CARE HOMES FOR OLDER PEOPLE
Lowfield House Railway View Road Clitheroe Lancashire BB7 2HA Lead Inspector
Mrs Christine Mulcahy Unannounced Inspection 14th November 2005 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.V253317.R01.S.doc Version 5.0 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.V253317.R01.S.doc Version 5.0 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.V253317.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 9th May 2005 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 service users 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 ensuite 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 which overlooks a well maintained garden. Lowfield House DS0000009446.V253317.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was the second unannounced inspection in 2005. The inspection took place over one day. At the time of the inspection 24 service users were accommodated at the home. The service was inspected against the National Minimum Standards for Older People and involved examination of records and discussion with a number of service users, relatives, visitors the responsible individual and the registered manager. There are various references to the case tracking process. This is a method where the inspector focuses on a small representative group of service users. All records pertaining to these people are inspected along with the rooms they occupy in the home. Observations are made of the care provided and the service users are invited to have a discussion with the inspector to discuss their experiences of life in the home. This is not to the exclusion of the other service users, with a number of other service users being involved in the inspection process in various other ways. Breaches in regulations and standards that pose an immediate risk to service users have been highlighted for urgent action. The inspection was carried out with the co-operation of service users, the registered manager, care staff and the responsible individual. Over the course of the inspection 2 service users, 4 staff members, the registered manager and the responsible individual were consulted. Documents were read and care observed. What the service does well:
The attitude of the management and staff team is to ensure that service users live in a comfortable, safe and secure environment. It was apparent there was a focus on ensuring that all facilities within the house were homely and reflected normal living as far as possible. The registered provider has a positive attitude towards the service users and stated, “This is their home and I try to meet their needs the best way possible.” Care plans are comprehensive and address service user personal, emotional and social care needs. Areas of care such as routines, likes and dislikes, allergies, health needs, personal hygiene and general health were also covered in detail to ensure staff adhered to the instructions and delivered the care accordingly. Staff were adequately trained and experienced to deliver care and support to service users and were observed competently delivering care to service users. It was apparent that the needs of the service users were put first to ensure their safety. Lowfield House DS0000009446.V253317.R01.S.doc Version 5.0 Page 6 Through the CSCI comment card a relative wrote, “My mum went into Lowfield early in the year and she could not be cared for anywhere else better than she is. She is very happy which makes me very happy. I have nothing but praise for the staff.” Comments form a service user read, “I am surprised how quickly I have settled into a very friendly home with very patient staff.” 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. Lowfield House DS0000009446.V253317.R01.S.doc Version 5.0 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 Lowfield House DS0000009446.V253317.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 1, 2, 3, 4, 5, 6 Written information about the home and the facilities was comprehensive. Service users had a plan of care for daily living and longer-term outcomes. Service users were always assessed before moving into the home. EVIDENCE: Case tracking and examination of service user case files showed that service users had been issued with the appropriate paperwork on admission to the home. This enabled service users and their representatives to find out more about the home and how it was run. Intermediate care is not provided at this home. Lowfield House DS0000009446.V253317.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 7, 8, 10, 11 Individual care plans were used to identify and meet service user needs. Service users were involved in drawing up their own care plans. EVIDENCE: The inspector examined the case file of the last service user admitted to the home. Case tracking showed that the care plan had been drawn up from the initial service user assessment. This care plan addressed service user routine, likes, dislikes, health and personal hygiene needs. The plan was comprehensive and detailed instructions enabled staff to deliver care to the service user. There was a nutritional risk assessment, records of professionals visiting, and prescribed medication detailed on the care plan. One area of the care plan required further information relating to the date of the service user admission. The care plan also identified that the service user had osteoporosis and could fall occasionally, but a risk assessment to prevent this was not included. It was also noted that the service user had angina, however the care plan did not detail what the staff should do in the event of the service user having an angina attack. The registered manager noted these comments and stated that she would amend the care plan to include this information.
Lowfield House DS0000009446.V253317.R01.S.doc Version 5.0 Page 10 It was apparent that service users were treated with dignity and respect as the inspector discreetly observed staff assisting service users with their daily routines. One service user when asked how she had settled since moving into the home in April said, “I’ve settled in very well thank you. I’ve got everything I need. The food is very nice and the staff help me with my food. I’ve made some new friends and the lady sat beside me helps me a lot.” Six CSCI service user comment cards were returned and each confirmed they felt well cared for and their privacy and dignity was respected by staff. Lowfield House DS0000009446.V253317.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 12, 13, 14, 15 Lifestyle opportunities in the home were available to all service users. Service users were given the opportunity to maintain outside contact at any time. Meals served were wholesome and nutritious. EVIDENCE: Routines and lifestyle opportunities were based on service user wishes and choices. Information to confirm this was noted n service user care plans. Care plans included details about past hobbies, interests, previous employment, family life and current family contact. The inspector observed a number of service users resting, reading newspapers, receiving visitors and moving around the home. One service user commented that she enjoyed watching T.V. and listening to music. “We can do whatever we like,” said another service user. Three full meals are served daily and two of these are hot. Meals were served in the dining room and people were encouraged to eat in this area. However service users could eat in other areas of the home if they wanted. A service user comment care read, “Lived at Lowfield for 2 months everyone is lovely and friendly, the food is very good, I am very happy.” Discussions with service users and staff confirmed that an entertainer, arts and craft worker and a physiotherapist visit regularly to provide leisure opportunities to the service users.
Lowfield House DS0000009446.V253317.R01.S.doc Version 5.0 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): This section was assessed at the last inspection. The inspector was satisfied that all policies, procedures and practices relating to this section were reviewed regularly and met the requirements of each standard. EVIDENCE: Lowfield House DS0000009446.V253317.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 19, 20, 21, 22, 23, 24, 25, 26 All areas in the home were safe and well maintained. The home was clean pleasant and hygienic. EVIDENCE: There is a ramp at the front entrance of the home to assist wheelchair users to access the building. The home has two lounge areas and one dining room. At the time of the inspection service users were seen using all of these areas. Bedrooms on the first floor can be reached via a passenger lift. All bedrooms are single, carpeted, decorated and furnished to a good standard. Bedroom doors had appropriate locks fitted. All rooms are centrally heated, pipe work and radiators are guarded and have low temperature surfaces. Emergency lighting is provided throughout the home. Lowfield House DS0000009446.V253317.R01.S.doc Version 5.0 Page 14 Two service users were asked about their bedrooms and said they were satisfied with their rooms. The inspector noted these bedrooms had been personalised with their own belongings. There were sufficient washing and toilet facilities in the home, these were examined along with the kitchen and dining room and were clean and hygienic. Lowfield House DS0000009446.V253317.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 27, 28, 29, 30 Staff numbers were appropriate to meet service user needs. Staff training was ongoing. Some staff files did not hold information required to protect service users form harm or abuse. EVIDENCE: Of the 4 staff files examined the inspector noted that one employee had been recruited in October 2005. Information required to protect service users from harm or abuse was not available on the file of the most recent employee. Some staff required a health declaration to confirm their fitness for the job. The inspector required the registered manager to ensure that these files held the appropriate information required to safeguard service users from harm. Discussions with staff and inspection of the staff rota confirmed the number and skill mix of staff on duty were appropriate to meet the needs of the service users. Domestic staff were employed in sufficient numbers to ensure the home was cleaned to a good standard. Training was ongoing and the registered manager confirmed that 3 carers were currently taking their Level 2 NVQ in care. It was apparent that appropriately experienced and trained staff assisted service users and staff were competent to deal with visitors or relatives to the home. Lowfield House DS0000009446.V253317.R01.S.doc Version 5.0 Page 16 Six service users who completed the CSCI comment card agreed that the staff treated them well and they felt safe. Two service users said they were very happy at the home. Lowfield House DS0000009446.V253317.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 31, 32, 33 The home is run and managed by a person who is fit to be in charge. The management and staff team try to ensure that the home is run in the best interest of the service users EVIDENCE: The registered manager has been employed at Lowfield for over 18 years and involved in the management of the home for many of these years. Although the registered manager has not yet achieved the Registered Managers Award she periodically updates her knowledge and skills through various courses. Through discussion and examination of records the registered manager was able to demonstrate her knowledge of the conditions and diseases of old age. Lowfield House DS0000009446.V253317.R01.S.doc Version 5.0 Page 18 The registered manager was reminded that she must hold a relevant qualification by the end of 2005. The registered provider was present during part of the inspection and commented that he was very happy with the registered managers work and her ability to manage the home successfully. The inspector reminded the registered provider that he was required to submit a monthly written report on the conduct of the care home to the Commission. Discussions with staff and service users confirmed they were happy with the registered manager and there was a clear sense of direction and leadership understood by staff and service users. It was apparent that the registered manager was popular and well liked amongst service users and staff and she was able to relate well to service users, visitors staff and the registered provider. Lowfield House DS0000009446.V253317.R01.S.doc Version 5.0 Page 19 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 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 N/A 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 N/A 17 N/A 18 N/A 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 N/A N/A N/A N/A N/A Lowfield House DS0000009446.V253317.R01.S.doc Version 5.0 Page 20 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. Standard Regulation Requirement Timescale for action 1 OP29 Sch 2 The registered person must 14/11/05 Reg 7, 9, ensure that all information and 19 documents in respect of people managing or working in the home are held at the care home. 2 OP7 Regulation The registered person must 14/11/05 4 (b)(c) ensure that all information relating to the service user is included on the service user care plan. A falls risk assessment must also form part of the care plan. 3 OP37 Regulation The registered provider must 14/01/05 26 prepare a monthly written report on the conduct of the care home and supply a copy of the report to the Commission and the registered manager. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Lowfield House DS0000009446.V253317.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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