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: 3 0 0 9 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 11 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. Care Homes for Older People Page 3 of 11 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. More recent further concerns have resulted in those contracts once again to be suspended from August 2009. We carried out a Random Inspection on 25th August 2008 to check compliance with the Improvement Plan when we found that some of the requirements were partially completed; we agreed extensions to the deadlines applicable to those requirements and those deadlines expired on 26th September 2009. 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 a Registered Manager from another care home that he owns and a consultant manager whose professional services he is now employing. We had been informed that the previous registered manager had left the employment of the home in the week before the last inspection and the two managers were now working within the home on an extended basis, 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. We were also told that a replacement long term manager had been apppointed, had commenced work at the home during September and had been suspended from her duties on 25th September, following a serious incident of medicines mismanagement. At this inspection, we re-examined the homes policy and procedures in relation to the Safeguarding of Vulnerable Adults in their care, which we had required to be revised, and at the last Inspection 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. We found that these procedures have been revised appropriately and were available in draft form. We also saw a single sheet protocol for staff that described the actions they should take if they suspect an incident of abuse has taken place. This has been put on display in key areas of the home for staffs attention and we saw a written record that the majority of staff have been briefed individually about this protocol. From discussions with one of the consultant managers we confirmed that formal updated training for staff in their responsibilities to recognise and report any suspicions of abuse had not occurred since the last inspection, and were told that this was being arranged with a training agency to take place after other key training planned for October. We feel that there is sufficient evidence to support that requirement four of the Improvement Plan, requirement two of the last inspection report, has been met. We will make a further requirement in respect of staff training as a result of 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 were informed by the consultant managers that since the last inspection the
Care Homes for Older People Page 4 of 11 levels of staff on duty at the home has been substantially increased to improve care standards and to meet resident needs in timely and consistent ways. We noted that the target of twelve care staff on duty throughout the day shifts had been achieved, but that this included regular use of agency staff. Additionally we noted an additional roster for the four people living at the home who are supported on an individual basis for extensive periods of time throughout the day, and that each individual has more regular individual care staff to attend to them. We confirmed that these arrangements have been made because of the special needs, and behaviours that challenge, that this group of people regularly exhibit. We also found that there were four qualified staff on duty during the day shifts, split equally between staff trained in general nursing and staff trained in mental health nursing. Although, as before, this roster included the deputy manager, we feel that the management arrangements of the home currently in place will allow for him to be drawn away from management and administrative responsibilities, from time to time. Our examination of staffing levels at the home would indicate that there is sufficient evidence that requirement five of the Improvement Plan, requirement three of the last inspection report, has been met. At the last inspection visit we reviewed the audits of care records carried out by the consultant managers and 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 also 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 at the home by the homes management from 21st August 2009. At this inspection visit we looked in detail at two care records of people living at the home and briefly at the records of eight others. We found that the review of care plans had been completed in all cases, and were told that the next stage of the managements action plans involved substantially revising the care plans and risk assessments of everybody living at the home and to examine the appropriateness of adopting a new style of documentation. We were also told that the person who had been living at the home for some time and who previously had presented serious concerns about her aggressive behaviours, whom we discussed at the last inspection, had transferred back to hospital for her needs to be reassessed. Our examination of care records would indicate that there is sufficient evidence that requirement six of the Improvement Plan, requirement one of the last inspection report, has been met. At the last inspection visit, we noted that within the care records 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. At this visit we noted this central monitoring document has now been created and holds records commencing in August 2009. We found that there were five records completed for September 2009 and three of these had been reported to the local Adult Social Care Department under statutory safeguarding procedures and also to the Commission under Regulation 37. Our examination of the homes records would indicate that there is sufficient evidence that requirement seven of the Improvement Plan, requirement five of the last inspection report, has been met. From our discussions with the provider about the events precipiting the suspension from
Care Homes for Older People Page 5 of 11 duty of the recently appointed manager and his submission of a full report, we are satisfied that he has acted appropriately throughout in taking steps to secure the health, welfare and sefty of all people living at the home. We did not carry out an audit of medicines at this inspection but were aware that the homes pharmacist was doing so in the afternoon of the visit. We have made a new requirement in relation to this. During our discussions with the homes proprietor and the consultant managers at the last inspection 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 had continued to compound this although we were reassured that these problems had been recognised, taken on board and addressed within the Emergency Action Plan described above. At this inspection visit we noted that, although these problems persisted, steps had been taken to reverse this trend and that progress is being made to address the serious shorfalls in care practice and levels of risk within the home. We also noted that a more detailed Action Plan is being developed and will be discussed at a multi agency meeting with representatives of the home in the near future. The appointment, and then suspension, of a replacement manager has been an unfortunate course of events that can only serve to have had a negative impact on the running of the home, but the confirmation of the two consultant managers in post for an extended period should allow for the development of consistency at the home and support the concluding words of the last inspection report: 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. Because of the current arrangements for the management of the home we feel that requirement four from the last inspection report will be held in abeyance as being not practical for achievement at this point in time. 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
Care Homes for Older People Page 6 of 11 following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 11 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 8 of 11 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 1 9 13 The systems in place for the 30/10/2009 management of medicines at the home must be carried out safely at all times and the recommendations of the recent audit carried out by the homes pharmacist must be compled with. A copy of the report from that audit must be forwarded to the Commission for examination. This is so that the health, welfare and safety of people living at the home is maintained at all times. 2 18 13 All staff working at the home 30/11/2009 must be given instruction or training in relation to their responsibilities for the safeguarding of vulnerable adults and be made fully aware of the homes policies and procedures that relate to this. 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 these policies and procedures. Care Homes for Older People Page 9 of 11 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 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 10 of 11 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 11 of 11 - 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!
