CARE HOMES FOR OLDER PEOPLE
Lowfield House Railway View Road Clitheroe Lancashire BB7 2HA Lead Inspector
Mrs Christine Mulcahy Key Unannounced Inspection 09:30 8th January 2007 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.V301662.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.V301662.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.V301662.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14th November 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 and this overlooks a well-maintained garden. Service users receive a copy of the homes service user guide and have access to the Statement of Purpose. Fees are £330 per week and service users are billed separately for hairdressing, newspapers and magazines. Lowfield House DS0000009446.V301662.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key unannounced inspection which included a visit to the home took place on the 8th and 9th of January 2007 Information was obtained from service user care plans, staff records, management systems, observations and policies and procedures. The inspector also spoke to 3 service users, 2 care staff and the registered manager. What the service does well: What has improved since the last inspection? What they could do better:
To ensure prospective service users have the information they need to make an informed choice about where to live documents given to service users must contain up to date information. Lowfield House DS0000009446.V301662.R01.S.doc Version 5.2 Page 6 Service user care plans must include sufficient details and appropriate risk assessments so that care staff know what to do to meet the identified needs and safeguard service users. To reflect the changing needs of service users and ensure activities meet their individual social needs the service user plan of care must be reviewed and actioned at least once a month. To promote and maintain a service user health needs an immediate GP assessment is necessary to prevent deterioration and promote the general wellbeing of other service users in the home. There should be greater effort made by the staff team to ensure that social and recreational activity reaches a service user who has poor mobility and is unable to take part in many of the activities as the lack of meaningful activity and social contact reduces service user quality of life. To ensure that medication is administered according to the homes policy and procedures service user MAR sheets must be signed by designated care staff to indicate that all prescribed medication has been administered so that service users are protected from mis administration. To ensure the premises are free from offensive odour the passenger lift should be professionally cleaned to eradicate the offensive odour. Not all staff has received abuse training and would not know what procedure to follow in the event of abusive practices. Staff training and development must be increased to ensure staff have the relevant skills, knowledge and competence to carry out the duties that are expected of them. An accurate record of training and development by all staff must be kept so it can be shown that staff have the skills, knowledge and competency to do their work. A thorough risk assessment must be carried out to ensure that unguarded radiators are safe while awaiting radiator covers. A thorough review and revision of the care staff application form would offer better protection to Service users by covering areas related to safeguarding adults.. 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.V301662.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 Lowfield House DS0000009446.V301662.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 1, 3 & 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Written information about the home was not up to date. Service users were admitted following a full assessment and staff know what their needs are. EVIDENCE: Two service user care plans were examined and showed that the registered manager had carried out a needs assessment before the service user moved into the home. The assessment documentation was always available to staff which helped familiarise them with the new service user. One staff spoken to was aware of the need service user assessments and knew that these formed the basis of the care plan. A service user guide given to a service user contained out of date information this meant that the service user didn’t have the information needed to make an informed choice about where to live.
Lowfield House DS0000009446.V301662.R01.S.doc Version 5.2 Page 9 Intermediate care is not provided. Lowfield House DS0000009446.V301662.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all service user care needs were set out in a plan of care this meant that their personal and health care needs could not be met properly. Service users were not fully protected by the homes medicine policies and procedures. Service users privacy and dignity was respected. EVIDENCE: Case tracking and discussion with the registered manager confirmed that care plans were completed soon after the service user moved into the home. However the care plans examined did not include sufficient details for staff to meet the identified needs and not all needs were identified. Three service users at the home used a ripple mattress to prevent pressure sores. The care plans of these service users were examined but did not include information about this equipment and other care plans did not confirm the use of hoists or wheelchairs. Another care plan did not include a falls risk assessment for a service user who had poor mobility and was at risk from falling. This meant that care staff did not have enough information to fully meet service user care needs or recognise signs to prevent risks to service users. Service user
Lowfield House DS0000009446.V301662.R01.S.doc Version 5.2 Page 11 monthly care plan review records had not been completed since October 2006. The care plan of a service user who was admitted to the home on 19/9/06 had only been partially completed and did not contain enough information for staff to know how to fully meet his needs. The registered manager was asked to ensure that a service user received an immediate GP assessment to prevent the deterioration of her psychological and mental health and promote the general wellbeing of other service users in the home. A service user medication administration record sheets (MAR) had not been signed to indicate that prescribed medication had been administered. The diary sheet of the service user was also checked and lacked information about why this had happened. Creams and dressings applied were also not signed for on the MAR sheet. Therefore it was unclear if medication had actually been given by care staff or taken by the service user. Service users who were able were assessed as able to self administer medication and consent forms signed by service users were seen. Access to other health professionals was given and evidence of district nurse, chiropody and ophthalmic services were seen. Service user health and personal care arrangements were discreetly observed and ensured their privacy and dignity was met. Service users who do not have a mobile phone are able to use a office phone and there is no charge for this. Service users confirmed that clothing worn that day was their own and clothing seen in wardrobes were named accordingly. Lowfield House DS0000009446.V301662.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 at least once during a 12 month period. 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 were available to meet some service users social interests and needs. Visiting from relatives and friends is flexible. Service users autonomy and choice was maximised in relation to meals and snacks ensuring variety and nutrition. EVIDENCE: Wherever practicable service users were able to make choices about aspects of their lives. When asked about their waking up and retiring times service users confirmed that they could stay up later if they wanted. One service user preferred to stay in his bedroom for most of the day and chose to eat his meals in room. He commented, “I stop in my room as I like to be on my own and keep out of the way, I even eat in here”. Service user files and care plans held information about their interests and hobbies and had been used to form part of the homes activity plan. There was also enough information to provide life-enhancing needs led activities for the service users. Activities usually took place after lunch and a large majority of service users were observed taking part in a game of bingo. Other activities held regularly at the home included an assortment of outside sing-a-long
Lowfield House DS0000009446.V301662.R01.S.doc Version 5.2 Page 13 entertainer’s, small group visits to places of interest and board games. TV, newspapers, books and magazines were also available for service users to access. The registered manager is reminded that although some service users were consulted she must ensure that all service users are given the choice of options available and ensure activities meet their individual social needs are recorded in their care plans. However one service user who was unable to take part in many of the activities because of mobility problems was asked what improvement’s she would make to her daily life and leisure time. She commented, “having someone to talk to, other than that nothing as the care is all right”. The registered manager said that she would talk to the service user to get ideas about those preferences and how they could be better met. Service users religious and cultural needs are assessed and identified when they move into the home as part of the admission process and arrangements are in place to meet these needs. The registered manager said that any diverse cultural or religious needs would be explored and access to those services would be made available when required. Menus were changed regularly and service users were reminded of the day’s menu each morning. There was always a choice if people don’t like the main meal and one service user confirmed she could have what they liked. “I’m not a big eater and if I don’t like what’s served I can have something else. When asked about the food at the home another service user said, “Food’s not bad, I’m used to curries, the cook makes me curries sometimes, they taste ok”. Lowfield House DS0000009446.V301662.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaints made by service users were acted on and recorded. The lack of staff training in protection of vulnerable adults may result in abusive practices being unrecognised and therefore unreported. EVIDENCE: The homes complaints procedure 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 28 days. Although there were no recent complaints the registered manager said that complaints made would include details of the investigation and any action taken. There were procedures for staff to follow if they suspected an incident of abuse had taken place. However not all staff had received adult abuse training and it was unclear if they knew what procedure to follow in the event of abusive practices. Lowfield House DS0000009446.V301662.R01.S.doc Version 5.2 Page 15 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 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users live in a safe well-maintained environment. Most areas of the home were clean, pleasant and hygienic. EVIDENCE: The home is well maintained, clean and decorated to a good standard, which gives a pleasant environment to live and work in. However the passenger lift needed professional deep cleaning due to an offensive odour. The door of the unused bathroom on the first floor currently used to store spare furniture should be kept locked at all times to prevent access to service users and to safeguard them from harm. Lowfield House DS0000009446.V301662.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing numbers and skill mix met service users assessed needs. Information about staff training was not clear and required updating. Recruitment processes needed improvements to ensure the protection of service users. Some staff required further training to ensure service user needs are fully promoted and protected. EVIDENCE: The duty rota was examined and showed which staff were on duty and at what times. Care staff were observed on duty in sufficient numbers. The file of one new employee was examined and showed that the registered manager had followed the homes recruitment procedures. All pre employment checks had been carried out. However the care staff application form needed a thorough review as it did not ensure the protection of service users and failed to ask for relevant information like previous experience of working with older people. This information is essential to determine the applicant’s suitability for the job. A discussion with one care worker said, “I enjoy working here and I’m happy here”. She knew where to find the homes policies and procedures and said that she would immediately tell the registered manager if she suspected service user abuse. Lowfield House DS0000009446.V301662.R01.S.doc Version 5.2 Page 17 Discussion with care staff confirmed they had been fully informed about their expected behaviour and responsibilities as social care workers. New staff completed an induction checklist as they learned new things about the home like the emergency evacuation procedure and other important procedures. Not all staff had the relevant skills and knowledge to work with a small number of the service users in the home. Some staff required awareness training in dementia care. An accurate record of training and development by all staff was not available for inspection so it could not be shown that staff had the skills, knowledge and competency to do their work. Concerns were raised that some staff might not be able to meet the diverse needs of a service user in particular to their current disability. 60 of the care staff was qualified to NVQ Level 2 and above. Lowfield House DS0000009446.V301662.R01.S.doc Version 5.2 Page 18 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, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is run and managed by competent people who ensure service users best interests are safeguarded, promoted and protected. quality assurance.systems do not capture the views of residents or staff about the way the home is run. EVIDENCE: The manager of the home has many years experience of working with older people. She currently works alongside a senior carer who is qualified to NVQ Level 4. There is a job description that outlines the manager’s role and responsibilities. A basic internal audit in the form of a satisfaction questionnaire is carried out annually. This is not accredited to a quality assurance system and the results
Lowfield House DS0000009446.V301662.R01.S.doc Version 5.2 Page 19 of the survey are not published or made available to the service users, their relatives or the CSCI. Staff and service user meetings are infrequent so there are limited opportunities for them to make their views known. Case tracking confirmed there were details of fees charged and paid. A record of service user cash held at the home was kept but required better signature arrangements to verify the transaction. A record of water temperatures was kept along with other relevant records that were examined and seen to be up to date. The registered manager said that she was awaiting the portable appliance test certificate and would forward a copy of to the CSCI. To prevent service users from risk of harm radiator guards were required on two radiators in the small lounge. All staff had received fire and first aid training as part of their induction to the home and the last fire drill was held in December 2006 Lowfield House DS0000009446.V301662.R01.S.doc Version 5.2 Page 20 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X 2 X X 2 Lowfield House DS0000009446.V301662.R01.S.doc Version 5.2 Page 21 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 OP1 Regulation Schedule 1 Requirement Timescale for action 08/01/07 2. OP7 The registered manager must ensure that the service user guide and statement of purpose is updated to reflect changes in the service. Regulation The registered person must 4 (b)(c) ensure that all information relating to service users is included on the service user care plan. A falls risk assessment must also form part of the care plan. Previous timescale of 14/11/05 not met 15(1) 13(4) 15(2)(b) 08/01/07 3 OP7 4 OP8 13(1) 5 OP9 Schedule 3 17(1)(a) The registered manager must 27/04/07 ensure that care plans are drawn up with the involvement of the service user, include appropriate risk assessments and are reviewed monthly. To prevent health deterioration 08/01/07 the registered manager must ensure that the health needs of a service user are immediately assessed by their GP. The registered manager must 08/01/07 ensure that medication is administered according to the homes policy and procedures
DS0000009446.V301662.R01.S.doc Version 5.2 Page 22 Lowfield House 6 OP12 16(2) 7 OP19 13(4) 8 OP26 16(2)(j) (k) 12(1) 8 OP29 9 OP30 12 18 service user and MAR sheets are signed by designated care staff. The registered manager must ensure that social and recreational activities reach service users who are unable to take part in the homes activities due to poor mobility. The registered manager must ensure that the door of the 1st floor unused bathroom is kept locked at all times to prevent access to service users. The registered manager must ensure that the lift is professionally cleaned to eradicate the offensive odour. The registered manager must ensure that the homes staff application form is thoroughly reviewed before recruiting further care staff at the home. The registered manager must ensure that staff training and development is increased and an accurate record of all staff training and development is kept. The registered manager must ensure that regular staff meetings are held so that staff can affect the way in which the service is delivered. The registered manager must ensure there is a system for reviewing and improving the quality of care provided at the home reflecting the aims and outcomes for service users. Written records of all service user financial transactions must be maintained and where practicable written acknowledgement and service user signatures kept. 08/01/07 08/01/07 08/01/07 08/01/07 29/06/07 10 OP32 21(2) 08/01/07 11 OP33 24(1) 29/01/07 12 OP35 Schedule 4 (8)(9) (a,b) 17(2) 08/01/07 Lowfield House DS0000009446.V301662.R01.S.doc Version 5.2 Page 23 13 OP38 13(3) The registered manager must ensure the health and safety of service users and staff by fitting radiator guards to the 2 radiators in the small lounge. Please ensure there is a risk assessment identifying potential risk to service users while the radiators are exposed and awaiting guards. 27/04/07 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.V301662.R01.S.doc Version 5.2 Page 24 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
© 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 Lowfield House DS0000009446.V301662.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
