CARE HOME ADULTS 18-65
Lowena Hostel Mitchell Hill Truro Cornwall TR1 1JX Lead Inspector
Ian Wright Unannounced 29 June 2005 15.00 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. Lowena Hostel D52-D04 S43186 Lowena Hostel V222220 290605 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Lowena Hostel Address Mitchell Hill Truro Cornwall TR1 1JX 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) 01872 270013 01872 241992 Cornwall County Council Ms Julia Jackson Care Home 25 Category(ies) of Learning Disability (25) registration, with number of places Lowena Hostel D52-D04 S43186 Lowena Hostel V222220 290605 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 1.12.05 Brief Description of the Service: Lowena is a care home for adults with learning disabilities providing respite care. Over 100 families are currently supported by the service. The home is located within the City of Truro. The home is purpose built, divided into four residential units, linked together by a central entertainments and activities room. One unit accommodates children which is inspected seperately. There is a sensory garden and brightly decorated courtyard for service users to enjoy. Each part of the home has its own kitchen, dining room and lounge. Lowena Hostel D52-D04 S43186 Lowena Hostel V222220 290605 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over five hours. The inspection was carried out on an unannounced basis. The primary focus was regarding requirements from the previous inspection and other standards not inspected at that time. Standards not inspected on this occasion were inspected during the inspection in December 2004, and were met. The inspector was able to observe practices and speak to several service users, and some of the staff on duty. The inspector examined the medication system, the home’s records, and inspected the building. What the service does well:
Lowena provides a valuable respite service for people with learning disabilities and their carers. The service appears to be well organised, and service users all stated they were very happy with care provided. Pre admission assessment and care planning procedures are to a good standard so staff can meet service users needs and provide consistent care. Medication systems are appropriately maintained. Service users are given appropriate assistance throughout their stay so they can maintain their activities such as attending college or day centres. Catering arrangements provide a balanced diet for service users. The home offers a pleasant, spacious, clean and suitable environment for service users. The home has generally suitable aids and adaptations to assist service users such as assisted bathing facilities and hoists. A new kitchen which can be used by wheelchair users has recently been fitted. Staff appear to be suitably professional, experienced, competent, well managed and supported. They provide a caring and supportive approach to service users staying at the home. They ensure a calm, caring and supportive atmosphere for service users. Service users were positive about the care they receive. Management appear to be suitably experienced and knowledgeable to manage the home. Staff stated the registered manager was supportive, and willing to ‘muck in’ where this was appropriate. Supervision and staff meetings are held regularly so staff receive appropriate support and consultation about practices. Lowena Hostel D52-D04 S43186 Lowena Hostel V222220 290605 Stage 4.doc Version 1.20 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Lowena Hostel D52-D04 S43186 Lowena Hostel V222220 290605 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Lowena Hostel D52-D04 S43186 Lowena Hostel V222220 290605 Stage 4.doc Version 1.20 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 standard(s) 1, 2, 4,5 Suitable information is made available to service users and their representatives. A suitable assessment process is in operation so service users can be assured staff can meet their needs. Appropriate arrangements are in place for service users to visit the home to assist them to make a choice regarding whether they want to stay at the home. No contract / statement of terms and conditions of residency is in place, although this is currently being developed. This issue has been renotified for the third time and must now be actioned. This is to ensure service users have appropriate information regarding the cost of the service and what services will be provided. EVIDENCE: The registered manager has developed a statement of purpose and a service user guide. These are available to service users and their representatives in the foyer of the home. As the manager was absent at the time of the inspection, it is not clear whether the registered persons wish to act on recommendations outlined in the previous report. Subsequently these have been renotified. The Senior Assistant Officer (SAO) outlined the assessment process i.e. social worker referrals are made to an assessment panel, then a home visit is completed. This seems suitable, and appropriate documentation is completed.
Lowena Hostel D52-D04 S43186 Lowena Hostel V222220 290605 Stage 4.doc Version 1.20 Page 9 The SAO said service users are able to visit before coming for respite. The registered persons are in the process of developing a suitable contract for service users. A draft version of this has subsequently been sent to the Commission. As this is not in place the requirement is renotified for the third time and must now be actioned. Lowena Hostel D52-D04 S43186 Lowena Hostel V222220 290605 Stage 4.doc Version 1.20 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 standard(s) 6, 8, 10 The registered persons have developed a satisfactory care planning system so systems are appropriate for service users to receive consistent care. Service users are given appropriate opportunities to be involved in their care so they are consulted about this and life in the home. Records are satisfactorily stored confidentially so service users can be assured information is handled appropriately. EVIDENCE: Each service user has a care plan, which includes appropriate information for staff to provide consistent care. Service users are involved in completing house hold tasks such as cooking according to their skills. Resident meetings occur and informal consultation also takes place for example over mealtimes. Records are stored appropriately Lowena Hostel D52-D04 S43186 Lowena Hostel V222220 290605 Stage 4.doc Version 1.20 Page 11 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, 14, 17 Service users are given appropriate support to maintain day activity programmes. Suitable leisure activities are also offered. This ensures suitable opportunities for service users are maintained during their stay. Meals appear to be of good quality so service users can be assured of a varied and healthy diet. EVIDENCE: On the evening of the inspection a trip to the theatre had been arranged. The registered provider has a minibus for use by service users. Service users are supported to maintain their usual day activities while they are staying at the home e.g. day centre, college. The inspector observed service users having a pleasant evening meal. It was a service users birthday on the day of the inspection and a cake had been made as part of the celebrations. Service users stated meals were of good quality. Suitable records are maintained regarding meals prepared. Lowena Hostel D52-D04 S43186 Lowena Hostel V222220 290605 Stage 4.doc Version 1.20 Page 12 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) 18-21 Staff maintain service users personal, emotional and health care needs appropriately. There is a satisfactory medication system. The home has an appropriate policy regarding death and dying. These measures ensure service users receive appropriate care and support. EVIDENCE: Personal, emotional and health care needs are appropriately documented in care plans. However some care planning files did not contain a photograph and this needs to be rectified as soon as possible. Service users said they were happy with the support provided. The inspector observed staff working in a caring and highly professional manner with service users. The home has a suitable policy regarding the storage, administration and disposal of medication. The inspector observed the medication system and this was satisfactory. Records regarding medication were also satisfactory. The Senior Assistant Officer stated all staff who administer medication had received suitable training-although records regarding this could not be reviewed as they were locked away due to the Registered Manager’s absence. Lowena Hostel D52-D04 S43186 Lowena Hostel V222220 290605 Stage 4.doc Version 1.20 Page 13 The registered provider has developed a suitable policy regarding death and dying. However as Lowena is a respite unit, care for people who are terminally ill is not routinely provided. Lowena Hostel D52-D04 S43186 Lowena Hostel V222220 290605 Stage 4.doc Version 1.20 Page 14 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) 22-23 The registered persons have suitable complaints / adult protection policies and procedures, so service users rights can be maintained. However CSCI must be informed if there are any adult protection investigations. EVIDENCE: The registered persons have developed suitable policies regarding the prevention of abuse and complaints. Policies however must be readily available to staff; for example a policy file could be maintained at each workstation for staff reference. The registered manager has received two complaints. These seem to have been appropriately investigated. One complaint involved adult protection issues. The registered manager is reminded that the Commission for Social Care Inspection must be informed, at the earliest opportunity, of any event which adversely affects the wellbeing or safety of any service user. The Senior Assistant Officer stated staff have received training regarding adult protection procedures-although documentation regarding this could not be observed as staff files were locked away. Lowena Hostel D52-D04 S43186 Lowena Hostel V222220 290605 Stage 4.doc Version 1.20 Page 15 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 Lowena offers a suitable environment for service users so they can have a safe and homely environment. EVIDENCE: Lowena provides a suitable environment for service users staying there. The building is well maintained, clean and has suitable space for service users. The home generally has suitable adaptations to meet the needs of service users. For example a new kitchen with adjustable surfaces for wheelchair users has just been fitted. There are suitable hoists, wheel chair accessible showers etc. provided. The office chair on blue wing needs to be recovered as the covering is badly torn. The chair could currently present a fire hazard. Lowena Hostel D52-D04 S43186 Lowena Hostel V222220 290605 Stage 4.doc Version 1.20 Page 16 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) 31, 33, 36 Staff roles are clearly defined. The staff team appears to be effective, and numbers of staff appear to be satisfactory. An appropriate supervision system is in place, and arrangements for day to day management are satisfactory. Although not fully assessed, induction, recruitment and training arrangements appear to be satisfactory. These measures ensure service users receive appropriate support. EVIDENCE: All staff have suitable job descriptions, and staff have a clear understanding of each others roles. Rota’s demonstrated there was suitable numbers of staff on duty. The inspector observed satisfactory staffing levels on the day of the inspection. Routines did not appear to be rushed, and interaction between staff and service users was positive. There are always four staff on duty on each wing, and one in the training flat during the waking day. Night staffing is suitable (i.e. two waking night staff). Day to day supervision is satisfactory (i.e. a manager is always on duty). A formal one to one supervision system is in place and this is documented. Recruitment, induction and training records were not available for inspection due to the registered manager being absent. From the discussion the inspector
Lowena Hostel D52-D04 S43186 Lowena Hostel V222220 290605 Stage 4.doc Version 1.20 Page 17 had with staff; training, recruitment and induction procedures appear to be satisfactory. Lowena Hostel D52-D04 S43186 Lowena Hostel V222220 290605 Stage 4.doc Version 1.20 Page 18 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) 37-42 Management arrangements are satisfactory so service users can be assured care is provided appropriately. Policies and procedures are satisfactory although access of these must be improved so staff have appropriate knowledge of these. Availability of information regarding health and safety precautions must be improved so this is readily available to staff and the Commission. EVIDENCE: The registered manager has suitable skills, experience and knowledge to manage the home. The home appears to be well managed and well organised. The management culture appears to be appropriate for example a suitable supervision system is in place, and there are regular staff and senior meetings. Staff were positive about the management approach. Managers also carry out some shifts- and this is to be commended considering the size of the staff team and the complexity of operations. Such a measure is recommended to
Lowena Hostel D52-D04 S43186 Lowena Hostel V222220 290605 Stage 4.doc Version 1.20 Page 19 ensure managers are integrated in to the team, can monitor work and be a role model. The home has a suitable approach to quality assurance for example care plans are reviewed regularly, and there is a regular carers group. A representative from the registered provider, visits at least on a monthly basis. Reports from monthly visits are forwarded to the Commission for Social Care Inspection. Suitable policies are in place, and records regarding service users and operations are generally satisfactory. However staff had some difficulty in finding some of the evidence required for the health and safety standard. Similarly a policy file should be kept at each work station containing relevant policies e.g. adult protection, complaints, death and dying which staff can refer to. It was not possible to ascertain whether health and safety precautions were totally satisfactory. For example a copy of the following information has not been inspected i.e. testing of: • hoists and other moving and handling equipment • central heating system / other gas appliances. Compliance regarding these issues has been generally satisfactory on previous inspections. The registered provider has prepared a suitable fire risk assessment, and testing of fire equipment is satisfactory. Health and safety risk assessments are satisfactory and were last reviewed in November 2004. 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded
Lowena Hostel (Commendable) 3 Standard Met (No Shortfalls)
Version 1.20 Page 20 D52-D04 S43186 Lowena Hostel V222220 290605 Stage 4.doc 2 Standard Almost Met (Minor Shortfalls) 1 Standard Not Met (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 3 x 3 2 Standard No 22 23
ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 x 3 x 3
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 x x 3 Standard No 31 32 33 34 35 36 Score 3 x 3 x x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 3 3 2 3 2 x Lowena Hostel D52-D04 S43186 Lowena Hostel V222220 290605 Stage 4.doc Version 1.20 Page 21 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 YA5 Regulation 5 Requirement The registered provider must develop a statement of terms and conditions of residency/contract as required by regulation. Timescale of 28.2.05 not met. 3rd Notification. Staff must be provided with fire training.Timescale of 28.2.05 not met. 2nd Notification. Policies and procedures required by regulation must be made readily available to all staff The registered persons are required to provide evidence to the Commission for Social Care Inspection within one month of evidence of testing of the: appliances. · hoists and other moving and handling equipment · central heating system / other gas appliances. Timescale for action 1.12.05 2. 3. 4. YA42 YA40 YA 41, YA42 23 12, 17,18 12,13, 17,23 1.12.05 1.12.05 7.8.05 5. 6. Lowena Hostel D52-D04 S43186 Lowena Hostel V222220 290605 Stage 4.doc Version 1.20 Page 22 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 YA7 YA16 Good Practice Recommendations The statement of purpose/ service users’ guide should provide information on access arrangements to the building with regard to the keypad system in operation and the single room that cannot be provided with a door lock. The home’s statement of purpose should contain a clear statement on confidentiality and the principles of sharing information for the benefit of all stakeholders. This should include information on how service users/ their representatives may gain access to their personal records. 2. YA10 3. Lowena Hostel D52-D04 S43186 Lowena Hostel V222220 290605 Stage 4.doc Version 1.20 Page 23 Commission for Social Care Inspection John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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