Inspection on 09/05/05 for Lowfield House

This inspection was carried out on 9th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Lowfield House 20/11/08

Lowfield House 10/09/07

Lowfield House 08/01/07

Lowfield House 14/11/05

Lowfield House 18/03/05

Lowfield House 08/07/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Lowfield House Railway View Road Clitheroe Lancashire BB7 2HA Lead Inspector Christine Mulcahy Unannounced 09 May 2005 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 F57 F07 S9446 Lowfield V225799 090505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Lowfield House Address Railway View Road Clitheroe Lancashire BB7 2HA 01200 428514 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Peter John Hitchen Ms Julie Dean Care Home only Personal Care 24 Category(ies) of Old age, not falling within any other category registration, with number (OP) 24 of places Lowfield House F57 F07 S9446 Lowfield V225799 090505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15 February 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. It is situated in the centre of Clitheroe giving service users good access to community facilities like Tesco supermarket are within walking distance. Public transport is within easy access of the property and the train staion is a short walk away from 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. Some are situated on the ground floor of the home. There are a number of lounge and communal areas throughout the home. access to the first floor is via a passenger lift. There is ample parking to the front of the building. The responsible individual for the home is Mr. Peter Hitchen and the Registered Manager is Ms Julie Dean. Lowfield House F57 F07 S9446 Lowfield V225799 090505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the first unannounced inspection in 2005. The inspection took place over one day. At the time of the inspection 23 service users were accommodated at the home. The inspector arrived at 10.00 am and continued until 4.30pm. 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, the responsible individual and the deputy 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 the deputy manager. Over the course of the inspection 4 service users, 6 staff members, and the responsible individual. A tour of the premises took place including 4 bedrooms. Documents were read and care observed. What the service does well: The attitude of the staff and management is to run the home around the needs of the service users. All aspects of medication are well managed and ensure that good health care is promoted and service users are protected from mis administration. Service user care plans addressed areas of care such as routines, likes and dislikes, allergies, health needs, personal hygiene and general health. Past interests, hobbies, present needs and wishes were also included in care plans. Service users commented positively on the meals served. One service user said, “You can eat your meals wherever you want in the home.” Service users were heard described the meals served as, very good, lovely and delicious. Service users knew how to complain and who to make a complaint to. They were confident their complaints would be listened to and taken seriously. One said, “Everything is lovely here, I’ve no complaints the staff do all they can to help. If I needed to complain I’d tell Julie or Carol and they would make things right because it’s there job.” Lowfield House F57 F07 S9446 Lowfield V225799 090505 Stage 4.doc Version 1.30 Page 6 The staff numbers were adequate to meet the service user need. Discussions with staff highlighted that the skill mix was appropriate to service user assessed needs. Staff confirmed that more training opportunities had been introduced at the home. All staff had undertaken training in first aid, moving and handling, basic food hygiene, drug awareness and management of medicines. Staff stated they were looking forward to a course on dementia in the near future. 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 F57 F07 S9446 Lowfield V225799 090505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Lowfield House F57 F07 S9446 Lowfield V225799 090505 Stage 4.doc Version 1.30 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 standard(s) 1, 2 and 3 Written information about the home and the facilities was comprehensive, up to date and set out the aims, terms and conditions of the home. Service users had a plan of care for daily living and longer-term outcomes based on the care management assessment. Service users were always assessed prior to admission to the home. EVIDENCE: When asked some service users said they were familiar with the service user guide and statement of purpose. A service user admission checklist showed that most service users had been issued with the documentation on admission to the home. Both documents contained the relevant information that was needed for a prospective service user to understand how the home was run. Case tracking showed that one newly admitted service user had been provided with a service user guide but was not given a contract. Lowfield House F57 F07 S9446 Lowfield V225799 090505 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9, and 10 The health care needs of service users were identified and met through care plans. Staff respected the service users privacy and dignity. The control of medication was well-managed promoting good health. EVIDENCE: Case tracking showed that care plans were drawn up from the initial service user assessment. Each care plan addressed areas of care such as routines, likes and dislikes, allergies, health needs, personal hygiene and general health. On the two care plans examined risk assessments for mobility and health, selfmedicating, and fire evacuation were included. A care plan for a newly admitted service user did not include a photograph of the service user. A tick list to confirm that the service user received the relevant information on admission was not available and the service user or their representative had not signed the care plan. There was no copy of a contract of terms and conditions included in the service user file. When asked the deputy manager confirmed that the new service user had not been given a contract because she was admitted on a trial basis five weeks ago. The service user had become permanent during the last two weeks. When asked the service user said, “I haven’t signed anything but my son may have.” Lowfield House F57 F07 S9446 Lowfield V225799 090505 Stage 4.doc Version 1.30 Page 10 The inspector discreetly observed staff assisting service users with their personal health care with dignity and respect. Case tracking showed that care plans highlighted the service users health care needs and how these were met. One service user said “Staff are quite helpful and take me to the toilet if necessary” another said, “Staff help me to do things that I can’t do”. Some service users were seen to be mobile and able to self-care with various levels of supervision from staff. Attention to service user needs was apparent and records of a recent minor injury to a service user had been noted and recorded accurately in the appropriate service user file. This information was satisfactorily cross-referenced and examined with other records held in accordance with relevant legislation. The medicines policies, procedures and records ensured service user and staff safety. The document included a policy that detailed who is responsible for medicines when service users are out of the home. A procedure for ordering repeat prescriptions, a homely remedies list, and a service user self-medicating consent form also formed part of the medicines policy. There were comprehensive procedures for the administration of Controlled Drugs, ordering repeat prescriptions, and the procedure followed in the event of administering mistakes. Medication administration record sheets were used and were seen to be accurate and up to date. Lowfield House F57 F07 S9446 Lowfield V225799 090505 Stage 4.doc Version 1.30 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 standard(s) 13, 15 Service users had the opportunity to maintain their social interests. The meal served was wholesome, varied and appealing. Service users were given sufficient time to eat and independent eating was encouraged. EVIDENCE: Case tracking and discussions with service users confirmed that routines and daily living were based on service user wishes. This information was highlighted in care plans. Past interests, hobbies, present needs and wishes were also included in care plans. One service user said, “every alternate Tuesday the physiotherapist comes and does gentle exercises with us. The hairdresser comes on the other Tuesday.” Staff said, “depending on the event, the sing-a-long entertainer comes and on Thursdays the craft lady visits. We try to make sure the residents enjoy their activities and the physiotherapy is very gentle exercise.” When asked service users told the inspector that the craft lady helped them with art and craft activities in the home. “ We make things like cards, we just make things for ourselves or people we know.” Three full meals were served daily two of these were hot. Meals were served in the dining room, although one service user was seen eating his lunch in the lounge. One service user said, “You can eat your meals wherever you want in the home. I don’t like to eat in my bedroom, I prefer to eat at the dining table with other people. It’s good manners.” When asked the cook said that Lowfield House F57 F07 S9446 Lowfield V225799 090505 Stage 4.doc Version 1.30 Page 12 breakfast was, “whatever the resident wants, cereal, porridge, toast or a cooked breakfast.” The meal served on the day was lamb hotpot or roast beef. For pudding it was home-made jam roly poly with custard. Yogurt and fresh fruit were also available. Service users described the meals served as, very good, lovely and delicious. One said, “evening meals are lighter and we can have scrambled eggs or something like that.” During lunch the inspector discreetly witnessed a service user having difficulty gathering food on her plate due to her poor eyesight. Some food fell onto the table and into the service users lap. A plate guard and napkins were not available for service users during lunch. Lowfield House F57 F07 S9446 Lowfield V225799 090505 Stage 4.doc Version 1.30 Page 13 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 standard(s) 16, 17, and 18 Service users knew how to complain and who to make a complaint to. They were confident their complaints would be listened to and taken seriously. Service users were able to take part in the recent general election. Service users were safeguarded from abuse in accordance with written policies. Staff were knowledgeable around the homes abuse procedure. EVIDENCE: Examination of records confirmed there had been one complaint recorded during the last 12 months. A complaints procedure was available to each service user. When asked service users said that they had no complaints. One said, “Everything is lovely here, I’ve no complaints the staff do all they can to help. If I needed to complain I’d tell the managers and they would make things right because it’s there job.” Some service users were asked if they had participated in the general elections. One responded by saying, “I didn’t go to the polling station this time, I voted by post, my relatives helped me fill in the form.” The deputy manager confirmed that all service users had postal votes this year. Appropriate policies and procedures were in place to ensure service users monies and financial affairs were protected. Discussions with staff highlighted their knowledge around the homes abuse policy. One staff said, “ The abuse procedure protects service users from harm.” She then went on to describe different types of abuse. Another said, “The home has a whistle blowing policy Lowfield House F57 F07 S9446 Lowfield V225799 090505 Stage 4.doc Version 1.30 Page 14 that protects staff if they inform the management of suspected abuse towards service users. Lowfield House F57 F07 S9446 Lowfield V225799 090505 Stage 4.doc Version 1.30 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 standard(s) 19, 21, 22, 24 and 26 Facilities in the home met the criteria for its stated purpose. All areas in the home were safe and well maintained. The home was clean, pleasant, and hygienic. EVIDENCE: The location of the home was suitable for it’s stated purpose. There was a ramp leading to the front entrance of the home. The home offered the use of two lounge areas and service users were seen using both. A tour of the home showed a good standard of cleanliness and hygiene. The inspector examined 5 bedrooms during the inspection. All were personalised and en suite. Following a requirement made at the previous inspection, the malodorous smell noted in one service user bedroom had been eliminated using deep cleaning and carpet shampoo. Bedroom doors had appropriate locks fitted. Access to the first floor of the home was via a passenger lift. Lowfield House F57 F07 S9446 Lowfield V225799 090505 Stage 4.doc Version 1.30 Page 16 The kitchen and dining room area were examined and seen to be clean and hygienic. There were sufficient toilet and washing facilities throughout the home. These were clearly marked and located near to service user accommodation to enable service users independence. One service user said, “The staff are always busy keeping the home clean and tidy.” Lowfield House F57 F07 S9446 Lowfield V225799 090505 Stage 4.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, and 30 The staff numbers were adequate to meet the service user need. Staff training had taken place and was ongoing. Some staff files still did not hold the required information, which is required to ensure service users are safe from harm or abuse. EVIDENCE: Service users who were spoken to said that there was always enough staff on duty to meet their needs. The staff rota examined complied with the minimum levels required by the previous registering authority. At busier times of the day staffing levels were above the minimum required. When asked this was confirmed by staff. Two staff said,” There’s never a problem with staff, there’s always enough staff on duty and we cover each other’s shift during holidays and sick leave. Discussions with staff highlighted that the skill mix was appropriate to service user assessed needs. The inspector spoke to a five staff who when asked were aware of the homes policies and procedures and knew where they could be located. One member of staff who had been employed at the home for 5 months described her employment route that followed the homes recruitment policy. A new starter induction tick list was completed and this highlighted what she needed to know about the home prior to starting work. Examination of the staff file confirmed that appropriate Criminal Record Bureau and POVA checks were carried out prior to her starting work at Lowfield. Lowfield House F57 F07 S9446 Lowfield V225799 090505 Stage 4.doc Version 1.30 Page 18 Staff confirmed that more training opportunities had been introduced at the home. All staff had undertaken training in first aid, moving and handling, basic food hygiene, drug awareness and management of medicines. Staff stated they were looking forward to a course on dementia in the near future. Staff files examined confirmed that some information required was not held on file. Lowfield House F57 F07 S9446 Lowfield V225799 090505 Stage 4.doc Version 1.30 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 35, 36 and 38 The attitude of the staff and management is to ensure the home is friendly and flexible for the service users. Staff received regular formal supervision. Written procedures ensure that the health and safety of staff and service users are safe guarded. Not all health and safety practices were in place at the time of the inspection, which may put service users at risk of harm. EVIDENCE: The registered manager has been involved in the management of the home for many years. The deputy manager has achieved National Vocational Qualification Level 4 and will begin the registered managers award in July. Both managers periodically update their knowledge through various courses. Records examined and through discussion confirmed that both had a good knowledge of the conditions and diseases of old age. Job descriptions outlining the responsibilities of both managers were examined. Lowfield House F57 F07 S9446 Lowfield V225799 090505 Stage 4.doc Version 1.30 Page 20 An external quality award for the home has been obtained and covers customer complaints, staff training, and internal audits. Two relative/ visitor comment cards were received in respect of the home and both commented positively on the staff, systems and the care at the home. One visitor said, “ I come here every day to see my friend, the staff are very kind and caring.” Case tracking confirmed that systems were in place to ensure service users control their own finances. Part of the admission process was to identify service user needs and wishes regarding their financial affairs. When asked two service users said that their relatives took care of their finances. There was a secure facility for service users money kept on the premises, and appropriate recording arrangements. Examination of staff files confirmed that staff received regular formal supervision. There was a tick list of issues discussed that included comments and actions. Staff files also contained information on individual training, interaction with service users, policies and procedures, good practice, quality issues, health and safety and record keeping. A number of equipment maintenance certificates were examined and noted to be up to date. An emergency evacuation procedure was in place and staff had signed to confirm their awareness and knowledge. The inspector witnessed a number of fire doors wedged open at the time of the inspection. Lowfield House F57 F07 S9446 Lowfield V225799 090505 Stage 4.doc Version 1.30 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 2 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 x 3 3 x x 3 3 STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 x x x 3 x x 2 Lowfield House F57 F07 S9446 Lowfield V225799 090505 Stage 4.doc Version 1.30 Page 22 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 5 (1) Requirement Timescale for action Immediate 2. OP7 3. OP29 4. OP38 The registered person shall produce a written guide to the care home that shall include the terms and conditions in respect of accommodation to be provided for service users including the amount and method of fees. All service users must be provided with a copy of this document. 15 (1) The registered person shall after consultation with the service user, or a representative of his, prepare a written plan that is signed by the service user, as to how the service users needs in respect of health and welfare are to be met and provide suitable aids to assist the service user at mealtimes. Schedule The registered person must 2 ensure that all information and Regulation documents in respect of persons 7, 9, 19 carrying on or managing or working at a care home are held at the care home. Regulation The registered person shall after 23 (4) consultation with the fire authority take adequate precautions against the risk of fire and ensure all fire doors are F57 F07 S9446 Lowfield V225799 090505 Stage 4.doc Immediate Monday 27th June 2005 Monday 27th jine 2005 Lowfield House Version 1.30 Page 23 kept shut at all times. Please inform the Commission in writing of the advice given by the fire authority by the date shown. 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 Good Practice Recommendations Lowfield House F57 F07 S9446 Lowfield V225799 090505 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 1st Floor, Unit 4 Petre Road, Clayton-Le-Moors Accrington Lancashire. 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 F57 F07 S9446 Lowfield V225799 090505 Stage 4.doc Version 1.30 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. 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