Inspection on 15/04/08 for The Knells Country House

This is the latest available inspection report for this service, carried out on 15th April 2008.

CSCI found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Knells Country House 20/11/05

The Knells Country House 26/04/05

The Knells Country House 10/11/04

The Knells Country House 26/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Knells Country House The Knells Houghton Carlisle Cumbria CA6 4JG Lead Inspector Mrs Margaret Drury Unannounced Inspection 15th April 2008 09:40 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Knells Country House DS0000059723.V361031.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Knells Country House DS0000059723.V361031.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Knells Country House Address The Knells Houghton Carlisle Cumbria CA6 4JG 01228 526496 01228 514872 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Amanda Farrer Mrs Amanda Farrer Care Home 23 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (23) of places The Knells Country House DS0000059723.V361031.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 23 service users to include: - up to 23 service users in the category of OP (Older people, not falling within any other category) - up to 5 service users in the category of DE(E) (Dementia over 65 years of age) The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 25th May 2006 2. Date of last inspection Brief Description of the Service: The Knells House is owned and operated by The Knells Country House Ltd. and run on a day-to-day basis by Mrs. Amanda Farrer, a partner of the company. The home is situated on the outskirts of the village of Houghton, approximately seven miles from the city of Carlisle. The Home is an older property, which has been adapted and extended for its present use. The accommodation for those living in the home is on two floors and access between the floors is by passenger lift or stair lift, as well as a staircase. The bedrooms are mainly for single occupancy, but there are three bedrooms that can be used by two people sharing if requested. There are two communal lounges and one dining room. There is also a conservatory to the side of the building with access from the lounge. There are toilets and bathrooms equipped to assist people with a disability. There are spacious, pleasant gardens surrounding the home with seating areas. There is a car park. The fees at this service are between £386.00 and £455.00 per week as from April 2008. There are extra charges for private chiropody, hairdressing, personal toiletries, newspapers and magazines. This home does not provide intermediate care. The Knells Country House DS0000059723.V361031.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. This site visit that forms part of the key inspection took place over one day in April and we (The Commission for Social Care Inspection) were in the home for seven hours. Information about the service was gathered in different ways: • Annual Quality Assurance Assessment document completed by the manager • Survey questionnaires returned by residents, staff and family members. • Interviews with residents, visitors and staff on the day of the visit. • Looking at any information received from other professional agencies We looked at care planning documentation to ensure the level of care provided met the needs of those living in the home and a tour of the building to inspect the environmental standards was undertaken. Medication records were examined and staff training records and personnel files were also inspected. Discussions with the registered manager about the running of the home, staffing and the dependency of those living in The Knells took place. What the service does well: The registered manager has recently reviewed and updated the literature provided for anyone wishing to come to live in the Knells. There is a Statement of Purpose and resident guide, both of which provide in depth information about the facilities on offer at this service. The information is such that an informed choice about whether or not to move in can easily be made. Any prospective resident is fully assessed prior to a place being offered. The manager is always mindful of the needs of those already living in The Knells when the assessments are carried out and there is a trial period before the placement is made permanent. This is seen as a safeguard to all concerned. The Knells Country House DS0000059723.V361031.R01.S.doc Version 5.2 Page 6 All those using this service have a full plan of care that is generated from the initial assessment of needs. The care plans are updated regularly to meet the changing needs of those living in the home. Medication records are kept in an appropriate way ensuring the safety of those living in the home. Recreational activities are provided for those wishing to join in and a varied nutritious diet is provided. Environmental standards within the home are very good ensuring the home is safe, warm and comfortable. There is an experienced and well-trained staff team providing a high level of care and support. The recruitment policy means that those using this service are safeguarded at all times. Staff training is constant with training courses completed “in-house” and/or provided by an external professional trainer. What has improved since the last inspection? What they could do better: There were no requirements or recommendations made as a result of this visit and we are confident that the manager and staff will continue to provide the high level of care and support already given. The Knells Country House DS0000059723.V361031.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Knells Country House DS0000059723.V361031.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Knells Country House DS0000059723.V361031.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2 & 3 Standard 6 is not applicable Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Knells provides detailed information about the facilities provided and undertakes comprehensive assessments prior to admission to ensure the service can properly meet peoples’ needs. EVIDENCE: The manager has recently reviewed and updated the statement of purpose and resident guide to ensure the information contained in these documents is current and applicable to this service. Copies of these documents were provided for us to inspect and retain for filing purposes. They contain details of the facilities on offer, staffing/management structure, information about the environmental standards and the aims and objectives of the home. Copies of The Knells Country House DS0000059723.V361031.R01.S.doc Version 5.2 Page 10 the statement of purpose and resident are on display in the hall together with a copy of the last inspection report. Comprehensive needs assessments are completed before anyone is admitted to The Knells to ensure that the home is suitable and able to meet any requirements in an appropriate manner. When we were discussing the assessment procedure the manager confirmed that she always takes into account the needs of those already living in the home before finally offering accommodation. We looked at the assessments of four residents who were recently admitted and found the documentation to be relevant and informative. This information is then used when drawing up the initial care plan after admission. The Knells Country House DS0000059723.V361031.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, & 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The high standard of health and personal care people receive is based on their individual needs, with the principles of respect, dignity and privacy maintained at all times. EVIDENCE: We looked at the care plans for four of those living in the home, two of which were written in the new format whilst the remaining two were in the old. All four plans were up to date and relevant to the needs of the individual. They all clearly identified the assistance required whilst encouraging and promoting as much independence as possible. The new format is a continuous working tool that covers a period of up to one year and shows at a glance the level of care required to meet the needs in a “person centred” way. The care plan/diary shows aims, needs observations and comments. Each care plan can be updated on a daily basis to meet the changing needs. Risk assessments are The Knells Country House DS0000059723.V361031.R01.S.doc Version 5.2 Page 12 included as details of medication and healthcare needs. Enhanced care plans are introduced for any resident who may need specialist and/or terminal care and we were able to examine one such plan. It showed clearly the level of care provided and the improvement in the health and well being of the resident in question. This type of plan can be discontinued should the improvement be permanent. All records viewed during this visit indicate that people living at the home have access to health care professionals such as doctors, community nurses, podiatrists/chiropodists and are assisted to attend hospital appointments where necessary. There is a medication policy and procedure in place at the home. Staff have received training in safe handling of medication to help ensure that this is administered safely. We looked at a sample of medication records and found them to be correctly and neatly completed. All medication is stored correctly and any controlled drugs are recorded in the appropriate way. The manager conducts regular checks on the records and periodic audits on all medication as a further safeguard. During the visit we observed the way that staff interacted with those living in the home. There was a warm and friendly atmosphere and the staff were heard to laugh and joke with the residents in a respectful manner whilst still preserving their dignity. The Knells Country House DS0000059723.V361031.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Routines are sufficiently flexible to meet changing needs and activities are available for those wishing to participate. EVIDENCE: We discussed with the manager the need to provide routines within the home that are flexible enough to meet the needs of those who live in the home whilst not making too many demands. She agreed that it was not always possible to persuade residents to take part in large group activities so she ensures there is a time after lunch when both the staff from the early shift and the staff from the night shift are on duty together. This allows time for one to one activities such as reading a magazine or newspaper or talking about old times with pictures of household items or places the resident may have visited when they were younger. During the visit staff were enjoying a “sing-song” with those sitting in the conservatory and another member of staff took a resident for a walk in the garden with her dog that also lives in the home. The lady The Knells Country House DS0000059723.V361031.R01.S.doc Version 5.2 Page 14 commented to us, “ I am so pleased that my dog could come and live with me at The Knells”. Visitors are welcome at anytime and the manager and staff told us that most of the families took an active part in the life at the home. There is a residents’ committee that is run by family members that meets on a regular basis. The committee organise fundraising and social events and have made a donation to the home to help with the cost of purchasing a large screen television. One of the visitors who serves on the committee told us they were hoping to purchase a specialist bed for use in the home in case there was ever a delay in obtaining one from the Health Authority. People from the community such as “the Mother’s Union” and visitors from the local churches come in to talk to the residents. Visiting entertainers come and birthdays are always celebrated. There are church services held for those wishing to attend. We spoke at length to the cook and discussed the menus and the various likes and dislikes of those living in the home. She has worked at The Knells for a number of years and it was obvious from our discussions that she knew the residents very well indeed. Special diets are catered for and all who spoke to us during the visit said they enjoyed their food. Visitors also remarked on the quality of the food and said, “ My mother never stops eating and really enjoys her meals”. The Knells Country House DS0000059723.V361031.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using this service are confident any complaints or concerns will be listened to and acted upon. EVIDENCE: There is a complaint log kept in the hall where any complaints or concerns are recorded although those we spoke to said they preferred to speak directly to the manager if they wished to discuss anything. We were able to look at the details of the few minor issues that had been written in the log and noted that they had been dealt with quickly and in the most appropriate manner. Staff told us that if any member of a family had any concerns they advised them to speak to the manager. We checked for any adult protection issues but there had been none raised and CSCI had not received any either. Staff have completed training in protection of vulnerable adults and those who spoke to use showed a good understanding of the subject and the protocol to follow should this be necessary. The manager had a place booked on a training course to “train the trainers” in adult protection that had been organised by Social Services. Unfortunately this had been cancelled but she hopes to be given a further opportunity in the near future. The Knells Country House DS0000059723.V361031.R01.S.doc Version 5.2 Page 16 The Knells Country House DS0000059723.V361031.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 23, 24, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The design and layout of the building enables residents to live in a warm, wellmaintained and comfortable environment that is suitable for it’s stated purpose. EVIDENCE: The Knells is a large Victorian property that has been extended and adapted for its current use as a care home. The rooms are large and airy with high ceilings and plenty of windows providing natural light. Since the current owners purchased the home some four years ago they have made a great many improvements to the environmental standards of the building. A new central heating system has been installed within the last twelve months and The Knells Country House DS0000059723.V361031.R01.S.doc Version 5.2 Page 18 the residents and staff commented on the difference this has made. A new conservatory was recently completed and this is proving very popular and gives extra communal space. There is no television in this room and it gives those living in the home opportunity to sit quietly or listen to music. During our visit those residents sitting the conservatory were enjoying a “sing-song” with the staff. The programme of re-decoration is on going with the hall and very large staircase being completed a few months ago. The home has recently employed a full time maintenance worker, which has meant that small repairs and decorating are completed with a minimum of delay. The Knells is situated in large well-maintained grounds and a summerhouse has been purchased with funds provided by the residents’ committee. The garden areas provide a lovely area for those using this service to enjoy during the warm weather. All of the residents’ rooms are well furnished with all those situated on the first floor having en-suite toilet facilities. Those living in the home have brought in items from their own homes, which has ensured the rooms are homely and personal to each individual. One resident commented, “ You should see my room it is lovely. I even have room for my dog”. The home is extremely clean with staff having completed training on infection control, which reduces risk to those using this service. Laundry facilities are good with the equipment maintained through an annual contract. The necessary policies and procedures are in place to ensure staff know how to deal with soiled linen. The Knells Country House DS0000059723.V361031.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff team have been correctly recruited and have the necessary skills and experience to provide a high standard of care and support to vulnerable people. EVIDENCE: Staff rotas and observation during the visit indicate the home has sufficient staff on duty with a range of skills and experience to provide a consistently high level of individual care. This and low staff turnover provides continuity for residents during the day and night. During the morning there are four care staff on duty plus the manager and during the afternoon there are three care staff plus the manager. There are two waking night staff. The manager ensures that there is a staff handover period of between one and two hours, which gives staff time to spend with residents on a one to one basis chatting or organising activities. Care staff do not prepare food as the catering staff are on duty until six o’clock in the evening. During the visit we observed staff talking to residents and visitors in a warm friendly and polite manner. Visitors commented, “the staff do a very good job” and “ the ladies in blue (care staff) are lovely”. The Knells Country House DS0000059723.V361031.R01.S.doc Version 5.2 Page 20 The manager ensures all training is kept up to date. There is 70 of the staff currently qualified in National Vocational Qualification in care at levels 2 & 3, with a further 10 working towards the completion of the course. Recently completed training includes, Manual handling, challenging behaviour, first aid, understanding learning disability and abuse of vulnerable adults. A private training company is used to deliver the induction and foundation training for all new staff. The Knells has a full recruitment and selection process and we were able to examine the files for four members of staff, two of whom had been recently employed. The files were all in order and up to date with evidence that all legal checks had been completed prior to staff starting work, apart from the 3 day induction programme that takes place away from the home. The files contained application forms, two references and details of the interview process. When we spoke to the staff they all said they enjoyed their work and felt valued by the manager and encouraged to give of their best to provide the highest possible level of care to those living in the home. The Knells Country House DS0000059723.V361031.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 35, 36, 37 & 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The Knells is well managed and organised. The home has a positive and inclusive atmosphere and is run in the best interests of those living there. EVIDENCE: The registered manager is a qualified nurse and has also completed the Registered Manager Award. Discussions with the staff team and residents confirmed that she is approachable and fair. Some comments received were, “Mandy is lovely and so kind” (visitor) “I see the manager every day and we always have a laugh together” (resident) “we can talk to Mandy about anything and she is always available for help or advice” (staff). She has a warm, relaxed The Knells Country House DS0000059723.V361031.R01.S.doc Version 5.2 Page 22 management style and whilst there are clear lines of accountability she enjoys working with the carers providing direct care. The home has a full set of policies and procedures that are available to staff at any time. These are updated on a regular basis to ensure all the legal requirements are met. Staff are supervised every 2 months and the manager sometimes holds group supervisions if there are specific subjects to discuss. Residents meetings are held and the residents’ committee meets on a regular basis. Quality audits are completed through questionnaires to residents, staff families/ advocates and healthcare professionals. All inspection certificates were in place and up to date including, gas safety, electric, small appliance testing, and the fire safety equipment. There is sufficient evidence through risk assessments and safety checks to demonstrate that the health and safety of those living and working in the home is promoted as much as possible. The manager is currently updating the business plan to include plans for the future. There are procedures in place to ensure that residents’ finances are safeguarded with suitable and appropriate records kept. The Knells Country House DS0000059723.V361031.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 4 4 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 4 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 X X 3 3 3 3 STAFFING Standard No Score 27 4 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 X 3 3 X 3 The Knells Country House DS0000059723.V361031.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Knells Country House DS0000059723.V361031.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Northwest Regional Contact Team Unit1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 01772 730 100 Textphone: 01772 730 176 Email: enquiries.northwest@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Knells Country House DS0000059723.V361031.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!