CARE HOMES FOR OLDER PEOPLE
Lowfield House Railway View Road Clitheroe Lancashire BB7 2HA Lead Inspector
Mrs Christine Mulcahy Unannounced Inspection 10th September 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 Lowfield House DS0000009446.V343137.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. Lowfield House DS0000009446.V343137.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Lowfield House Address Railway View Road Clitheroe Lancashire BB7 2HA 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) 01200 428514 01200 444365 Mr Peter John Hitchen Ms Julie Dean Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Lowfield House DS0000009446.V343137.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection Brief Description of the Service: Lowfield House is registered with the Commission for Social Care Inspection to provide care and accommodation to 24 older people. The home is situated in the centre of Clitheroe giving the people who use the service good access to community facilities. Sainsbury’s supermarket, public transport and the train station are within easy access of the home. The property is detached and set in its own grounds. All bedrooms are single and have a door lock. Most are en-suite and some are situated on the ground floor of the home. There are a number of shared and communal areas throughout the home including the dining room and lounge. Access to the first floor is via a passenger lift. There is ample parking to the front of the building and this overlooks a well-maintained garden. The people who use the service and their relatives receive a copy of the homes information guide and have access to the Statement of Purpose. Fees are £350 per week and residents are billed separately for hairdressing, newspapers and magazines. Lowfield House DS0000009446.V343137.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. A key unannounced inspection, including a visit to the home, was carried out on 10th September 2007. Information was obtained from resident’s care plans, records, management systems, resident’s and relative questionnaires and care observations. The inspector spoke to 5 residents, 4 staff and the person in charge. What the service does well:
At Lowfield the staff try to provide the people who use the service with a comfortable, homely environment to live in. The atmosphere at the home was welcoming and friendly residents and relatives responded to the Commission for Social Care Inspection survey with the following comments: “The meals are excellent. I’m very happy and content. I cannot manage at home and I’m looked after well at Lowfield. The staff are very friendly and look after all my needs”. “The staff phone me if my mother is unwell or there any concerns. Staff work hard trying to meet the needs of the clients. My mother is always consulted about daily activities. A warm friendly atmosphere caters excellently for the clients. Visitors are always made welcome. The service appears to cover all my mothers needs. The location is ideal for clients to visit shops churches etc”. “I don’t know the qualifications the staff have but they are always very caring towards my father. I’m very happy with the standard of care, the cleanliness and attitude of the staff. My father is very happy and content there he loves the food too!” “If there are any problems we are contacted immediately. Good home cooked food and a high level of personal care from staff that genuinely care for their wellbeing. They are kept very clean both the home and residents”. 70 of the staff team are currently trained to NVQ level 2 or equivalent. Lowfield House DS0000009446.V343137.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better:
To complement the good practice already in place more staff should be trained in safeguarding vulnerable adults so that the safety and wellbeing of the people who use the service is promoted. Staff meetings are not held regularly and the last one was held last year. To ensure that staff can affect the way in which the service is delivered and their views are known the registered manager must introduce strategies to regularly enable this.
Lowfield House DS0000009446.V343137.R01.S.doc Version 5.2 Page 7 There is not an effective system to measure the service provided to the residents. The registered manager must ensure there is a system for reviewing and improving the quality of care provided at the home that reflect the aims and outcomes for service users. Examination of a staff personnel file and discussion with the person in charge showed that care staff do not receive formal supervision. This must be done at least 6 times a year to ensure that the procedures adopted by the home and it’s induction and training arrangements are put into practice. 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. Lowfield House DS0000009446.V343137.R01.S.doc Version 5.2 Page 8 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 Lowfield House DS0000009446.V343137.R01.S.doc Version 5.2 Page 9 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): OP 1, 3 & 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are admitted following a full assessment so that care staff know what their needs are. Care plans are based on these assessments to ensure staff can meet these needs. EVIDENCE: The person in charge understands the importance of having sufficient information when choosing a care home. There is clearly written guide the people who use the service and statement of purpose to help people understand what services the home can provide. Both documents clearly set out the objectives and philosophy of the service. The person in charge said that admission to the home only takes place if they are confident they have the skills, ability and qualifications to meet the prospective residents assessed needs. Lowfield House DS0000009446.V343137.R01.S.doc Version 5.2 Page 10 The care plan of one resident was examined and showed that a needs assessment was carried out before admission into the home. The resident had been provided with a contract that is clear and easy to understand so that the resident and their relatives know what service they can expect. The assessment documentation was always available to staff which helped familiarise them with the residents needs. Intermediate care is not provided. Lowfield House DS0000009446.V343137.R01.S.doc Version 5.2 Page 11 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): OP 7, 8, 9 & 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health care needs of the people who use the service were set out in a plan of care. Residents were protected by the homes medicine policies and procedures. The care practiced observed showed residents privacy and dignity was respected. EVIDENCE: Case tracking of a person who uses the service and discussion with the person in charge confirmed that all resident’s had a plan of care that included sufficient details for staff to meet the identified needs. Care plans seen had been reviewed regularly and included details about the resident profile, communication, mobility personal safety, medical history and medication. Personal details and physical description, mental, physical state, daily routines likes and dislikes were also included. The plan also detailed other areas such as dental, eye and foot care, the resident’s religion, and social activity. The care plan of one service user was examined and showed that it contained an assessment of the resident’s daily living pattern including written
Lowfield House DS0000009446.V343137.R01.S.doc Version 5.2 Page 12 information about their personal care and physical wellbeing. The assessment was based on the resident’s ability to care for himself and maintain his independence with staff support for as long as possible. A moving and handling assessment and risk assessments clearly described the action to be taken and the risk associated with the activity. The plan had been reviewed regularly and changes in the resident’s needs were identified and acted on immediately. Further records examined indicated that appropriate health care appointments were made available to the resident and other people who use the service as required or necessary. A number of residents were observed being given their new spectacles by the visiting optician on the day of the site visit. The home has an efficient medication policy supported by procedures that staff understand and follow. The manager and the supplying pharmacist make regular checks to ensure compliance with the procedures. Examination of the medication administration records showed they had been fully completed, contained the required entries and were signed by appropriate staff. All areas of medicines handling, recording and storage were well managed. Staff responsible for the administration of medication has completed accredited training in this area. A number of residents were observed using their bedrooms, dining area and lounge area and it was apparent that residents could access any area of the home to maintain their privacy. A resident confirmed that clothing worn that day was his own and clothing seen in his wardrobe was named accordingly. Another said, “I’m looked after well at Lowfield. Staff are very friendly look after all my needs”. A relative commented on the level of care at the home stated, “The service appears to cover all my mothers needs and all will be well if current standards are maintained”. Lowfield House DS0000009446.V343137.R01.S.doc Version 5.2 Page 13 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): OP 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Leisure and recreational activities available met the social needs and interests of the people who use the service. Visiting from relatives and friends is flexible. Meals and snacks ensured variety and nutrition. EVIDENCE: The person in charge said that wherever possible people who use the service were able to make choices about aspects of their lives including waking and going to bed times and handling their own finances. Case tracking, examination of records and discussion with some of the resident’s confirmed that this was the case. The religious and cultural needs of the people who use the service had been assessed and identified when they moved into the home as part of the admission process and details were included in the care plan. The local Church of England Vicar called into the home on the day of the site visit to carry out Holy Communion for the residents who wanted to take part. This showed that the managers were aware of different religions within the home and how to meet the religious beliefs of residents.
Lowfield House DS0000009446.V343137.R01.S.doc Version 5.2 Page 14 Activities at the home were planned and varied to suit their preferences and capabilities. Some of the resident’s enjoy watching TV, conversation, newspapers, magazines and flower arranging. A relative who used the CSCI survey commented, “Could improve by more stimulation ie occupational therapists to try craft”. When asked residents were more than happy with the activities available to them and one resident said, “I like a good book, or the telly. There’s always something to do here if you want”. Another resident said, “You don’t have to do anything if you don’t want to. The staff are so kind”. There is an activities programme and copies are available to them. A record of resident’s individual activities were noted in the daily report book and included brief details of the visits from relatives, outings, religious observance, hairdresser, art, music, games, TV and local walks. The hairdresser visited on the day of the site visit and it was apparent that the residents were familiar with her and looked forward to her coming. Relatives were observed visiting the home throughout the morning and afternoon and were made welcome by the staff team. The lunch served was cheese and onion pie, mashed potato and baked beans or roast ham with vegetables and a choice of apple crumble, trifle or yogurt. The meal was well presented and looked wholesome and nutritious and portions looked generous. It was apparent from the resident’s positive comments that they enjoyed their meal and a number of residents asked for a second helping. A relative of a resident at the home stated, “My father is very happy and content he loves the food too!” Hot and cold drinks were served at regular intervals throughout the day. Lowfield House DS0000009446.V343137.R01.S.doc Version 5.2 Page 15 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): OP 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints made by service users and relatives were acted on and recorded. EVIDENCE: There is a complaints procedure that specifies how complaints may be made and who will deal with them. There is an assurance that complaints will be responded to within a maximum of 3 working days. Although there have been no complaints to the CSCI since the last inspection the person in charge said that complaints made would include details of the investigation and any action taken. When asked, the people who use the service knew who was in charge and who to complain to if they were dissatisfied with their care at the home. A resident said, “The staff are lovely, never need to complain. They’ll do anything for you”. There were procedures for staff to follow if they suspected an incident of abuse had taken place. Discussion with the person inn charge confirmed that eight care staff were trained in safeguarding adults. This means that more care staff will now be aware of abusive practices and would know how to report them. The person in charge said there were plans to train a further eight care staff in the near future. Lowfield House DS0000009446.V343137.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): OP 19 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of decoration and furnishings in the home ensured the environment was comfortable and homely. The home was clean, pleasant and hygienic. EVIDENCE: A tour of the home showed it was suitable for it’s stated purpose. Shared facilities, communal areas, bedrooms, bathrooms and the kitchen were decorated and furnished to a good standard. The home was light, bright and homely. The people who use the service were encouraged to personalise their bedrooms with their own furnishings and ornaments. Lowfield House DS0000009446.V343137.R01.S.doc Version 5.2 Page 17 The home was well lit, clean and tidy and smelled fresh. When asked about the environment the resident’s made positive comments like, “It’s lovely and cosy here, very homely”. A relative commented that the home is kept very clean. Lowfield House DS0000009446.V343137.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): OP 27, 28, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care staff are trained and skilled and in sufficient numbers to support the people who use the service and facilitate the smooth running of the service. EVIDENCE: The staff rota showed the home was staffed sufficiently. Particular attention was given to busy times of the day and specific needs of the people who use the service like medical appointments, leisure interests and at peak times of activity. The inspector observed staff involved in a number of daily activities with resident’s during the inspection demonstrating there were enough staff available to meet their needs. There is a staff-training matrix that shows staff training is ongoing and future training planned includes safeguarding adults, dementia care, 1st aid and other mandatory courses. There are 17 care staff and 70 of the care staff team have NVQ level 2 or above. There is a good recruitment procedure that clearly defines the process to be followed and ensures the protection of the people who use the service. The person in charge had recently reviewed the staff job application form to ensure equality of opportunity for applicants. Lowfield House DS0000009446.V343137.R01.S.doc Version 5.2 Page 19 A staff member spoken to confirmed pre employment checks required to ensure the protection of the residents were done before she was recruited. And records in her personnel file were examined to confirm this. 80 of the people who use the service were white British and the care staff employed was able to meet the health and specific cultural needs of all residents and their specific cultural needs. There were no male care staff employed at the home therefore the 5 male residents did not have a choice about whether they wished to have a male carer to assist with their personal care needs. The person in charge recognised there was a lack of male carers and said she would welcome male applicants along with others when a vacancy arose. Lowfield House DS0000009446.V343137.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): OP 31, 33, 35 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run in the best interest of the people who use the service. The lack of an effective quality assurance system and regular meetings for residents and staff means their views are not always known. EVIDENCE: The registered manager has the required skills and experience to run the home. She is currently undertaking her Level 4 NVQ in Care. Discussion with the person in charge on the day of the site visit showed that she has a clear understanding of the key principles and focus of the service. The management team regularly review the homes policies, procedures, records and practices to ensure staff awareness and ensure the wellbeing of the people who use the service.
Lowfield House DS0000009446.V343137.R01.S.doc Version 5.2 Page 21 The lack of regular staff and resident’s meetings and staff formal supervision showed that residents and staff views were not always recorded. This means that their views might not always be known and acted on. The person in charge said that there is an open door policy and staff could talk to the manager at any time, however these talks were not recorded. The lack of an internal audit to measure relatives and resident’s satisfaction meant that the manager could not be sure if the homes objectives were being met. There is a clear health and safety policy that ensures safe working practices. Records and documents examined showed fire drills, equipment and appliance safety checks were done regularly. The home has the necessary insurance cover in place to fulfil any loss or legal liabilities. There were details and records kept of resident’s fees charged and paid. A record of resident’s cash held at the home was examined. Resident and staff signatures verified the transaction. There are sound policies and procedures that are reviewed by the management team to ensure these are in line with current practice. Risk assessments were completed and taken into account when planning resident’s care and routines within the home. Lowfield House DS0000009446.V343137.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 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 3 Lowfield House DS0000009446.V343137.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? YES 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 OP32 Regulation 21(2) Requirement To ensure that staff can affect the way in which the service is delivered and their views are known the registered manager must introduce strategies to regularly enable this. Timescale of 08/01/07 not met. The registered manager must ensure there is a system for reviewing and improving the quality of care provided at the home that reflect the aims and outcomes for service users. Timescale of 29/01/07 not met. So that staff are properly supervised the registered manager must ensure that care staff receive formal supervision at least 6 times a year. Timescale for action 12/10/07 2. OP33 24(1) 11/01/08 3. OP36 18(2) 12/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Lowfield House DS0000009446.V343137.R01.S.doc Version 5.2 Page 24 No. Refer to Standard Good Practice Recommendations Lowfield House DS0000009446.V343137.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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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