We carried out an inspection of Lowfield house Limited on 23 and 25 April 2018. The first day was unannounced.

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

Lowfield house Limited is located in the centre of Clitheroe in Lancashire. The service is registered to provide accommodation and personal care for up to 24 people. The service does not provide nursing care. There were 20 people accommodated at the time of the inspection. Accommodation is provided over two floors linked by a passenger lift. All bedrooms are single occupancy and 21 have ensuite facilities.

At the previous inspection on 2 and 3 October 2017, we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to the recruitment of new staff, staff training, the implementation of the Mental Capacity Act 2005, maintenance of the property and a continuing breach in relation to the governance arrangements. We also made a recommendation about ensuring people’s care plans fully reflected their personal preferences and the care they were receiving. Following the inspection, we asked the provider to take action to make improvements and to send us an action plan.

During this inspection, we found there had been improvements made to the recruitment policies and procedures, the provision of staff training, maintenance and servicing of the property and to the governance arrangements. We found improvements to risk and incident management, medicines management and care planning were ongoing.

The service was managed by a registered manager. 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 told us they felt safe in the home and they were very happy with the service they received. People appeared comfortable in the company of staff. Safeguarding adults' procedures were in place and staff understood how to protect people from abuse. Staff treated people in a respectful and dignified manner and people's privacy was respected.

There were systems in place to manage people’s medicines although additional improvements to the systems were needed. Staff administering medicines had been trained and supervised to do this safely.

Risks associated with the environment and with people’s health and welfare had been assessed. There was a system in place to record accidents and incidents. However, the registered manager was aware further action was needed in order to monitor people’s skin integrity and to identify any patterns and trends associated with accidents.

Quality assurance and auditing processes had been improved to help the provider and the registered manager to identify and respond to matters needing attention. The systems to obtain the views of people, their visitors and staff had also been improved.

A safe and robust recruitment procedure was in place to ensure new staff would be suitable to care for vulnerable people. Arrangements were in place to make sure staff were trained and competent. People considered there were enough staff to support them when they needed any help.

Appropriate Deprivation of Liberty Safeguard (DoLS) applications had been made to the local authority and people's mental capacity to make their own decisions had been assessed. However, additional information was needed to ensure people’s preferences were met.

People had access to a number of activities inside the home and were supported to maintain relationships with friends and family. There were no restrictions

We carried out an inspection of Lowfield House Limited on 2 and 3 October 2017. The first day was unannounced.

Lowfield House Limited is located in the centre of Clitheroe in Lancashire. The service is registered to provide accommodation and personal care for up to 24 people. There were 24 people accommodated at the time of the inspection. Accommodation is provided over two floors linked by a passenger lift. All bedrooms are single occupancy and 21 have ensuite facilities.

At the previous inspection on 14 October 2016, we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to staff knowledge of safeguarding procedures, infection control practices and the systems in place to monitor the quality of the service. Following the inspection, we asked the provider to take action to make improvements and to send us an action plan.

During this inspection, we found there had been some improvements to the management of safeguarding procedures and infection control practices. However, we found there was limited progress to establish quality monitoring systems. We found four breaches of regulation in respect to the recruitment of new staff, staff training, the implementation of the Mental Capacity Act 2005 and the governance arrangements. You can see what action we told the provider to take at the back of the full version of the report. We also made a recommendation about ensuring people’s care plans fully reflected their personal preferences and the care they were receiving.

The service was managed by a registered manager. 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 told us they felt safe and staff were kind and caring. Safeguarding adults’ procedures were in place and staff understood how to safeguard people from abuse. We found some risks associated with people’s health and safety had not been assessed and recorded. Whilst all people had an individual care plan, which was reviewed at regular intervals, we found the plans lacked detail about people’s personal preferences.

There was no evidence to indicate people’s mental capacity to make their own decisions had been assessed and recorded in line the requirements of the Mental Capacity Act 2005 and there had been no consideration given to the Deprivation of Liberty Safeguards.

We found there were systems in place to manage people’s medicines.

The owner carried out all routine maintenance and undertook audits of the environment on a monthly basis. However, there were no checks in place to ensure safety certificates were in date and renewed. We found the electrical safety certificate and fire system servicing certificate had both expired. Immediate arrangements were made for an engineer to visit the home during the inspection. We received copies of the safety certificates following the inspection.

Whilst there was a system in place to record accidents and incidents, we saw an analysis had not been carried out in order to identify any patterns and trends.

There were sufficient staff on duty at the time of the inspection and people’s needs were met in a timely manner. A safe recruitment process had not always been followed and the recruitment and selection procedure did not cover all current regulatory requirements. The staff had completed a range of training and were appropriately supervised. However, staff had not completed moving and handling training for several years. This is important to ensure staff are aware of how to assist people’s mobility safely.

There were appropriate arrangements in place to support people to have a varied and healthy diet. People had access to a GP and other health care professionals when th

This unannounced inspection took place on 14 October 2016.

Lowfield House Limited is located in the centre of Clitheroe in Lancashire. The service is registered for up to 24 people. All bedrooms are single occupancy and 21 have ensuite facilities. Accommodation is provided over two floors for people who require personal care. 19 people lived at the home at the time of the inspection visit.

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 service was last inspected on 14 October 2013. We identified no concerns at this inspection and found the provider was meeting all standards we assessed.

At this inspection carried out in October 2016, people who lived at the home, friends and relatives told us they were happy with the care provided from staff. They told us people were safe at the home and were supported by staff who knew them well.

Although people told us they felt safe, we identified risks to the environment were not always suitably addressed and managed. During the inspection visit we identified concerns which posed risks within the environment. We discussed these concerns with the deputy manager at feedback and immediate action was taken following the inspection visit to rectify the concerns. We have made a recommendation about this.

Infection control procedures were inconsistently managed by the service and there was no identified person responsible for infection control processes within the service. This was a breach of Regulation 12 of the Health and Social Care Act 2008, (Regulated Activities) 2014.

Staff had knowledge of safeguarding procedures and were aware of their responsibilities for reporting any concerns; however staff were not fully aware of reporting procedures to external agencies. This was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

We found improvements were required to ensure the service was consistently well led. Audits of the service were carried out between the owner and the registered manager. However, auditing systems in place were ineffective and had failed to identify the concerns identified as part of the inspection visit. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

Arrangements were in place for safe management and administering medicines. However these were not consistently applied. We have made a recommendation about this.

Staff were kind and caring. We observed positive interactions throughout the inspection visit. Relatives praised staff for their caring natures.

The service ensured visitors were welcomed to the home. Relationships with families were encouraged.

We found suitable recruitment procedures were in place which meant staff were checked before starting employment.

The service had established links with health professionals to enable people to maintain good health. Care plans were developed and maintained for people who used the service. Care plans covered support needs and personal wishes. Plans were reviewed and updated at regular intervals and information was sought from appropriate professionals as and when required.

Feedback on the quality of food provided was positive. People were happy with the variety and choice of meals available to them. People’s nutritional needs were addressed and monitored.

We received mixed feedback about the range of activities on offer at the home. Staff said activities were offered but people often declined to take part. We have made a recommendation about this.

Staff told us they were provided with training which allowed them to carry out their tasks effectively. Ongoing training was prov

Three people who used the service confirmed staff always knocked on the door before entering and asked permission to undertake any activity. Comments received were, “The staff ask permission before doing anything”, “The staff always knock before entering my room, I have given consent to my care”.

We looked at the care for three people who used the service. All followed a chronological pattern and contained all relevant information for example, personal details, next of kin and GP.

We looked at the duty rota and saw there were sufficient numbers of staff on duty. Staff we spoke with told us if extra staff were needed for example, hospital appointments they would bring extra staff in to cover these. Staff confirmed there was enough staff on duty for the work load and agency staff were not used.

We spoke with two staff members who were complimentary about the manager. One person told us, “The manager is very supportive and approachable; she is easy to talk to”. Another said, “I am very happy with the manager she is very supportive. I feel able to go to her with any concerns and she will sort things out. If you can’t confide in your manager it’s a poor do”.

We spoke with three people who used the service. All confirmed they had no complaints and they were aware how to raise any concerns in the home. Comments received were, “I have no concerns or complaints, I feel safe here, if I had any I would tell the staff”, “The staff look after me well, I have no complaints”.

We spoke with four people who used the service. They told us they were happy with their care and accommodation and said they were treated very well by the staff at the home. They commented, "It’s lovely here, they look after us very well” and “I’m fine and happy here” also “The home and staff are brilliant. My room is great. I have everything I need” and “The girls here are a great help to me. They even got me a television for my room”. During our visit we observed the staff treating people in a kind, professional, friendly and respectful manner.