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Inspection on 19/01/06 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 19th January 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 5 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 home provides residents with a bright, colourful and stimulating environment to live, work and play in. Care has been taken to offer individuals a range of different textures, shapes and sensory materials in all the communal spaces.

What has improved since the last inspection?

The home continues to give the residents a good standard of care and support to meet their needs. This is provided by staff that enjoy their work and are determined to do it well.

What the care home could do better:

Better recording systems are needed for complaints and accidents so information about the residents is kept confidential and in keeping with Data Protection guidance. 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.

CARE HOME ADULTS 18-65 Lowfield House Care Home Cornwall Street Kirton-in-lindsey Gainsborough Lincolnshire DN21 4EH Lead Inspector Eileen Engelmann Unannounced Inspection 19th January 2006 09:30 Lowfield House Care Home DS0000002793.V263911.R01.S.doc Version 5.0 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.V263911.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V263911.R01.S.doc Version 5.0 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 Mrs Patricia Ann Atkin Care Home 20 Category(ies) of Learning disability (20), Physical disability (20) registration, with number of places Lowfield House Care Home DS0000002793.V263911.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st July 2005 Brief Description of the Service: Lowfield House is owned by Prime Life Ltd. The home is registered to provide care for 20 adults aged 18-65 that 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 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. At the time of the inspection the home was seen to be in good repair. Decoration in communal areas was bright and colourful and the bedrooms reflected the needs and personalities of individual service users.The home employs nursing and care staff. A qualified nurse is on duty at all times. Lowfield House Care Home DS0000002793.V263911.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out with the manager, deputy manager, staff and residents of Lowfield House. The inspection took 2.45 hours and included a tour of the premises, examination of staff and resident files and records relating to the service. Staff and residents were spoken to in an informal manner and their comments and viewpoints are included within this report. All key standards have been inspected over the past year and information on these and the outcomes can be found in this report and the one for 1st July 2005. What the service does well: 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 Lowfield House Care Home DS0000002793.V263911.R01.S.doc Version 5.0 Page 6 contacting your local CSCI office. Lowfield House Care Home DS0000002793.V263911.R01.S.doc Version 5.0 Page 7 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.V263911.R01.S.doc Version 5.0 Page 8 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): 5. The home’s statement of terms and conditions for funded individuals is inadequate and does not offer prospective residents the same depth of information as that provided for self-funding individuals. This could prevent funded residents from being able to make an informed decision about admission to the home. EVIDENCE: The 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 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. This is an outstanding requirement from previous reports and must be given priority in the home’s action plan for this inspection report. Lowfield House Care Home DS0000002793.V263911.R01.S.doc Version 5.0 Page 9 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 and 10. Inconsistencies in how the staff use the care planning system means that staff are not always being provided with the information they need to satisfactorily meet the residents needs. EVIDENCE: Individual care plans are in place for all residents and set out the health, personal and social care needs identified for each person. Two plans were looked at and there were distinct differences in how these plans have been maintained by the key workers. The first examined showed that it had been evaluated on a monthly basis and any changes to the care being given were clearly documented and implemented by the staff. The second plan although set out as the first had not been updated for over a year and therefore the information within it could not be relied on as accurate for the resident’s care needs. This was discussed with the manager who said she would address the problem through supervision with the key worker concerned. 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.V263911.R01.S.doc Version 5.0 Page 10 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): 15. The arrangements for contact between residents and family/friends are good, and staff demonstrated a clear understanding of their role in supporting individuals to maintain these relationships. EVIDENCE: Contact arrangements between the residents and families/friends are clearly documented in the individual care plans and have been made using a risk assessment process that looks at vulnerability and risk of harm. Staff help the residents to maintain links to those relatives who find visiting difficult, by taking the individuals out to visit their families or by writing letters/cards and using telephone calls as a means of communication. 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. Lowfield House Care Home DS0000002793.V263911.R01.S.doc Version 5.0 Page 11 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): 20. The medication at the home is well managed promoting good health for the residents. EVIDENCE: Discussion with the deputy manager indicated that the home had yet to arrange suitable collection for its waste medications, in line with recent changes to legislation. Nursing homes now need to make arrangements with a certificated waste disposal company for them to take all unnecessary medication from the premises. The inspector gave the deputy manager the information needed to take the correct action and this was implemented before the visit ended. 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 showed that these are up to date, accurate and well managed. Lowfield House Care Home DS0000002793.V263911.R01.S.doc Version 5.0 Page 12 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. 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: The home has a complaints procedure that residents and staff are aware of and are confident of using if needed. The complaints records show that there has been one complaint made since the last inspection and this was around a recurring theme of stained clothing for one particular resident. The issue was investigated by the manager and resolved. 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 manager assured the inspector that only she and the deputy manager had access to the book, and is kept in the manager’s office. However, this could mean that complaints are not recorded when the deputy or manager are not around. The inspector recommended 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 and resolved. Lowfield House Care Home DS0000002793.V263911.R01.S.doc Version 5.0 Page 13 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. The standard of the environment within this home is good providing residents with an attractive and comfortable place to live. EVIDENCE: The home décor is bright and cheerful with corridors decorated with a variety of different themes and textures to capture the interest of the residents. Improvements since the last inspection include new carpets and decoration for the corridors, two new carpets for bedrooms and new floor covering for the kitchen. The home has also benefited from supplies of replacement continence sheets for the beds (kylies) and new towels for bathing/washing. All areas seen during this inspection were clean, tidy and odour free. There are some small areas of the home that need attention and maintenance and these 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. Lowfield House Care Home DS0000002793.V263911.R01.S.doc Version 5.0 Page 14 ∗The hairdressing sink pedestal (wooden) is broken and needs repairs carrying out. ∗Settees and chairs in the main lounge are well worn and require new covers. The manager said that these repairs have been notified to the maintenance team and they are waiting for a response. Lowfield House Care Home DS0000002793.V263911.R01.S.doc Version 5.0 Page 15 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): 36. Formal supervision of the staff is not always meeting the required standards, and this unsatisfactory practice could potentially place the residents at risk. EVIDENCE: All key standards were met in full at the last inspection. Discussion with the manager indicated that supervision of the staff is improving and the frequency is now approaching every two to three months. Given the discrepancies in the staff working approach to care plans, the supervision process must improve further to ensure staff receive the necessary support and feedback from the management team on their work performance. This should help them achieve consistency in care and maintain good standards of service within the home. Lowfield House Care Home DS0000002793.V263911.R01.S.doc Version 5.0 Page 16 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): 39 and 42. The management of the home is satisfactory overall, but the lack of an electrical wiring certificate could potentially place residents at risk. EVIDENCE: No progress has been made since the last inspection to produce an Annual Development Plan as part of the Quality Assurance system for the home. Time was spent with the manager discussing how this could be achieved. Resident meetings are held on a regular basis and minutes are circulated to people living in the home. Staff have meetings with the manager and everyone is encouraged to join in with discussions and voice their opinions. Residents and staff agreed that they are able to express ideas; criticisms and concerns without prejudice and the management team will take action where necessary to bring about positive change. 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. A quality Lowfield House Care Home DS0000002793.V263911.R01.S.doc Version 5.0 Page 17 assurance book has been devised to invite comments from relatives and visitors to the home; this is currently kept next to the signing in book in the entrance area. The residents have completed satisfaction questionnaires and the head office publishes the results of these. Policies and procedures are up dated and reviewed as an ongoing practice and action is being taken to ensure the requirements of the inspection reports are met. Discussion with the manager indicated that staff and residents are able to discuss the home’s policies and procedures through attending meetings, reading newsletters and as part of the supervision process for staff. No progress has been made since the last inspection to have the electrical wiring checked at the home. The provider has been asked by the Commission to provide written evidence that his insurance company are aware that the home does not have an electrical wiring certificate, and that this does not affect the insurance cover for the home. 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 manager’s office. The inspector recommended that the 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 manager only. Lowfield House Care Home DS0000002793.V263911.R01.S.doc Version 5.0 Page 18 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X 2 Standard No 22 23 Score 2 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X X 2 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X X X X X 2 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Lowfield House Care Home Score X X 3 X Standard No 37 38 39 40 41 42 43 Score X X 2 X X 2 X DS0000002793.V263911.R01.S.doc Version 5.0 Page 19 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 YA5 Regulation 5 Requirement 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 were not met. The residents care plans must be reviewed and updated to reflect changing needs, and agreed changes must be recorded and actioned. Staff must ensure that information (complaints and accidents) about the residents is kept confidential. All staff must receive regular recorded supervision at least six times per year (pro-rata for part time staff) and receive an annual appraisal (given timescales of 29/10/02, 5/3/03, 30/9/03, 29/02/04, 31/10/04, 01/10/05 were not met). There must be an annual development plan for the home, based on a systematic cycle of DS0000002793.V263911.R01.S.doc Timescale for action 17/04/06 2. YA6 15 17/04/06 3. YA10 17 17/04/06 4. YA36 18 17/04/06 5. YA39 24 17/04/06 Lowfield House Care Home Version 5.0 Page 20 planning, action and review; reflecting the aims and outcomes for residents. 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 YA22 Good Practice Recommendations 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 provider should ensure all repairs to the environment are carried out as soon as possible. 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. The provider should provide the Commission with written evidence that the home’s insurers are aware that the home does not have an electrical wiring certificate and that this does not affect the insurance status of the home. 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. 2. 3. 4. YA24 YA35 YA42 5. 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