Care Home: Lowenva

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What the care home does well The home undertakes good pre-admission planning, which ensures that anyone moving into the home can have his or her needs met. New service users and their representatives are provided with sufficient information to enable them to make an informed choice about whether or not Lowenva is somewhere they would like to live. The home undertakes a thorough assessment of need and writes a detailed plan about how the care should be delivered. This plan takes into account the persons wishes and their particular likes and dislikes. Wherever possible residents are consulted on issues regarding their daily routines and care arrangements. There are good behaviour management plans and on-going risk assessments to manage the risks associated with residents challenging behaviours. This enables residents to have a good quality of life while successfully managing behaviours. There is a consistent staff team who have a good understanding of service users needs. The staff treat the residents with dignity and respect whilst providing a lively and fun environment appropriate to the needs of younger adults. Staff feel valued and well supported by their colleagues and management. The organisation has a good staff- training programme in place. What has improved since the last inspection? The home continues to be managed to high standards The service user group has changed from older people to learning disabilities. Changes have been made to the layout of the home. Outside the parking area has been extended and safe walkways constructed around the perimeter of the building. Inside a new kitchen and additional communal space has been provided. The peoples individual rooms are well appointed and excellently personalised. They all have ensuite facilities and are of a good size. Policies, procedures, records and other documentation have been updated and amended as necessary to inform the new client group. What the care home could do better: Some policies still refer to outdated addresses of the commission. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Lowenva Rescorla St Austell Cornwall PL26 8YT     The quality rating for this care home is:   two star good service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Michael Dennis     Date: 0 7 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Lowenva Rescorla St Austell Cornwall PL26 8YT 01726850823 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) : Margaret Ellen Eaton,Mr John Michael Eaton care home 6 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 6 The maximum number of service users who can be accommodated is 6. The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability - Code LD Date of last inspection Brief description of the care home Lowenva is a dormer bungalow home in the peaceful village setting of Rescorla. Far-reaching countryside views are enjoyed from several of the rooms. The Home is registered to provide personal care for six Service Users in the category of Learning Disabilities. The facilities of the home conform to environmental standards. All rooms have ensuite facilities and are on the ground floor. There is a lounge with adjoining dining room and a conservatory, which are decorated to a high standard. Considerable work and refurbishment has taken place since the last inspection and indeed since the home first opened. A car park has been built at the front of the home and an additional conservatory has been added. Wheelchair access is available to the rear of the property. Care Homes for Adults (18-65 years) Page 4 of 27 Brief description of the care home The well-stocked gardens are accessible from several exits in the property and are well cared for. There is a patio area and water feature. The Registered Providers live at the home and supervise the day-to-day running of the home. Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection, which took place on 7th.May 2009 and lasted for approximately five hours. The purpose of the inspection was to ensure that service users needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus is on ensuring that service users placements in the home result in good outcomes for them. Information received from and about the home since the previous inspection has also been taken into consideration in making judgements about the quality of outcomes for the service users living there. The inspection included observation of the service users. Members of staff were observed providing one to one care and there were opportunities to directly observe aspects of service users daily lives in the home and staff interaction with them. Care Homes for Adults (18-65 years) Page 6 of 27 Other activities included an inspection of the premises, examination of care, safety and employment records and discussion with the registered manager of the home. Case tracking of two service users involved a more in-depth review of how the home meets their needs, with particular reference to their age, racial and cultural origin, religion, gender, sexual orientation and disabilities. Information telling service users about the home is held on their personal files and is available in pictorial formats, if required. What the care home does well: What has improved since the last inspection? 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 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides prospective service users and their representatives with sufficient information for them to make an informed choice about where they live. The admissions process ensures that the home has adequate information to decide whether or not they can meet an individuals assessed needs. Evidence: There is an up to date Statement of Purpose and Service Users Guide, which is provided for all prospective Service Users. This documentation has been updated and new brochures printed to meet the needs of the current client group. Contracts and Terms of Conditions are in place and signed by the service user. There is evidence that comprehensive information about the Service Users needs is gathered prior to the Service User moving into the home. A range of communication aids including signs, symbols and photographs are used to give any new residents information about the home. Records were case tracked to establish the quality of the homes admission procedure. Care Homes for Adults (18-65 years) Page 10 of 27 Evidence: The process was found to be competently undertaken. The service user is given every opportunity to visit the home prior to taking up residence. Multidisciplinary review meetings are held soon after admission to consolidate the placement and reaffirm the care plan Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a clear, consistent care planning process, which provides staff with the information they need to satisfactorily meet service users needs. Staff have a good understanding of how service users communicate and use this knowledge to encourage them to make choices and have control where possible about their care and lifestyle. Evidence: The care plans and records relating to three residents living in the home were looked at during the inspection. The information included good information about each individuals needs. Each area of care was supported by a detailed assessment, behaviour management guidelines, activities plan, risk assessments and information about any involvement from other agencies. Throughout the inspection staff were observed supporting residents to make choices Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: about their daily routines. Care plans included detailed information about how each resident communicates. A range of communication tools are used dependent on the assessed needs of the individual. Several service users had pictorial timetables. Risk assessments had been written for all activities inside and outside the home. These were found to be detailed, signed and included a date for review. All records inspected were found to be well maintained, up to date and stored safely. Care Homes for Adults (18-65 years) Page 13 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans and records relating to three residents living in the home were looked at during the inspection. The information included good information about each individuals needs. Each area of care was supported by a detailed assessment, behaviour management guidelines, activities plan, risk assessments and information about any involvement from other agencies. Throughout the inspection staff were observed supporting residents to make choices about their daily routines. Care plans included detailed information about how each resident communicates. A range of communication tools are used dependent on the assessed needs of the individual. Several service users had pictorial timetables. Risk assessments had been written for all activities inside and outside the home. These were found to be detailed, signed and included a date for review. All records inspected were found to be well maintained, up to date and stored safely. Care Homes for Adults (18-65 years) Page 14 of 27 Judgement: Evidence: The manager and staff were able to talk in detail about the personalities of each resident and the activities that they enjoy. Care planning, and daily activity charts supported this verbal information. All the residents had individualised activities, taking place through support from the home. The service has continuously developed new activities for each resident to maintain their presence in the community and to give the residents valued activity and good quality of life. In many cases this activity has contributed to the residents improved stability and reduced challenging behaviour. The home had a detailed process of recording and analysing the outcome of activities to ensure that they remain appropriate. Activities external to the house are thoroughly risk assessed and continuously reviewed to ensure that they continue to be safe. We observed staff interacting with service users on a one to one basis in an appropriate and unobtrusive manner. A written weekly menu was available, which showed that residents are offered a wellbalanced and varied selection of meals. Any special dietary requirements or eating plans were documented with clear guidelines for staff. Care Homes for Adults (18-65 years) Page 15 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal support in the home is offered in a way that promotes and protects service users privacy, dignity and independence. Service users health care needs are regularly monitored and any changes are addressed with specialist input when necessary. Evidence: Service user records contained detailed information about their personal, emotional and healthcare needs. Information was documented in a way that helped staff understand their daily routines, likes and dislikes, and how they prefer to be supported. Records confirmed that residents are supported to attend regular routine health checks including hearing, sight and dental checks. The home has a consistent staff team who have a good awareness of service users needs. The manager said that this consistency and the homes daily recording procedures ensures that health needs are closely monitored and any concerns are dealt with promptly. Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: Throughout the inspection staff were observed treating service users in a respectful and dignified way. Records confirmed that external advice and guidance was sought when necessary from local Health Care professionals and the specialist learning disability services. The home has written procedures for the receipt, storage and administration of medication. There is also a medication profile on each service users care plan. The home receives its medication from the local GP surgery. There is clear information for care staff on the nature of the service users medication and any possible side effects. Clear administration records are kept. Care Homes for Adults (18-65 years) Page 17 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems in the home ensure that all service users are listened to and any concerns or complaints are dealt with promptly and appropriately. Service users are protected from abuse, neglect and self-harm. Evidence: The complaints procedures have been brought up to date and include details as to how to contact the Commission. The Commission has received no complaints about this home. Relatives have previously informed us that anything that could be done or provided to make their relatives feel more comfortable would be done. Service user voting preferences are respected and each service user is registered to vote. Advocacy information is available within the home. There are up to date Protection of Vulnerable Adults and Whistle blowing Policies and Procedures. Staff training has been undertaken and this is recorded within the staff training records. There is an up to date policy on the Management of Service Users Money and Financial Affairs, in addition to Autonomy and Privacy & Dignity. There is evidence that the staff take their responsibility to protect vulnerable adults seriously. Care Homes for Adults (18-65 years) Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedures have been brought up to date and include details as to how to contact the Commission. The Commission has received no complaints about this home. Relatives have previously informed us that anything that could be done or provided to make their relatives feel more comfortable would be done. Service user voting preferences are respected and each service user is registered to vote. Advocacy information is available within the home. There are up to date Protection of Vulnerable Adults and Whistle blowing Policies and Procedures. Staff training has been undertaken and this is recorded within the staff training records. There is an up to date policy on the Management of Service Users Money and Financial Affairs, in addition to Autonomy and Privacy & Dignity. There is evidence that the staff take their responsibility to protect vulnerable adults seriously. Evidence: The location and layout of the home is accessible, safe and very well maintained, it meets the service users individual needs in a very comfortable and homely way. There is an ongoing programme of maintenance and redecoration. A new kitchen has been constructed as has additional communal space for service users. The gardens and Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: patio area are well cared for. There is a car park at the front of the home. The home is a very comfortable, modern residential property. There is a lounge with dining area and a conservatory. There are lovely gardens surrounding the property. All areas were noted to be smoke free. Furnishings were noted to be of a high standard with plenty of natural light and domestic lighting. We observed that the decor was homely in nature, whilst offering a high standard of decoration. There is a communal bathroom. Each Service User has their own facilities including a toilet and a wash hand basin. Specialist equipment is provided on an individual basis as required. Rooms are individualised, the fittings and furnishings are suitably well appointed. Service Users are encouraged to bring in furniture and personal effects to furnish their rooms. A lockable storage space has been provided for all rooms. All rooms have been fitted with door locks. All rooms have plenty of natural ventilation and light. Water supplies have been regulated throughout the home and a Legionella risk assessment has been undertaken. Radiators have been covered to reduce the risk of contact with hot surfaces and all windows are fitted with restrictors. Environmental risk assessments are completed and reviewed. The premises were found to be spotlessly clean on the day of the Unannounced Inspection and there was no evidence of any odours within the home. Regular audits are completed on processes within the home such as the laundry, health and safety, medicines. Care Homes for Adults (18-65 years) Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are met by a sufficient number of competent, well-trained and motivated staff. Evidence: We were informed that there are two staff are on duty at all times. On the day of the inspection the registered manager, a senior care assistant and a care assistant were on duty. There are two staff available on the premises at night. Service Users have a call bell that they press if they wish for assistance over night. Staff under eighteen are not employed and no one under twenty-one years of age is left in charge of the home. Two of the care staff have National Vocational Qualification Level 2 and one has National Vocational Qualification Level 3. Both the Registered Providers have achieved their National Vocational Qualification Level 2, and the registered manager holds the Registered Managers award. All staff have a First Aid certificate. The induction and foundation training is based upon Skills for Care standards. All staff complete an application form, two written references are obtained and staff are provided with a Job description and contract. Criminal records bureau checks are obtained before staff are allowed to commence working. There is an Equal Opportunities Policy. Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: The Registered Manager ensures that the Induction and the annual training programme for the staff complies with National Training Organisation and Skills for Care standards. A comprehensive training programme has been developed, to include Learning Disabilities and Mental Health training. The training records are kept up to date for each staff member. There is an excellent training manual. The Registered Manager works part time for a local education Provider as a Tutor and assessor. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management approach is open and inclusive, providing clear leadership and guidance. Service users rights, health, safety and welfare are protected and promoted. Evidence: The Registered Manager has over twenty years experience in a care setting and has gained the Registered Managers Award and Diploma in Performance Coaching. There is evidence that she remains professionally up to date. There are clear lines of accountability within the home. Staff meetings have been held and records of these kept. There is evidence to confirm that Service Users, their relatives and staff contribute to the running of the home. The Registered Manager works part time in the home. She is working as a Distance Learning tutor and National Vocational Qualification Assessor. There is a Quality and Quality management Policy. A regular audit is undertaken to cover a broad range of issues such as the kitchen, laundry, record keeping and medicines. There is an annual development plan. A questionnaire has been circulated to relatives or visitors and other stakeholders. An annual report has been compiled. This is made available to Service Users and the Care Quality Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: Commission. Employers Liability insurance has been obtained and the certificate is evident within the home. There is evidence of Business and financial planning. There are Maintenance, Legionella, COSSH, Missing Persons and Health & Safety Policies and Procedures within the Home. The Accident book for Service Users complies with Data Protection legislation. The Fire records book is up to date. The Registered Manager has data sheets for any substance that maybe hazardous. Risk assessments and Health and Safety checklists have been completed for most identified environmental hazards within or without the Home. One of the Registered Providers has completed a Safety at Work course. Radiators have been covered, all water sources have been regulated and a legionella risk assessment been undertaken. Records of decoration and refurbishments are kept. By way of discussion with the staff team it is evident that various forms of work supervision is a regular occurrence. This includes formal one to one supervision. Care Homes for Adults (18-65 years) Page 24 of 27 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 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, Care Homes 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 Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or 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. 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