Archived: Lowther Park (Adult Care Home)

Lowther Park is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Lowther Park (Adult Care Home), (Lowther Park), provides personal care and accommodation for up to seven adults who have a learning disability. The accommodation is provided in two semi-detached houses which have been adapted and turned into one property. The home is arranged as two areas with four people living in one side of the premises and three people living in the other side of the home.

There was a registered manager employed in the home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection in August 2017 the service was rated overall as Requiring Improvement and we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There was a breach of Regulation 18: Staffing as we found that there were not enough staff working in the home to ensure people were safe living there. And a breach of Regulation 17: Good governance as the registered provider had not taken action promptly in response to the concerns raised by the staff about the staffing levels.

We asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe and Well-led to at least Good and thereby meet the regulations.

At this inspection, October 2018, we found the actions required to address the particular issues found at the August 2017 inspection had been completed. However, we found further breaches and the service continues to have the rating of Requires Improvement.

This was because the service had not been developed and designed in line with the values that underpin the Registering the Right Support and Building the Right support guidance. These values include choice, promotion of independence and inclusion. If applied these would allow people with learning disabilities and autism using a service to live as ordinary a life as any citizen.

We found that the way support was organised at Lowther Park meant that people were expected to go to day services during the week and staff were not provided within the home across the day time. People’s choice was being compromised and some people had made it clear they no longer wanted to attend day services. Staff spoke of rushing some people in the morning and they were concerned that this was de-skilling them. The home was not providing care and support that was person-centred, reflected their preferences and was designed in-line with nationally recognised evidenced-based guidance. This is a breach of Regulation 9: Person-centred care.

The provider was working with the local authority to explore a new model of support but this had yet to be decided. We found that this model had an impact in a number of different ways for people living in the home and this is reflected across the report.

While we now found that there were enough staff working in the home to ensure people were safe the way staff were deployed meant that people did not have choice of how to spend their day. This is a continued breach of Regulation 18 Staffing.

However, within the confines of this model it was clear that staff worked hard to offer people as much choice as possible. We observed in the home staff giving people options and choices and supporting people’s individual interests and hobbies. Although attending day service was the expectation staff did try to accommodate people who expressed that they didn’t want to go by offering to work extra shifts at short notice. If someone was not well then this was always accommodated.

People who could share their views told us they liked living at Lowther Park and said they felt safe there. They told us they liked the staff who worked in the home and we saw people were comfortable and relaxed around the staff on duty. The staff treated people in a kind and friendly way.

People received the support they required to maintain good health. Medicines were handled safely and people received their medicines as they needed. The staff in the home took prompt action to obtain medical advice when a person showed signs of ill health. People were supported to access appropriate health services as they required.

The staff were well trained and competent to provide people’s care. Systems were in place to identify when training needed to be repeated to ensure staff knowledge and skills were up to date. Staff received support and supervision to enable them to undertake their roles effectively.

Staff understood and were trained on how to deal with any allegations of abuse and records we looked at confirmed investigations had been completed in-line with local safeguarding guidance.

The principles of the Mental Capacity Act 2005 were understood by the registered manager and the staff team. However, people were not always supported to have maximum choice and control of their lives.

Staff supported people in the least restrictive way possible; the policies and systems in the service supported this practice.

People were included in planning their care and staff knew people well and understood how they expressed their wishes and communicated. The home made good use of a range of ways to help with communication, such as easy read materials, signage and technology to aid people's understanding and participation.

People were included in planning and preparing meals and drinks that they enjoyed. Staff knew the importance of promoting people’s independence and supported people to do as much as possible for themselves.

The service was well-led with an open inclusive culture promoted by the registered manager and staff. People living in the home were encouraged to engage and participate in the running of the service and to have a voice, such as in the selection of staff and to attend local and national conferences. Staff spoke highly about the registered manager’s support and leadership.

The provider undertook a range of audits to check on the quality of care provided. We found the provider was keen to consult with people in the home and other stakeholders, such as relatives, as to the future model at Lowther Park.

You can see what action we told the provider to take at the back of the full version of the report.

Lowther Park (Adult Care Home), (Lowther Park), provides personal care and accommodation for up to seven adults who have a learning disability. The accommodation is provided in two semi-detached houses which have been adapted and turned into one property. The home is arranged as two areas with four people living in one side of the premises and three people living in the other side of the home.

The home is in a residential area of Kendal in south Cumbria. People have their own bedrooms which are on the ground and first floors of the home. There are suitable shared facilities including toilets and bathrooms, sitting rooms, kitchens and dining areas.

There was a registered manager employed in the home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People who could share their views told us they liked living at Lowther Park and said they felt safe there. They told us they liked the staff who worked in the home and we saw people were comfortable and relaxed around the staff on duty. The staff treated people in a kind and friendly way.

Before we carried out our inspection the registered manager had notified us of an incident which was being investigated under local safeguarding procedures. We did not investigate this incident, but we looked at how the service protected people from harm.

Records we looked at showed there had been number of incidents which had caused people who lived in the home to experience distress or anxiety. There had also been occasions when staff members had needed to intervene to prevent people experiencing harm or distress. The registered manager had identified that staffing levels needed to be increased to ensure the safety of people who lived at Lowther Park. The registered manager had raised this with the registered provider and they were in the process of recruiting additional staff to increase staffing levels. Existing members of staff were working extra hours to provide additional support. However, we found there were times when it was not possible for the staff team to work additional hours and when there were not sufficient staff available to ensure the safety of people who lived in the home.

We found that there were times when there were not enough staff working in the home to ensure people were safe living there. This was a breach of Regulation 18 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The staff in the home had shared concerns about staffing levels with the registered manager of the service. Although the registered manager had shared these concerns with the registered provider, action had not been taken promptly in response to the concerns raised by the staff. This was a breach of Regulation 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We shared our concerns about staffing levels with the registered manager of the home. They immediately contacted the registered provider and were supported to increase staffing levels without further delay.

The staff on duty in the home knew people well and knew how people communicated their wishes. We saw that people made choices about their lives and the decisions they made were respected.

People received the support they required to maintain good health. Medicines were handled safely and people received their medicines as they needed. The staff in the home took prompt action to obtain medical advice when a person showed signs of ill health. People were supported to access appropriate health services as they required.

The staff were trained and competent to provide people’s care. Systems were in place to identify when training needed to be repeated to ensure staff knowledge and skills were up to date.

People were included in planning and preparing their meals and drinks and were provided with meals and drinks that they enjoyed.

The principles of the Mental Capacity Act 2005 were followed and people’s rights were protected. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were included in planning and agreeing to the care they received. The staff knew people well and knew how people expressed their wishes.

People were asked for their views and included in decisions about how the service was developed. The registered manager carried out checks on the service and took action where further improvements were required.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to staffing levels and how the provider listened to and acted on concerns raised by the staff employed in the home. You can see what action we told the provider to take at the back of the full version of the report.

People said the staff were 'nice' and told us they made choices about their lives including where to spend their time and whether to take part in the activities provided.

No-one we spoke with raised any concerns about the service.

We saw that the staff in the home treated people with respect. They supported people to be involved in making decisions about their daily lives and in being able to consent to the support they received.

We found that procedures were in place to protect people from the risk of harm. Medication was managed safely and robust systems were used when recruiting new staff to ensure they were suitable to work in the home.

We observed people in communal areas of the home and saw people were treated in a manner which respected their dignity, independence and rights. We saw that people were given choices about their lives including where they spent their time and the activities they took part in. The decisions people made were respected by the staff supporting them. We observed that people were comfortable and confident with the staff on duty and appeared well cared for.