Inspection on 25/04/06 for Lowmoor Care Home

This inspection was carried out on 25th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 20/12/05

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 Judith Avill Key Unannounced Inspection 25th April 2006 10.15 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.V291457.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.V291457.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 Mr 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.V291457.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th December 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 en-suite facilities. Bathrooms are fitted with adapted facilities. Lowmoor Care Home DS0000024647.V291457.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection commenced at 10.15 am and was over 7.5hours. The registered manager was on duty and a selection of qualified nurses and care staffs were seen during the inspection. Both the manager and staff gave valuable assistance and were helpful during the inspection process. At the time of inspection there were 40 residents accommodated at the home. The main method used for inspection was Case Tracking, due to the nature of the illnesses of the residents accommodated at the home minimal comments were received from residents living at the home. An analysis of the records and talking with members of staff was used to ensure that those living at the home have their needs met and their health and welfare maintained appropriately. A tour of the home was conducted and inspection of environmental records was completed. One visitor was spoken to during the inspection. What the service does well: What has improved since the last inspection? What they could do better: The installation of pictures or murals would help the corridors from looking bland. A written programme of redecoration would provide a focus in the redecoration and refurbishment programme. To ensure consistent practice the medication policies and procedures need to be developed. The storage of some individual residents medication, which needs to be administered twice-daily needs to be secure, and a system developed to prevent the overstocking of medication. A review of the policy and procedures for residents finances needs to be completed and residents finances stored individually to ensure personal allowances are not pooled and can be inspected at all times. Whilst the registered manager provided documentation for recording staff supervision a plan of action and timescale for the introduction of supervision needs to be set. Lowmoor Care Home DS0000024647.V291457.R01.S.doc Version 5.1 Page 6 Some of the administrative and filing systems would benefit from organising. The home would benefit from more structured administrative processes and regular administrative hours of work. 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.V291457.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.V291457.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 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before this visit to this service. Prospective are assessed appropriately qualified member of staff assesses residents prior to or on admission to the home. The home does not provide an intermediate care service. EVIDENCE: 5 residents files were case tracked. The files viewed evidenced assessment by hospital staff and staff from the home identifying the specific needs of the prospective residents. One assessment seen was not signed and dated by staff at the home. Lowmoor Care Home DS0000024647.V291457.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 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before this visit to this service. Prospective The 5 residents files and documents case tracked evidenced that the health needs of residents were being met. The medication policies and procedures did not reflect the practices of the home. Medication observed in the medication room was not stored securely. A relative of a resident at the home stated that staff respect and maintain the dignity of individual residents. EVIDENCE: The documentation of 5 residents case tracked contained care plans to address the needs of the residents. Health records were well maintained and details of diet and weight were recorded. Since the last inspection areas of specific care are recorded on individual record sheets dependent on identified need. The computerised system has not been installed. Medication is stored in a locked room. However the inspector observed medication stored on the top pf the morning medication trolley, staff reported this was transferred to the top of the afternoon trolley for administration later in the day. The medication was stored securely during the inspection. The Lowmoor Care Home DS0000024647.V291457.R01.S.doc Version 5.1 Page 10 medication policy and procedure seen did not reflect the practice of the home for disposal of medication, nor the process for residents who wish to selfmedicate. Accident records case tracked from one resident were followed up on the daily records and appropriate action was taken. All residents observed at the time of inspection were appropriately dressed for the weather, clean and presentable. A relative spoken with confirmed the laundry services were good and their relatives clothing were returned promptly. Lowmoor Care Home DS0000024647.V291457.R01.S.doc Version 5.1 Page 11 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 &15 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before this visit to this service. Prospective Resident have opportunities for activities at the home, have visitors at any reasonable time, maintain contact with their families and can exercise control and choice as far as they are able. EVIDENCE: The home has three activity coordinators who have other duties within the home. One member of staff makes all the residents beds another undertakes some administrative tasks. From the rota provided no specific activity time for staff working with the residents is recorded. Staff record on the daily record and the activity record what activity residents have anticipated in. During the inspection staff were observed with individual residents doing individual hobbies. From discussion with the staff no specific designated hours are allocated for activity and they reported they are involved in feeding and some care of residents. Staff stated they had attended basic training on dementia awareness but no specific training on reminiscence, dementia mapping or activities for calming and individual conditions. Food observed being prepared and eaten by residents appeared nutritious and well balanced. Residents observed being assisted with food were dealt with sensitively and in a pleasant manner. Lowmoor Care Home DS0000024647.V291457.R01.S.doc Version 5.1 Page 12 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): 16,18 Quality in this outcome area adequate. This judgement has been made from evidence gathered both during and before this visit to this service. The home has comprehensive complaints procedure and staff’s spoken with were aware of policies to follow in the event of an allegation of abuse but he homes policy did not include detaials of the Local Authority adult protection procedures. EVIDENCE: The service user guide includes details of how to make a complaint. Relatives spoken with commented they were aware of whom to complain to. Staff spoken with confirmed they have attended training on protection of vulnerable adults. The policy and procedure seen did not include details of the Local Authority adult protection procedures. No evidence of the policies and procedures regarding resident’s monies and financial affairs were seen. Lowmoor Care Home DS0000024647.V291457.R01.S.doc Version 5.1 Page 13 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): 19 & 26 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before this visit to this service. Prospective The home provides a clean and comfortable environment for residents. Further refurbishment to corridors would personalise the corridors. EVIDENCE: Bedrooms visited during the inspection were clean, pleasantly decorated and comfortably furnished. Some residents had personal items in their rooms. At the time of the inspection the home was benefiting from ongoing maintenance to some bedrooms and corridors. Work was ongoing in a bathroom conversion to a shower room. The registered manager provided estimates for new flooring in some areas. No written record of planned refurbishment was available. The lounge areas were clean and spacious. Aids and equippment is available to meet residents needs. Lowmoor Care Home DS0000024647.V291457.R01.S.doc Version 5.1 Page 14 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): 27,28,29 &30 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before this visit to this service. Prospective The rota provided and staff and relatives confirmed that the home provides adequate staff to meet the needs of the residents. The recruitment policy and procedure did not reflect practice at the home. Staffs training records seen were well maintained. EVIDENCE: The staff rota provided evidenced sufficient staff to meet the resident’s needs. However the rota does not indicate the individual activity coordinators hours for activities, bed changing, administrative duties and other roles and responsibilities. The recruitment policy and procedure seen did not include obtaining two references, obtaining satisfactory checks for the Protection of Vulnerable Adults prior to appointing a member of staff and other requirements as stated in the National Minimum Standards and legislation. Four staff files and training records seen evidenced references and checks and work permits One staff file viewed employed by the last manager several years ago contained only one reference. No records of supervision were seen on staff files. The registered manager provided a supervision template and stated he plans to introduce recorded supervision the near future. Staff spoken with stated that they felt able to talk to the registered manger and all the senior staff about concerns and felt their comments were listened to. The staff training for all levels of staff is recorded but no evidence of a planned training programme for 2006/2007 was seen. Lowmoor Care Home DS0000024647.V291457.R01.S.doc Version 5.1 Page 15 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): 31,33,35 36 &38 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before this visit to this service. Prospective The registered manager has several years experience in managing a care home. The home has a system of quality assurance. Resident’s finances are pooled. Staff’s supervision is not recorded. Not all records are signed and dated. Health and safety records are well maintained. EVIDENCE: The registered manager is a registered nurse with several years of working with people with dementia. The quality assurance system is included with the service user guide. No record of the outcome of questionnaires was seen on this inspection. These will be inspected at further inspections. It is evident that many of the residents lack the capacity to manage their finances appropriately. Residents finances are maintained in a joint account at a local bank in which resident’s monies, money paid by relatives by cheques or Lowmoor Care Home DS0000024647.V291457.R01.S.doc Version 5.1 Page 16 Social Service are pooled together. On the day of the inspection individual residents personal cash was pooled together. From the last inspection the registered manager reported that application to Social Services for ‘Client investment accounts’ to be set up for resident’s. These have not been completed. The manager of the home provided records of the bank account transactions and residents personal finances. Due to the pooling of individual finances no evidence of specific individual cash held for specific residents was seen. Details of extra costs for hairdressing and chiropody are paid by cheque to the hairdresser/ chiropodist service by the home -owner and monies deducted from individual residents account records stored at the home. The inspector raised concerns with the registered manager as one resident who was not in credit within the joint account is in essence loaning money from other residents. The registered manager stated and bank statement seen evidenced that the account is a no interest account. Staff spoken with stated that they felt well supported by the manager and staff. No record of supervision was seen on staff files. The manager showed the inspector a supervision document that he is proposing to record meeting for supervision. Accident records were maintained and records of follow up from recorded accidents were well maintained. Records in the accident book were not stored confidentially as required. Fire and health and safety tests and checks were maintained up to date. Lowmoor Care Home DS0000024647.V291457.R01.S.doc Version 5.1 Page 17 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 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 3 2 2 2 3 Lowmoor Care Home DS0000024647.V291457.R01.S.doc Version 5.1 Page 18 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 2 3 Standard OP3 Regulation 17(1) (a) 13(2) 13(2) Requirement The registered person must ensure that all assessments are signed and dated The registered person must ensure that medication is stored securely at all times The registered person must ensure that the medication policy and procedure reflects the practice at the home. The registered person must ensure that the procedures in response to allegations or evidence of abuse include reference to the Local Authority guidance and include action to be taken by staff The registered person must develop a policy and procedure regarding residents monies and financial affairs The registered person shall provide a written programme of maintenance and renewal of the fabric and decoration of the premises The registered person must ensure that the staff rota includes details of what capacity staff are working Timescale for action 17/05/06 25/04/06 25/04/06 OP9 OP9 4 OP18 13 (6) 17/05/06 5 OP18 20(1) 17/05/06 6 OP19 17,(3) 23 (2) 17/05/06 7 OP27 17(2) 17/05/06 Lowmoor Care Home DS0000024647.V291457.R01.S.doc Version 5.1 Page 19 8 OP29 19 (10)(11) 18(1) (c) 9 OP30 10 OP35 20 (1) (a) (b) 11 OP36 18(2) 13 OP37 17(1) (b) The registered person must further develop the recruitment policy and procedure to include NMS and legislation The registered person must ensure that a written programme of training is provided for all staff working at the home The registered person must ensure that residents personal finances are maintained individually and are not used to supplement other residents The registered person must provide an action plan and timescale for the commencement of supervision for all staff. The registered person must ensure that accident records are stored securely as required 17/05/06 17/05/06 17/05/06 17/05/06 17/05/06 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 Refer to Standard OP12 OP13 OP29 Good Practice Recommendations Training in specialist activities, dementia mapping be considered Training in specialist activities, dementia mapping be considered Obtain second reference for staff member employed by previous manager Lowmoor Care Home DS0000024647.V291457.R01.S.doc Version 5.1 Page 20 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. 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