This inspection visit took place on 9 January 2019 and was announced. Lowena is a short break service run by Cornwall Council for adults with learning disabilities. Lowena is situated close to the centre of the city of Truro with all amenities being a walk or short drive away. The service provides single room accommodation for up to 25 adults with a learning disability, physical disability and people living on the autistic spectrum, who need assistance with personal care. Occupancy levels vary each week due to the nature of the service. The service is purpose-built on one site.

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

The registered manager had recently left their post and de registered with the CQC. There was an interim manager in post. The manager and two team leaders were responsible for the day-to-day running of the service. A registered manager is a person who has registered with the CQC 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.

As part of this comprehensive inspection we checked to see if the provider had made the required improvements identified at the inspection of 4 December 2017. At that inspection we found the service environment was not being maintained to a satisfactory level which had the potential to have a negative impact on people using Lowena. The heating system was not providing consistent heat throughout the service. There were six rooms which were not occupied at the time of inspection where radiators were not working. Some parts of the large lounges were cool to sit in. One room had a carpet which had a malodorous odour. Two specialist baths were not working, one had been de commissioned and required replacement, another was waiting for parts. There were two adapted showers which were being used by people until the baths were replaced and repaired. The general decoration of the service was not satisfactory. Walls were damaged and marked as was some woodwork surrounding peoples sinks in some rooms.

In addition, at the previous inspection in December 2017 survey feedback had highlighted some mattresses were hard and needed replacing. This was also highlighted by staff during the inspection. No action had been taken to address this. The quality of towels being used was poor. White towels were grey and coarse, two were frayed and not fit for purpose.

External areas of the service were not being maintained. A rear garden area could not be used due to the grass not being cut and therefore was too long to play ball games, which people had always enjoyed in good weather.

Governance systems were not effective. Oversight of the services environment had not identified and acted upon defects in a timely way. The decoration and overall general maintenance of the service was not being managed or reviewed effectively.

The views of people were not regularly formally sought and acted upon. A recent negative comment about mattresses had not been investigated and acted upon.

At this inspection we found governance systems were inadequate. There was an organisational lack of leadership and oversight to improve the services environment. The organisation had not acted upon defects in a timely way. The decoration and overall general maintenance of the service was not being managed or reviewed effectively.

From our findings during this inspection we noted quality audits had not identified the impact on people in respect of the temperature in the building. People using the service had complex needs. Many people were not mobile and most were unable to verbally communicate. Th

This comprehensive inspection took place on 04 December 2017 and was announced. We told the provider of our inspection prior to the visit due to the nature of the service. Respite services are not always staffed during the day if nobody is occupying the service.

Lowena is a ‘care home’. People in care homes receive accommodation and nursing care as single under one contractual agreement. CQC regulates both the premises and care provided. We looked at both during this inspection. Lowena provides respite personal care and support to younger adults and older people for up to 25 people. At the time of our inspection seven people were receiving respite care at Lowena. People used the service for various short term periods to provide respite for them and their families who were their main carers. However, one person had been resident at Lowena for several months due to an emergency situation and a suitable permanent placement was currently being arranged as the service was not designed for long term placements.

Lowena is situated close to the centre of the city of Truro with all amenities being a walk or short drive away. The service provides single room accommodation for up to 25 adults with a learning disability, physical disability and people living within the autistic spectrum, who need assistance with personal care. Occupancy levels vary each week due to the nature of the service. The service is a purpose built service on one site.

There were a range of aids and adaptations in place to support people with disabilities which impact on their mobility and movement. Each person had their own room. There are no en-suite facilities but there were two adapted baths and two walk in showers. There were additional toilets located at various points around the service. The service was divided into two wings, one for people who were mobile and one for people who required more equipment to support them. There was also a self-contained adapted flat for people to use who had a greater level of independence.

There was a registered manager in place. 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.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service environment was not being maintained to a satisfactory level which had the potential to have a negative impact on people using Lowena. The heating system was not providing consistent heat throughout the service. There were six rooms which were not occupied at the time of inspection where radiators were not working. Some parts of the large lounges were cool to sit in. One room had a carpet which had a malodorous odour. Two specialist baths were not working, one had been de commissioned and required replacement another was waiting for parts. There were two adapted showers which were being used by people until the baths were replaced and repaired. The general decoration of the service was not satisfactory. Walls were damaged and marked as was some woodwork surrounding peoples sinks in some rooms. Survey feedback had highlighted some mattresses were hard and needed replacing. This was also highlighted by staff during the inspection. No action had been taken to address this. The quality of towels being used was poor. White towels were grey and coarse. Two were frayed and not fit for purpose.

External areas of the service were not being maintained. A rear garden area could not be used due to the grass not being cut and therefor

We carried out a comprehensive inspection on 23 November 2015. A breach of the legal requirements was found. This was because water temperature was compromised in one room by turning off the cold water supply in order to prevent the risk of a person flooding a room. The person using this room had a documented history of leaving the tap running. This action had resulted in only hot water being discharged which was found to be at an unsafe temperature in this room. This had the potential to put people at risk. Following the comprehensive inspection the registered provider wrote to us to say what they would do to meet the legal requirements in relation to the breach. As a result we undertook a focused inspection on the 6 February 2017 to check they had followed their plan and to confirm they now met legal requirements.

This report only covers our findings in relation to the question ‘is the service safe?’ You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lowena on our website at www.cqc.org.uk

Lowena is a respite service that provides care and support for people who have learning disabilities and other complex needs. Lowena can accommodate up to a maximum of 25 people, although due to the nature of the service this fluctuates on a daily basis. The service is owned and operated by Cornwall Council.

There was a registered manager in post. 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.

The service had taken action to ensure all hot water outlets were operational and were discharging water at a safe temperature. We checked the room where we found the cold water tap had been turned off during the November 2015 inspection. This tap was now operational and the hot water temperature was being safely regulated by ‘mixer valves’.

Observation of the maintenance records showed there were monthly checks to ensure temperatures were safe and being maintained and that legionella testing was being carried out. This was to ensure there was no risk of legionella bacteria being present and met the approved code of practice and guidance on regulations for Legionnaires’ disease.

The service had a new boiler fitted in March 2016 which the registered manager said had improved the continuity of hot water throughout the service.

Staff checked the water temperature before assisting a guest with a bath to ensure it was within safe limits.

At this focused inspection we found the registered provider had taken effective action to meet the requirements of the regulations and the breach had been met.

This was an unannounced inspection, carried out on 23 November 2015. As the service provides respite support to people we gave short notice of the inspection visit to ensure staff were available. The service was last inspected in January 2014 when the requirements of regulations were being met.

Lowena is a respite service that provides care and support for people who have a learning disabilities and other complex needs. Lowena can accommodate up to a maximum of 25 people, although due to the nature of the service this fluctuates on a daily basis. The service is owned and operated by Cornwall Council.

People using the service had a range of learning, sensory and physical disabilities and there were a range of aids and adaptations in place which met those needs. There was a sensory room as well as kitchens and dining areas which incorporated a range of seating and equipment to support people with physical disabilities.

There was a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People were leaving the service after a week end break when we arrived. However nine people were arriving later in the day for an overnight stay. People using the service had limited verbal communication. We therefore observed peoples activities when they arrived at the service and saw people were relaxed and engaged in their own choice of activities. There were enough staff to support people in what they chose to do. One person was preparing to go swimming and another two people were being supported to prepare their evening meal.

We looked around the environment which was divided into three units including a self-contained flat. This was a bungalow set in its own grounds. Where possible people used the same rooms so they were familiar to them. People brought their own personal items to make the rooms homely during their stay. In some instances rooms were sparse due to the safety and needs of people using them.

A written communication entry highlighted concerns from the maintenance person that a cold water connector at a sink in a room had been switched off due to a risk of the person flooding the room. However, this resulted in hot water being discharged at an unsafe temperature. This meant there was a hazard when people ran the hot water tap in that room.

We saw many positive interactions and people enjoyed talking with and interacting with staff. One staff member said, “I have worked here for a long time, it’s a very rewarding place to work”. People told us that staff supported them to maintain their independence and we saw evidence of this within the care documentation we viewed.

Staff were trained and competent to provide the support people required. They were supported through a system of induction and training. Staff told us the training was thorough and gave them confidence to carry out their role effectively. The staff team were supportive of each other and worked together to support people. Staffing levels met the present care needs of people that used the respite service.

Staff were competent in how they were providing support to people. They were familiar with what support and care people needed. Staff supported people to make meaningful decisions about their lives and respected people’s decisions and wishes. People were supported to lead full and varied lives and staff supported them to engage in a wide variety of activities. A relative told us, “They (staff) are always doing something whether it’s in the home or outside”.

We found people and others who were important to them, were involved in the planning of their care and documentation was written ina way that was focused on the person. A relative told us the service consulted with them and responded to peoples’ needs promptly and with understanding and empathy

The home was registered to provide personal care and accommodation for up to eighteen people who had a learning disability. The service was divided into three units: ‘Malpas’ provided accommodation for nine people; ‘Porth’ provided accommodation for six people- these people generally had more profound learning disabilities; and ‘Pentire’ had three beds-these people had the ability to live more independently.

Some people who used the service had a physical disability or were on the autistic spectrum. The service was primarily for people to have a break from their home environment. People stayed at Lowena for a weekend, overnight or for a few days/nights during the week.

The people who used the service, on the day of the inspection, had limited or no verbal communication skills. We were able to speak however to four people who all said they enjoyed their visits, liked the staff and enjoyed the food. We were able to speak with four staff members who all said they thought a good service was provided at Lowena.

On the day of the inspection the accommodation was furnished, decorated and maintained to a good standard. The home was very clean and there were no offensive odours. Satisfactory systems to minimise the risk of infection control were in place.

There were satisfactory numbers of staff on duty. The service had a suitable quality assurance system to ensure good standards of care were maintained.

People experienced care, treatment and support that met their needs and protected their rights.

People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

Did not speak to any people using the service as they were all out or did not come into the service until the weekend for their respite stay.