Random inspection report
Care homes for older people
Name: Address: Lowmoor Care Home Lowmoor Road Kirkby In Ashfield Nottinghamshire NG17 7JE two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Brian Marks Date: 2 5 0 8 2 0 0 9 Information about the care home
Name of care home: Address: Lowmoor Care Home Lowmoor Road Kirkby In Ashfield Nottinghamshire NG17 7JE 01623752288 01623752288 Lowmoorcarehome@msn.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Lowmoor Nursing Home (Kirkby) Limited care home 50 Number of places (if applicable): Under 65 Over 65 0 50 dementia mental disorder, excluding learning disability or dementia Conditions of registration: Date of last inspection Brief description of the care home 50 0 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 and 5 double bedrooms; 10 of which are en-suite. However, it has been the recent policy of the home to only offer single accommodation so the current maximum people living at the home would be 45. The home has an enclosed garden and a car
Care Homes for Older People Page 2 of 12 Brief description of the care home park for visitors and staff and there is a passenger lift linking the two floors of the home. There are lounges on the ground and first floor and bathrooms are fitted with adapted facilities. Information about the service is provided in the statement of purpose and service user guide, which are given to people at the start of their stay at the home. The current range of fees at the time of this inspection is #348 to #476 per week, as specified by the registered manager. There are additional costs for hairdressing and chiropody. Care Homes for Older People Page 3 of 12 What we found:
The purpose of this Random Unannounced Inspection was to check compliance with the Improvement Plan, previously issued on 16th March 2009 and the providers response that we received back on 21st April 2009. The requirement for this Improvement Plan was made against the backdrop of major concerns, shared with other local statutory agencies at a number of meetings held under Safeguarding Procedures, about the homes capability to properly meet the needs of and to protect the people in its care. Contracts with the key commissioning authorities were suspended from January until May 2009 as a result of these concerns. Our last Key Inspection took place on 22nd July 2008. We met with the homes proprietor, Dr J Lidder, during this inspection and he was accompanied by two Registered Managers from other care homes professionally linked to his organisation. We were informed that the previous registered manager had left the employment of the home in the week before the inspection and the two managers had agreed to spend some time at the home assisting the proprietor to address a number of operational issues that had become apparent with the departure of the former. We refer to the latter as the consultant managers throughout this report. Before the inspection we had received updated copies of the homes Statement of Purpose, Service Users Guide and Admissions Policy and Procedures. We had required that these be extensively revised so that the criteria for admission to the home were explicit and everybody involved with making an application for accommodation and care at the home could be clear about their rights and responsibilities, and about the capability of the home and its staff to provide the right forms of support. Within this we required much clearer clinical definitions of the terms dementia and challenging behaviour. Within the Service Users Guide we required an updated reference to the contact details of the relevant statutory authourities to be contained within the homes complaints procedure. Our examination of these documents proved them to be satisfactory and we found that complaince with Requirements 1, 2 and 3 of the Improvement Plan had been achieved. We also examined the homes policy and procedures in relation to the Safeguarding of Vulnerable Adults in their care, which we had required to be revised. However we found that the procedures described within this document did not meet the requirements of local statutory protocols in relation the timeliness of reporting any suspicions to the Adult Social Care Department of the Local Council. This matter was discussed with the consultant managers during this inspection. We also noted that the homes staff had not received any updated training or instruction in their responsibilities to recognise and report any suspicions of abuse since October 2008. During this inspection we looked at a number of documents related to the staffing arrangements at the home and examined the staff rosters for qualified and care staff for the current and previous weeks. We noted that the target of eight care staff on duty throughout the day shifts had been achieved, but that this included regular use of agency staff to cover the four vacancies currently existing at the home and that five people living at the home are supported on an individual basis for extensive periods of time throughout the day. The latter arrangements have been made because of the special needs, and behaviours that challenge, that this group of people regularly exhibit. We also found that,
Care Homes for Older People Page 4 of 12 although there were two qualified staff on duty during the day shifts, this frequently included the deputy (now acting) manager, drawing him away from management and administrative responsibilities. In the light of the range of management issues identified following the departure of the previous manager we feel that those responsibilities are in danger of not being met. Our examination of staffing levels at the home would indicate that there is little evidence that requirement five of the Improvement Plan has been met. The care records, of somebody who had come to live at the home since the suspension of the homes contracts had been lifted, were examined in detail, and we also looked at others relevant to our discussions with the consultant managers about standards of clinical and care practice at the home. Whilst the standard of documentation of the former was generally satisfactory it was clear that his care records had only been evaluated and reviewed once since his admission in May 2008. This is of particular concern as his condition and behaviour had seen considerable fluctuations since his admission. When we reviewed the audits of care records carried out by the consultant managers it was clear that standards of clinical practice and the completion of routine nursing and care activities for a number of people living at the home had deteriorated considerably. This was since the response to our Improvement Plan had been returned. We were told that an urgent review of the care plans of everybody living at the home had been commenced and that this was part of an Emergency Action Plan that had been put into operation by the homes management from 21st August 2009. We also looked at the file of one person who had been living at the home for some time and who previously had presented serious concerns about her aggressive behaviours, and we noted that a resolution of those behaviours had not been achieved and that she continued to place other people living at the home in a vulnerable position. We also looked at the care records of somebody who had come to the home in May 2009 and since that time had sufferred considerable weight loss that had not been addressed by the staff at the home. She had recently been referred to the Local Adult Social Care Department for investigation under the statutory Safeguarding Procedures referred to above. Our examination of care records would indicate that there is little evidence that requirement six of the Improvement Plan has been met. Within the care records we looked at, we noted that untoward incident forms had been completed to describe a number of instances of aggressive or disturbed behaviour that the individuals had carried out, either towards staff or other people living at the home. These had been recorded in individual files only and had not been collated, audited or analysed within a central monitoring document. Given that this feature has been a critical cause for concern about the homes operation, it is clear that the safety of the more vulnerable people living at the home has continued to be placed at risk. It is also clear that actions taken by the homes management has not limited these occurrences since concerns were raised earlier this year, and raises serious questions about the homes capacity and capability to continue with the current categories of registration. Our examination of the homes records would indicate that there is little evidence that requirement seven of the Improvement Plan has been met. During our discussions with the homes proprietor and the consultant managers it was clear that the performance of the home during recent months has exposed serious flaws in communication between groups of staff at the home, and that levels of accountability for and the quality of auditing of care activities diminished. The lack of leadership and the absence of a manager has continued to compound this although we were reassured that these problems have been recognised, taken on board and addressed within the
Care Homes for Older People Page 5 of 12 Emergency Action Plan described above. We were told about the changes that needed to be made to management systems that ensures they indentify and react to problems in service delivery as they occur. We agreed that a move from a reactive to a more proactive style of management needs to be made, and that the real test for the home will be sustainability of improvements in the longer term. What the care home does well: What they could do better: 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 set out on page 2. Care Homes for Older People Page 6 of 12 Are there any outstanding requirements from the last inspection? Yes £ No R 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 7 of 12 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, 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 7 15 The care plans of all people 26/09/2009 living at the home must be reviewed and revised, along with other care documentation that is designed to help staff manage the hazards and risks that are confronted by the people living at the home. The revisions must reflect the complexity of the needs of people living at the home. Additionally the homes management must formally submit a copy of the Emergency Action Plan dated 21st August 2009 to the Commission and indicate how all of the activities listed in it will be carried out and within identified timescales. This so that all the social, physiological and healthcare needs of the people living at the home are described in full and that their health, welfare and safety is maintained at all times. Care Homes for Older People Page 8 of 12 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 2 18 13 The homes policies and 26/09/2009 procedures in relation to safeguarding of vulnerable adults must be revised to reflect the Nottingham and Nottinghamshire multi agency policy and procedures currently in use. Clear internal guidelines to staff working at the home that relate to their responsibilities to Alert and Report must be included in these revisions. All staff working at the home must be given intruction or training in relation to these policies and procedures. This is so that the guidance given to all staff working at the home makes clear their responsibilities to Alert and Report any instances occurring at the home that might be considered under the Policy and Procedures. 3 27 18 The levels of staff working at 26/09/2009 the home and their deployment and supervision around the building at any time must be reviewed. There must be at least two qualified nursing staff on duty during the day shifts and at the times when there is not a Mental Health trained nurse (RMN) on duty, then clear guidelines must be established as to how they are to gain specialist advice and support when they need
Page 9 of 12 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 it. This is so that the health, welfare and safety of residents is maintained at all times. 4 31 8 A manager must be 26/09/2009 appointed to run the day to day operation of the home and the homes owners must work closely with that person within clearly established guidelines. This is to ensure that all of the issues outlined in this report are addressed in an ongoing way and so that leadership and professionalism are restored to the homes operation. 5 33 17 Any instances of untoward, 26/09/2009 violent or disturbed behaviour that occur at the home and which adversely affect the well being or safety of people living at the home must be fully recorded within the homes records, brought to the attention of and discussed with the senior officers of the home and reported to all of the appropriate statutory agencies including the Commission. This is so that the health, welfare and safety of residents is maintained at all times, so that patterns of such incidents can be
Care Homes for Older People Page 10 of 12 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 monitored and to comply with the requirements of the law. 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 Care Homes for Older People Page 11 of 12 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 12 of 12 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
