Inspection on 21/09/05 for Lowdon House

This inspection was carried out on 21st September 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Lowdon House 17/05/06

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 14 & 21 September 2005 th st The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lowdon House F57 F09 S9837 Lowdon House V195162 140905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Lowdon House Address 12 Bairstow Street Preston Lancashire PR1 3TN 01772 258313 01772 258313 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Joan Smith Mrs Joan Smith Care home only 6 Category(ies) of MD Mental Disorder (6) registration, with number of places Lowdon House F57 F09 S9837 Lowdon House V195162 140905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th April 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 service users with a history of mental illness that do not require nursing care. Lowdon House provides accommodation over two floors and all service users are accommodated in individual bedroom accommodation. Although bedroom accommodation is not provided with an ensuite 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 service users 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 service users. At the time of inspection the dining room was in the middle of a complete refurbishment and redecoration to communal areas of the home has also taken place. Lowdon House is a smaller family type establishment with the proprietor providing care and support supplemented by a small nucleus of staff. In consequence, service users needs and preferences are well known and therefore more easily addressed. Social activity is determined in accordance with the collective and individual wishes of service users accommodated. Lowdon House F57 F09 S9837 Lowdon House V195162 140905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over part of an afternoon and early evening period of the same day. A brief visit also took place on another day to complete the inspection that in total spanned a period of approximately five and a half hours. The inspector spoke with two senior care staff and a carer who were on duty during the course of the visits. In addition, three of the residents were spoken with together in the lounge area of the home and another resident was briefly spoken with individually. A number of records and policies and procedures were also examined and a tour of the building took place that included communal areas, bedroom accommodation and kitchen and laundry facilities. One additional unannounced visit had been made since the last inspection by the Commission For Social Care Inspection pharmacist inspector. This was to make sure that the requirements and recommendation from the last inspection regarding medication issues had been addressed. The letter sent to the registered person following this visit can be obtained from the Commission For Social Care Inspection office on request. The majority of the core standards regarding Care Homes for Adults (18-65) had been assessed at the last inspection that took place in April 2005. The outstanding seven core standards were assessed at this inspection along with a reassessment of the requirement and recommendations identified at the last inspection. What the service does well: Lowdon House has a group of staff that work well together and are keen to provide a good quality service to residents who live at the home. Residents spoken with were satisfied with the service provided and felt that staff had built a good relationship with them and did their best to help improve residents’ quality of life. Routines within the home are flexible so that the people who live there can enjoy the lifestyle of their choice. Residents are encouraged to make choices and decisions for themselves and to take part in social activities in the community and to access therapeutic work placements and educational college courses if they so wish. A number of residents spoken with were keen to Lowdon House F57 F09 S9837 Lowdon House V195162 140905 Stage 4.doc Version 1.40 Page 6 explain how much they enjoyed the work placement and socialising with other people. Another resident is keen to learn a foreign language and staff are helping him make enquiries about where a suitable course can be accessed. Residents are encouraged to have their say and help make decisions about the running of the home. The atmosphere in the home is welcoming, relaxed and friendly. Visitors are made welcome at any time of the resident’s choice. What has improved since the last inspection? What they could do better: Staff at Lowdon House try hard to ensure that the needs of residents are well met and that residents feel comfortable living at the home. However there are a small number of things identified at this inspection that could be improved. Further members of staff could undertake nationally recognised training in care and one to one staff supervision should be introduced. This would make sure that all staff have the opportunity to talk individually with the manager about their work at the home and any further training they would like to attend. The current induction training for staff that have recently started working at the home should be checked to make sure that it is compliant with Lowdon House F57 F09 S9837 Lowdon House V195162 140905 Stage 4.doc Version 1.40 Page 7 recommendations and a questionnaire about the home could also be made available for family, friends and other people who visit to complete. 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 F57 F09 S9837 Lowdon House V195162 140905 Stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Lowdon House F57 F09 S9837 Lowdon House V195162 140905 Stage 4.doc Version 1.40 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 & 5 The home’s Statement of Purpose and Service User Guide are good in providing service users and prospective service users with details of services the home provides, enabling an informed decision about admission to the home. The contract of residency has been reviewed and updated to good effect. Along with details of the cost of the accommodation, the contract provides service users with a comprehensive account of what is provided by the home and what service users have to provide themselves. EVIDENCE: As recommended in the last inspection report, the collated views of all service users accommodated have now been incorporated in the recently amended Service Users Guide. It was evident that service users had been provided with a questionnaire to help identify if they considered their individual needs, wants and wishes were being fulfilled. Following on from this, the views of each service user had also been individually collated and placed in their individual personal file. Since the last inspection, a detailed, revised contract of residency has been provided to all service users accommodated that now fulfils all but one of the recommendations. It was evident that each contract has been signed by the individual service user and at the service user’s request kept with their personal file. Lowdon House F57 F09 S9837 Lowdon House V195162 140905 Stage 4.doc Version 1.40 Page 10 However in accordance with Standard 16.11, rules on smoking, alcohol and drugs should also be incorporated in the individual contract. Lowdon House F57 F09 S9837 Lowdon House V195162 140905 Stage 4.doc Version 1.40 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of the five standards were assessed at this inspection. EVIDENCE: None of the five standards were assessed at this inspection. Lowdon House F57 F09 S9837 Lowdon House V195162 140905 Stage 4.doc Version 1.40 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 standard(s) 12,13,15,16 & 17 Links with the community are good and support and enrich service users social, work and educational opportunities. Dietary needs of service users are well catered for with a balanced and varied selection of food available that meets service users tastes and choice. EVIDENCE: At present none of the service users accommodated at Lowdon House are seeking employment opportunities. However four of the six service users accommodated attend a therapeutic workplace for between three and five days a week. Service users said that they enjoyed this and that it also provided an opportunity to meet new people. In addition, educational courses provided by Preston College, are also accessed by some service users while attending the therapeutic workplace. The remaining two service users have ‘retired’ from work related tasks and as observed spend time either in the house attending to personal domestic tasks with the support of staff such as washing and cleaning their individual bedroom Lowdon House F57 F09 S9837 Lowdon House V195162 140905 Stage 4.doc Version 1.40 Page 13 or alternatively access local community resources and facilities independently. If a service user wished to take up general employment opportunities this would be in consultation with the service user’s Social Worker/Community Psychiatric Nurse. Lowdon House is situated in close walking distance of the city centre and local facilities and resources that can be accessed either independently or alternatively with the support of staff as required. Staff support is offered flexibly and in accordance with individual wants and needs. Service users confirmed that it is normal practice to determine their own daily activities and they enjoyed the freedom to come and go as they pleased. Service users who choose are registered on the electoral register and can independently visit the polling station. Family and friends are encouraged to visit the home at any time of the service users choice. Likewise, service users are enabled to maintain existing family and friendship links or alternatively develop new friendships. All current service users at Lowdon House are physically able with independent mobility. Service users confirmed that bathrooms and individual bedroom accommodation is fitted with a locking mechanism with the service user retaining the key to their individual bedroom accommodation. Service users are also provided with a key to the front door if they so wish. Mail is distributed directly to service users as it arrives at the home and the preferred term of address of all prospective service users’ is identified prior to admission and always respected. It was observed that the relationship between staff and service users is relaxed and comfortable with residents dictating whether to participate in an activity or enjoy the privacy of individual bedroom accommodation. Service users health is promoted by ensuring a nutritious, varied and balanced diet that is designed round the known likes and dislikes of service users accommodated. Although there is a rotating menu available, meals are generally determined by what is in season and what service users would like to eat on any particular day. From observation it was noted that the teatime meal served was attractively presented and service users spoken with stated they had enjoyed the meal. Service users were positive in their comments with regard to the meals served and in order to promote independence, service users routinely assist with kitchen duties such as making themselves hot drinks and washing up. Lowdon House F57 F09 S9837 Lowdon House V195162 140905 Stage 4.doc Version 1.40 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20 The medication in this home is now well managed promoting good health. EVIDENCE: At the last inspection the Commission for Social Care pharmacist inspector also visited the home to assess the medication standard. A number of requirements and recommendations were made that were identified in the inspection report. A further visit by the pharmacist inspector took place in July 2005 to ascertain if the requirements and recommendations had been addressed. It was noted that significant improvement had taken place with regard to medication issues however a further recommendation was made in respect of double-checking hand written medication records that should be evidenced by two staff signatures. At this inspection, it was clear from the medication administration records observed that this recommendation had not always been implemented. 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 F57 F09 S9837 Lowdon House V195162 140905 Stage 4.doc Version 1.40 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Neither of the two standards were addressed at this inspection. EVIDENCE: Neither of the two standards was addressed at this inspection. Lowdon House F57 F09 S9837 Lowdon House V195162 140905 Stage 4.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 & 30 The standard of the environment within this home is satisfactory providing service users with a homely and comfortable place to live. Some improvement was noted in respect of the laundry area however some further work is required to ensure that any potential risk is minimized. EVIDENCE: The physical environment within the home is maintained to a satisfactory standard and is suitable for its stated purpose. Since the last inspection, redecoration has taken place to communal areas of the home and the dining room/refreshment area is currently in the process of a complete refurbishment and refit. This has included new kitchen units, new domestic appliances and new tables and chairs. Service users spoken with were pleased with the changes that were taking place and stated they were looking forward to using the new tables and chairs once the new floor covering was in place. 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 service users accommodated. Furnishings are domestic in character and provide comfortable accommodation. Service users currently accommodated are all Lowdon House F57 F09 S9837 Lowdon House V195162 140905 Stage 4.doc Version 1.40 Page 17 independently mobile with no physical mobility difficulties. Service users who are wheelchair users cannot be accommodated. Since the last inspection a number of risk assessments have been developed in respect of the physical environment that has included communal areas of the home and laundry area. Through discussion with the senior person on duty, it is understood that this process is to be further extended to assess for any potential risk in individual bedroom accommodation and action taken to minimise any risk identified. Although some improvement has been made to the laundry area and steps leading to the laundry area since the last inspection, there is still some clutter in the laundry room that could cause a potential safety risk and further attention to this area is still required. Lowdon House F57 F09 S9837 Lowdon House V195162 140905 Stage 4.doc Version 1.40 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,34,35 & 36 All required references and clearances in respect of staff recruitment have now been obtained. This helps to ensure service users are protected. Staff training is given high priority to make sure that staff have the skills and knowledge to provide a good quality service. EVIDENCE: Recruitment practices have improved since the last inspection and now all required references and clearances have been obtained in respect of the staff group. Lowden House enjoys a small stable staff group who support the registered proprietor to address the strengths and needs of service users accommodated. The relationship observed between staff and service users is positive with current residents wants, wishes and requirements well known and addressed on an individual basis. Staff training is ongoing and currently one member of the care staff team holds an NVQ Level 3 in care and assessors award, one member of staff has recently successfully completed Level 2 of this award, another member of staff is currently undertaking this course of study and a further member of staff is making enquiries about re-commencing NVQ Level 2. In addition, the majority of staff have undertaken further short course training that has included health and safety training topics. Lowdon House F57 F09 S9837 Lowdon House V195162 140905 Stage 4.doc Version 1.40 Page 19 As identified at the last inspection, staff supervision is informal and conducted as part of the routine day-to-day management role. However, all staff received a formal appraisal in November 2004 and May 2005. 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. Although the staff group is in the main, of long standing, newly appointed staff undertake ‘in-house’ induction training that is expected to be followed by NVQ Level 2 in care. Whilst the induction-training programme available is relevant to the home it could not be evidenced that the induction training available was compliant with the ‘Skills For Care’ induction-training programme. It is again recommended that current induction training be evidenced against the ‘Skills For Care’ induction-training programme to ensure compliance. It was evidenced from training certificates observed and other documentation that there is a staff training and development plan and that the majority of staff receive at least five paid training days a year that are linked to the home’s service aims and service users needs. Lowdon House F57 F09 S9837 Lowdon House V195162 140905 Stage 4.doc Version 1.40 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 & 42 The home regularly reviews aspects of its performance through a programme of self-review and consultation with service users and staff. However a system could be developed to establish the views of other people that visit the home as this would also inform the internal quality audit. Systems are in place to ensure as far as possible the health and safety of service users, staff and visitors. EVIDENCE: Formal and informal systems are in place to ensure service users views are known that includes service users questionnaires and informal daily dialogue with staff. This allows service users to have some say into how the home is run. Service users can also influence change through bi-monthly service user meetings. As recommended in the last inspection report, a further questionnaire could be developed for other stakeholder to complete such as family and friends, social workers, community psychiatric nurses or other Lowdon House F57 F09 S9837 Lowdon House V195162 140905 Stage 4.doc Version 1.40 Page 21 people who visit the home on a regular basis to enable them to comment on how they felt the home was meeting service users needs. 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 service users. The majority of staff have 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 and it is understood that a qualified first aider is now on duty at all times. A number of staff have also recently attended updated first aid training and it is understood that this will be arranged for all remaining staff in the near future. Although a policy document in respect of COSHH requirements has been developed, as yet risk assessments in respect of all safe working practices have yet to be introduced and it is again recommended that risk assessments be undertaken for all safe working practice topics. Lowdon House F57 F09 S9837 Lowdon House V195162 140905 Stage 4.doc Version 1.40 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 x x x 3 Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score x x x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 2 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 3 Standard No 31 32 33 34 35 36 Score x 2 x 3 3 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Lowdon House Score x x 3 x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 3 x F57 F09 S9837 Lowdon House V195162 140905 Stage 4.doc Version 1.40 Page 23 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard 5 32 35 36 39 42 Good Practice Recommendations The newly amended individual contract of residency should incorporate rules on smoking, alcohol and drugs. At least 50 of the care staff team should achieve at minimum a NVQ Level 2 in care. It is recommended that current induction training be evidenced against the Skills for Care induction training specifications to ensure compliance. It is recommended that formal one to one supervision be introduced. To supplement service user questionnaires a further questonnaire could be developed for other stakeholders. The current programme of undertaking environmental and safe working practices risk assessments should be continued until completed. Lowdon House F57 F09 S9837 Lowdon House V195162 140905 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Unit 1, Tustin Court Portway 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 F57 F09 S9837 Lowdon House V195162 140905 Stage 4.doc Version 1.40 Page 25 - 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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