Inspection on 17/02/09 for Lowgate Care Home

This inspection was carried out on 17th February 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lowgate Care Home 10/10/08

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Lowgate Care Home Lowgate Hexham Northumberland NE46 2NN The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this full assessment a ‘key’ inspection. Lead inspector: Elaine Charlton Date: 1 7 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought 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. 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 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 Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Lowgate Care Home Lowgate Hexham Northumberland NE46 2NN 01434605316 01434602959 lowgate@roseberrycarecentres.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Roseberry Care Centres GB Ltd Mrs Susan Gray-Smith Care home 42 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration Category(ies): Dementia Old age, not falling within any other category Additional conditions: Number of places (if applicable): Under 65 0 0 Over 65 5 42 The maximum number of service users who can be accommodated is: 42 The registered person may provide the following category of care 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: Old Age, not falling within any other category, Code OP - maximum number of places 42 Dementia Code DE, maximum number of places 5 Date of last inspection: Brief description of the care home: 1 0 1 0 2 0 0 8 Lowgate is situated on the outskirts of Hexham on the way to Allendale. It is a purpose built, single storey building, providing nursing and residential care to older people. There are 42 single bedrooms, 18 of which have ensuite facilities. There are additional bathing, shower and toilet facilities located around the home. As well as their bedrooms, residents have access to a large lounge and dining room. Care Homes for Older People Page 4 of 27 The home sits in its own grounds and there is plenty of space for parking. Fees for the home are bronze residential £366.77 per week, silver residential £419.08 and nursing £417.57. People who may wish to move into the home can find out about the services they might expect from the service user guide. Copies of the Commission for Social Care inspection reports are also available, and displayed, in the home. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service How we did our inspection: An unannounced visit was made on the 17 February 2009. A total of seven hours were spent in the service. The manager was present throughout the inspection. Before the visit we looked at Information we have received since the last visit on the 10 October 2008. The Annual Quality Assurance Assessment (AQAA) that had been provided for the previous inspection and gives CSCI evidence to support what the service says it does well, and gives them an opportunity to say what they feel they could do better and what their future plans are. How the service has dealt with any complaints and concerns since our last visit. The providers view of how well they care for people, and the views of people Care Homes for Older People Page 6 of 27 who use the service, their relatives, staff and other professionals who visit the service. We have also reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the service are not put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. During the visit we Talked with people who use the service, staff and the manager. Arranged for an inspection of medicines and the medication administration systems to be carried out by the CSCI Pharmacist. Looked at information about the people who use the service and how well their needs are met, other records which must be kept, and checked that staff had the knowledge, skills and training to meet the needs of the people they care for. We looked around the building/parts of the building to make sure it was clean, safe and comfortable and checked what improvements had been made since our last visit. We told the manager what we found. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: Make sure that proper policies and procedures are followed for the safe handling of medication, helping to keep people who live in the home safe. Make sure that all assessment and care planning documentation is complete, signed and dated and has been updated if a persons needs have changed since the assessment was carried out. Carefully monitor the weights of people living in the home and keep CSCI up to date with the recalibration or replacement of the weighing scales. This will help to promote the health and wellbeing of the residents. Make sure that risk assessments and manual handling plans are always fully completed and give staff clear advice about the equipment they should be using to support this area of care. Care Homes for Older People Page 8 of 27 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 on page 4. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by telephoning our order line – 0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1-6) Health and personal care (standards 7-11) Daily life and social activities (standards 12-15) Complaints and protection (standards 16-18) Environment (standards 19-26) Staffing (standards 27-30) Management and administration (standards 31-38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home have their care and support needs properly assessed so that everyone can be sure they can be met. Evidence: The registered manager or a member of the nursing staff carry out and document preadmission assessments. We looked at two assessments for people most recently admitted to the home. Both the assessments we saw were detailed and staff had noted where they had been unable to get information from other healthcare professionals, for example, hospital staff. The home also uses a range of professionally recognised assessment tools to record tissue viability, nutritional needs and areas of risk. The home does not provide intermediate care. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are able to see a range of healthcare professionals as they need and are supported in the home by properly trained nurses, medications are in the main safe and people are encouraged to self-medicate if they are able and wish to do so. Evidence: As well as the records for the two people most recently admitted to the home we also looked at two more files for people who had lived in the home for a longer period of time. All the records we saw were kept in a consistent way and there was evidence of care plans being regularly evaluated. Staff completing care plans and other supporting documents had included some guidance for staff that was nice. This included carers to explain simply and clearly what they are going to do and use simple yes or no questions. We saw a number of records including risk assessments, accountability charts, body maps, and care plans that either did not include the residents name, the name of the person completing the document, their signature or a date. For one person we saw conflicting information between the assessment and the care plan about their ability to eat independently. One entry said W eats a normal diet and likes to feed himself with finger food but it was recorded in the assessment that the person was at risk of choking and needs thickened fluids. Care Homes for Older People Page 12 of 27 For two residents the accountability charts that staff initial to say they have updated the file had not been completed on three occasions. We discussed with the manager the weight monitoring arrangements. Recent records still seem to show that some residents continue to have some weight loss. The manager said that the scales were going to be recalibrated to make sure they were operating correctly or replaced, she was asked to confirm to CSCI when this had been completed. Throughout the inspection we saw staff talking to and helping residents in a calm and sensitive way, respecting their privacy and dignity when entering their rooms or carrying out personal care. The residents we spoke to told us that the staff were nice and they liked living in the home. We saw that people had been provided with pressure relieving equipment or adapted beds where this need had been identified. For one resident whose file we looked at we saw that they had been encouraged and enabled to continue to self-mediate by using prescribed inhalers independently. We checked the blood glucose monitoring arrangements that had changed since the last inspection. There is a laminated sheet in the nurses office that identifies which residents need their blood or urine to be checked and the frequency at which these checks should be carried out. The records we saw showed that checks had been properly and regularly carried out and recorded and additional notes had been added where a resident had needed to have some milk, sugar, or a biscuit. An audit of medicines in the home and medication administration arrangements was carried out by a Pharmacy Inspector from CSCI. His findings are detailed below. Medicine storage within the home is generally secure and well managed. Some stocks of laxatives and nutritional supplements were stored on open shelving rather than in a locked cupboard and the refrigerator was not locked at the time of the visit. The current medication administration record (MAR) chats were looked at. There were no gaps on the MAR charts or any significant discrepancies between the quantities of medicines received, the number of doses recorded and the quantities of medicine remaining. This indicates that people are getting their medicines as prescribed. Some handwritten entries in the MAR charts were incomplete and did not always include the quantity of medication received or carried over from one month to the next, or a witness signature to confirm their accuracy. The MAR chart file contained photographs of each resident to assist in their identification but the name of the person was not always included beneath the photograph to confirm their identity. Care Homes for Older People Page 13 of 27 The controlled drug cupboard appears to meet safe custody regulations. There were no discrepancies between controlled drugs held in the home and the relevant entries in the controlled drug register and on the MAR charts. We noted some bottles of morphine sulphate solution 10mg/5ml were stored in the medicines trolley and were not being treated as controlled drugs in line with good practice guidance. Medicines for disposal are documented but the date of their removal and a signature to confirm collection were not recorded in the book. The medicines policy is brief and does not contain sufficient detailed guidance for staff on all aspects of handling medicines. In particular, guidance on handling controlled drugs, recording medicines not administered and self administration of medicines is limited. Although regular medication audits are carried out these are not detailed enough to help identify any medication problems promptly or to confirm that staff are closely following the home’s medicines policy. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home can choose what they want to do and whether they want to join in the wide range of activities and social events taking place that provide them with stimulating and interesting opportunities. Evidence: An extensive programme of activities and events continues to take place. We were given copies of the computerised Activities Diary for November, December and January. There had been lots of events and activities. These included keep fit, film shows, baking days, birthday celebrations, entertainers and parties. There had been outings to the Queens Hall to see the Mikado, Swan Lake, and The Adventures of Sinbad. There had been a carol service in the home and other sing-a-long sessions. People who wish to attend a communion service enjoy the regular monthly services conducted in the home. It was hairdresser day when we carried out our inspection. We talked to lots of residents who were enjoying this event. Two ladies told us that the hairdresser is very busy but has everyone booked in and knows what she is doing. There are still lots of picture boards around the home to remind people of outings and events that have taken place. The manager told us that work was being undertaken to try and attract funding Care Homes for Older People Page 15 of 27 towards the cost of providing residents with a sensory garden outside the main lounge. This is a nice sheltered area that residents would be able to make more use of if it was landscaped to meet their needs. People we spoke to told us that they enjoy the food in the home. We spoke to the cook about the menus and the amount of fortified, pureed and/or soft diets she provides. Residents are able to choose what they want to do and when and are looking forward to the warmer weather when they can get out and about again. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home and their relatives are listened to and encouraged to make their concerns or complaints known. Their safety is promoted through policies, procedures and staff training. Evidence: The home has an up to date complaints policy and procedure that is displayed in the entrance hall and is contained in the service user guide. One complaint had been received by the home since the last inspection. This had been properly recorded and we saw evidence of an investigation and feedback to the complainant. Staff are made aware through their professional codes of conduct and the company handbook of the need to bring any concerns or issues of poor practice to the attention of the manager. All staff have received training in Safeguarding Adults, and know the procedure to follow if a concern or allegation is brought to their attention. People who work in the home are required to have a Criminal Records Bureau (CRB) check at an enhanced level to make sure that they are able to work with vulnerable adults. The manager carries out regular checks to make sure that the nurses Personal Identification Numbers (PINs) and registrations are current. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is warm, comfortable and clean and gives them the chance to spend time in private. Areas of the home that may cause residents some risk are kept secure to protect them. Evidence: We walked around the premises to check that all the requirements and recommendations made at the last inspection had been carried out. We also saw that work was being carried out to replace or fit incumescent strips throughout the home following the advice of the Fire Officer on a recent visit. Everyone living in the home has their own bedroom that they are able to personalise in a way they choose, it also helps them to make their environment more familiar to them. Some areas of the home like the kitchen and laundry have key pad entry systems fitted to help keep residents safe. These were all being properly used throughout the inspection. All areas of the home were seen to be clean, tidy and odour free. Old pillow cases and duvets had been cleared out of the laundry and the new bedding was now being used. We spoke to the housekeeper who had just started to work in the home and complimented her on the changes that had taken place. The majority of swing bins in the home have now been replaced with foot operated ones, and during the inspection we were told that extra ones had now arrived and were ready for collection in Hexham. Care Homes for Older People Page 18 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are protected through recruitment and selection procedures that are properly followed and they know that the staff who provide their care and support are properly trained to keep them safe and well. Evidence: The home has clear policies and procedures for the recruitment and selection of staff. We looked at two files for people who had been recruited to work in the home since the last inspection which showed that these procedures had been properly followed. The files we looked at showed that references had been sought, CRB and nurses personal identification number checks had been carried out to make sure that applicants were able to work with vulnerable people, and evidence of a persons identity had been seen. On one application form the statement about whether the person had previously had any cautions or convictions that should have been disclosed had not been completed. However, the manager told us that people are also asked this question at interview when the need for a CRB check is explained. We saw the staffing rotas for the previous four weeks. These showed that the home had been properly staffed to meet the needs of the residents. Some limited use had been made of bank staff to cover periods of sickness. Staff have had and continue to have access to an extensive range of training that includes a variety of National Vocational Qualifications, BETC awards in dementia care, infection control, bereavement and palliative care. The deputy manager is still working towards a Foundation Management degree. New staff told us that they had started their induction and were enjoying working in Care Homes for Older People Page 19 of 27 the home. Care Homes for Older People Page 20 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run with the best interests of residents uppermost although some areas of recording still need to be improved to ensure people and the home are kept safe. Evidence: The manager is qualified and experienced to run the home. She provided us with a copy of the homes Annual Quality Assurance Assessment (AQAA) when we asked for it and it was very detailed. The provider makes regular visits to the home and records these as required under Regulation 26 of the Care Home Regulations 2001. The records are always detailed and thorough and include evidence of the residents and staff he has spoken to. Staff continue to receive regular, recorded supervision and support to help them do their job and identify any issues or training needs. There have been no changes in the arrangements to protect residents personal monies since the last inspection in October 2008. The homes administrator keeps very detailed and accurate records that are regularly audited by the regional accountant. Some risk assessments had not been fully completed, did not give the name of the resident and had not been signed by the person carrying out the assessment. Care Homes for Older People Page 21 of 27 Moving and handling plans were in place and detailed the equipment that should be used to assist a person to transfer. Although the plan identified the piece of equipment to be used, for example the type of hoist, it did not detail the sling and loops that should be used but just said and appropriate sling. We saw a number of records including accountability charts, body maps, and care plans that either did not include the residents name, the name of the person completing the document, their signature or a date. A new health and safety monitor sheet had been introduced. It details servicing and contract arrangements and when these are due to be renewed or carried out. This is a very good idea. The manager and staff have worked well together to meet all the requirements and recommendations made at the last inspection and to improve standards in the home. Care Homes for Older People Page 22 of 27 Are there any outstanding requirements from the last inspection? Yes 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 27 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, Care Homes 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 8 13 CSCI must be provided with evidence that the scales used to monitor residents weights have been recalibrated or replaced. This will help to keep people who live in the home safe and well 17/03/2009 2 8 13 CSCI must be provided with a copy of the Record of visual checks of equipment Airflow Mattresses document on a monthly basis as this gives an overview of residents weights. This will help to monitor any weight loss and keep people living in the home safe and well. 17/03/2009 Care Homes for Older People Page 24 of 27 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 1 7 There should be no discrepancies between the information collected at assessment and the care plans. If a persons needs or abilities have changed this should be clearly recorded and dated. This will help to make sure that people get the right care and support and are kept safe. When waste medicines are removed from the home a member of staff should sign and date the record book to confirm removal. The medicines policy should be extended and updated in line with current best practice guidance so that staff understand how to handle and administer medicines safely. Staff should sign and date any handwritten entries and changes on MAR sheets and record the amount of medication received. The entry should be checked and countersigned by a second person. This makes sure that the correct information is recorded and the person receives their medication as prescribed. The medicine refrigerator should be locked when not in use and the key kept with the person in charge of the unit. This will help to make sure that medications are properly and securely stored at all times. A system should be in place to record all medication kept in the home and any carried over from the previous month. This helps confirm medication is being given as prescribed and assists in checking stock levels. The name of each resident should be added to their MAR chart photograph to assist staff who may not be familiar with people living in the home. This will help to keep people who live in the home safe and well A more detailed and comprehensive audit of the whole medication system should be regularly undertaken to confirm that staff are following the medicines policy. This will help to keep people who live in the home safe and well. 2 9 3 9 4 9 5 9 6 9 7 9 8 9 Care Homes for Older People Page 25 of 27 9 9 Morphine Solution 10mg/5ml should be treated as a controlled drug and stored and recorded accordingly. This will help with the auditing of medicines in the home and help to keep the people who live there safe. All documents and records must include the residents name, the name of the person complete the record, their signature and date. This will provide a clear audit trail and help to keep people who live in the home safe. Moving and handling assessments and plans should be fully completed, dated and signed and include details not only of the equipment to be used but any associated slings. This will make it clear to staff how they should be helping a person and what they should be using. 10 37 11 38 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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. ©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. 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