Care Home: Lowdon House

What the care home does well The information gathered before admission was sufficiently detailed, providing staff with a clear picture of each individual, so they were confident that the assessed needs of each person could be adequately met. The plans of care were detailed and well written providing staff with guidance about how the assessed needs of people living at the home were to be met and how people were to be supported to live a lifestyle of their choice.One recently admitted resident said that living at the home had, "been brilliant for me". This person went on to say that he had been fully involved in the pre admission assessment and in the development of his individual care plan. The routines of the home were flexible and encouraged residents to be independent and have control over there lives. This promoted equality and diversity and encourage people who live at the home to make decisions and choices for themselves. Residents spoken with felt that they were well supported and that they had a good relationship with the staff team. What has improved since the last inspection? Since the last inspection the form used to record complaints has been reviewed and updated. This now provides a clear record of how any complaint received would be investigated and of any action taken as a result of the complaint. All but one member of staff has now achieved a nationally recognised qualification in care at a higher level. This will help to make sure that a good quality service is provided and ensure that staff are competent to undertake their role. In addition to questionnaires for residents, a questionnaire has now been developed for other people who have an interest in the home. This encourages people such as relatives, social workers, and community psychiatric nurses to have their say about how the home is run and whether it meets the needs of people living there. As recommended at the last inspection, the induction training package provided to newly appointed care staff has now been updated and is compliant with the national induction standards for care staff. What the care home could do better: Although the pre admission assessment is detailed to make sure that the home can provide the level of support required, the prospective new resident should be informed in writing that the home can meet their needs. The manager said that in the future, any new resident would receive written confirmation before they become resident at the home. At the time of the first visit to the home, some records were not available to evidence. There is a requirement that all records must be kept at the home and be available for inspection at all times.Some improvement could be made to the way medication is recorded. This would make sure that all hand written information is correctly recorded and ensure that the medication administration record is completed correctly. CARE HOME ADULTS 18-65 Lowdon House 12 Bairstow Street Preston Lancashire PR1 3TN Lead Inspector Denise Upton Unannounced Inspection 31st December 2007 & 21 January 2008 09:30 st Lowdon House DS0000009837.V351271.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 Lowdon House DS0000009837.V351271.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. Lowdon House DS0000009837.V351271.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lowdon House Address 12 Bairstow Street Preston Lancashire PR1 3TN 01772 258313 01772 258313 joanlowdonhouse@aol.com 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) Mrs Joan Smith Mrs Joan Smith Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6) of places Lowdon House DS0000009837.V351271.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th October 2006 Brief Description of the Service: Lowdon House is a terraced property situated close to the centre of the city and within easy reach of community resources and facilities. These can be accessed independently or with the assistance of staff. The home is registered to accommodate up to six residents with a history of mental illness that do not require nursing care. Lowdon House provides accommodation over two floors and all residents are accommodated in individual bedroom accommodation. Although bedroom accommodation is not provided with an en-suite facility, bathing and toilet facilities are sufficient in number and located close to communal areas of the home and bedroom accommodation. Although the majority of residents smoke in communal areas, the home has attempted to provide a none smoking environment in the dining room and conservatory although this is dependent on the cooperation of residents. Lowdon House is a smaller family type establishment with the homeowner providing care and support supplemented by a small nucleus of staff. In consequence, resident’s needs and preferences are well known and therefore more easily addressed. Social activity is determined in accordance with the collective and individual wishes of residents accommodated. The current charge for residential care at Lowdon House is £329.00 per week. Lowdon House DS0000009837.V351271.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced site visit took place during the course of two separate midweek days, three weeks apart. On this occasion, the timing of the 2nd site visit was unavoidable. In total, the site visits spanned a period of approximately seven hours. Twenty-three core standards of the forty-two standards identified in the National Minimum Standards-Care Homes For Adults were assessed along with a partial re-assessment of the recommendations identified in the last inspection report. The inspector spoke with the registered homeowner/manager, the deputy manager and two senior care assistants. In addition, individual discussion took place with one of the people living at the home and the remaining residents were also briefly spoken with collectively in a communal area of the home. A number of records were examined and a partial tour of the building took place that included communal areas of the home, laundry and some bedroom accommodation. Some limited information was also gained from the Annual Quality Assurance Assessment completed by the registered manager. In addition, all residents and a number of relatives also completed a Commission for Social Care Inspection survey forms that helped to form an opinion as to whether resident’s needs and requirements were being met. This key inspection focused on the outcomes for people living at the home and involved gathering information about the service from a wide range of sources over a period of time. What the service does well: The information gathered before admission was sufficiently detailed, providing staff with a clear picture of each individual, so they were confident that the assessed needs of each person could be adequately met. The plans of care were detailed and well written providing staff with guidance about how the assessed needs of people living at the home were to be met and how people were to be supported to live a lifestyle of their choice. Lowdon House DS0000009837.V351271.R01.S.doc Version 5.2 Page 6 One recently admitted resident said that living at the home had, “been brilliant for me”. This person went on to say that he had been fully involved in the pre admission assessment and in the development of his individual care plan. The routines of the home were flexible and encouraged residents to be independent and have control over there lives. This promoted equality and diversity and encourage people who live at the home to make decisions and choices for themselves. Residents spoken with felt that they were well supported and that they had a good relationship with the staff team. What has improved since the last inspection? What they could do better: Although the pre admission assessment is detailed to make sure that the home can provide the level of support required, the prospective new resident should be informed in writing that the home can meet their needs. The manager said that in the future, any new resident would receive written confirmation before they become resident at the home. At the time of the first visit to the home, some records were not available to evidence. There is a requirement that all records must be kept at the home and be available for inspection at all times. Lowdon House DS0000009837.V351271.R01.S.doc Version 5.2 Page 7 Some improvement could be made to the way medication is recorded. This would make sure that all hand written information is correctly recorded and ensure that the medication administration record is completed correctly. 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. Lowdon House DS0000009837.V351271.R01.S.doc Version 5.2 Page 8 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 Lowdon House DS0000009837.V351271.R01.S.doc Version 5.2 Page 9 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. There is a clear and detailed system in place to make sure that the home can meet the needs and requirements of a prospective new resident. However this information must be confirmed to the prospective resident in writing. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Lowdon House has a good system in place, which ensures that a thorough assessment of current strengths and needs takes place before a new resident is admitted. This process also incorporates the outcomes of other recent multi disciplinarily assessments including a copy of the Care Programme Approach (CPA) care plan and risk assessment. This detailed and comprehensive pre admission assessment process ensures that the prospective resident’s strengths, needs, wants and wishes were known and also to confirm that the level of care and support required could be provided. Lowdon House DS0000009837.V351271.R01.S.doc Version 5.2 Page 10 Since the last inspection, one new resident had been admitted to the home. In addition to the health and social care assessments already provided, a member of staff at Lowdon House had completed a further comprehensive assessment of strengths and needs/risk assessments that also included detailing the future wishes of the new resident. The prospective resident confirmed that he had been fully involved throughout this process and had signed all the assessment forms and records as acknowledgement, understanding and acceptance of the contents. The recently admitted resident also explained that he had visited Lowdon House on several occasions prior to becoming resident and that sufficient written and verbal information had been provided to make an informed choice. A contract of residency was evidenced that had been signed and dated. This resident was very pleased to be at Lowdon House and said that living at the home “has been brilliant for me”. Although a good pre admission assessment had taken place to ensure that the home could meet needs and expectations, the new resident had not been informed of this in writing. There is a requirement that when a pre admission assessment has been completed, the outcome of the assessment must be provided to the prospective resident in writing. Lowdon House DS0000009837.V351271.R01.S.doc Version 5.2 Page 11 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, & 9 Quality in this outcome area is good. There were good arrangements to ensure that residents were properly consulted about their care. Residents had choice and control over their lives because staff respected their rights to make independent decisions and take responsible risks. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the course of the inspection, two resident were ‘case tracked’. This involved looking carefully at all the information that is kept by the home regarding the help, encouragement and support required, to ensure that the resident can enjoy the lifestyle of his choice. Lowdon House DS0000009837.V351271.R01.S.doc Version 5.2 Page 12 The care plans observed were detailed and provided a clear description of the level of support and assistance required. One recently admitted resident said that he had been fully involved in developing his care plan and his Social Worker was also aware of the content. All care plans are rewritten on an annual basis with a formal review of the care plan, taking place after six months. However it is understood that with regard to a recently admitted resident, although significant change had taken place, the original care plan had not been updated. Although staff were clearly aware of the changed needs of this resident, any changes should have been immediately amended on the care plan. The individual care plan incorporated elements of the Care Programme Approach care plan, clear and appropriate risk assessments are in place and residents are encouraged to maximize their potential. Residents are provided with verbal information on how to protect their own personal safety to avoid limiting the resident’s choice. The home has a good record for dealing promptly with any unexplained absences of residents. During the course of the first visit, resident’s written care plans were not available in the home. Whilst it is quite acceptable for care plans to be held in an electronic form, all staff must have access to the individual care plan. In addition all documents/records required by Regulation must be kept at the home and available for inspection at any time. Residents spoken with all said that they always made their own decisions about what they want to do each day. Resident’s are also enabled and encouraged to manage their own financial affairs. However in instances when a resident requires assistance, the support provided is properly recorded then signed and dated by the resident and two members of staff. All residents at Lowdon House are encouraged to make their own life style decisions and that right is only limited by individual risk assessment findings. Prior to admission, the multi disciplinary Care Programme Approach care planning meetings had identified risks and risk management strategies had been agreed. This is supplemented by ‘in-house’ risk assessments that are regularly reviewed. Lowdon House DS0000009837.V351271.R01.S.doc Version 5.2 Page 13 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, & 17 Quality in this outcome area is good. Flexible routines encourage residents’ choices and control over their lives. Social activities are determined individually to provide daily variety and interest. Staff promote resident’s contact with family and the local community to ensure social relationships are maintained. Residents enjoyed of meals of their choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As at the last inspection none of the residents at Lowdon House are seeking paid employment. However four of the six residents continue to attend a therapeutic workplace for up to five days a week. One resident is also attending a computer course and enjoying a walking group one day a week. Lowdon House DS0000009837.V351271.R01.S.doc Version 5.2 Page 14 Another person living at the home visits the library on a regular basis and a further person chooses to spend some time painting in his bedroom. A number of residents had chosen to enjoy a foreign holiday with some members of staff. Activities arranged within the home are limited with people preferring to access the local community facilities independently. Some residents used to enjoy going to the pub but this has been curtailed because of the no smoking ban. However two residents did attend a quiz that was enjoyed and a concert at the Guild Hall is being arranged for the New Year. Residents said that they got on well and supported each other, but had privacy and could be alone in bedrooms when they wished. One resident said that he was enjoying “a stable home and the company”. Residents who choose are registered on the electoral register and can independently visit the polling station. Social relationships are always encouraged. Family and friends can visit the home at any time of the resident’s choice. Likewise, residents are enabled and encouraged to maintain family and friendship links and visit their relatives and friends on a regular basis. One relative wrote on a Commission for Social Care Inspection (CSCI) survey form, in answer to the question, ‘Does the care service support people to live the life they choose’, that “As people have different needs and some people have different lives, I find that Joan and her staff do their best to support them”. As at previous inspections, all residents and staff are racially and culturally similar. However in the past the home has accommodated residents with differing diversity needs that have been respected and accommodated. Residents spoken with all felt that they were well supported and that they got on well with the staff team. People living at the home continue to be physically able with independent mobility. Bathrooms and individual bedroom accommodation is fitted with a locking facility with the resident retaining the key to their individual bedroom accommodation. Residents are also provided with a key to the front door if they so wish. The relationship observed between staff and residents was again seen to be relaxed and comfortable with residents deciding whether to participate in an activity or enjoy the privacy of their individual bedroom accommodation. Residents spoken with enjoyed the meals served. Although there is a menu available, meals are generally determined by what resident’s would like to eat on any particular day. One person explained that residents are asked if they would like the planned meal of the day but if this was declined, the resident had a more or less free choice of what to eat. In reality each resident could be eating something different at each mealtime. Lowdon House DS0000009837.V351271.R01.S.doc Version 5.2 Page 15 Meals are varied and generous and specialist diets in respect of religious, cultural or medical need could be accommodated. As observed, hot and cold drinks are available throughout the day. There is a small kitchen area in the dining room with a kettle for residents to use as and when they wish. Residents were seen to be making good use of this facility. Lowdon House DS0000009837.V351271.R01.S.doc Version 5.2 Page 16 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 & 20 Quality in this outcome area is good. Residents’ personal and healthcare support needs are identified and met in a manner that respected privacy, dignity and independence. Medication is generally well managed to ensure resident’s medication needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents at Lowdon House continue to be mainly self-caring and at most only require prompting and encouragement in order to undertake personal care tasks. Residents spoken with said staff were helpful and supportive with healthcare needs. Staff accompanied residents to outpatient, dental and General Practitioner (G.P.) appointments when required and generally support residents with their physical and mental health needs. Residents are also assisted with lifestyle support as identified on the individual care plan that is determined by the strengths, needs, wants and wishes of each individual. Routines within the home are flexible to accommodate individual requirements. Lowdon House DS0000009837.V351271.R01.S.doc Version 5.2 Page 17 One relative had written, “They attend their reviews with the doctors, social workers and myself. If Joan and her staff think that there is a problem, they contact me and keep me informed”. The active involvement of Community Psychiatrist Nurses and Mental Health Social Workers is available when required. The home maintains links with the local psychiatric services that will provide staff with advice as needed. Medication practices observed were safe and in the main good records had been maintained. The staff members responsible for the administration of medicines had received training to ensure they had basic knowledge of how medicines are used and how to recognise and deal with problems in use. However the two senior carers spoken with explained that the medication training undertaken had taken place some time ago. In order to ensure current best practice principles are applied, consideration should be given to arranging for staff with responsibility for the administration and recording of medication to receive updated medication training. Although it appeared that medication had been given as prescribed, it was noted that there were occasional dose omissions without explanation on the drug administration records observed. This suggests that the drug administration record is not being completed immediately after the medication has been given. It is essential that the drug administration records be completed immediately after each individual resident’s medication has been given in order to provide accurate record of the drugs administered and to provide a clear audit trail. There still remains one outstanding recommendation from the last two inspections. This recommendation is in respect of double-checking any hand written medication records on the drug administration sheets. These should be recorded by one member of staff and countersigned by a second member of staff to confirm accuracy. It is strongly recommended that all hand written medication records be double checked and signed by two staff signatures to confirm that an accurate record has been maintained. Lowdon House DS0000009837.V351271.R01.S.doc Version 5.2 Page 18 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 & 23 Quality in this outcome area is good. The home has a robust complaints procedure, so residents can be confident that any complaints would be taken seriously and acted upon. An appropriate vulnerable adults policy and procedure and staff training ensured that people living in the home are protected from risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of this site visit, no complaint’s had been received by the home or The Commission for Social Care Inspection since the last inspection. Residents are encouraged to voice any concerns or complaints immediately so that issues can be discussed and addressed. Residents accommodated continue to be vocal in their approach to resolving issues and prefer this option to raising any formal complaint. However a resident spoken with was aware of the written formal complaint information and where this could be located in the home. It was clear that he knew whom he would speak with if he did have a complaint. This same person did say that he had had occasion to speak with the homeowner once about a matter and this had been dealt with straight away and addressed to his satisfaction. Lowdon House DS0000009837.V351271.R01.S.doc Version 5.2 Page 19 The home has a procedure in place for dealing with allegations of abuse. The manager and staff have a good understanding of the procedures to be followed in the event of any allegations or suspicion of abuse or neglect. All staff have received adult protection training that included abusive practices and how to recognise these. Adult protection training had also been covered during National Vocational Training (NVQ). Lowdon House DS0000009837.V351271.R01.S.doc Version 5.2 Page 20 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 & 30 Quality in this outcome area is good The standard of the environment in this home is satisfactory in providing residents with a comfortable and homely place to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Lowden House is an older type of terraced property that is in keeping with the local neighbourhood. The home is situated in close proximity to the city centre and local facilities and services that suits the personal and lifestyle needs of residents accommodated. Furnishings are comfortable and residents spoken with said they were satisfied with their bedroom accommodation and the communal areas of the home. Lowdon House DS0000009837.V351271.R01.S.doc Version 5.2 Page 21 Residents currently accommodated are all independently mobile with no physical mobility difficulties. People who are wheelchair users cannot be accommodated. All service users are provided with individual bedroom accommodation. Although bedroom accommodation does not provide an ensuite facility there are sufficient bathroom and toilets available. In order to promote independence, residents are encouraged to attend to their own washing or other domestic tasks, with the assistance of staff as required. Since the last inspection the laundry area, located in the basement of the home has been tided up and is now less cluttered. The Annual Quality Assurance Assessment (AQAA) confirmed that the majority of staff have received infection control training. Since the last inspection new double glazed windows have been fitted to some windows at the back of the property. Lowdon House DS0000009837.V351271.R01.S.doc Version 5.2 Page 22 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, 35 & 36 Quality in this outcome area is good. The deployment of staff is sufficient to meet the needs of residents. The home’s recruitment procedures are robust and these provide safeguards for the protection of residents. Staff are trained and competent to do their jobs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As stated in previous reports, Lowdon House is a smaller family type care home with a very stable staff group who have worked at the home for an extended period of time. The staff know the needs and requirements of each individual resident very well and the relationship observed between staff and residents was very positive. One resident said the staff were, “Brilliant, they will do anything for you, if you have a problem they will sort it out”. Staffing levels were sufficient for the number of residents living at the home. Residents confirmed that they always received the level of support required. Lowdon House DS0000009837.V351271.R01.S.doc Version 5.2 Page 23 Observation of the staff training records confirmed that all but one member of staff has now completed at minimum a nationally recognised, National Vocational Qualification (NVQ) in care at Level 3. This is commendable. The remaining member of staff only works a few hours one day a week and has been told that she cannot access NVQ training because of this. In addition, the deputy manager has commenced that Registered Managers Award. This is a qualification that all managers of care homes are expected to achieve. It is understood that a second member of staff is also considering undertaking this qualification. Since the last inspection no new members of staff have been appointed. However examination of records during previous inspections showed good systems were in place for obtaining relevant documentation for staff members employed by the home ensuring the protection of residents. As recommended at the last inspection, the home’s induction training programme is now compliant with the ‘Skills for Care’ induction training standards for newly appointed care staff. By undertaking this basic training, staff are equipped to provide a satisfactory standard of care. As identified at numerous previous inspections, staff supervision is informal and conducted as part of the routine day-to-day management role. However, all staff received formal appraisals at six monthly intervals. In order to supplement the formal appraisal process and as recommended in several last inspection reports, formal documented supervision should be introduced and take place at least six times a year in order to support staff and provide an opportunity for individual discussion. Lowdon House DS0000009837.V351271.R01.S.doc Version 5.2 Page 24 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 & 42 Quality in this outcome area is good. The homeowner/manager is well supported with all staff demonstrating a good awareness of their role and responsibilities. The home reviews aspects of its performance through a programme of selfreview and consultation with residents, staff and other stakeholders. Systems are in place to ensure as far as possible the health and safety of residents, staff and visitors. This judgement has been made using available evidence including a visit to this service. Lowdon House DS0000009837.V351271.R01.S.doc Version 5.2 Page 25 EVIDENCE: The homeowner/manager at Lowdon House has extensive experience in running the care home and has sucessfully completed the Registered Managers Award. All members of staff support the manager in achieving positive outcome for residents that meets their individual expectations. One resident spoken with made very positive comments about the homeowner/manager and said, “Joan (the manager) has worked a miracle on me since I have been here”. Although the Annual Quality Assurance Assessment (AQAA) was completed and returned on time, the AQAA did not provided good or detailed information. It is essential that in future, the AQAA should be completed in full in order to give an accurate and detailed account of practices in the home. The numerical information requested should also be accurate and complete. Systems continue to be in place for residents to air their views and opinions. This includes informal daily dialogue with staff and regular resident meetings. In the past resident surveys have also been provided, however it was noted that this last occurred in 2005. It is recommended that resident surveys be provided annually. This would give residents a chance to formally say what they think about living at the home. The outcome of resident surveys should then be updated in the Service User Guide that should also be reviewed on an annual basis. In addition, the home has achieved the ‘Investor In People’ award that provides an external quality monitoring system on how the home is achieving aims for residents. As recommended in the last inspection report, questionnaires have now been developed for other people who have an interest in the home. This includes people such as family and friends, social workers, community psychiatric nurses, chemist or other people who visit the home on a regular basis. Once introduced, these completed questionnaires will give some further indication as to whether people other than staff or residents feel that the home is meeting resident’s needs and requirements. The vast majority of staff have now sucessfully completed health and safety training that included a fire safety awareness course, health and safety in the work place course, moving and handling training, food hygiene training, first aid training and it is understood that a qualified first aider is now on duty at all times. However the deputy manager explained that refresher training in respect of all health and safety topics is to be arranged in the near future when external funding becomes available. This should be provided for all staff. Updated infection control training has recently been provided by an external agency. Lowdon House DS0000009837.V351271.R01.S.doc Version 5.2 Page 26 Environmemental risk assessments covering a wide range of topics were in place that are regularily reviewed. There was also clear evidence to show that systems and equipment within the home had been appropriately checked so that the health and safety of people living at the home was protected. Lowdon House DS0000009837.V351271.R01.S.doc Version 5.2 Page 27 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 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 4 33 X 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 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 2 X 3 X 3 X X 3 X Lowdon House DS0000009837.V351271.R01.S.doc Version 5.2 Page 28 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 YA2 Regulation 14(1)(d) Timescale for action Prior to admission, all 31/01/08 prospective residents must receive written confirmation that their needs and requirements can be met at the home. Records required by regulation 31/01/08 must be kept in the care home and available for inspection at all times. Requirement 2. YA41 17(1)(a) 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. Refer to Standard YA6 YA20 Good Practice Recommendations Care plans should be updated immediately when change has taken place. It is recommended that double-checking and signing of hand written medication labels be consistently applied. The drug administration record should be signed immediately medication has been given. Consideration should be given to arranging updated medication training. It is recommended that formal one to one staff supervision should be introduced. 3 YA36 Lowdon House DS0000009837.V351271.R01.S.doc Version 5.2 Page 29 4 5 6 YA37 YA39 YA42 The Annual Quality Assurance Assessment (AQAA) should be completed in more detail to provide an accurate and holistic response to the questions asked. Resident questionnaires should be provided on at least an annual basis. Updated health and safety training should take place as planned when new funding becomes available. Lowdon House DS0000009837.V351271.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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 Lowdon House DS0000009837.V351271.R01.S.doc Version 5.2 Page 31 - 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. 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