Inspection on 20/12/05 for Lowmoor Care Home

This inspection was carried out on 20th December 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Lowmoor Care Home 30/09/09

Lowmoor Care Home 25/08/09

Lowmoor Care Home 22/07/08

Lowmoor Care Home 18/04/07

Lowmoor Care Home 25/04/06

Lowmoor Care Home 09/08/05

Lowmoor Care Home 03/02/05

Lowmoor Care Home 17/08/04

Lowmoor Care Home 09/02/04

Lowmoor Care Home 02/10/03

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

CARE HOMES FOR OLDER PEOPLE Lowmoor Care Home Lowmoor Road Kirkby In Ashfield Nottinghamshire NG17 7JE Lead Inspector Unannounced Inspection 20th December 2005 09:00 X10015.doc Version 1.40 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 Lowmoor Care Home DS0000024647.V273987.R01.S.doc Version 5.1 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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lowmoor Care Home DS0000024647.V273987.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Lowmoor Care Home Address Lowmoor Road Kirkby In Ashfield Nottinghamshire NG17 7JE 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) 01623 752288 01623 752288 LowmoorCarehome@MSN.com Lowmoor Nursing Home (Kirkby) Limited Thiyagraja Govindaraju Care Home 50 Category(ies) of Dementia (50), Mental Disorder, excluding registration, with number learning disability or dementia - over 65 years of of places age (50) Lowmoor Care Home DS0000024647.V273987.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th August 2005 Brief Description of the Service: Lowmoor is a privately run, purpose built two storey 50 bedded care home for people with dementia and mental heath needs. Qualified nursing care is provided throughout the 24 hour period. The home is situated in a semi -residential area within half a mile of local amenities and the town centre of Kirkby -in - Ashfield. It can accommodate up to 50 people, in 40 single bedrooms, 10 of which are en-suite and there are 5 double bedrooms. The home has an enclosed garden and a car park for visitors and staff. There is a passenger lift to the first floor. There are lounges on the ground and first floor. Toilets are situated near communal rooms and convenient for service users with no ensuite facilities. Bathrooms are fitted with adapted facilities. Lowmoor Care Home DS0000024647.V273987.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The main method of inspection was case note tracking, this is a method of selecting service users within the home and discussing with them their expectations and experiences of living within the home environment. The case tracking method also analyses the records of the service users to ascertain if the service users identified needs are being addressed appropriately within the care home setting and that their safety and well being is being maintained. On this occasion two residents notes were case tracked. The report indicates minimal comments from the residents, primarily due to the nature of the illness of those accommodated but the case tracking process allowed a relative and a staff member to be informally interviewed to further evidence the quality of care afforded to the service users. At the time of the inspection a total of 48 residents were accommodated at the home. It was evident that the management and staff within the home are committed to providing an appropriate standard of care for the service users. The manager and staff within the unit were very helpful and cooperative thus ensuring that the inspection process progressed in a professional and efficient manner. What the service does well: What has improved since the last inspection? Lowmoor Nursing Home now employs two activities coordinators who now provide and document the varied social activities provided at the home. Lowmoor Care Home DS0000024647.V273987.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Lowmoor Care Home DS0000024647.V273987.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lowmoor Care Home DS0000024647.V273987.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. 6. An appropriately qualified member of staff identifies service users needs at the time of admission. Lowmoor Nursing Home does not accommodate intermediate care services. EVIDENCE: The pre-admittance assessments within the two case tracked notes were detailed in identifying the specific needs of the service users to maintain optimum independence within the home. The assessment documentation is clear, concise, signed and dated by the assessor. Lowmoor Care Home DS0000024647.V273987.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7. 8. 9. 10. The case tracking procedure established that the care plans examined did not fully address the health needs of the service users and as such it could not be established that health needs were being fully met at the home. No service users within the home are responsible for the administration of their own medication at the time of the inspection, although facilities for selfadministration of medicines are available should it be required. A relative of a service users spoken with stated that staff at the home maintains respect and dignity for the service users. EVIDENCE: The documentation of two service users was case tracked at the time of the inspection. The two case-tracked care-planning documentation did not contain effective care plans to address all the identified needs within the preadmittance assessment. 30 minute monitoring by a nominated member of staff was identified as a need for one case tracked service user as she had been assessed as a high risk of absconding. No documentary evidence was available to evidence that this Lowmoor Care Home DS0000024647.V273987.R01.S.doc Version 5.1 Page 10 identified need was being addressed effectively at the home. The same service user had been identified as requiring nutrition monitoring once again this requirement could not be evidenced even though the service users had lost 2.5kg since admittance to the home. The second case tracked service users had been assessed as “at risk” of pressure ulcer formation together with the need to encourage the service user to toilet every two to three hours to promote continence, once again no care plans were formulated to effectively manage these identified needs. The home maintains daily progress documentation for all service in which the elements of care identified in care plans should be evaluated effectively. It was evident that the evaluation process was not effective. The daily evaluation records evidenced comments such as “to continue as per plan” which is not an effective evaluation of the care plans. The manager of the home confirmed that elements within the care planning and assessment process requires further development and it was established that he would be addressing the shortfalls with a newly devised computerised system which is to be installed in the very near future. At the tine of the inspection the Commission for Social Care Inspection issued a requirement to address the identified shortfall and will be monitoring the manager’s progress at the next inspection. At the time of the inspection no service users were responsible for the selfadministration of medicines. It was established that should a service user wish to be independent in the administration of medicines the manager would perform a risk assessment, if the service users was deemed as being safe, selfmedication would be facilitated if at all possible. At the time of the inspection, service users were clean, presentable and dressed in appropriate clothing for the season. A relative who visits his wife on a daily basis at the home was very positive in relation to all aspects of care afforded to his wife, he stated that staff spoke to his wife in a considerate and caring manner as they did with all the service users within the home. The service user relative also stated that the staff always respected his wife privacy and dignity and that all the staff within the home are helpful and pleasant. It was established that staff always knocked on the bedroom doors of service users before entering thus promoting the principles of privacy and dignity. All service users were very presentable at the time of the inspection, a relative of a service user stated that the laundry facilities within the home are very good and that his wife’s clothes were always returned promptly and in a clean well ironed condition. Lowmoor Care Home DS0000024647.V273987.R01.S.doc Version 5.1 Page 11 Lowmoor Care Home DS0000024647.V273987.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, Service users have the opportunity and choice to participate in varied and stimulating social activities. Service users maintain contact with family, friends and representatives from the local community. Service users can exercise choice and control over their lives. EVIDENCE: The pre admittance assessment allows for the identification of service users hobbies and interests and the two activities coordinators employed at the home will attempt to facilitate them if at all possible. The activities coordinators, who are jointly employed over fifty hours per week, are responsible for the provision of varied and stimulating social activities such as knitting, bingo, guest entertainers, painting, baking, movement to music and foot spas. Should the service users wish, the activities coordinator will accompany service users into kirkby town centre to shop or browse. Service users relatives are also encouraged to take resident out as they wish. Lowmoor Care Home DS0000024647.V273987.R01.S.doc Version 5.1 Page 13 Hired transport is also available to take service users to local areas of interest such as parks, public house and the coast. It was established that no restrictions are in place in relation to visiting times. The relative of a service user was spoken with and he confirmed that the home operates an open policy in relation to visiting times. Lowmoor Care Home DS0000024647.V273987.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were inspected at the last inspection performed on 9th August 2005 at which time no concerns were identified. EVIDENCE: Lowmoor Care Home DS0000024647.V273987.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26 Lowmoor Nursing Home on the whole provides a homely, clean and comfortable environment for service users, although the first floor corridors within the home would benefit from redecoration. EVIDENCE: All of the bedrooms viewed during the inspection were clean, pleasantly decorated and comfortably furnished. Service users had been encouraged to bring photographs and ornaments to personalise their bedrooms. The home is benefiting from an ongoing routine maintenance programme, it was established that all the downstairs corridors had been recently re-carpeted and the service users bedrooms have been redecorating to a satisfactory standard. The first floor corridors would benefit from redecoration as they are somewhat shoddy, bland and not particularly pleasant for the service users, it is recommended that this issue should be prioritised within the homes maintenance programme. Lowmoor Care Home DS0000024647.V273987.R01.S.doc Version 5.1 Page 16 Lowmoor Care Home DS0000024647.V273987.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27-30 were not inspected on this occasion. EVIDENCE: Lowmoor Care Home DS0000024647.V273987.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35. A clear financial audit trail could be established for all service users, although elements appertaining to Regulation 20 are not adhered to at Lowmoor Nursing Home. EVIDENCE: The registered manager should ensure that service users control their own money except where they state that they do not wish to or they lack capacity. The manager of the home should ensure that safeguards are in place to protect the interests of the service users. It is evident that the service users accommodated at the home do lack sufficient capacity to manage their finances appropriately. It was established that a joint account is maintained at a local bank in which service users monies, paid by relatives or social services are pooled together. This procedure does not satisfy the requirements identified in the Care Standards Act (2000) Regulation 20, which states that the registered person Lowmoor Care Home DS0000024647.V273987.R01.S.doc Version 5.1 Page 19 shall not pay money belonging to any service user into a bank account unless the account is in the name of the service user and the account is not used by the registered person in connection with the carrying on or management of the care home. After discussion with the manager of the home it was established that the system was in place as the majority of service users money is paid by cheque and that the local bank would not open individual accounts for service users especially as they lack capacity to manage the account and sign for withdrawals. The manager of the unit could clearly demonstrate a financial audit trail for all service users accommodated at the home and that all extra interventions, not included in the “care package” at the home, such as podiatry services and hairdressing are paid by cheque, out of the joint account. Although the inspector was satisfied that no financial irregularities were evident, concerns were identified. Service users who are not in credit within the joint account are in essence loaning monies from the joint account without the consent of fellow service users. Also it was not clear as to how interest is calculated for individual service users. The Commission for Social Care Inspection will require further clarification from the registered provider in relation to the homes management of service users monies and will require documentary evidence to demonstrate the following 1 The joint account is kept from the main business account of the home, not forming part of its assets. 2 The account records need to be itemised to show separate deposits and withdrawals for each individual service user for whom monies are received. These need to be available for inspection to the Commission for Social Care Inspection. 3 The home will also need to demonstrate how each individual service user will receive any interest applicable to their individual savings. Once this information has been received a decision will be made as to the appropriateness of the current system of managing the service users finances. Lowmoor Care Home DS0000024647.V273987.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 x X X X X X X X 2 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 2 X X X Lowmoor Care Home DS0000024647.V273987.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? No 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 7 Regulation 15 Requirement The registered person shall ensure after consultation with the service user, or a representative of his, prepare a written plan as to how the service users needs in respect of his health and welfare are to be met. The registered person shall ensure that the assessment of the service user’s needs is kept under review and revised at any time when it is necessary to do so having regard to any change of circumstances. Timescale for action 31/03/06 2 8 14 (2) 31/03/06 3 35 20 (1) (a) (b) 31/01/06 The registered person shall not pay money belonging to any service user into a bank account unless the account is in the name of the service user, or any of the service users, to which the money belongs and the account is not used by the registered person in connection with the carrying on or management of the care home. Lowmoor Care Home DS0000024647.V273987.R01.S.doc Version 5.1 Page 22 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 26 Good Practice Recommendations The garden area outside the main reception area is very untidy and gives a poor impression of the home for visitors and service users. As such it is recommended the area should be maintained effectively. The first floor corridors would benefit from redecoration as they are somewhat shoddy, bland and not particularly pleasant for the service users, it is recommended that this issue should be prioritised within the home. 2 26 Lowmoor Care Home DS0000024647.V273987.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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 Lowmoor Care Home DS0000024647.V273987.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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