CARE HOMES FOR OLDER PEOPLE
Lowenva Rescorla St Austell Cornwall PL26 8YT Lead Inspector
Mike Dennis Key Unannounced Inspection 15th May 2007 10:00 X10015.doc Version 1.40 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 Lowenva DS0000044957.V335662.R01.S.doc Version 5.2 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 Older People. 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. Lowenva DS0000044957.V335662.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Lowenva Address Rescorla St Austell Cornwall PL26 8YT 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) 01726 850823 Margaret Ellen Eaton Mr John Michael Eaton Mrs Caroline Old Care Home 5 Category(ies) of Old age, not falling within any other category registration, with number (5) of places Lowenva DS0000044957.V335662.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. Service users to include up to 5 adults of old age (OP) Service users to include one named person only under 65 years of age on admission with a mental illness (MD) Total number of service users not to exceed a maximum of 5 For one named service user who falls into the category of learning disability (LD) and physical disability (PD) under the age of 65 years To include one named service user under the age of 65 who falls into the category of learning disability (LD) 14th February 2006 Date of last inspection Brief Description of the Service: Lowenva is a dormer bungalow home in the peaceful village setting of Rescorla. Far-reaching countryside views are enjoyed from several of the rooms. The Home is registered to provide personal care for five Service Users over the age of sixty-five, to include the service users as listed above. The facilities that conform to the new environmental standards. All rooms have ensuite facilities and are on the ground floor. There is a lounge with adjoining dining room and a conservatory, which are decorated to a high standard. Considerable work and refurbishment has taken place since the home opened. A car park has been built at the front of the home and there are plans to build another conservatory to the front of the home. Wheelchair access is available to the rear of the property. The well-stocked gardens are accessible from several exits in the property and are well cared for. There is a patio area and water feature. The Registered Providers live at the home and supervise the day-to-day running of the home. Lowenva DS0000044957.V335662.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place over a six hour period the 15th. May 2007. Three service users are currently accommodated, one being in the category of MD, the other two in the category of LD. This complies with the conditions of registration placed on the home. The main registration criteria for this home also includes the Older Persons category. As there are no service users within this category at present the registered providers are in the process of making an application to change to a learning disability home. We met with the Registered Providers, the Registered Manager and staff on duty. All three of the current service users were spoken with. They were unanimous in stating their satisfaction with all aspects of their care. They confirmed that staff respect their wishes, privacy and dignity. Individually they told us of their interests, hobbies and lifestyle. They applauded the accommodation provided. We had positive discussions with the registered providers and the registered manager. We examined a full range of records, policy documents and service agreements. Case tracking was undertaken in respect of all three service users. What the service does well:
The Providers and staff work very hard to provide a truly home from home environment. The atmosphere is relaxed and peaceful. The home was spotless on the day of the unannounced inspection. Considerable commitment is made to ensure that individual social and personal care needs are met, in a way that the Service User would like. The home is run flexibly and the Providers are ‘hands on’, supervising everything on a day-to-day basis. Families and visitors are welcomed at anytime. The registered provider maintains close contact with service user’s family and representatives, which allows for exemplary responses to inspection recommendations. Recommendations from previous reports have been acted upon. Lowenva DS0000044957.V335662.R01.S.doc Version 5.2 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 report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Lowenva DS0000044957.V335662.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lowenva DS0000044957.V335662.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2,3,5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective Service Users are provided with up to date information about the home to enable them to make an informed choice. EVIDENCE: There is an up to date Statement of Purpose and Service Users Guide, which is provided for all prospective Service Users. This documentation has been updated and new brochures printed in preparation for the planned change of category from older people to learning disability. Contracts and Terms of Conditions are in place and signed by the service user. There is evidence that comprehensive information about the Service Users needs is gathered prior to the Service User moving into the home.
Lowenva DS0000044957.V335662.R01.S.doc Version 5.2 Page 9 On the day of inspection a multi-disciplinary conference was held attended by a range of professional people to discuss if the home could meet the needs of a potential new service user. We were advised by Service Users that the staff and Providers work very hard to meet all their needs in an individual way. Prospective Service Users and their families or representative are encouraged to visit the home before the Service User moves in. Intermediate care is not provided in this home. Lowenva DS0000044957.V335662.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The Service Users health, personal and social care needs are fully met in an individualised way. EVIDENCE: We case tracked the three service user files. Comprehensive care plans are based upon the initial assessment of Service Users needs, these include social, health and personal care needs. These are reviewed monthly. The Service User is involved in this process and signs their care plan. There is a client review sheet which shows evidence of any formal reviews with a third party e.g. Social Worker. Risk assessment and management strategies are undertaken for each Service User, to include Moving and Handling, environmental risks. A comprehensive daily record is completed to include daily occurrences.
Lowenva DS0000044957.V335662.R01.S.doc Version 5.2 Page 11 The local Primary Health Care teams support the Home and all the Service Users are registered with a General Practitioner. A Private Chiropodist, Optician and Dentist visit the home, as required. Specialist advice and equipment is sought on an individual basis, for example Hydrotherapy, Tissue Viability, Physiotherapy, District Nurse. Service Users have informed us that they feel their privacy and dignity is respected. Service Users speak highly of the staff and Providers, their environment and the personalised care provided. Medication practices were inspected and all found to be satisfactory. Lowenva DS0000044957.V335662.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The Service Users participate in a wide range of social activities depending on their wishes. The daily routines are flexible within the home. EVIDENCE: The size of the home enables the daily living routines and activities to be very flexible and personalised. Consultation with the Service Users results in a choice in relation to all activities and routines. Information relating to activities is recorded in the daily record, for example playing games, watching videos, walking the dogs, structured clubs such as Horizon, trip to the beach or a drive. Social Interests, past history and preferences are documented. The Home operates an open visiting policy, whilst asking visitors not to come too late in the evening. Visitors are welcomed and offered refreshments during their stay. Service Users and their representatives are provided with information about visiting from the point of initial enquiry.
Lowenva DS0000044957.V335662.R01.S.doc Version 5.2 Page 13 Service Users are encouraged to make choices in relation to their finances and personal belongings. Information about advocacy is available within the Home. All the Service Users have an independent person acting on their behalf. We were informed by Service Users that they were most content with their accommodation and lifestyle. Service Users have the choice of eating in the dining room or in their rooms. There is a constant supply of fresh fruit available. The menu changes every three weeks and Service Users stated if they wished for anything in particular the Registered Providers would purchase it. There is a choice of menu at all meals and a record is kept of the food consumed. Hot and cold drinks are offered regularly or on request from the Service User. Likes, dislikes and allergies are recorded in the assessments. Service Users spoke very highly of the food provided. Fridge and freezer temperatures are recorded. Occasions are celebrated. Special diets are provided as required on an individual basis. The Registered Providers have completed their Intermediate Food Hygiene certificate. Lowenva DS0000044957.V335662.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users are listened to and their rights protected. EVIDENCE: The complaints procedures have been brought up to date and include details as to how to contact the Commission for Social Care. ( Contact details will now have to be changed due to the closure of the St.Austell Office). The Commission has received no complaints about this home. Relatives have previously informed us that anything that could be done or provided to make their relatives feel more comfortable would be done. Service user voting preferences are respected and each service user is registered to vote. Advocacy information is available within the home. There are up to date Protection of Vulnerable Adults and Whistle blowing Policies and Procedures. Staff training has been undertaken and this is recorded within the staff training records. There is an up to date policy on the Management of Service User’s Money and Financial Affairs, in addition to Autonomy and Privacy & Dignity. There is
Lowenva DS0000044957.V335662.R01.S.doc Version 5.2 Page 15 evidence that the staff take their responsibility to protect vulnerable adults seriously. Lowenva DS0000044957.V335662.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Service Users live in a safe, clean and homely environment that meets their individual needs. EVIDENCE: The location and layout of the home is accessible, safe and very well maintained, it meets the service user’s individual needs in a very comfortable and homely way. There is an ongoing programme of maintenance and redecoration. The kitchen has been relocated to what was the garage and work is underway to link this area to the main house. The space the old kitchen has vacated is now additional communal space. The gardens and patio area are well cared for. There is a car park at the front of the home.
Lowenva DS0000044957.V335662.R01.S.doc Version 5.2 Page 17 The home is a very comfortable, modern residential property. There is a lounge with dining area and a conservatory. There are lovely gardens surrounding the property. All areas were noted to be smoke free. Furnishings were noted to be of a high standard with plenty of natural light and domestic lighting. We observed that the décor was homely in nature, whilst offering a high standard of decoration. There is a communal bathroom. Each Service User has their own facilities including a toilet and a wash hand basin. Sluice facilities are not felt to be necessary by the Providers at this time. Specialist equipment is provided on an individual basis as required. Rooms are individualised, the fittings and furnishings are suitably well appointed. Service Users are encouraged to bring in furniture and personal effects to furnish their rooms. A lockable storage space has been provided for all rooms. All rooms have been fitted with door locks. All rooms have plenty of natural ventilation and light. Water supplies have been regulated throughout the home and a Legionella risk assessment has been undertaken. Radiators have been covered to reduce the risk of contact with hot surfaces and all windows are fitted with restrictors. Environmental risk assessments are completed and reviewed. The premises were found to be spotlessly clean on the day of the Unannounced Inspection and there was no evidence of any odours within the home. Regular audits are completed on processes within the home such as the laundry, health and safety, medicines. Lowenva DS0000044957.V335662.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29,30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users needs are met by safe and competent staff, in sufficient numbers to meet their needs. Recruitment practices were seen to be satisfactory. EVIDENCE: We were informed that there are two staff are on duty at all times. On the day of the inspection the registered providers were present plus a care assistant. The registered manager joined the inspection mid morning. There is one sleeping night staff and a second person on call within the home. Service Users have a call bell that they press if they wish for assistance over night. Staff under eighteen are not employed and no one under twenty-one years of age is left in charge of the home. Two of the care staff have National Vocational Qualification Level 2 and one has National Vocational Qualification Level 3.
Lowenva DS0000044957.V335662.R01.S.doc Version 5.2 Page 19 Both the Registered Providers have achieved their National Vocational Qualification Level 2, and the registered manager holds the Registered Managers award. All staff have a First Aid certificate. The induction and foundation training is based upon Skills for Care standards. All staff complete an application form, two written references are obtained and staff are provided with a Job description and contract. Criminal records bureau checks are obtained before staff are allowed to commence working. There is an Equal Opportunities Policy. The Registered Manager ensures that the Induction and the annual training programme for the staff complies with National Training Organisation and Skills for Care standards. A comprehensive training programme has been developed, to include Learning Disabilities and Mental Health training. The training records are kept up to date for each staff member. There is an excellent training manual. The Registered Manager works part time for a local education Provider as a Tutor and assessor. Lowenva DS0000044957.V335662.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Service Users benefit from the ethos, leadership and management of the home. EVIDENCE: The Registered Manager has over twenty years experience in a care setting and has gained the Registered Managers Award and Diploma in Performance Coaching. There is evidence that she remains professionally up to date. There are clear lines of accountability within the home. Staff meetings have been held and records of these kept. There is evidence to confirm that Service Users, their relatives and staff contribute to the running of the home. The Registered Manager works part
Lowenva DS0000044957.V335662.R01.S.doc Version 5.2 Page 21 time in the home. She is working as a Distance Learning tutor and National Vocational Qualification Assessor. One of the registered providers is currently undertaking the Registered Managers award. There is a Quality and Quality management Policy. A regular audit is undertaken to cover a broad range of issues such as the kitchen, laundry, record keeping and medicines. There is an annual development plan. A questionnaire has been circulated to relatives or visitors and other stakeholders. An annual report has been compiled. This is made available to Service Users and the Commission for Social Care Inspection. Employers Liability insurance has been obtained and the certificate is evident within the home. There is evidence of Business and financial planning. There are Maintenance, Legionella, COSSH, Missing Persons and Health & Safety Policies and Procedures within the Home. The Accident book for Service Users complies with Data Protection legislation. The Fire records book is up to date. The Registered Manager has data sheets for any substance that maybe hazardous. Risk assessments and Health and Safety checklists have been completed for most identified environmental hazards within or without the Home. One of the Registered Providers has completed a Safety at Work course. Radiators have been covered, all water sources have been regulated and a legionella risk assessment been undertaken. Records of decoration and refurbishments are kept. By way of discussion with the staff team it is evident that various forms of work supervision is a regular occurrence. This includes formal one to one supervision. The recording of the one to one supervision needs to be more regular to evidence that this form of supervision occurs at least 6 times per year. Lowenva DS0000044957.V335662.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 4 X 4 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 X 3 3 3 3 Lowenva DS0000044957.V335662.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NONE 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 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 OP36 Good Practice Recommendations The registered provider should make arrangements to ensure that formal one to one supervision occurs and is recorded at least 6 times per year for each staff member. Lowenva DS0000044957.V335662.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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