Care Home: Lowdell Close, 186-188

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What the care home does well The majority of records, documents, policies and procedures that were required during the inspection were accessible, accurate and up to date. It was indicated that the home was organised and well run, and that the health, safety and welfare of people were being safeguarded. Overall, the home was found to be clean, hygienic and well maintained. The atmosphere was calm, pleasant and homely. The information available on the needs of the people who use the service in the form of a Person Centred Plan was excellent, proving relevant and detailed information for the guidance of staff. What has improved since the last inspection? Improvements have been made to the home with the exterior woodwork being painted, and the purchase of a new bed for one person. The above-mentioned person centred plans have also been developed since the last inspection. No requirements were identified at the previous inspection. What the care home could do better: Two requirements have been made with regard to improving the environment. A structural assessment of the wall is the lounge is needed and the kitchen lino must be replaced to improve hygiene standards. CARE HOME ADULTS 18-65 Lowdell Close, 186-188 Yiewsley West Drayton Middlesex UB7 8RA Lead Inspector Ms Susan Woolnough-Singh Key Unannounced Inspection 18th November 2008 10:00 Lowdell Close, 186-188 DS0000027064.V371420.R01.S.doc Version 5.2 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 Lowdell Close, 186-188 DS0000027064.V371420.R01.S.doc Version 5.2 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 Adults 18-65. 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. Lowdell Close, 186-188 DS0000027064.V371420.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lowdell Close, 186-188 Address Yiewsley West Drayton Middlesex UB7 8RA 01895 434697 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) pwitter@lod-uk.org.uk lifeopportunitiestrust.co.uk www.lifeopportunitiestr Life Opportunities Trust Mr Paul Jeremy Witter Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Lowdell Close, 186-188 DS0000027064.V371420.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 4 14th December 2006 Date of last inspection Brief Description of the Service: This is a home for four adults with learning and physical disabilities. Two have profound disabilities. Although the home is not purpose built it has all the aids and adaptations people need. It is on two floors and there is a lift. All the bedrooms are single rooms and they are an adequate size for wheel chair users. The home is owned by Ealing Family Housing Association and managed by Life Opportunities Trust. It is on a housing estate and is a long walk to shops and other local amenities. There is a minibus for taking people out of the home. Activities are provided in house and outings are arranged. Two people are taken to a weekly club for people with learning disabilities. The service users socialise with people who live in homes managed by Life Opportunities Trust nearby. There were no vacancies on the day of inspection. Lowdell Close, 186-188 DS0000027064.V371420.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection of Lowdell Close. All of the key national minimum standards for younger adults were assessed. The inspection took place on the 18th November 10am and 16.15 and 20th November between 15.00 and 17.15 During the course of the inspection, the home’s records, policies, procedures and documents were examined and observations were made. On the second visit we were able to talk with one person who lives at Lowdell Close. We met with the Registered Manager and spoke with one support worker with regard to medication policies and procedures in the home. Care support workers were co-operative and provided appropriate assistance throughout the inspection. What the service does well: What has improved since the last inspection? Improvements have been made to the home with the exterior woodwork being painted, and the purchase of a new bed for one person. The above-mentioned person centred plans have also been developed since the last inspection. No requirements were identified at the previous inspection. Lowdell Close, 186-188 DS0000027064.V371420.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Lowdell Close, 186-188 DS0000027064.V371420.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lowdell Close, 186-188 DS0000027064.V371420.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of people using the service are appropriately assessed prior to admission. EVIDENCE: Assessments that had been submitted to the home by placing Authorities in relation to people using the service were within the persons care records. All of the people living at Lowell Close had done so for a number of years and since the home had opened. There were no new needs led assessments to be viewed. Lowdell Close, 186-188 DS0000027064.V371420.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments are being appropriately drawn up and people are assisted with making decisions, where possible. The presentation and content of the person centred plans is excellent. EVIDENCE: The care records of two people who use the service were looked at in detail. The documents seen were the care plan, health action plan and person centred plan. The health action plan is covered in standard 18. The care plan files seen contained information and guidance on the person’s needs and how these would be met. The information had been reviewed and updated recently. Lowdell Close, 186-188 DS0000027064.V371420.R01.S.doc Version 5.2 Page 10 The person centred plans seen were excellent. Person centred plans had been completed for the three people who are not able to communicate their needs and wishes verbally. The plans are clear and very detailed; a photograph of each person is on the front of the plan. The person centred plan covers the daily routine for the individual and how certain areas of support are to be given; for instance the preferred position a person may like when lying down and their character traits. Reference is made to people’s likes and dislikes and social activities. People at Lowell close do not have high- risk life styles, they all need support with daily living and three people have high dependency needs and need support with eating and personal care. We viewed a range of risk assessments that covered guidance on maintaining a safe environment for people. Risk assessments on moving and handling, fire safety, and daily activities. Lowdell Close, 186-188 DS0000027064.V371420.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People participate in appropriate activities and contact with relatives and/or friends are being maintained. Varied and wholesome meals are provided to people who use the service. EVIDENCE: People are supported by staff in their daily routines. During the day people attend a day centre, with one day off a week when they usually go out with a member of staff. We were able to talk with one person about life in the home and daily routines. He/she said that they attend the day centre and visit family regularly. When asked he/she indicated that the food is good and the staff are nice. Lowdell Close, 186-188 DS0000027064.V371420.R01.S.doc Version 5.2 Page 12 People have a range of leisure activities. For instance; shopping trips and meals out, people also attend special evening clubs. One person has aromatherapy twice a month. The care plan and person centred plan cover people’s daily and weekly activities. We looked at the menu chart for three weeks. The menus were reflective of varied and nutritional meals being provided to people who use the service. Lowdell Close, 186-188 DS0000027064.V371420.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The personal and health care needs of people are being met satisfactorily. The home’s policy and procedures on medication are appropriately detailed. EVIDENCE: We were able to look at the Health Action Plan for two people. All of the people who use the service have these. These cover the support required for personal care as well as a plan of care for physical and emotional wellbeing. People receive personal care in the privacy of the bedroom or bathroom. Separate health care needs were identified within care plans. A record to monitor health care professional visits and appointments is made. We were able to see from this that people have appointments with GPs, Physiotherapists, Occupational Therapists and District Nurse. Regular dental and optical checks are arranged. Lowdell Close, 186-188 DS0000027064.V371420.R01.S.doc Version 5.2 Page 14 The home’s medication policy was in place. We were able to look at the storage and administration of medication. Medication is provided and administered using a monitored dosage system provided by a national pharmacy chain. Additional medication is available in liquid form this is dated when opened. A separate record is made for the use of prescribed laxative liquid, this is to enable to Registered Manager to monitor the frequency of use of this PRN Medication. We looked at the medication administration record and found this in order. The storage, disposal and administration of medicines were satisfactory and medication reviews were carried out on an annual basis. We were able to see the Medication Administration Policy. We ascertained that the service users lacked the capacity to self-administer their own medication. Lowdell Close, 186-188 DS0000027064.V371420.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure is satisfactory and policies and procedures are in place to safeguard vulnerable adults. EVIDENCE: The complaints procedure was clearly written and concise. Life Opportunities Trust has a policy on Safeguarding Adults. The London Borough of Hillingdon multi agency safeguarding adult’s policy is also available in the home. No complaints had been made to the home following the last inspection. No safeguarding adults issues had been referred or recorded. Staff receive training on the protection of adults from the London Borough of Hillingdon safeguarding adults department. We were also informed that protecting adults forms part of the new staff induction process. The records were indicative of training on the protection of vulnerable adults being delivered to the care support workers. Personal allowances are safeguarded at the home. We discussed with the Registered Manager the administration and safeguards in place for peoples finances. Daily transactions for personal needs are made; checking and recording procedures are in place for these. Lowdell Close, 186-188 DS0000027064.V371420.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26,27,28,29, and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is safe, pleasant and well maintained. People who live in the home have comfortable bedrooms and satisfactory facilities. The positive inspection received from the Environmental Health department indicated that standards of overall food hygiene in the hone are at the required standard. However two requirements have been made with regard to replacement flooring for the kitchen and a remedy for the hairline wall cracks in the lounge. EVIDENCE: We were able to tour the building with a member of staff. People’s bedrooms are individualised and adapted to suit their needs for physical support. One person had just had a new bed delivered; which enables him/her to be positioned comfortably. The necessary tracking is fitted on the ceiling for hoists. Since the last inspection external woodwork has been painted. Lowdell Close, 186-188 DS0000027064.V371420.R01.S.doc Version 5.2 Page 17 No issues were identified in relation to the laundry, which looked clean and well managed. The communal areas at the home were adequately spacious, comfortably furnished and suitable for shared or individual activity. . There were some areas of improvement identified in discussion with the Registered Manager. An environmental Health Inspection had taken place by London Borough of Hillingdon. The home was awarded four stars(very good) Despite this there was one contravention; it was noted that the lino by the fridge is split/damaged and not impervious. This floor covering needs to be replaced. We were able to see that some structural damage has appeared in the lounge/dining room, this takes the form of hairpin cracks to the wall and requires a structural survey and remedy. We were informed that structural renovations to the home might have contributed to this. Overall, the home was found to be clean, hygienic and well maintained. The atmosphere was calm, pleasant and homely. Lowdell Close, 186-188 DS0000027064.V371420.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care support workers are suitably trained and qualified for meeting the needs of the service users. The policies and procedures relating recruitment are satisfactory. EVIDENCE: On arrival on the first day of the inspection three members of staff were on duty and one person was at home. On the second day two staff were on duty in the afternoon with one person at home. Three staff were on duty when people arrived home from the day centre. We looked at the weekly rota for staff; from 9th November to 22nd November. We were able to see that generally there are two or more staff duty during waking hours with one member of night staff. On two occasions there was only one person on the evening shift. The staff rota is changed as required and not clear to decipher especially the agency cover. Lowdell Close, 186-188 DS0000027064.V371420.R01.S.doc Version 5.2 Page 19 We received a copy of the staff profile. The staff team consists of the Registered Manager, two senior care workers and three care workers. There are three night care workers. There are currently two vacancies. Agency staff are employed to cover vacancies for care workers. Staff receive induction training when they commence employment. On the second day of the inspection we met a member of staff who is part of the Life Opportunities Trust relief team. The member of staff reported that she had received induction training and was aware of the Whistle Blowing Policy, which is kept in the policies file. The Registered Manager had given medication training. It was evidenced on Training Certificates that staff training delivered during 2007/08. It was reflected on training records that four care support workers had achieved level 2 National Vocational Qualification in care. Two senior members of staff had commenced National Vocational Training Level 3. We were able to see a spreadsheet, which indicated that staff are receiving regular one to one supervision. We looked at the personnel files/recruitment files of two members of staff. These contained the required information including identify verification, criminal records bureau checks and references. Lowdell Close, 186-188 DS0000027064.V371420.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Registered Manager is appropriately qualified. Quality assurance exercises have been carried out satisfactorily. The safety and welfare of the service users are being safeguarded. EVIDENCE: The Registered Manager and Deputy Manager have completed the National Vocational Qualification Level 4; the Manager has the Registered Managers award. Lowdell Close, 186-188 DS0000027064.V371420.R01.S.doc Version 5.2 Page 21 The London Borough of Hillingdon had recently reviewed the home; we were able to see the report and that the report was positive with no concerns with regard to care in the home at the time of the inspection. The Annual Quality Assurance Assessment had been completed; this identified how the home is meeting the National Minimum Standards, improvements since the last inspection and areas for future improvement. A monthly quality assurance monitoring form is in place, this covers care plans, policies and procedures, leisure activities and health and safety. We were able to see that a full range of environmental risk assessments had been completed including a fire risk assessment for the premises. We looked at the fire safety records and were able to see that weekly fire alarm testing had taken place. Fire equipment had been maintained and serviced. The London Fire and Civil Defence Authority had inspected the premises on 18/01/08 and the premises had been deemed to comply with the required standards. Information included on the Annual Quality Assurance Assessment indicated that electrical, gas and fire appliances/equipment had been serviced in 2008. Lowdell Close, 186-188 DS0000027064.V371420.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 3 3 X 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 3 3 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x x 3 Lowdell Close, 186-188 DS0000027064.V371420.R01.S.doc Version 5.2 Page 23 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 Standard YA24 YA24 Regulation 4 (a) 4 (a) Requirement The Registered Provider must ensure he Lino in the kitchen must be replaced. The Registered Provider must ensure that the hairline cracks in the lounge/dining room are surveyed and a remedy identified. Timescale for action 01/01/09 01/02/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Lowdell Close, 186-188 DS0000027064.V371420.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: 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 © 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 Lowdell Close, 186-188 DS0000027064.V371420.R01.S.doc Version 5.2 Page 25 - 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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