613.R01.S.doc Version 5.3 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 and 3 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who move to Loppington House may be vulnerable if the home does not carry out appropriate assessments of identified risks to ensure their safety. EVIDENCE: When asked, the responsible individual said that four people had been admitted one week earlier to Loppington House, the project manager confirmed that she had met four of them. The acting deputy manager later confirmed that there had been six admissions. We were surprised to discover this, as the organisation had agreed a ‘suspension of referrals’ at a Safeguarding meeting in May 2009. The intention of this was to ensure that people were not admitted to the home until the situation had improved. However, the responsible individual stated that she believed that these admissions were acceptable as they had been accepted as referrals the previous year, the reason for their delayed admission being due to the commencement of the 2009 – 2010 academic year. No referrals have been processed since the agreement in May 2009’ Loppington House DS0000020698.V377613.R01.S.doc Version 5.3 Page 11 We looked at the care files of two of the six people newly admitted and found a basic care plan in place for each of them with assessments of need available carried out by social care professionals. We also saw basic initial assessments of needs carried out by the home. However assessments of risks had not been completed to ensure peoples safe support upon admission. Information provided by the placing authority was not always reflected in the care plan developed by the home in relation to the risks posed by one person to others. Loppington House DS0000020698.V377613.R01.S.doc Version 5.3 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples living at Loppington House are vulnerable and at risk of harm if staff do not know how (or do not follow guidelines) to meet and respond to their identified care and support needs safely. EVIDENCE: We looked at the care files for three people living at Loppington House. One care file had been reviewed on previous visits and it was seen to be better organised with evidence that information is now being reviewed in order for the home to demonstrate that it is able to respond to that persons individual needs. Loppington House DS0000020698.V377613.R01.S.doc Version 5.3 Page 13 Behavioural management plans were in place although records suggested that staff do not always follow them when responding to identified behaviours. As a result the person may not be receive care and support that she requires in order for her to live a safe and happy life. When we carried out our follow up visit following the last key inspection we found that risk assessments had been developed and implemented to offer safe support to people. During this visit the files for the two new admissions were reviewed. Care plans were basic and we found that requirements that we had previously made in relation to the need to assess the risks involved in people’s everyday life and activities were still not being assessed on all occasions leaving people vulnerable and their safety compromised. This suggests that the home is able to make improvements when required but do not take on board requirements and ensure that they become safe practice within the home. There is also evidence that the care plan implemented for one new admission had not been followed and as a result an incident had occurred that left the individual distressed and a staff member injured. Behavioural management guidelines were in place to support all three people whose care we looked at during this inspection. For two people we found that staff were not always following the guidelines. The response to an identified behaviour on one plan was inappropriate offering no support to staff during an incident and this placed the individual, others in the environment and staff offering support at risk of harm. It was of concern that this management plan had been written by someone who had been trained to do so and signed by six people, all of whom had received relevant training and no one had identified the error. This evidence suggests that staff are not always following instruction and that people who are trained and considered competent to support people who have challenging behaviour are not. As a result people are vulnerable and at risk of harm. The home plans to introduce person centred care plans in the near future and training is taking place to equip staff to do this. On files reviewed we did see evidence that this process had started as staff had recorded information about people’s lives before they moved to Loppington House. Loppington House DS0000020698.V377613.R01.S.doc Version 5.3 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: Standards 12, 13, 15, 16 and 17 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. Potentially people living at Loppington House can take part in a variety of identified leisure and social opportunities that they enjoy however staffing levels are currently having an impact on people’s opportunities and thus meaning that they can not live full and active lives. People benefit from supported family contact and involvement meaning that they are able to stay close to the people that matter to them. EVIDENCE: From the 1st August 2009 day services for people living at Loppington take place in peoples own homes. Loppington House DS0000020698.V377613.R01.S.doc Version 5.3 Page 15 Currently the home has a weekly activities timetable that shows where people are to be on each day but it does not show what they are planned to be doing on all occasions. Activities scheduled include swimming, nature activities, a photography course, ‘pedal power’ and other community based activities. The activity timetable also shows when activities do not happen. For example swimming was cancelled on 14th September due to staff sickness. Staff told us that staffing levels and covering for sickness were currently an issue for the home and is impacting on people’s activities. Our evidence reflects that staffing levels are impacting on people’s quality of life and arrangements for support are being made in response to the needs of the service and not based on individual choices and preferences. This will affect people’s quality of life. We also found that people who do not live in individual houses are going to named houses for activities and meals. This does not reflect that the organisation is recognising that the houses are people’s homes. For example on the day of our visit a person who visits Loppington for day services was having lunch in one of the houses, apart from the rest of the group. People are however supported to stay in touch with families and people who are important to them. A recent open day was well attended by families and friends and the care file reviewed for one person showed regular recorded visits to and from family. Staff are enthusiastic about the appointment of an activities coordinator to develop people’s opportunities to enjoy a range of activities of their choice. The project manager informed us that people now have their meals in their houses, unless they are taking part in a community based activity. Although we did not see individual menus during our visit the project manager stated that each house now has its own menu to reflect individual tastes and choices and also said that all four of the houses now shop for their own food and have a budget. She said that each house is having support from the cook in the main kitchen to support this process to be successful. This will mean that people are able to have a say in what they eat and be able to develop their independent living skills as they take part in food preparation. Loppington House DS0000020698.V377613.R01.S.doc Version 5.3 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20 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. We can not be sure that people receive their care and support in a way that they prefer as care plans do not always reflect individual preferences and choices, staff do not always follow care plans and there have been some concerns raised by outside agencies suggesting people’s health and personal care needs are not being met. People are generally safeguarded by the home’s system for handling, storing and administering medication EVIDENCE: Health care appointments were seen documented on the file of one person whose care we looked at during our visit. This showed that she attends regular routine health care appointments. There was also a nutritional assessment in Loppington House DS0000020698.V377613.R01.S.doc Version 5.3 Page 17 place to support a healthy eating plan. There was no current health information seen on the files of the new admissions. The project manager said that the home is looking to develop and implement Health Action Plans to reflect peoples identified health care needs. This will mean that the home will be able to demonstrate in a person centred way how and when they support people to remain in good health and receive regular check ups to keep them well. In the last two months two social care professionals have raised concerns in relation to the home not meeting people’s personal and health care needs. Both of these concerns are currently being investigated. Each area of the home has its own medication storage and administration records. The arrangements for one of the houses was looked at and seen to be satisfactory. A member of the organisation’s senior staff team, who was carrying out a formal monthly audit of the homes performance, was seen to be checking the medication records throughout the home and later she reported that she had identified some issues that would need addressing. Loppington House DS0000020698.V377613.R01.S.doc Version 5.3 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standard 22 and 23 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Loppington House cannot be sure that staff employed to support them would raise concerns on their behalf in order to keep them safe as they may not have the knowledge in relation to recognising or reporting abuse or be reluctant to speak out. As a result people are vulnerable in their care. Complaints have not been managed effectively or satisfactorily meaning people are dissatisfied with the home and people may not be receiving better care as a result of sharing concerns. EVIDENCE: While we recognise that the current project manager is working to address complaints raised to the home it is also apparent that recent management arrangements have failed to address complaints leaving people dissatisfied with the home. Since our last visit in July two complaints have been made. One of these complaints was received prior to that visit but it was not made available to us for review. Both complaints are currently being investigated although one complainant is unhappy with the amount of time it has taken for the home to respond. Loppington House DS0000020698.V377613.R01.S.doc Version 5.3 Page 19 Staff tell us that they have not all had training in relation to safeguarding adults or in recognising and reporting abuse. Training records reflected this and the project manager has recognised it as a priority. After speaking with one staff member we could not be sure that staff feel comfortable to speak out against suspected abuse stating that previous experiences have affected their confidence. We passed this information to the project manager to follow up. A concern raised to us during our visit was accepted as a safeguarding referral the following day. In recognition of the homes current 0 Star status and the continuing number of referrals of suspected or alleged abuse being made to the local multi agency safeguarding team, contracts with Loppington House are currently suspended. Loppington House DS0000020698.V377613.R01.S.doc Version 5.3 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 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. People who live at Loppington House are provided with a safe place to live however redecoration and new furnishings will make the houses more homely and improvements to the laundry room in two of the houses will make the environment more hygienic. EVIDENCE: We visited all of the five residential areas as part of this inspection including the college accommodation. Each area was seen to be clean but all need further refurbishment. The décor in many areas looks tired and kitchens and laundry rooms need to be brought up to an acceptable standard to enable people to use them to develop their Loppington House DS0000020698.V377613.R01.S.doc Version 5.3 Page 21 independent living skills (as is the stated ethos of the service) and maintain good standards of hygiene. A number of people told us that they liked their rooms. The manager was seen to have a list of work that is still required to bring the houses up to a good standard. Furniture for communal areas had been purchased making for a more homely appearance. On the day of the inspection the exterior of the college building was being painted. The manager confirmed that the work identified at the time of the last inspection as being necessary in the laundry area of one of the houses had not been carried out. Similar work would be needed in the main laundry area that services the college area and The Shrubbery. Staff talked about how the swimming pool was now available to the people who live in this home and guidelines for its safe use were being drawn up. The grounds for the home were spacious with each house having its own garden area for recreation. Within the parklands for the house there is also plenty of space for the parking of vehicles whether they belong to visitors, staff, the home or individuals who live there. There is also an area to the rear of the college that is specifically for gardening groups to develop as an activity. The rest of the grounds were seen providing the opportunity for people to mow lawns and generally carry out that type of maintenance work. Loppington House DS0000020698.V377613.R01.S.doc Version 5.3 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 33, 34 and 35 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Loppington House cannot be sure that they are supported by a qualified or competent staff team and as a result they may be at risk of harm if staff cannot keep them safe or follow guidelines to in order to offer safe support. Likewise staffing levels are not enabling people to lead full and active lives and currently staff sickness and other cover requirements are affecting staff morale and opportunities for people living at the home. EVIDENCE: Staff told us that they liked working at Loppington however all recognised that there has been considerable change recently and this has affected their ability to offer a consistent and well planned service. Although improvements are identified in relation to the introduction of a new rota and the appointment of Loppington House DS0000020698.V377613.R01.S.doc Version 5.3 Page 23 an activities coordinator all felt that staffing levels and particular covering for staff sickness are impacting on their ability to offer people good opportunities to lead full and active lives. One staff member told us that care plans are ‘good’ and reflected peoples care needs however there was also evidence that staff continue to support people in ways that are not specified in peoples support and management plans and this is potentially compromising peoples safety. Staff training is slowly improving with dates set for staff to attend mandatory training but the lack of training in areas such as adult protection may now have made people vulnerable. Staff who spoke with us had not had recent formal supervision and the manager was made aware of this. The staff files of the last three care staff to join the team were reviewed and found to contain the essential information required for the home to demonstrate that people are recruited safely to ensure the protection of vulnerable people. All checks are carried out before people work with the people living at the home. Records were well maintained and readily available for inspection. Loppington House DS0000020698.V377613.R01.S.doc Version 5.3 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Current management arrangements have not had time to positively affect the overall quality of the service provided and whereas some changes have been made to improve peoples quality of life some areas remain of concern making people potentially vulnerable and unable to exercise real choices and control over their life. Some management decisions have ultimately made people moving into the home vulnerable. EVIDENCE: Loppington House DS0000020698.V377613.R01.S.doc Version 5.3 Page 25 The project manager who is currently overseeing management responsibilities at Loppington House is committed to improving the quality of the service provided and she is supported by a regular senior management presence on site. However there is considerable work still to be done before we feel that Loppington is a well run home and that people who live there are safeguarded by the home practices, policies and procedures. We shared the managers frustrations that although she is implementing processes and support plans they are not being carried out by all staff and this is negatively impacting on the overall quality. We have questioned the responsible individuals decision to admit six people to the home over the last week and the lack of management input into their admission is concerning. We now plan to meet with the responsible individual to discuss future management arrangements. The home has a quality assurance programme in place and a new tool being piloted by the organisation to support senior managers to monitor and review quality within the home was seen in use by the responsible individual. Her feedback reflected that it enabled her to carry out comprehensive audits of process and identify shortfalls within the service as part of a continuous self monitoring process that should ultimately drive improvement and make Loppington a better and safer place for people to live. Loppington House DS0000020698.V377613.R01.S.doc Version 5.3 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 1 3 1 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 1 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 1 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 1 X 2 X X 2 X Version 5.3 Page 27 Loppington House DS0000020698.V377613.R01.S.doc NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA23 Regulation 13 (6) Requirement The organisation must work within the local multi agency guidelines and protocols. This is to make sure that people are safeguarded within the home and people are not admitted to the home when it is considered that the home is unable to meet their needs safely. Staff must follow care plans and guidelines developed by the home at all times. This is to ensure that people receive safe and consistent support Risks associated with people’s behaviours must be identified and minimised through the effective use of risk assessments. This is to ensure that as far as is possible people remain safe. Complaints must be thoroughly and promptly investigated and records be available to demonstrate this process. This is so that the home can show that they listen to peoples concerns and ensure that appropriate DS0000020698.V377613.R01.S.doc Timescale for action 26/10/09 2 YA6 12 26/10/09 3 YA9 13 (4) (C) 26/10/09 4. YA22 22 (3) 26/10/09 Loppington House Version 5.3 Page 28 action is taken in a timely manner to keep people safe and improve the service provided. 5 YA33 18 (1) (a) Safe and adequate staffing levels 26/10/09 must be maintained at all times to ensure that people receive the service that is planned for them. Staff must receive training in 26/10/09 relation to safeguarding people from abuse and recognising and reporting abuse. This is to ensure that staff have the knowledge and understanding of the roles they are to carry out in order to meet peoples assessed needs and keep them safe. 6 YA35 18 (1) (c) 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 YA30 Good Practice Recommendations The laundry room walls at Park House should be washable to ensure the room is hygienic and the risk of spreading infection from soiled laundry is reduced. It is recommended that the individual houses that make up Loppington House are refurbished to make them more homely and comfortable. It is recommended that people are told when the service to be provided is not going to meet all of their expectations as this may mean that they decide that the home is not right for them and they can make that decisions prior to moving in. It is strongly recommended that the home respects that the houses that make up the Loppington registration are peoples own homes and it is not appropriate to send people to those houses for meals and activities. This is a recourse issue that is impacting on people’s right to privacy in their own home. DS0000020698.V377613.R01.S.doc Version 5.3 Page 29 2. YA24 3 YA2 4 YA12 Loppington House 5 YA18 Staff should receive regular and recorded supervision in order for them to discuss their job roles, training needs, concerns and success. Loppington House DS0000020698.V377613.R01.S.doc Version 5.3 Page 30 Care Quality Commission Care Quality Commission West Midlands 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). 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. Loppington House DS0000020698.V377613.R01.S.doc Version 5.3 Page 31 - 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!