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Inspection on 14/06/06 for Lowfield House Care Home

Also see our care home review for Lowfield House Care Home for more information

This inspection was carried out on 14th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 no outstanding requirements from the previous inspection report, but made 19 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The needs assessment process at the home is robust and thorough, enabling residents to be confident that their needs can be met by the service. The home offers residents the opportunity to make choices and decisions around their daily lives. One resident spoken to said `staff look after me well, but let me decide how and when the care is given. I like my independence and the staff respect this`. The home is welcoming and has a relaxed atmosphere. Residents said they are happy with their bedrooms and can bring in their own possessions, making it feel more like home.

What has improved since the last inspection?

The home is recording staff supervision and appraisals, where individuals are offered the chance to discuss any work problems and issues with their line manager and they receive comments back about their work practice and conduct. This improves the consistency and quality of care provided and helps the residents receive a better service.

What the care home could do better:

Staff need to have training and develop knowledge and skills about MAKATON (a way of communicating using pictures and symbols to help individuals understand information and express their needs), and other communication methods to make sure they can talk to and understand the residents requests for help and assistance. The home must develop a statement of terms and conditions for funded individuals, that offers prospective residents the same depth of information as that provided for self-funding individuals. Without this happening funded residents will not be able to make an informed decision about admission to the home. This is an outstanding requirement from previous reports (July 2005 and January 2006) and must be given priority in the home`s action plan for this report. Care plans need to be looked at and brought up to date by the staff to a consistently high standard, to ensure changes to the residents current needs are written down, actioned and met by the staff. Relatives and residents need to be able to take part in the process of writing the plans so their wishes, choices and decisions about care are understood and included in the plan. Better recording systems are needed for complaints and accidents so information about the residents is kept confidential and in keeping with Data Protection guidance. The selection of meals and social activities provided by the home has become poor over the past year, and action must be taken by the acting manager to introduce a better range and variety of food and activities, which suit the special needs of the residents. Residents have asked for a wider range of activities both within and outside of the home. Staff comments also say they would like the opportunity to spend more time with the residents. The way in which staff are offered employment at the home must follow the recruitment policy and procedure to ensure all checks on the employee are carried out before they start work. Failure to do so could result in the residents being put at risk.The interior of the home needs repainting and there are a number of minor repairs and refurbishments required in the communal facilities. These do not present a risk to the residents but do not make the environment a pleasant and pleasing place to live. A number of repairs are outstanding from the last report (January 2006) and must be given first priority for completion. Information from the staffing rotas and pre-inspection questionnaire indicate that staffing numbers are insufficient to meet the needs of the residents and discussion with the residents, relatives and staff shows this is impacting on the quality of care being provided. The provider must ensure that enough staff are on duty at all times to give flexibility to the service and give residents a good standard of life. The inspector would like to thank everyone who completed a questionnaire and/or took the time to talk to her during this inspection. Your comments and input have been a valuable source of information, which has helped create this report.

CARE HOME ADULTS 18-65 Lowfield House Care Home Cornwall Street Kirton-in-lindsey Gainsborough Lincolnshire DN21 4EH Lead Inspector Eileen Engelmann Key Unannounced Inspection 14th June 2006 09:30 Lowfield House Care Home DS0000002793.V299904.R01.S.doc Version 5.2 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 Care Home DS0000002793.V299904.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 Adults 18-65. 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 Care Home DS0000002793.V299904.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lowfield House Care Home Address Cornwall Street Kirton-in-lindsey Gainsborough Lincolnshire DN21 4EH 01652 648835 01652 648835 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) Prime Life Limited Position Vacant Care Home 20 Category(ies) of Learning disability (20), Physical disability (20) registration, with number of places Lowfield House Care Home DS0000002793.V299904.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th January 2006 Brief Description of the Service: Prime Life Limited owns Lowfield House. The home is registered to provide care for 20 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-inLindsey and is close to local shops and amenities. It has a large private garden and a sensory garden. The home has 18 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 acting manager on 23/05/06 within the PreInspection Questionnaire indicates the home charges a range of fees depending on the specific needs of the residents. Current fee scales are from £392.00 to £1600 per week and that there are no additional charges other that those for hairdressing, private chiropody treatment, toiletries newspapers/magazines and reflexology treatments (all of these are optional). Lowfield House Care Home DS0000002793.V299904.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out with the acting manager; staff, relatives and residents of Lowfield House. The inspection took place over one day and included a tour of the premises, examination of staff and resident files and records relating to the service. One of the staff on duty, two relatives and three of the residents were spoken to; their comments have been included in this report. Information was gathered from a number of different sources before the inspector visited the home. Questionnaires were sent out to relatives, residents and staff and their written response to these was good. The inspector received 3 back from relatives (50 ), 5 from staff (52 ) and 4 from residents (66 ). The provider completed a pre-inspection questionnaire and returned this to the Commission within the given timescale. There has been a Protection of Vulnerable Adult Investigation at the home in March 2006, carried out by the Social Service Team and the Police. The outcomes of the investigation were that there was no criminal intent, however the home carried out disciplinary hearings for two members of staff; one was dismissed and will be referred to the vulnerable adult protection list and another was demoted and transferred to a Prime Life home in another area. Since the last inspection there has been a change of manager at the home, and feedback from the residents, relatives and staff is positive about the new acting manager. Individuals who commented said they feel more optimistic about the service and they hope that the changes taking place will raise the standards of care offered by the home. What the service does well: The needs assessment process at the home is robust and thorough, enabling residents to be confident that their needs can be met by the service. The home offers residents the opportunity to make choices and decisions around their daily lives. One resident spoken to said ‘staff look after me well, but let me decide how and when the care is given. I like my independence and the staff respect this’. The home is welcoming and has a relaxed atmosphere. Residents said they are happy with their bedrooms and can bring in their own possessions, making it feel more like home. Lowfield House Care Home DS0000002793.V299904.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Staff need to have training and develop knowledge and skills about MAKATON (a way of communicating using pictures and symbols to help individuals understand information and express their needs), and other communication methods to make sure they can talk to and understand the residents requests for help and assistance. The home must develop a statement of terms and conditions for funded individuals, that offers prospective residents the same depth of information as that provided for self-funding individuals. Without this happening funded residents will not be able to make an informed decision about admission to the home. This is an outstanding requirement from previous reports (July 2005 and January 2006) and must be given priority in the home’s action plan for this report. Care plans need to be looked at and brought up to date by the staff to a consistently high standard, to ensure changes to the residents current needs are written down, actioned and met by the staff. Relatives and residents need to be able to take part in the process of writing the plans so their wishes, choices and decisions about care are understood and included in the plan. Better recording systems are needed for complaints and accidents so information about the residents is kept confidential and in keeping with Data Protection guidance. The selection of meals and social activities provided by the home has become poor over the past year, and action must be taken by the acting manager to introduce a better range and variety of food and activities, which suit the special needs of the residents. Residents have asked for a wider range of activities both within and outside of the home. Staff comments also say they would like the opportunity to spend more time with the residents. The way in which staff are offered employment at the home must follow the recruitment policy and procedure to ensure all checks on the employee are carried out before they start work. Failure to do so could result in the residents being put at risk. Lowfield House Care Home DS0000002793.V299904.R01.S.doc Version 5.2 Page 7 The interior of the home needs repainting and there are a number of minor repairs and refurbishments required in the communal facilities. These do not present a risk to the residents but do not make the environment a pleasant and pleasing place to live. A number of repairs are outstanding from the last report (January 2006) and must be given first priority for completion. Information from the staffing rotas and pre-inspection questionnaire indicate that staffing numbers are insufficient to meet the needs of the residents and discussion with the residents, relatives and staff shows this is impacting on the quality of care being provided. The provider must ensure that enough staff are on duty at all times to give flexibility to the service and give residents a good standard of life. The inspector would like to thank everyone who completed a questionnaire and/or took the time to talk to her during this inspection. Your comments and input have been a valuable source of information, which has helped create this report. 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 Care Home DS0000002793.V299904.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lowfield House Care Home DS0000002793.V299904.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 5. Quality in this outcome area is good. All residents have a full needs assessment carried out and are given enough information about the home and its facilities before admission, for them to be confident that their needs can be met by the service. EVIDENCE: Each resident has their own individual file and all those looked at include a needs assessment completed by the funding authority and also one from the home. Discussion with the acting manager and the staff on duty indicates that there is an active process of staff going out to visit all prospective residents before admission to assess their needs, and decide if they will fit into the current mix of people living at the home. Comments from the care assistants indicate that this process makes them feel more a part of the team as they can be involved in a person’s care from the very beginning. Discussion with three residents and two relatives indicated that they are satisfied with the care at the home and those who spoke to the inspector all said the staff are caring and attentive to the residents’ needs. The service has a majority of residents from a white, British culture although it can and does cater for others from different backgrounds. Information in the individual care plans includes specific wishes regarding spiritual needs, diets and activities of daily living. The care plans include risk management strategies that are in the process of being reviewed and updated for each Lowfield House Care Home DS0000002793.V299904.R01.S.doc Version 5.2 Page 10 individual. One care plan looked at showed that the resident had used an advocate in the past before coming into the home, but there is little evidence from the records viewed that the home promotes this within the service. Information from the pre-inspection questionnaire indicates there are four residents with specialist communication needs in the home, and the written/ verbal feedback from the staff indicates that they need to develop their skills in Makaton to enable better communication with these residents. The acting manager said that he has undergone training in this technique and is passing his knowledge onto the staff. The acting manager must consider how he can promote advocacy and better communication within the home and put his ideas into practice. The acting manager told the inspector that no changes to standard 5 have taken place since the last inspection. The home has produced a statement of terms and conditions for private paying residents, which meets the required standard, but this document has not been given to funded individuals. Previous discussion with Louise Hayward (July 2005) from Prime Life Limited indicated that the company is currently working on the development of a suitable format that can be given to all residents on admission, but this does not appear to be in use. This is an outstanding requirement from previous reports (July 2005 and January 2006) and must be given priority in the home’s action plan for this inspection report. Lowfield House Care Home DS0000002793.V299904.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 and 10. Quality in this outcome area is adequate. The systems for resident and relative consultation are unsatisfactory, with little evidence that their views are sought or acted on. EVIDENCE: Individual care plans are in place for all residents and set out the health, personal and social care needs identified for each person. Risk management strategies are in place for certain individuals where a need is identified; these cover aspects of daily living as well as specific behaviours. Discussion with the acting manager indicated that he has recognised that the plans need updating and this process is being completed. Four plans looked at showed that two have been reviewed and the others need doing. Areas where the plans could improve include filing of old paperwork, completing or removing of care charts as appropriate, and ensuring that care staff are writing changes to care, identified for each individual, in the correct area of the plan and not in the daily records. Verbal feedback from relatives and residents is that they are involved in the review of the plans and have the opportunity to discuss any changes or wishes at this point. Written comments from the surveys indicate that relatives do not Lowfield House Care Home DS0000002793.V299904.R01.S.doc Version 5.2 Page 12 feel that staff involve them enough in making decisions on the care of their relatives (where they cannot speak for themselves), or notify them when changes occur outside of the review process. The acting manager must look at ways in which communication between all parties can be improved and a better way of working established. Discussion with the staff and feedback from the surveys indicates that they respect the residents’ rights to make decisions, however this process can be hampered by the poor communication skills of some of the people living at the home. Staff use body language and facial expressions to understand requests from the residents and at least one resident can use a picture board to show staff what they need. Another resident will take staff by the hand to lead them to what she/he wants, although staff utilise their knowledge of the residents to work out individual requirements. The relatives spoken to said that they would ‘appreciate the opportunity to teach staff how to meet specific needs of their relative, especially around feeding and personal hygiene tasks, as this would help us feel a part of our relatives care and ensure their wishes and choices were understood and met’. It is recommended that the acting manager encourage this opportunity to learn from people who have intimate knowledge of the resident(s) and who can express how the individual likes their care to be given. Discussion with the acting manager indicates that the risk management strategies for individual residents require updating and reviewing. The majority of the residents are heavily dependant on the staff for assistance and support, however where ever possible residents are encouraged to take responsible risks. Verbal and written comments from the staff, residents and relatives indicates that over the past year a lack of staff has reduced the amount of activities that residents use to enjoy, this includes swimming, horse riding and bowling. It is hoped by everyone that as the new acting manager settles into his post, staffing levels will improve and these risk-based activities will become viable once again. Concerns were raised by the inspector over the confidentiality of complaints and accidents given that these are recorded in bound books, and do not have removable pages. See comments in standard 22 and 42. Lowfield House Care Home DS0000002793.V299904.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17. Quality in this outcome area is adequate. The provision of meals and activities has deteriorated since the last inspection and people using the service are limited in their choice of diet and social stimulation. There are concerns relating to how and if the special dietary and nutritional needs of some residents are being met. EVIDENCE: Information received from the acting manager, relatives, staff and residents indicates that individuals living at the home are too physically or mentally dependent on others to enable them to consider having a job outside of the home. Discussion with the manager indicates that there is currently no educational input to the residents, but that he hopes to improve this resource and assist certain individuals to go to college or skills classes in the future. This aspect of care will be monitored and reviewed at the next inspection. Eight residents were out on a day trip to Cleethorpes during the inspection and information in the care plans indicates that trips out are a regular weekly Lowfield House Care Home DS0000002793.V299904.R01.S.doc Version 5.2 Page 14 occurrence. Discussion with the residents indicates that they enjoy going out into the community and have their own interests and hobbies that they like to pursue. Verbal feedback from the relatives, staff and residents indicates that under the previous manager certain activities were stopped due to a shortage of staff and have not been re-introduced. Five residents like to attend the Brigg resource centre on a weekly basis and another community venture is the Gateway Club, where residents enjoy discos and other social opportunities. The acting manager said that he is aware of the shortcomings of the current activities in the community and he is looking to expand on the range of social events open to the residents. Discussion with the manager and checks of the staffing levels against the Residential Staffing Forum Guidelines indicates that the home has inadequate staffing levels to meet the needs of the current residents, based on information given in the pre-inspection questionnaire. Staff time and flexibility of support especially for evenings and weekends is missing, one resident wrote that ‘ I cannot do what I want on a weekend as there are not enough staff on duty’. Staff training files do not indicate if individuals have the opportunity to take part in sessions around the Disability Discrimination Act, Equality and Diversity and Advocacy. The manager must ensure that staff have a good understanding of the residents’ rights of access to public facilities and can support them in their choices of activities. The amount of contact with others depends on the wishes of the resident and the family; these choices are recorded in their plans. Some individuals see their families on a regular basis, whilst others choose to visit less often or not at all. Written and verbal feedback from the relatives indicates that there is an open visiting policy for the home and staff welcome them whenever they call in. Two individuals spoken to were picking up their relative from the home, they said they visited regularly and often took him home for overnight stays. Residents spoken to are very happy with the way that staff look after them, they felt that they are given choices in their everyday life and staff respected their privacy and dignity. Observations of the interaction between staff and residents showed that there is a good relationship between the two groups of people, based on trust and friendship. Copies of the menus supplied with the pre-inspection questionnaire showed that these are basic and the acting manager told the inspector that he is in the process of updating them and introducing more appropriate meals and snacks. One change recently introduced was the moving of the main meal of the day to the evening time and the provision of a cooked breakfast, as residents have said that this is what they would prefer. One resident told the inspector that ‘I Lowfield House Care Home DS0000002793.V299904.R01.S.doc Version 5.2 Page 15 had the full works today, bacon, sausage, beans, black pudding and toast, it was lovely’. Written and verbal information from the residents, staff and relatives indicates that they would like to see a wider variety of meals that cater for specialist diets, such as diabetic, low fat and soft/pureed meals. Two relatives said that they had expressed concerns over the weight loss of their relative in the previous year; he had lost two stone over a short period of time. They came in to the home to show staff how to feed him appropriately and insisted that he be given a high calorie diet. This was agreed and followed by the staff and he soon put weight back on. Checks of the care plans showed that residents are not being weighed regularly and discussion with the acting manager indicated that although the home had purchased a set of wheelchair scales these were lent to another home and subsequently broken. Observation of the lunchtime meal showed that residents were offered soup, sandwiches and yoghurt as a pudding. However, residents requiring a soft diet were offered a sandwich cut up with soup poured over the top. One resident did not want to eat this and the staff member did not try to obtain an alternative, but said to the cook ‘just give me a drink for them, they probably had a good breakfast’. Staff comments from the survey indicate that they feel some colleagues do not give residents enough to eat as they are trying to speed up the mealtime process. The inspector spoke to the acting manager about her concerns over the suitability of the diet being offered for people needing soft food and the comments received from the relatives and staff about staff practices. The acting manager must ensure that better alternatives/choices of food are provided at all times and staff practices should be monitored and addressed through supervision. The acting manager should ensure the weighing scales are repaired and returned to the home as soon as possible and start a regular weighing programme for the residents. Lowfield House Care Home DS0000002793.V299904.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is good. The health, personal and social care needs of the residents are documented and being met by the service and staff. The medication at the home is well managed promoting good health. EVIDENCE: Comments from the resident and relative surveys indicates that all individuals are pleased with the care given and are satisfied that the needs of the residents are being met. Information in the care plans shows that each resident has their own preferred routine and discussion with staff demonstrated they have a good understanding of the wishes and choices made by each individual. One resident was able to describe his care needs and reported that staff are quick to offer help where needed but also respected his wishes to be as independent as possible. The manager said that the staff rota is worked out so there is always a good mix of male and female staff on duty and two staff members are from different cultures other than white/British, and are able to offer insight into the needs and expectations of individuals from their ethnic backgrounds. The need for improved staffing levels has already been discussed in this report (standards 12, 13 and 33), and if implemented would provide residents with more Lowfield House Care Home DS0000002793.V299904.R01.S.doc Version 5.2 Page 17 flexibility in activities and daily living tasks especially on evenings and weekends. Equipment is provided within the home to assist residents with moving/handling procedures, and to maintain their independence where possible. Comments from the staff surveys indicates they would like to see the return of a shower trolley as they feel it gives the residents more choice and a better standard of care than the current shower and bathroom arrangements. The manager should discuss this with the staff and provider to see if more appropriate equipment is needed. All the individual care plans seen during this visit document the visits and input each resident has received from various outside professionals, including local GPs, chiropody, dentist, optician and hospital outpatient clinics. Staff spoken to, said that they would accompany the resident’s to any appointment or support them to attend independently if wished. Concerns were raised with the acting manager that residents’ weights and nutritional needs were not being assessed and reviewed on a regular basis. This aspect of health should be carried out and appropriate action taken, including the input from a dietician if needed. The medication policy for the home says that individuals can self-medicate if they want to and after a risk assessment has been completed and agreed. At the time of this inspection none of the residents were able to self-medicate and those individuals spoken to were happy with the way that staff carried out the task of administration. Checks of the medication records and the system used showed that these are up to date, accurate and well managed. Staff have received medication training from the pharmacist supplying the home and medication is only administered by a qualified nurse. Lowfield House Care Home DS0000002793.V299904.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is adequate. Improvements to the recording aspect of the complaint system must be made to ensure issues raised by individuals are kept confidential; however, residents are satisfied that their views are listened to and acted on. EVIDENCE: Information from the residents survey indicates that the majority of the people living at the home are unaware of the complaints procedure. No evidence was seen to indicate that residents are encouraged to use a local independent advocacy service to help them through the complaints process, but those spoken to are confident about talking to the staff if they have any problems. The acting manager said that he is aware that the complaints policy and procedure is not in a user-friendly format and is working on developing a more appropriate one, which residents can understand and access. The acting manager must look at ways in which residents can be enabled to access outside independent advocacy and/or communication support workers agencies as required. At the last inspection (January 2006) the inspector raised concerns over the confidentiality of recorded complaints. At the moment complaints are recorded in a bound book, but this does not offer individuals confidentiality because the format means that anyone writing in the book can see previous complaints that have been made by different people. The inspector recommended in the last report (January 2006) that a separate complaints form should be developed that can be filled in by the complainant or staff and filed away by the manager once an issue has been investigated Lowfield House Care Home DS0000002793.V299904.R01.S.doc Version 5.2 Page 19 and resolved. Discussion with the acting manager indicated that no action has been taken to resolve this issue, but he will be reviewing this soon. Survey results from the staff questionnaires show that individuals have different levels of understanding around the complaints procedure and their role and responsibilities regarding Protection of Vulnerable Adults (POVA) issues. There has been one adult protection investigation, led by the Police and social services, since the last inspection. The report from the investigation found that it was not possible to take the matter to court, however the home carried out its own disciplinary hearing with two members of staff. As a result one staff member was dismissed and will be referred to the vulnerable adult protection register and another was demoted and moved to another Prime Life Home in a different area. The acting manager should monitor the effectiveness of the training being given to staff and discuss staff awareness during supervision. Examination of a number of staff files showed that although the majority of staff have their employment and background history/Police checks in place, some of the new staff were started in employment before the results of their adult protection register checks were obtained. There is no evidence that these individuals were supervised during their work and this leaves the residents at risk of harm and is not acceptable practice. The acting manager assured the inspector that from now on new staff would not start work until the checks are completed. This will be followed up at the next inspection and monitored at future visits. Lowfield House Care Home DS0000002793.V299904.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 28, 30. Quality in this outcome area is adequate. There has been no change to the décor or furnishings in the last twelve months and although this does not pose a risk to residents, it does not create a pleasing and pleasant environment to live in. EVIDENCE: Walking around the premises the inspector observed that the decorations and objects previously in place on the corridor walls have been removed, leaving large blank areas that need redecorating. It was seen that the repairs highlighted in the last report (January 2006) have not been done and the environment has deteriorated further. Previously noted areas that need attention and maintenance include: ∗The corridor wall outside bedroom 7 has cracked and broken plasterwork around the bedroom door, which needs filling or replacing. ∗The fans in the Poplars bathroom and shower room are not working and need repairs. ∗There are a number of panes of ‘blown’ double-glazing in the windows around the home, which need replacing. ∗The hairdressing sink pedestal (wooden) is broken and needs repairs carrying out. Lowfield House Care Home DS0000002793.V299904.R01.S.doc Version 5.2 Page 21 ∗Settees and chairs in the main lounge are well worn and require new covers. These repairs must be given priority in the providers action plan for the home. Other areas that require action are as follows: ∗The door lock to Poplars bathroom is broken and there is a continually dripping hot water tap on the bath. The lock and tap need repairing or replacing. ∗The parker bath facility needs redecorating. ∗All the bathrooms need cupboard doors fitting to the open storage units to prevent cross infection of linen or new storage facilities providing. ∗Corridor walls throughout the building need redecorating. ∗Carpets to a number of bedrooms require deep cleaning to remove stains. ∗Fire doors are badly damaged by wheelchairs, and need replacing. ∗The two lounges need redecorating and new furniture providing that is suitable for the needs of the residents. ∗Residents are unable to use the Jacuzzi bathroom as it has poor ventilation and no window covering and requires an extractor fan fitting and curtains or a blind in place. ∗The corridor carpet is worn at the joins and needs repairing or replacing. ∗Bedroom 6 needs the fire door adjusting, as it is not closing properly. Outside of the home the residents have a large enclosed garden to walk in. This area is well maintained and includes a lawn, planted areas with mature shrubs and trees that offer shade and privacy and a patio area with a range of tables and chairs for residents to sit at and enjoy the better weather. There is a large conservatory provided for the residents, fitted with ceiling fans, as the temperature inside can get very warm. The acting manager has recently changed furniture in this area, removing cane items as he feels these are unsuitable for use by the residents. Replacement chairs from the lounges are worn, torn and need refurbishing. The residents have two lounges and a dining room to sit in and enjoy each other’s company. Observation of these facilities show that they all need redecorating and the lounge furniture needs replacing as it is worn. One lounge is used as a soft/play facility, feedback from the relatives, staff and residents suggests that this need to be provided with suitable seating and furnishings to make it appealing and stimulating for the residents. Bedrooms are decorated to suit the tastes and choices of each resident and each one is provided with a suitable door lock for privacy. Discussion with the relatives and residents indicates they are able to personalise the bedrooms with furniture and possessions, and this makes them feel homely and welcoming. The acting manager said that he has ordered new beds for all the rooms; although where residents have purchased their own bed they will be able to Lowfield House Care Home DS0000002793.V299904.R01.S.doc Version 5.2 Page 22 retain these. Bedroom furniture provided by the home is beginning to look worn and tatty in places and should be considered for replacement. The home is clean, warm and comfortable and no malodours were present. Domestic staff are employed for cleaning tasks, but care staff carry out the laundry work. The acting manager said that he has provided an extra 8 hours of staffing (since he came into post) for one individual to attend to the ironing of bed linen and clothing. Policies and procedures are available for the control of infection. And there is a separate laundry room with washing machines that meet disinfection standards. The laundry is kept locked when not in use and a sluicing facility is situated on the first floor. Lowfield House Care Home DS0000002793.V299904.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36. Quality in this outcome area is adequate. The deployment and number of staff available is not sufficient to meet the needs of the residents, especially on evenings and weekends. Improvements are needed in the standard of vetting and recruitment of staff to ensure appropriate checks are being carried out; this poor practice is potentially leaving residents at risk. EVIDENCE: The staff team at Lowfield House has a mix of experienced and new workers, which includes Registered General Nurses, Learning Disability Nurses and care assistants. All individuals have access to the Prime Life Limited training department and can take part in a range of different learning sessions. Information from the staff files and that given by the acting manager indicates that Prime Life Limited is accredited with BILD to deliver LDAF training to its staff and that over 50 of the care staff have achieved NVQ 2 and 3 with new staff being expected to start this training. Written and verbal feedback from the staff, residents and relatives all mentioned concerns about staffing shortages that are impacting on the service being provided by the home. Lowfield House Care Home DS0000002793.V299904.R01.S.doc Version 5.2 Page 24 Relatives voiced their concerns that they have to wait between 15-25 minutes for staff to attend to their relative when they are brought back to the home after being out in the community. Other issues raised were around a lack of staff in the lounges when residents were sat inside. The inspector found this proven when she looked around the home in the afternoon and found the staff in the dining room and residents left alone in the lounges. This is not acceptable practice and could put the residents at risk of harm. The acting manager must ensure sufficient staff are on duty and attending to the residents at all times. Staff expressed concerns that residents are not being fed properly by some staff who try to hurry the mealtime process and that certain activities enjoyed by the residents have been stopped due to a lack of staff on duty to take them out, especially on evenings and weekends. One resident wrote that they are unable to do what they want at the weekend as there are not enough staff on duty to do activities. Discussion with the acting manager showed that he is aware of these issues and he assured the inspector that he would be looking at staffing levels to ensure enough cover was provided for all daily activities of living to be met in full. Information from the pre-inspection questionnaire and discussion with the acting manager about the number of staffing hours provided and the dependency levels of the residents was used with the Residential Staffing Forum Guidance and showed that the home is at least 500 hours a week short of the recommended guidelines. The staffing rotas show that there is one nurse and 4 carers on duty during the day (Monday to Friday) and this drops to one nurse and 3 care staff on a weekend. There is one nurse and two care staff on duty at night. The acting manager said that he has increased the staffing levels in anticipation of a new resident coming in and the figures given to the inspector reflected this. Based on these figures the home should be providing 182 hours 1-1 care a week, in addition to the care for other residents. Discussion with the acting manager took place about these figures and he was asked to assess how the home could meet the shortfall and ensure that sufficient staff are on duty to meet the health, personal and social care needs of the residents. The home has a recruitment policy and procedure that the acting manager understands and uses when taking on new members of staff. Checks of two staff files showed that police (CRB) checks, written references, health checks and past work history are all obtained and satisfactory before the person starts Lowfield House Care Home DS0000002793.V299904.R01.S.doc Version 5.2 Page 25 work. Two other staff files showed that the employees had started work before their check to see if they are on the adult protection register (POVA) had been obtained by the home. Anyone working at the home who has had a POVA check completed and before their CRB report is received by the Provider, must be supervised at all times. There was no evidence in the staff files to indicate that these individuals had received supervision during their work hours. These are not acceptable practices and must stop immediately as it potentially puts the residents at risk of harm. The acting manager assured the inspector that all future employees would not start work until the checks were completed and received. This area of practice will be checked at the next inspection and monitored on future visits. Nurses at the home undergo regular registration audits with the Nursing and Midwifery Council to ensure they are able to practice. Information from the pre-inspection questionnaire and the staff training files shows that the home provides a rolling programme of staff training that covers mandatory subjects and an NVQ programme designed for learning disabilities. It was recommended in the last report (January 2006) that staff should have access to a wider range of specialist training to improve staff knowledge of the client group and illnesses related to their conditions. Discussion with the acting manager indicated that this has not taken place and therefore it remains a recommendation on this report. Staff supervision files showed that individuals are starting to attend formal supervision sessions with their line managers; this was a requirement from the last report (January 2006). Information in the staff files indicates this process has been implemented since the new acting manager came into post. Discussion with the acting manager and staff showed that employees are also receiving their annual appraisals. Throughout this report the inspector has recommended that the acting manager monitors and reviews staff practice using the supervision process, especially around nutrition and mealtimes, to ensure a consistent approach to care is being delivered. This standard will be assessed at the next inspection and monitored at future visits. Lowfield House Care Home DS0000002793.V299904.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 42. Quality in this outcome area is good. The acting manager has a good understanding of the areas in which the home needs to improve, and is working with the staff and residents to implement changes that will enrich the daily lives of the residents. EVIDENCE: Since the last inspection the registered manager has left the home and an acting manager has been put into place. The provider should submit an application for a registered manager to the Commission as soon as possible. The acting manager (Brian Ward) has been at the home for 4 weeks. He is not a registered nurse although he has considerable knowledge of the needs of people with learning disabilities, and has past experience of management responsibilities with Prime Life. The acting manager is supported by registered nurse cover 24 hours a day and has two line managers who are trained nurses. The acting manager said that he has achieved the Registered Managers Award and an NVQ 4 in care. Lowfield House Care Home DS0000002793.V299904.R01.S.doc Version 5.2 Page 27 Written and verbal feedback from the relatives, residents and staff is positive about the appointment of the new acting manager. There have been some concerns raised during this inspection that relate to the time before he came into post, but the majority of respondents are optimistic that the change in management can only benefit the home and the residents. Staff comments are enthusiastic about the changes in staffing and work practices and they say they feel supported and motivated by the new acting manager. One individual said ‘Brian is approachable and is quick to deal with any queries or problems’. Information from the staff minutes and discussion with the staff indicate they can attend meetings every month and are encouraged to express their views and opinions. The home has a Prime Life Limited Quality Assurance system in place and audits of the service are carried out on a regular basis. No annual development plan has been created from the results of these audits; this was a requirement in the last report (January 2006). Time was spent discussing this with the acting manager and he assured the inspector that there is an expectation that this will be produced over the next year. The residents have completed satisfaction questionnaires and the head office publishes the results of these. Information in the pre-inspection questionnaire indicates that policies and procedures are up dated and reviewed as an ongoing practice. Discussion with the acting manager and information provided in the preinspection questionnaire indicated that staff and residents are able to discuss the home’s policies and procedures through attending meetings/supervision and on a 1-1 basis between key workers and residents. Maintenance certificates are in place and up to date for the utilities and equipment within the building and training records show that staff have attended safe working practice up dates. Discussion with the acting manager and observation by the inspector showed that changes to the accident books recommended in the last report (January 2006) have not been implemented, and therefore will remain on this report. Checks of the accident books found that incidents are accurately recorded, but the books do not promote confidentiality, as they do not have removable pages so information about different people is available to anyone using the book. Staff spoken to confirmed that all employees have access to the book within the acting manager’s office. The inspector recommended that the acting manager ask the company for the new ‘data protection’ type book where the pages detach from the book and can be filed away in the resident’s personal file or for access by the acting manager only. Lowfield House Care Home DS0000002793.V299904.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 2 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 1 25 X 26 2 27 X 28 2 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 1 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 2 LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 3 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 2 3 2 X X 2 X Lowfield House Care Home DS0000002793.V299904.R01.S.doc Version 5.2 Page 29 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 YA1 Regulation 18 Requirement The registered person must ensure that staff have the knowledge and skills to communicate effectively with the residents. The registered manager must develop and agree with each prospective service user a written and costed contract/statement of terms and conditions between the home and the service user (given timescales of 29/10/02, 5/3/03, 30/9/03, 31/3/04, 31/10/04, 1/4/05, 1/10/05, 17/04/06 were not met). The residents care plans must be reviewed and updated to reflect changing needs, and agreed changes must be recorded and actioned (given timescale of 17/04/06 was not met). The registered person must ensure that the care plans are drawn up with the involvement of the residents, together with family, friends and/or advocate as appropriate. DS0000002793.V299904.R01.S.doc Timescale for action 06/09/06 2 YA5 5 06/09/06 3 YA6 15 06/09/06 4 YA6 15 06/09/06 Lowfield House Care Home Version 5.2 Page 30 5 YA7 12 6 YA9 13 7 YA10 17 8 YA12 16 9 YA13 16 10 YA13 16 11 YA17 13, 16 12 YA22 22 The registered person must ensure that staff provide residents with the independent advocacy and communication support they need to make decisions about their own lives. The registered person must ensure that risk management strategies are recorded, reviewed and updated as appropriate for each resident. Staff must ensure that information (complaints and accidents) about the residents is kept confidential (given timescale of 17/04/06 was not met). The registered person must ensure that residents are enabled to take part in Education and training sessions and are able to take part in activities they enjoyed prior to coming into the home. The registered person must ensure that staff time with, and support for, residents outside of the home is flexibly provided, including evenings and weekends and is recognised as part of staff duties. The registered person must ensure that staff have knowledge about the residents rights of access to public facilities under the Disability Discrimination Act 1995. The registered person must ensure that residents are offered a choice of suitable meals and snacks to meet their specific needs, and that their nutritional needs are assessed and regularly reviewed including risk factors associated with low weight and eating and drinking disorders. The registered person must ensure the complaints policy and DS0000002793.V299904.R01.S.doc 06/09/06 06/09/06 06/09/06 06/09/06 06/09/06 06/09/06 06/09/06 06/09/06 Lowfield House Care Home Version 5.2 Page 31 13 YA23 13 14 YA24 23 15 YA24 23 16 YA28 23 17 YA33 18 18 YA34 19 19 YA39 24 procedure is available in a format that is understood by the residents. Residents must be helped to access local independent advocacy and communication support workers if wished. The recruitment policy must be followed and all new staff must have a POVA First and/or a CRB check completed before they start work. The registered person must ensure that the premises are well maintained and carry out all repairs identified in this report. The registered person must ensure that the furnishings, fittings, adaptations and equipment are good quality and are suitable for purpose and domestic in nature. The registered person must ensure the shared spaces provided for the residents are comfortable, safe and suitably adapted for use by the residents. The registered person must ensure that the home has an effective staff team, with sufficient numbers and complementary skills to support residents’ assessed needs at all times. The numbers and skill mix of staff on duty must ensure that there is sufficient time for uninterrupted work with individuals and the day-to-day running of the home. The registered person must ensure that new staff are confirmed in post only after a satisfactory check of the protection of vulnerable adults register is completed or a satisfactory police check is received. There must be an annual DS0000002793.V299904.R01.S.doc 06/09/06 06/09/06 06/09/06 06/09/06 06/09/06 06/09/06 06/09/06 Page 32 Lowfield House Care Home Version 5.2 development plan for the home, based on a systematic cycle of planning, action and review; reflecting the aims and outcomes for residents (given timescale of 17/04/06 was not met). 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 2 3 4 Refer to Standard YA3 YA7 YA17 YA19 Good Practice Recommendations The acting manager should consider how he can promote advocacy use with the residents throughout the process of choosing a home. The acting manager should look at how relatives can pass their knowledge of looking after the resident onto the staff, using a safe and sharing approach to care. The acting manager should monitor staff practices around nutrition and feeding and address these through the supervision process. The acting manager should ensure the residents’ health is monitored and potential problems identified and dealt with at an early stage, including prompt referral to an appropriate specialist. The weighing scales should be repaired and returned to the home and a regular weighing programme for the residents set up and carried out. A separate complaints form should be developed that can be filled in by the complainant and filed away by the manager once an issue has been investigated and resolved. The acting manager should monitor the effectiveness of the POVA training being given to staff and discuss staff awareness during supervision The registered person should consider replacing the worn and tatty bedroom furniture in the home. There should be staff on duty at all times who can communicate with residents and having skills in Makaton and other communication methods. A wider range of specialist training should be developed and implemented, to improve staff knowledge of the client group and illnesses related to their conditions. DS0000002793.V299904.R01.S.doc Version 5.2 Page 33 5 YA22 6 7 8 9 YA23 YA26 YA33 YA35 Lowfield House Care Home 10 11 YA37 YA42 The provider should submit an application for a registered manager to the Commission as soon as possible. The home should introduce an accident book in line with ‘data protection’ guidance, with detachable pages so information about individual residents can be filed into their own personal files or kept where only the manager has access. Lowfield House Care Home DS0000002793.V299904.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 Care Home DS0000002793.V299904.R01.S.doc Version 5.2 Page 35 - 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. 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