Random inspection report
Care homes for adults (18-65 years)
Name: Address: Lowfield House Care Home Cornwall Street Kirton-in-lindsey Gainsborough Lincolnshire DN21 4EH two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Wilma Crawford Date: 1 4 1 2 2 0 0 9 Information about the care home
Name of care home: Address: Lowfield House Care Home Cornwall Street Kirton-in-lindsey Gainsborough Lincolnshire DN21 4EH 01652648835 F/P01652648835 lowfieldhouse@prime-life.co.uk info@prime-life.co.ukwww.prime-life.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Joseph William Veall Mr Brian Charles Ward Type of registration: Number of places registered: Conditions of registration: Category(ies) : Prime Life Ltd care home 21 Number of places (if applicable): Under 65 Over 65 0 0 learning disability physical disability Conditions of registration: 21 21 The maximum number of service users who can be accommodated is: 21 The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD Physical Disability - Code PD Date of last inspection Care Homes for Adults (18-65 years) Page 2 of 13 Brief description of the care home Prime Life Limited owns Lowfield House. The home is registered to provide care for 21 adults aged 18-65 who have a learning disability and additional physical and nursing needs. The home is situated in a residential area of Kirton-in-Lindsey and is close to local shops and amenities. It has a large private garden and a sensory garden. The home has 19 single bedrooms and one double bedroom; all bedrooms have a wash hand basin. There is a range of communal rooms and facilities including a large conservatory and a spa bath. The home employs nursing and care staff. A qualified nurse is on duty at all times. Information about the home and its service can be found in the statement of purpose and service user guide, both these documents are available from the acting manager of the home. A copy of the latest inspection report for the home is available in the reception area. Information given by the Deputy Manager on 25th June 2009 stated that fees charged range from £329.70 to £1795 pounds per week, including charges for additional hours. Care Homes for Adults (18-65 years) Page 3 of 13 What we found:
Two inspectors visited the home on December 14th 2009, to look at the progress being made to address a number of requirements made at the last key inspection visit in June 2009. We looked at individuals care plans to see if they now contained all the information included in their community care assessments and details of how people preferred to receive the support they required. Although there had been some work done and a new care plan system introduced, only one of the twenty five care plans was complete. The new format is much better, easier to follow and more appropriate for the people living there. Of the new care plans seen, the majority had large gaps within the information provided in the support plans. For example; no information about their life stories, a lack of information about how people needed assistance with being moved, including which sling size they needed to use. Records of weights, chiropody and other professional input were not evidenced in all care plans. The majority of information included was outdated, with some going back from as far as 2007. Similarly although assessments had taken place with speech and language therapists, the guidance offered to assist with eating and drinking had not been included in the persons support plan. Other areas identified included a further lack of information or guidance about supporting with bathing, eating and drinking, maintaining weights and the management of complex behaviours.When this was discussed with the acting manager, he explained that he had involved staff in the development of these and staff had received some training , but acknowledged that further work was required. Risk assessments seen, showed no evidence of further development or review and had not been evaluated in line with the agreed timescales or signed.The risk assessment documents available in individuals files covered a range of activities of daily living but the majority were not fully completed, or reviewed, which indicated that staff are still not being provided with the full information that they need to reduce identified risks. This included documentation about the use of specialist equipment such as hoists, bed rails and wheelchairs. Health action plans were also available but these were incomplete. A tour of the building was made and demonstrated that considerable work had been completed to improve the environment. This included a new shower room being developed and a further single bedroom, so that the last remaining double room could be used for single occupancy. The majority of the bedrooms have been redecorated and the acting manager stated that people had been involved in choosing the colours for these. Previously sash windows had needed to be repaired or replaced, this work has been completed. However the windows now cannot be opened due to being painted up. Similarly in one bedroom where furniture has been replaced, it was evident that the previous furniture had been painted around. Care Homes for Adults (18-65 years) Page 4 of 13 On the day of the visit everyone in the home was going out for Christmas lunch. People spoken with said that they had been involved in the planning of this through the weekly Thursday Club. This is a newly developed group, consisting of staff, relatives and people living in the home who meet every Thursday for lunch and to discuss activities, plan menus and any other suggestions to improve the home. The group has been positively received by all involved in it. An activity plan was seen and detailed;card making, Xmas decorations, Xmas lunch, DVDs. Whilst these activities were suitable for more abled people, the plan did not include details of how people with more profound disabilities could be accommodated. These individuals were not provided with a seperate activity plan, nor were their personal preferences or activities suitable to meet their needs, identified within their individual care plans. Similarly there was no information explaining how these people could be enabled to make choices, or other methods of non verbal communication that they used to express themselves. There have been no further changes to the staffing levels within the home. The staffing consists of a nurse and six carers between 8 a.m. and 2 p.m, then a nurse and five carers between 2 p.m. and 8 p.m. During the night there is one nurse and two carers. Currently five people living in the home are provided with additional hours, consisting of 37 hours each day. Due to the high level of the support of the people living in the home, the home continues to present as being very task orientated, in order to meet peoples needs. This leaves the staff who are supporting individuals who are not funded on a 1:1 basis, little time for interaction and unable to provide more individual, structured activities for people with more profound disabilities. As the majority of the people living in the home are unable to access the local community or leave the building independently, positive outcomes for these individuals are limited by the current staffing levels available. In addition to the care staff there is an administrative assistant 20 hours, a laundry assistant 8 hours, catering staff 35 hours and cleaning staff 28 hours each week. The current staffing levels available in the home continue to impact on the role of the acting manager. He continues to work the majority of his time in the home, covering nursing shifts. As a result of this he has been unable to fully complete his management tasks or fully comply with the requirements made at the previous inspection made by the Care Quality Commission. When this was discussed with the acting manager, he confirmed that he would have liked more progress to have been made since the last visit. Staff files examined demonstrated that there has been some progress with supervision, but this was varied. Two staff members had received three supervisions, whilst others had had one in the previous six month period. Staff files examined showed that not all of the staff team were up to date with mandatory training. When this was discussed with staff, they explained that they were expected to complete training in their own time and they were not paid for their attendance. This system presented some difficulties for staff. Similarly, it was difficult for staff to be released from their duties when in house training was being held as they were needed to support the people living in the home.
Care Homes for Adults (18-65 years) Page 5 of 13 We attempted to look at the monthly Regulation 26 reports for the home, but the electronic copies that had been sent to the home, could not be opened. What the care home does well: What they could do better:
Further work needs to be completed to address the requirements made at the last key inspection on the 3rd June 2007. Although some improvements have been made, the acting manager needs time to fulfil his management duties in order to comply with the CQC requirements previously made. Care plans need further work to ensure that they reflect the identified needs made in individuals community care assessments and give details of how people wish to be supported. These should also be kept under review and record details of all professional input and any advice from these included in the support plans. In order that people can be supported appropriately to take responsible risks, risk assessments need to be made available for all areas of risk identified within individuals community care assessments. These must be regularly reviewed in line with agreed timescales and updated to reflect any changes. The activities available within the home has improved since the last key inspection and the introduction of the Thursday Club has supported the development of this. However, further work needs to be completed to support people with more complex needs to participate and engage in a variety of stimulating activities, both within the home and the community, based on their personal wishes and preferences. Further work is needed to the sash windows in the home, to ensure that they can be opened and closed properly. The frequency of staff supervision needs to be increased, so that all staff receive a minimum of six sessions each year. This would support staff further to do their jobs effectively. Further consideration needs to be given to the staffing levels available within the home. The current staffing levels need to be revised, to ensure that there are suitably qualified and experienced staff available within the home, in adequate numbers at all times. Staffing levels should be based on individuals identified needs as well as providing additional staff to fulfil contractual agreements where this has been identified. The organisation needs to consider how all staff can be given the opportunity to attend
Care Homes for Adults (18-65 years) Page 6 of 13 training and how appropriate backfill can be provided, in order that staff can keep up to date with mandatory training and access additional training to develop new skills. Approximately half the people living in the home are prescribed rectal Diazepam, in order that people remain safe and can be supported to access community facilities, staff should receive training in how to administer this. We have reviewed our practice when making requirements, to improve national consistency. In future if a requirement is repeated it is likely that enforcement action will be taken. As not all of the previous requirements made have been met, further action may be taken to ensure compliance with CQC Regulations is made. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Adults (18-65 years) Page 7 of 13 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 6 12 Regulation 12(1)(a)(b)The 31/01/2010 registered person should ensure that individual care plans reflect the identified needs made in the individuals community care assessment, and give details of how people prefer to be supported. This would help care staff to understand what they have to do and how to support people in their preferred manner. 2 9 13 Regulation 13(4)(b)(c).The 31/01/2010 registered person should ensure that risk assessments are available, are fully completed and kept under review for all areas of risk identified within individuals community care assessments. This would enable people to be supported appropriately to take responsible risks. 3 33 18 Regulation 18(1)The 31/01/2010 registered person must ensure that the home provides a staff team, in sufficient numbers to support service users assessed needs
Page 8 of 13 Care Homes for Adults (18-65 years) Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action at all times, particularly during the evening to allow for impromptu or planned late activities e.g. to the theatre to take place. Ongoing 14/06/07 4 36 18 Regulation 18(2) the 31/01/2010 registered person shall ensure that persons working at the care home are appropriately supervised. To make sure that people are being cared for properly the work staff do should be supervised and staff should have a minimum of six line management supervision sessions per year. This would support staff to do their jobs properly. Care Homes for Adults (18-65 years) Page 9 of 13 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 12 16 Regulation16(2)(n).The 31/03/2010 Registered Provider shall ensure that each person living in the home is provided with a planned programme of activities based on their individual needs and abilities. In particular those people who are not mobile and cannot communicate their individual needs to others. This would enable people to be occupied and stimulated and enhance their quality of life. 2 24 23 Regulation 23(2)(b). The 31/03/2010 Registered Provider shall ensure that the sash windows are repaired so that they can be opened and closed as required. This would enable staff and people living in the home to ventilate rooms. 3 32 18 Regulation 18(1)(c), (i)(ii). 31/03/2010 The Registered Provider must ensure that all care staff are
Page 10 of 13 Care Homes for Adults (18-65 years) Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action given training appropriate to the work they are to perform and suitable assistance, for the the purpose of obtaining further qualifications appropriate to such work. This would enable staff to access training and keep manadatory training up to date as well as accessing further training to develop their skills. 4 32 18 Regulation 18(1)(c) (i). The 31/03/2010 Registered Provider should ensure that care staff are provided with training on the administration of rectal Stesolid This would enable people with epilepsy to be supported safely when out in the community in the care of staff. 5 33 18 Regulation 18(1) (a). The 31/03/2010 Registered Provider must ensure that the acting manager is given some dedicated hours off the rota, to undertake his management duties and ensure compliance with CQC Regulations is made. To make sure that the work required to address the previous requirements made can be completed. 6 39 26 Regulation 26. The Registered Provider must 31/03/2010 Care Homes for Adults (18-65 years) Page 11 of 13 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action ensure that a copy of the monthly regulation 26 report visits are sent to the Care Quality Commission. This would enable the commission to review the progress and action being taken to meet the requirements made. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 12 of 13 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 13 of 13 - 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!
