Inspection on 17/05/06 for Lowdon House

This inspection was carried out on 17th May 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Lowdon House 21/09/05

Lowdon House 19/04/05

Lowdon House 14/01/05

Lowdon House 15/09/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Lowdon House 12 Bairstow Street Preston Lancashire PR1 3TN Lead Inspector Denise Upton Unannounced Inspection 17th May 2006 9:45 Lowdon House DS0000009837.V286540.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lowdon House DS0000009837.V286540.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lowdon House DS0000009837.V286540.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Lowdon House Address 12 Bairstow Street Preston Lancashire PR1 3TN 01772 258313 01772 258313 joanlowdonhouse@aol.com 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) Mrs Joan Smith Mrs Joan Smith Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6) of places Lowdon House DS0000009837.V286540.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st September 2005 Brief Description of the Service: Lowdon House is a terraced property situated close to the centre of the city and within easy reach of community resources and facilities. These can be accessed independently or with the assistance of staff. The home is registered to accommodate up to six residents with a history of mental illness that do not require nursing care. Lowdon House provides accommodation over two floors and all residents are accommodated in individual bedroom accommodation. Although bedroom accommodation is not provided with an en-suite facility, bathing and toilet facilities are sufficient in number and located close to communal areas of the home and bedroom accommodation. Although the majority of residents smoke, the home has attempted to provide a none smoking environment in the dining room and conservatory although this is dependent on the cooperation of residents. Since the last inspection, the refurbishment of the dining room has been completed and some redecoration has also taken place in the bathroom and shower room. Lowdon House is a smaller family type establishment with the homeowner providing care and support supplemented by a small nucleus of staff. In consequence, resident’s needs and preferences are well known and therefore more easily addressed. Social activity is determined in accordance with the collective and individual wishes of residents accommodated. Lowdon House DS0000009837.V286540.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit took place over two sessions during the morning and early afternoon period and early evening period of the same day. In total, the combined visits spanned a total of approximately six and quarter hours. The twenty-two core standards of the forty-three standards identified in the National Minimum Standards-Care Homes For Adults (18-65) were assessed along with a partial re-assessment of two recommendations identified in the last inspection report. The inspector spoke with the homeowner and deputy manager and informal discussion took place with the remaining members of the staff team who were on duty during the course of the visit. In addition, four of the six residents living at the home were spoken with individually and general informal discussion also took place during the evening site visit. A number of records and policies and procedures were also examined and a partial tour of the building took place that included communal areas of the home, the laundry area, kitchen area and some bedroom accommodation. Currently the cost of residential care fees at Lowdon House is £338.00 per week in respect of all residents. What the service does well: What has improved since the last inspection? Since the last inspection in September 2005, the home has made a number of improvements. The dining room/refreshment area where residents can make their own drinks and snacks has been refurbished and residents said that they were pleased with the result. Also the bathroom has been repainted and carpeted and some new tiles have been fitted to part of the shower room. Lowdon House DS0000009837.V286540.R01.S.doc Version 5.1 Page 6 The contract between the homeowner and resident has been extended to provide detail regarding the rules in respect of smoking, drinking and drugs. In addition improvements have been made to the way prescribed medication is obtained and recorded. The majority of staff have now successfully completed nationally recognised training for care staff and further environmental risk assessments are in place that helps to protect residents, staff and visitors. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Lowdon House DS0000009837.V286540.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lowdon House DS0000009837.V286540.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Standard 5 was also reassessed in part. Quality in this outcome group is good. A good pre admission assessment system is in place to ensure individual assessed needs are met. A comprehensive contract exists between the home and the resident detailing expectations from both parties. EVIDENCE: Although no new residents have been admitted to Lowdon House for some substantial period of time, it was evident through observation of existing residents pre admission assessments and the home’s admission policy and procedures, that residents are only admitted to the home when it is clear that the staff team can provide the care and support required. The original pre admission assessment document was updated to good effect that incorporates the manager’s assessment along with an overview of the prospective resident’s requirements. The pre admission assessment looks at variety of topics including daily living, communication, social needs, personal relationships, work, health, medication and finance. In addition, the prospective resident is invited to visit the home on several occasions that can include an overnight stay, prior to making a decision as to whether to live at the home. During the course of the visit, the pre admission process was confirmed by the last resident that had taken up residence at Lowdon House who again confirmed that his Social Worker had also being fully involved in the pre admission assessment and the development of his individual care plan. Lowdon House DS0000009837.V286540.R01.S.doc Version 5.1 Page 9 As recommended in the last inspection report, the recently revised contract of residency now clearly states the rules in respect of smoking, alcohol and drugs while living at the home. All residents are provided with an individual contract of residency that is signed by the resident and the homeowner. Lowdon House DS0000009837.V286540.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Quality in this outcome group is good. There is a clear and consistent care planning system in place to provide staff with the information they need to meet resident’s needs and requirements. In order to promote independence and choice, residents are encouraged to make decisions about their lives and lifestyle and are consulted about the running of the home. EVIDENCE: During the course of the inspection, one resident was ‘case tracked’. This involves looking carefully at all the information that is kept by the home regarding the help, encouragement and support required to ensure that the resident can enjoy the lifestyle of his choice. Each resident has an individual plan of care that tells staff what the resident’s strengths and needs are and how the wants and wishes of each resident can be achieved. Residents are invited to contribute to their individual care plan that includes relevant risk assessments. This is to make sure the resident is involved as much as they wish to be, in developing and reviewing their care plan. All care plans are reviewed on at least a six monthly basis with the Lowdon House DS0000009837.V286540.R01.S.doc Version 5.1 Page 11 document signed by the individual resident to acknowledge their understanding of and agreement to the outcome. A resident confirmed that staff had read to him his proposed care plan and explained what it meant prior to him signing the document. In addition, an individual monthly written report is produced that comments on current wants, needs and requirements and of any changes that have occurred. The plan of care is then amended as required. One person spoken with said that “ I am given my monthly report to read and generally it is fair and O.K. If I didn’t think it was right I would say so”. All residents at Lowdon House are encouraged to make their own life style decisions and that right is only limited by individual risk assessment findings. Recently a number of residents decided that they would like to increase the number of days they go to work and this was arranged with the support of the staff team. Resident’s are also enabled and encouraged to manage their own financial affairs. However in instances when this cannot be achieved independently, the resident signs a document agreeing to the management team holding personal monies in safe keeping until the resident requires it. When necessary, staff assists the individual resident with budgeting and shopping that was identified on the care plan and confirmed by a resident spoken with. This resident stated that “the staff are not bad about helping you with things, they will help you like when you want it”. Prior to admission, the multi disciplinary Care Programme Approach care planning meetings had identified risks and risk management strategies had been agreed. This is supplemented by ‘in-house’ risk assessments that are regularly reviewed. Residents are provided with verbal information on how to maximise their own personal safety to avoid limiting individual choice that was confirmed by a resident spoken with. Lowdon House DS0000009837.V286540.R01.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome group is good. Links with the community are good that support and enrich resident’s social, work and educational opportunities. Residents are encouraged to maintain family and friendship links and to take part in local community activities. Dietary needs of service users are well catered for with a balanced and varied selection of food available. EVIDENCE: At this present time, none of the residents at Lowdon House are seeking employment opportunities. However four of the six residents attend a therapeutic workplace for up to five days a week. A resident individually spoken with stated that he “ enjoyed the different jobs that have to be done”. Another resident said that regarding the work placement, “I enjoy the general work and I am learning how to do different things, I also enjoy meeting new people”. In addition, the same resident is teaching himself German from books, cassettes and a C.D. The management team at the home are helping this resident to locate a local evening educational course that provides German Lowdon House DS0000009837.V286540.R01.S.doc Version 5.1 Page 13 lessons in order to provide an opportunity for him to speak German with other people and also to increase his skills. Residents spoken with again confirmed that it is normal practice for them to determine their own daily activities and that they enjoyed the freedom to come and go as they pleased. A number of residents spoken with stated that four of them had recently enjoyed a holiday in Spain with two members of staff, the remaining two residents had decided not to go. One resident also said that he thought a holiday in the Lake District was also going to be organised. Residents who choose are registered on the electoral register and can independently visit the polling station. Currently all residents and staff are racially and culturally similar. However in the past the home has accommodated residents with different diversity needs that have been respected and accommodated. Family and friends are encouraged to visit the home at any time of the resident’s choice. Likewise, residents are enabled to maintain existing family and friendship links or alternatively develop new friendships. One resident stated that he visited his family regularly and also his girlfriend however “sometimes my girlfriend also visits me here and stays for a meal”. Residents at Lowdon House continue to be physically able with independent mobility. Bathrooms and individual bedroom accommodation is fitted with a locking mechanism with the resident retaining the key to their individual bedroom accommodation. Residents are also provided with a key to the front door if they so wish. Mail is distributed directly to residents as it arrives at the home and their preferred term of address is always respected. The relationship observed between staff and residents was again seen to be relaxed and comfortable with residents deciding whether to participate in an activity or enjoy the privacy of their individual bedroom accommodation. Residents spoken with all felt that they were well supported while living at the home and that they got on well with the staff team. Residents are offered a varied, wholesome and nutritious diet and specialist diets in respect of religious, cultural or medical need can be accommodated. As observed, hot and cold drinks and snacks are available throughout the day by the provision of a microwave, kettle and toaster for residents use in the dining room. Residents were seen to be making good use of this facility. Although there is a menu available, main meals are generally determined by what is in season and what individual resident’s would particularly like to eat on a specific day. It was observed that the evening meal served was generous and residents spoken with described the meals as “ food good and plenty of it”, “food very good and varied”. Since the last inspection, new records have been introduced Lowdon House DS0000009837.V286540.R01.S.doc Version 5.1 Page 14 to record fridge, freezer and food temperatures along with a record of what foods each resident has actually eaten. Lowdon House DS0000009837.V286540.R01.S.doc Version 5.1 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome group is good. Personal support is offered in such a way as to maximise resident’s lifestyle choices. The physical and mental health care needs of residents are well met with evidence of good multi disciplinary working taking place on a regular basis. Medication is well managed to ensure resident’s medication needs are met. EVIDENCE: Residents at Lowdon House are in the main self-caring and at most only require prompting and encouragement in order to undertake personal care tasks. However residents are regularly assisted with lifestyle support as identified on the individual care plan that is determined by the strengths, needs, wants and wishes of each individual. Routines within the home are flexible to accommodate individual requirements and residents spoken with stated that they were comfortable with all members of staff and liked them Although the active involvement of Community Psychiatrist Nurses and Mental Health Social Workers are not required at this present time, the home maintains links with the local psychiatric services that will provide staff with advice as required. Residents are supported to manage their own healthcare requirements and have access to a range of health care professionals that Lowdon House DS0000009837.V286540.R01.S.doc Version 5.1 Page 16 includes routine appointments with a consultant psychiatrist and a medication review on a regular basis. Following the involvement of the Commission for Social Care Pharmacist Inspector, significant improvement has been noted in respect of the administration and recording of medication. Since the last inspection, an alternative method of obtaining medication in blister packs supplied by a local pharmacist has been introduced. This has minimised storage of medication in the home although some resident medication is still provided independently of the pharmacist blister packs via the Community Psychiatric Nurses on a weekly basis. The deputy manager explained that the new system has much improved the administration of medication and the home has developed a good working relationship with the new pharmacist. Although all staff with responsibility for the administration of medication had already undertaken medication training, an updated ‘Managed Care Training Package’ medication-training course is to be introduced in the near future. This will include initial training from the company who provide the training module and staff will then complete a workbook that will be assessed by the training and development department and a certificate issued on successful completion of the course. Although the administration and recording of medication has improved there still remains one outstanding recommendation. This recommendation is in respect of double-checking any hand written medication record that should be evidenced by two staff signatures. As at the last inspection, it was clear that this recommendation has not been consistently applied. It is strongly recommended that all hand written medication records be double checked and signed by two staff signatures to confirm that an accurate record has been maintained. Lowdon House DS0000009837.V286540.R01.S.doc Version 5.1 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome group is good. Lowdon House has developed a satisfactory complaints system and adult abuse policy and procedures for the protection of service users. EVIDENCE: No complaint or concern has been made in respect of Lowdon House for some considerable period of time. The home’s complaint procedure is compliant with requirements and incorporated in the written information provided to newly admitted residents. Residents are encouraged to voice any concerns and complaints immediately so that issues can be discussed and addressed. Residents accommodated are vocal in their approach to resolving issues and prefer this option to raising any formal complaint. However two residents spoken with were aware of the written formal complaint information and were also clear as to who they would speak with if they did have a complaint. Although a form has been devised to record any complaint made, this could be expanded to include sections to record the date the complaint was received, details of the complaint, how the complaint was investigated, the outcome of the complaint, any action taken as a result of the outcome and the date the complainant was informed of the outcome of their complaint. At the time of this inspection, although the home’s adult abuse policy was available the adult abuse procedures could not be located. However this document has been previously evidenced and found to be compliant with requirements and recommendations. Various other policies and procedures were also available in respect of the protection of residents that included the home’s policies and practices with regard to service users monies and valuables. Lowdon House DS0000009837.V286540.R01.S.doc Version 5.1 Page 18 During the course of the site visit, it was noted that with the resident’s verbal consent, the personal allowance of one particular resident was given out on a daily basis to ensure that his personal allowance was not spent immediately and sufficient funds were available to last the rest of the week. Discussion with this resident confirmed that he was pleased with the arrangement however it is strongly recommended that a formal written contract is developed that is signed by the homeowner and resident confirming and agreeing this arrangement. Whilst there is no suggestion that this resident’s monies are not well protected while in held safekeeping, it is recommended that consideration be given to the way resident’s financial transactions are recorded in order to provide a clear audit trail. To assist this process, individual receipts of resident’s purchases from monies held in safekeeping should be maintained along with the residents monies and residents should always be invited to sign the financial record as an acknowledgement and agreement of the monies spent. If a resident does not wish to become involved in signing their financial record, the transaction should be witnessed and countersigned by a second member of staff. Lowdon House DS0000009837.V286540.R01.S.doc Version 5.1 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome group is adequate. The standard of the environment in this home is satisfactory in providing residents with a comfortable and homely place to live. Some further improvement was noted in respect of the laundry area however this should be an ongoing process to ensure that any potential risk is minimized. EVIDENCE: Since the last inspection, the refurbishment to the dining room/refreshment area has been completed and residents stated that they were pleased with the result. This has included new kitchen units, new domestic appliances, new tables and chairs and new floor covering. The bathroom has also been repainted and carpeted and some new tiling has been fitted to part of the shower room. The premises are in keeping with the local environment and in close proximity to local facilities and services to suit the personal and lifestyle needs of residents accommodated. Furnishings are domestic in character and provide comfortable accommodation. Residents currently accommodated are all independently mobile with no physical mobility difficulties. Service users who are wheelchair users cannot be accommodated. Lowdon House DS0000009837.V286540.R01.S.doc Version 5.1 Page 20 As recommended in the last inspection report, physical risk assessments have now been developed in respect of individual bedroom accommodation. This supplements the existing physical risk assessments regarding the communal areas of the home, laundry and kitchen areas in order to minimise any potential risk to residents or staff. The laundry is situated in the basement area of the home and does not intrude on residents accommodated. In order to promote independence, all residents are encouraged to attend to their own washing with the assistance of staff as required. Although some further improvement has been made to the laundry room and the steps leading to the laundry area that have now been painted white to highlight, there still remains some clutter in the laundry room that could cause a potential safety risk. From discussion with the homeowner, it is understood that this area is to be tided up and the unnecessary clutter removed. Lowdon House DS0000009837.V286540.R01.S.doc Version 5.1 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36 in part Quality in this outcome group is good. Staff morale is high resulting in a group of staff that work positively with residents to help improve their quality of life. . Staff training is seen as a priority to ensure staff have the skills and knowledge to provide a good quality service. EVIDENCE: Lowdon House is a small home with a family type atmosphere. The majority of staff have worked at the home for a considerable period of time and know the needs, wants and wishes of each resident very well. Each resident is an individual and the relationship observed between staff and residents is positive. One resident reported that he got on well with all the staff and stated “every credit to Joan (homeowner/manager) staff and other residents, they have helped me and I do the same for others”. Staff training at Lowdon House is viewed positively. Four members of the care staff team have achieved a National Vocational Qualification (NVQ) in care at Levels 2 or 3 with a further member of staff currently undertaking this course of study and the remaining member of staff waiting to commence this training. The homeowner/manager and deputy manager has also recently completed a ‘First Line In Management’ training course and all staff has also undertaken a variety of other training including health and safety training courses. Lowdon House DS0000009837.V286540.R01.S.doc Version 5.1 Page 22 Since the last inspection, one new member of staff had taken up employment at the home. The staff file of this person was observed and confirmed that the recruitment practices followed were in accordance with requirements and recommendations. Appropriate references and clearances had been obtained and deemed to be satisfactory before the new member of staff commenced employment at the home. It was evident that induction training had been provided to the newly appointed member of staff, but it was difficult to establish if the induction training provided was compliant with the nationally recognised ‘Skills For Care’ induction training standards. It is recommended that the different components of the existing induction training be collated and then evidenced against the ‘Skills For Care’ specifications to ensure compliance. Although each member of staff has an individual training matrix that identifies the training undertaken, this was not up to date. Certificates to confirm the successful completion of training topics were observed but it is recommended that once a course has been completed the individual training matrix be brought up to date. As identified at previous inspections, staff supervision is informal and conducted as part of the routine day-to-day management role. However, all staff received formal appraisals at six monthly intervals. In order to supplement the formal appraisal process and as recommended in the last inspection report, formal documented supervision should be introduced and take place at least six times a year in order to support staff and provide an opportunity for individual discussion. Lowdon House DS0000009837.V286540.R01.S.doc Version 5.1 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome group is good. The homeowner/manager is well supported with all staff demonstrating a good awareness of their role and responsibilities. The home regularly reviews aspects of its performance through a programme of self-review and consultation with service users and staff however this could be extended to include other people who have contact with the home. Systems are in place to ensure as far as possible the health and safety of service users, staff and visitors. EVIDENCE: The homeowner/manager at Lowdon House has extensive experience in running the care home and has sucessfully completed the Registered Managers Award, which is a more advanced qualification, that managers of care homes are expected to achieve. The homeowner/manager has also undertaken recent additional training to ensure her skills and knowledge are kept up to date. Discussion with a resident confirmed that the service was what he had expected and he was comfortable living at the home. Lowdon House DS0000009837.V286540.R01.S.doc Version 5.1 Page 24 Systems are in place to ensure resident’s views and opinions about living at the home are known. This includes informal daily dialogue with staff and periodic resident questionnaires, allowing residents to say what they think and to have some say into how the home is run. Residents can also influence change through regular resident meetings. Staff meetings also take place on a bi-monthly basis to enable staff to formally voice their views and opinions. In addition, the home has achieved the ‘Investor In People’ award that provides an external quality monitoring system on how the home is achieving aims for residents. As recommended in the last inspection report, a further anonymous questionnaire could be developed for other people to complete who have an interest in the home. This would give some indication as to whether people other than staff or residents feel that the home is meeting resident’s needs and requirements. This could include people such as family and friends, social workers, community psychiatric nurses, chemist or other people who visit the home on a regular basis. The vast majority of staff have now sucessfully completed health and safety training that included a fire safety awareness course, health and safety in the work place course, moving and handling training, food hygiene training, first aid training and it is understood that a qualified first aider is now on duty at all times. Although a policy document in respect of the ‘Control of Substances Hazzardess to Health’ (COSHH) requirements has been developed, and environmental risk assessments introduced, it is recommended that the environmental risk assessments for each room incorporate all safe working practice topics as identified in Standard 42.3. This is especially important regarding COSHH requirements. It was noted that the Portable Appliance Testing (PAT) for electrical equipment is overdue. It is understood that arrangements are being made to have this work completed in the near future. Please advise in the Action Plan of the date this work was completed. Although there was evidence that induction training was provided, as previously stated in this report, it is recommended that this be evidenced against ‘Skills For Care’ specifications in respect of safe working practices to ensure complience. Lowdon House DS0000009837.V286540.R01.S.doc Version 5.1 Page 25 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 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Lowdon House DS0000009837.V286540.R01.S.doc Version 5.1 Page 26 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. Standard Regulation Requirement Timescale for action Lowdon House DS0000009837.V286540.R01.S.doc Version 5.1 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA20 YA22 YA23 Good Practice Recommendations It is recommended that double-checking and signing of hand written medication labels be consistently applied. The existing complaint record form could be further extended. It is recommended that a contract be signed between the resident and homeowner to confirm the agreement that personal monies of one resident will be provided on a daily basis rather than weekly. It is also recommended that consideration be given to improving the way resident’s finances are recorded when held in safe keeping in order to provide a clear audit trail. The laundry area should receive further attention to provide a clutter free environment. It is recommended that current induction training be evidenced against ‘Skills For Care’ specifications to ensure compliance. The individual staff-training matrix should be brought up to date. It is recommended that formal one to one staff supervision should be introduced. The supplement resident questionnaires, a further questionnaire could be developed for other people who have an interest in the home. Please advise in the Action Plan the date that PAT testing of electrical equipment took place. 4 5 YA24 YA35 6 7 8 YA36 YA39 YA42 Lowdon House DS0000009837.V286540.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lowdon House DS0000009837.V286540.R01.S.doc Version 5.1 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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