Archived: Lowdon House

Updated 8 January 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place across two dates 05 and 10 November 2015 and was unannounced.

The inspection team consisted of three adult social care inspectors. Two inspectors on each day of the inspection.

Prior to this inspection we looked at all the information we held about this service. We reviewed notifications of incidents that the provider had sent us since our last inspection.

We also requested feedback from community professionals, such as general practitioners and mental health care co-ordinators. We received limited feedback. Comments are included within the main body of the report.

There were six resident's living at Lowdon House. We spoke with all the resident's who lived at the service, three support workers, the registered manager, and the registered provider who is also registered manager.

We looked at three resident’s care records, staff duty rosters, staff recruitment files, training records, management audits, safety checks, medication records and quality assurance documents.

Updated 8 January 2016

This inspection took place across two dates 05 and10 November 2015 and was unannounced.

The last inspection of Lowdon House was 22 May 2014 and the service was found to be fully compliant against the five outcomes we looked at.

Lowdon House is registered to provide support, care and accommodation for up to six residents with mental health conditions. The home is situated in a residential area close to Preston City Centre. Accommodation is provided in single rooms. There is a communal dining room and lounge.

The registered provider who was also registered manager and a second registered manager was available throughout our inspection and received feedback during and at the end of the inspection.

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.

Resident's told us that they felt safe. We found that safeguarding principles were understood by support workers and the management team. However we found that some support systems at the service were not based on current practice and did not always take into account resident's individuals needs and abilities; this resulted in an organisational safeguarding alert being made around institutionalised care and support at the service.

We looked at resident’s care records and found that risk assessments had been undertaken for known risk factors and these were individualised. However we found that incidents and accidents were not always reported.

We found that resident’s safety was being compromised. The service failed to protect resident's against the risk of fire. We found five fire doors had been wedged and recording around fire risk assessment was poor. This meant that resident's were at risk of avoidable harm.

We looked at staff recruitment records and found that important checks had not always been undertaken prior to a person being recruited. This meant that the provider could not evidence how they had ensured resident's were being supported by staff with good character.

The provider did not assess staffing levels on a formal basis, we asked to see a dependency assessment tool and this was not produced. Staff were deployed to undertake house work. We did not see personal support being provided for resident's on a group or individual basis other than during medicines administration.

We looked at the way medicines were managed and found significant failures. We found that unsafe systems were used which placed resident's at risk of not receiving their correct prescribed treatments. The provider acknowledged this during the inspection and implemented improved systems that would facilitate safe administration of medicines.

We observed staff use protective clothing during cleaning duties. However we found that communal bathrooms and toilets did not have sufficient hand washing facilities. This placed resident's, staff and visitors at risk of cross contamination of infection and disease.

We looked at staff training records. We found that staff had undertaken training as outlined in the providers policies and procedures. However we observed the provider undertake medicines administration and their training records showed failure to complete training and competency assessment around all mandatory courses specified in the providers policies and procedures.

Staff told us that they felt supported and had received regular supervision. Staff told us that they would benefit from training in mental health recovery, this was a core need at the service and training had not been obtained.

We looked at resident's care records and found that written consent/agreement had been requested for various reasons. The service did not have the tools in place to assess a resident's mental capacity prior to requesting written consent. The registered managers and staff were unable to demonstrate sufficient knowledge of the Mental Capacity Act 2005 or associated Deprivation of Liberty Safeguards.

Resident's were sufficiently supported to maintain their physical health. Staff escorted Resident's to appointments and maintained contact with community professionals.

The premises did not fully facilitate resident's to maintain their life skills. Independent access to the main kitchen was not allowed and resident's told us that they did not have free access to kitchen facilities that would help them maintain cooking skills.

We found that the staff team had built trusting relationships with all resident's. We observed staff interact with people in a kind way. However staff told us that they would like to be able to support people more often rather than attending to house work.

Resident's had access to advocacy information.

Resident's told us that their dignity was always considered. We saw that the provider and registered manager had built close relationships with resident's. A small family run service provided continuity for resident's who lived at Lowdon House.

We found that resident's were not always provided with support that was person centred. This was due to an organisational failure to understand best practice and  models in health and social care for ways of supporting people with mental health needs including re-enablement and recovery.

We saw that the service was responsive to resident’s changing needs, this included referral to external health care professionals and mental health relapse rates at the service were extremely low.

We looked at care plans and found that minimal person centred detail was recorded. Care plans did not always tell us what skills the resident had and how these could be maintained or developed.

The provider did not have any records of complaints or compliments.

The provider told us that surveys were undertaken by resident's twice per year. However when we asked to see the records during the inspection they were not provided. After the inspection the provider sent us a record of what survey results had been collated in 2015. These stated that some resident's participated in surveys, however we were unable to fully analyse records because the provider did not show us original documents.

We found that the registered provider/manager was not suitably qualified to provide oversight at the service in line with current legislation and best practice. They had not undertaken mandatory training since 2004.

The service had two registered managers. The second registered manager had maintained training and updated their knowledge on a regular basis.

We observed a family run culture at the service, although this had some positive outcomes for resident's we found that conflict between the registered provider and manager prevented the service from being developed in line with current day regulation.

Staff meetings were held regularly and staff told us that communication at the service was effective. Staff told us that they felt supported by the management team.  Resident's told us that they felt supported by the team and confident in the managements response should they raise concern.

Quality assurance systems were not robust. We looked at audits that had been undertaken for medicines and infection control, the audits had not identified issues found during our inspection.

We have made recommendations in relation to best practice when working with resident's who live with mental health needs to help maintain their life skills and independence, routinely listening to resident's experiences, complaints and concerns and quality assurance.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 these were in relation to person centred care, safe care and treatment and need for consent.

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