Inspection on 02/07/07 for Knappe Cross Care Centre

This inspection was carried out on 2nd July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Knappe Cross Care Centre 24/05/06

Knappe Cross Care Centre 27/01/06

Knappe Cross Care Centre 31/08/05

Knappe Cross Care Centre 16/11/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Knappe Cross Care Centre Knappe Cross Care Centre Brixington Lane Exmouth Devon EX8 5DL Lead Inspector Teresa Anderson Key Unannounced Inspection 2nd July 2007 10:30 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 Knappe Cross Care Centre DS0000061403.V338113.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. Knappe Cross Care Centre DS0000061403.V338113.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Knappe Cross Care Centre Address Knappe Cross Care Centre Brixington Lane Exmouth Devon EX8 5DL 01395 263643 01395 223648 knappcross@onetel.com 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) Ashdown Care Limited Paula Burtoft Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42) of places Knappe Cross Care Centre DS0000061403.V338113.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) 2. The maximum number of service users who can be accommodated is 42. Date of last inspection Brief Description of the Service: Knappe Cross is a 42 bedded care home (with nursing) situated in a semi-rural area of Exmouth. The house is a Grade 2 listed building, which has been extended to include a large annexe. It is situated in its own grounds with ample parking and some views to the sea. The home has several lounges/seating areas, a dining room and a ‘function room’. Two small passenger lifts link the floors, one in the main building and one in the extension. There are 34 single bedrooms and 4 shared bedrooms. All but two of the rooms have ensuite facilities. There are Registered Nurses on duty throughout the day and night. Information about this service, including CSCI reports, is provided by the home by contacting them directly. The fees range from £306.00 to £860.00 per week. There are additional charges for transport and some social activities, and for items such as toiletries and newspapers. Knappe Cross Care Centre DS0000061403.V338113.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place as part of the normal programme of inspection. There were two inspectors at the site visit, who arrived at 10.30am and left at 8.00pm. During that time we looked closely at the care and services offered to 6 people as a way of judging the standard of care and services generally. Where possible we spoke with these people in depth, and tried to contact their relatives and any health or social care professionals involved in their care. We looked at their care assessments and care plans closely, and spoke with staff about their knowledge and understanding of the plans. We looked at their bedrooms and we looked at the overall environment from their perspective. We also spoke with approximately 15 other people who live here, with 5 visitors, with the manager, with nurses, carers and kitchen staff. We looked around the building at all communal areas and saw many of the bedrooms. We looked at other records including medication, staffing, accident and incident reports, training, fire safety and recruitment. Prior to the visit to the home we sent surveys to various people asking for feedback and comments. We sent 11 surveys to people who live here and 6 were returned; 10 to relatives of the people who live here and 3 were returned; 12 to staff and 6 were returned; 19 to health and social care professionals who attend people living here and 11 were returned. Their feedback and comments are included in the report. Other information given to the commission throughout the year has been taken into account. In addition, and before we visited, the manager provided information about the management of the home and their own assessment of what they do well and what they plan to improve upon. What the service does well: People who consider coming to live here have enough information about the home on which to base their decision. They, and/or their supporters, are invited to visit the home and to meet with other people who live here and with staff. Each of these people is assessed by a Nurse working at the home so that the home can be sure that their needs can be met. When they come to live here people are helped to settle in. People living here have their health well cared for. Their care is planned to help prevent for example skin damage, malnutrition, dehydration and falls. GP’s and other specialist services are involved appropriately and they report that their advice is acted upon and used to improve practice overall. Knappe Cross Care Centre DS0000061403.V338113.R01.S.doc Version 5.2 Page 6 People who live here really enjoy the food and appreciate the efforts made by the chefs to meet their likes and preferences. One person commented that the chef seemed to really understand how important food is to older people and really tries hard to please everyone. Meals can be taken in the dining room, the lounge or in bedrooms. To make sure that hot meals stay hot, they are delivered to bedrooms in a heated trolley. Hot and cold drinks and snacks are available throughout the day. People have their complaints heard and these are dealt with. The home have, since the last inspection, received some complaints about call bells not being answered quickly and staff not being available. The manager and Director of Operations have dealt with these complaints and no complaints have been received for some months now. People living here feel safe and staff try to ensure that their privacy and dignity is protected. Staff receive training in safeguarding adults. The manager is trained as a trainer in preventing abuse and has a good understanding of the procedures to be followed. Staff are described as ‘lovely’ and ‘kind’ and some staff were mentioned by name as being particularly good. There are usually 2 Registered Nurses on duty in the morning together with 5 or 6 carers. In the afternoon there is one Registered Nurse with 4 carers and at night 1 Registered Nurse with 3 carers. In addition there is a cook, a cleaner, a laundry person and an administrator. People say that the staff are very busy but always helpful. The manager of this home was repeatedly praised for her competence in managing this home and for the improvement she has bought about. Staff say she has bought structure to the home, that they now better understand their roles and responsibilities and that they are continually working towards developing their skills and improving practice. People who live here describe her as ‘excellent’. One healthcare professional said ‘she is a breath of fresh air’ who knows what needs improving and is making sure that things are put in place to make that happen. The manager ensures that the home is safe, that staff receive mandatory training and that people’s monies are kept safely and securely. In addition she canvases the views of the people who live here as a way of helping to ensure that the home is run in their best interests, based on their needs and preferences. What has improved since the last inspection? Since the last inspection many improvements have taken place. Staff have worked really hard to improve care planning and to ensure the needs of people at risk of dehydration and malnutrition are met. Knappe Cross Care Centre DS0000061403.V338113.R01.S.doc Version 5.2 Page 7 The way that medicines are managed has improved and the home has bought fridges so that medications needing refrigeration can be stored safely and securely. The manager is ensuring that all staff receive mandatory training and appropriate updates. The guide to the home has been updated and staff now read this to ensure they know what services are being offered. All people who come to live here undergo a comprehensive assessment of their needs and this includes nutritional screening. Mealtimes are less hurried and a heated food trolley has been purchased to ensure that those people who eat in their rooms, receive hot food. Some areas of the home have been redecorated or refurbished and some carpets have been replaced. What they could do better: The work ongoing to ensure that all people who live here receive person centred care should continue to ensure that people have their needs met in an individual way. This will also help to ensure that issues relating to communication, equality and choice are addressed. The member of staff who applies prescribed creams must sign to say that they have done so that there is no confusion about whether or not this has been done. Some medicines have a limited shelf life once they are opened and staff should record what this is so that they are not used beyond this date to ensure they remain effective. All medications that have been prescribed for a person but which are no longer used must be disposed of to reduce the risk of them being used or taken by someone else. All the people living here should benefit from opportunities which would help them to meet their needs for stimulation and to be social. This is particularly the case for those people who spend long periods of time in bed or who have communication and/or sensory disabilities. The manager has already started to address this. All areas of the home should be made safe so that people can wander around as they choose. Hazards such as creased carpets or hazards posed to people with communication problems should be identified and addressed. Knappe Cross Care Centre DS0000061403.V338113.R01.S.doc Version 5.2 Page 8 The floor in the kitchen should be cleaned and the area in the kitchen where the plaster is peeling should receive attention to ensure that all food is stored and prepared in a safe environment. In addition the manager should check whether eggs need to be stored in a fridge. People with mobility problems should have access to appropriate seating in all the areas of the home that they use. Staffing levels and the mixture of skills of those on each shift should be kept under review to ensure that all the needs of all the people who live here can be met. The manager should continue to aim for having 50 of care staff trained to National Vocational Qualification (NVQ) level 2 or above. In addition, training relating to caring for people with dementia should meet the specifications set out by ‘Skills for Care’ so that the training is appropriate to the needs of people. All foods which require refrigeration should be stored at an appropriate temperature. Where the equipment used for this is faulty, this should be fixed. 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. Knappe Cross Care Centre DS0000061403.V338113.R01.S.doc Version 5.2 Page 9 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 Knappe Cross Care Centre DS0000061403.V338113.R01.S.doc Version 5.2 Page 10 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): 1 and 3. (This home does not provide intermediate care). Quality in this outcome area is good. The people who come to live here can be assured that their needs will be assessed and that the staff can meet those needs. People have good information about the home that helps them to make a decision about where to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Knappe Cross has a guide to the home that is up to date and relevant. Staff sign a record to say they have read this so that they know what services are being offered and what people can expect from the home. Relatives of people who live here say they saw this and that they were able to visit and look around the home. In surveys people who live here confirm they had enough information about the home before they moved in. One person said they had Knappe Cross Care Centre DS0000061403.V338113.R01.S.doc Version 5.2 Page 11 been invited to a cream tea party as a way of getting to know the home before their relative moved here from out of the area. Nurses assess each person who wants to come to live here. This assessment is comprehensive and helps to ensure that the home can meet the person’s needs. This information is recorded and is used as the basis for plans of care. Staff say they have good information about people’s moving and handling and skincare needs when they move in which helps them to care for people safely. When asked, staff say they help people to settle in to the home by introducing them to other people who live here and to staff. They make sure their rooms are personalised with their possessions and that they are shown around the home. In addition, staff try to ensure that, at meal times, people sit with people with whom they may have common interests. One person said staff have been really helpful. Another person with a communication disability said that the staff couldn’t have been nicer and although they had not yet been introduced to other residents, they would like to be. This information was passed to the manager. Knappe Cross Care Centre DS0000061403.V338113.R01.S.doc Version 5.2 Page 12 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): 7, 8, 9 and 10. Quality in this outcome area is good. People who live here have their healthcare and medication needs met through good planning and management. Staff are working hard to help ensure that the delivery of ‘person centred care’ continues to improve. Their privacy and dignity is respected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person who lives here has a plan of care. These are easy to access and to understand. Core needs such as maintaining nutrition and hydration, moving and handling and skin care needs are identified. Plans are put in place which detail how these needs will be met and these are reviewed as needed to ensure the plan is working. Care plans detail the favourite foods of those people who are identified as being at risk of malnutrition. Care plans say that some people need special equipment to eat and this was seen to be in use. People are weighed regularly and appropriate actions are taken where needed. Knappe Cross Care Centre DS0000061403.V338113.R01.S.doc Version 5.2 Page 13 In surveys people who live here say they usually get the care and support they need, that staff listen to them, call the doctor when needed and look after them when they are not well. Healthcare professionals say that the staff communicate with them clearly, that staff demonstrate a good understanding of the care needs of the people who live here and that specialist advice is incorporated into care planning. One person said that the nurses seek advice and use this to improve practice. Some GP’s report that it can be difficult to get hold of the Nurse on duty to discuss care needs because of the layout of the building. They have suggested that the Nurse in charge carries a portable phone so that she can be contacted when needed. This information was passed to the manager. Only one person has a pressure sore, and this had developed prior to their admission here. Pressure relieving equipment such as special beds, mattresses and cushions, is available and was seen in use around the home. Residents fall infrequently and these are usually related to supporting people to be as independent as they wish. One person said how impressed they were with staff who had assessed their relative when they were admitted, had put all this information together, seen how the care and support provided could be improved and made sure that happened. Care plans demonstrate that information gathered by carers and reported to nurses is used to plan and deliver care. For example one person has had difficulty sleeping. This was recorded and reported and actions have been taken to help this person. Care plans also show that reviews of the care being delivered are taking place and that appropriate actions are taken to alter the care where needed. The information provided by the manager prior to our visit demonstrates an understanding of the importance of person centred care, a knowledge of what still has to be achieved in this area and a plan relating to this. Inspection of care plans and discussions with staff demonstrate real improvement in this area in relation to meeting health care needs. Areas which still need further improvement relate to planning the care and meeting the needs of people with communication difficulties in a person centred way. For example, one person has little or no sight. This affects every aspect of their day-to-day living. Whilst staff demonstrate a genuine desire to support this person, the care plan does not provide information for staff on how this might be achieved in a person centred way. The care plan does state that staff should ‘give reassurance’ and that things ‘need explaining at every point’, however Knappe Cross Care Centre DS0000061403.V338113.R01.S.doc Version 5.2 Page 14 people, in surveys and interviews, say this does not always happen. They say that explanations and reassurance are not always given or are not given in terms that can be understood. Another person has communication problems. The care plan contained good general information relating to one of these communication problems and staff have had some basic training relating to another. However, the care plan did not contain information which specifically related to this person which would help staff to support this person to communicate in a person centred way. In surveys, a health care professional identified that this is an area that needs further improvement. Another person with impaired sight said that staff are generally very good. However, they do not always make sure that things are put within reach and did not always return items to their usual place meaning they could not find these items. There was no information in the care plan of one person who becomes confused , as to what might cause their confusion. Since the last inspection the management of medication has improved. Staff say it is easier to manage medications since additional storage systems had been introduced and that work is ongoing to improve the recording of allergies. There are generally good records relating to medicines received into the home, administered by staff and of those disposed of. Medication records were mostly up to date, although the staff applying these creams are not always recording that they have done this. Records also show that staff monitor how well newly prescribed medicines are working. Stock medicines are mostly kept to a minimum for easy management and controlled drugs are stored safely with good record keeping in place. However, in one area of the home some medications that are no longer in use are being stored in the home when they should be disposed of. The date of opening some medicines with a limited shelf life have not been recorded meaning that these medicines could be used for longer than they are effective. Staff have a good understanding of the importance of promoting privacy and dignity for the people who live here and were seen putting this into action. People say that staff knock on their bedroom doors before entering if the door is closed. Knappe Cross Care Centre DS0000061403.V338113.R01.S.doc Version 5.2 Page 15 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): 12, 13, 14 and 15. Quality in this outcome area is adequate. Some people living here benefit from a varied and interesting social life. However, the diverse range of needs and abilities of individuals living here have yet to be addressed satisfactorily. People benefit from a diet which is varied and nutritious and which they thoroughly enjoy. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In surveys, there was a mixed response from the people who live here as to whether there are activities in which they can take part. Of the 5 people who responded, 1 said there are always activities they can take part in, 1 said usually, 1 said sometimes and 2 said never. Knappe Cross Care Centre DS0000061403.V338113.R01.S.doc Version 5.2 Page 16 Activities include occasional trips out, a weekly session of either a quiz, art and crafts or story telling, weekly bingo, visits from the hairdresser and a keep fit session. The home has an activities co-ordinator who arranges these activities and who, on two afternoons each week, visits with people who cannot join in with organised activities but benefit from one to one attention/stimulation. We did not look at the records kept by the activities co-ordinator but it is reported that stimulation includes bible reading, letter writing and reminiscence therapy using photographs and pictures to stimulate conversation. On the day of this site visit approximately 12 people were joining in the drawing class, or were happy being part of the activity without actually joining in. The Director of Operations reports that each afternoon a carer is allocated to spend the afternoon with those people who sit in the lounge to carry out social activities. We looked at how the social care needs of 6 people were being met. Although there is a place to record and plan to meet social care needs, the quality of the information recorded varies. For example there was no information relating to the daily lifestyle of one person or their social contacts, which would help staff to meet this persons individual needs. Another person’s form relating to social activities was blank. Although their care plan did say that this person needs lots of stimulation, it did not provide information about how this might be achieved and had not been evaluated or reviewed. The care plan states that this person had experienced 8 social interventions in one month and 6 in another. Some people have visitors frequently or for long periods of time. Care plans records show that during these times people’s social needs are being met, however there are no plans in place to meet their needs outside these times. One person said they would not visit so much if they thought their relative was getting more attention in this area. One visitor said ‘I wish staff were able to just sit and talk with my relative apart from when they are being attended to’. A resident said ‘I wish we had more to do’ and others said they could get bored. The care plan of one person identified that they have a strong religious belief. The Director of Operations reports that this person is visited by a priest weekly. Although there is a chapel in the home staff say that for safety reasons this person is closely supervised and therefore cannot have free access to this area and that they do not have the time to sit with them. The information provided by the manager prior to the site visit identified that many people living here have a religious faith. However people say that a church service is not held in the home, although some people receive monthly communion. Knappe Cross Care Centre DS0000061403.V338113.R01.S.doc Version 5.2 Page 17 Care plans contain information which help people to make choices in their daily lives. This includes food preferences and preferred getting up and going to bed times. Staff say these times are not always followed because people get tired or wake earlier. Some people were seen to have been put to bed at around 5 o’clock. Visitors report they are made really welcome and often offered refreshments. Some stay and have meals with their relative or spend whole days with them. Visitors are free to come and go as they please, although they are reminded that the front door is locked at 8pm for security reasons. Meals are described as ‘lovely’, ‘excellent’ and ‘the best’. The chef is a real favourite and is described as ‘helpful’ and ‘always accommodating’. People say if they do not like something they can have something different. One person said that the chef really understands how important food is to older people. Meals are eaten in the dining room or in the lounge, or in individual bedrooms. Those that are served in bedrooms are kept warm using a heated trolley and people say this works really well. Drinks and snacks are offered throughout the day and these often include homemade cakes. Knappe Cross Care Centre DS0000061403.V338113.R01.S.doc Version 5.2 Page 18 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): 16 and 18. Quality in this outcome area is good. People who live here have their complaints heard and acted upon. They are kept safe and are protected from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In surveys people say they are listened to and know who to speak to if they are not happy. People feel that the management of complaints had improved since the new manager had taken over. Since the last inspection some people have raised concerns about this home, some of which we have asked the manager to investigate. The manager reports that 7 complaints have been received, that all have been acted upon within 28 days (as per the complaints policy), that 5 were upheld, and that actions were taken to address the issues raised. No complaints have been received in recent months. Staff have received training in safeguarding people. They demonstrate a good knowledge of what abuse is and say they would report any allegations or suspicions to the manager. The manager is trained to train people in safeguarding vulnerable adults and is familiar with the procedures to follow if an allegation were made. People say they feel safe. Knappe Cross Care Centre DS0000061403.V338113.R01.S.doc Version 5.2 Page 19 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): 19, 22 and 26. Quality in this outcome area is adequate. People who live here benefit from a home that is clean, generally safe and homely. Some improvements have been made and further actions would make the environment safer and easier to access for those people who are disabled. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the lounge in the extension and the upstairs corridors in the main building have been redecorated. In addition the carpet in the extension lounge has been replaced, the call bell and heating systems have been updated and a specialist bed has been bought for a person who needs this. People say that minor repairs are attended to quickly. Knappe Cross Care Centre DS0000061403.V338113.R01.S.doc Version 5.2 Page 20 The home has a Hotel Services Manager who takes responsibility for housekeeping duties. People say the cleaners work really hard and the home is always clean and fresh. Gloves and aprons are distributed throughout the home for staff to use when needed to help prevention infection. The home has one level access shower and another is being created on another floor of the home. In addition there are adapted baths for people with mobility problems. One person was pleased that additional aids were being arranged for their toilet so that they could continue to use this unaided. The home have a number of communal areas for people to sit in. One person reported that people are not allowed to sit in one area any more. When we checked we found the chairs had been removed. The manager could not recall why this had happened and agreed to review this arrangement based on the preferences of individuals. Staff were overheard discouraging one person from walking. When asked why this was, staff say they feel the environment is not safe for them to walk around in on their own. When we checked we found that risk assessments relating to this person, their desire to walk around and the environment had not been undertaken. Some people pointed out to the inspectors that the function room only has low seating. They say that some higher chairs are put there but these are frequently moved and not put back. This issue was raised at the residents meeting held in April. On the day of the site visit we saw three chairs here which would be suitable for people who cannot get into or up from low chairs. However, these were placed against a wall and not in position where people could use them without help. The laundry looked a little untidy and disorganised on the day of inspection but it was clean. People say their clothes are well cared for and did not report that any items had gone missing. Washing machines have programmes to deal appropriately with soiled linen. One piece of carpet near to the reception area is creased and a notice pointed this out as a hazard has been placed nearby. However, this could not be seen. No one has fallen here, although one person said they had stumbled. This was discussed with the manager. Knappe Cross Care Centre DS0000061403.V338113.R01.S.doc Version 5.2 Page 21 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): 27, 28, 29 and 30. Quality in this outcome area is adequate. People who live here are supported by kind and caring staff who would benefit from further training. Staffing levels are not always adequate to meet the needs of all the people who live here. Recruitment processes have improved but some documentation is not available which would show that these processes are robust. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The duty rota shows that there are usually 2 Registered Nurses on duty in the morning together with 5 or 6 carers. In the afternoon there is one Registered Nurse with 4 carers and at night 1 Registered Nurse with 3 carers. The Operations Manager reports that there are sometimes 3 Registered Nurses on duty in the morning. In addition there is a cook, kitchen assistant, 2 cleaners, a laundry person and an administrator. The manager is supernumerary to care/nursing staff. In surveys and in conversations people say that staff are kind and that nothing is too much trouble. One person said ‘they are so lovely, they come to see me just to give me a hug’. They say they are always busy but do their best to Knappe Cross Care Centre DS0000061403.V338113.R01.S.doc Version 5.2 Page 22 attend to them. One person said they spend long periods in their room, that they wished staff could stay longer and that they got bored. Concerns raised with the commission (some of which were passed to the manager to investigate) were generally about not being to find staff when needed and call bells ringing for a long time. In a survey one person said that staff are ‘stretched’ and that sometimes it is difficult to find staff. Some relatives report that the people they visit spend long periods alone and get bored. Staff say they just about manage. The manager recognises that staff are stretched and is currently recruiting for an additional member of staff. In surveys staff say they are well supported and they are not asked to care for anyone outside their area of expertise. In the questionnaire completed by the manager, she reports that induction training has not been based on recognised best practice but that this will be the case for the most recently appointed person. She reports that 36 of staff currently hold a National Vocational Qualification (NVQ) in care to level 2 or above, and that she continues to aim for 50 . The Operations Manager reports that 5 staff are currently working towards an NVQ in care. It was noted that on some occasions none of the carers working on night duty have an NVQ qualification. The Operations Manager says that these carers have worked at the home for a long time. Nine people living here have impaired vision, five have impaired hearing and eight have specialist communication needs. Staff have received some training in these areas. One health professional reported that training had been requested and staff had attended, that this training had been put into action in the home with a resulting improvement in practice. One health care professional commented that continued improvement was needed to further improve the support offered to people with communication and mental health problems. The manager reports that she is arranging training for staff relating to caring for people with dementia. Records do not demonstrate that staff have received training in how to meet people’s social care needs. The recruitment files of 3 staff members were checked. Each contained an application form, written references and proof of identity, as is good practice to ensure that appropriate people are recruited to work in the home. However, the manager could not locate the police checks which she believed have been carried out. There was evidence in the file that these had been done. The Operations Manager confirmed this and says that, as per Data Protection guidance, they have been destroyed or returned to the owner. Knappe Cross Care Centre DS0000061403.V338113.R01.S.doc Version 5.2 Page 23 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): 31, 33, 35 and 38. Quality in this outcome area is good. People benefit from living in a well managed home which is striving to improve person centred care and which is working hard towards trying to make sure it is run in their best interests. Although people who live here, and their belongings, are generally safe, additional risk assessments and action would further reduce the risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Prior to this sit visit the manager provided comprehensive information relating to the management of this service. In general, this demonstrates a good Knappe Cross Care Centre DS0000061403.V338113.R01.S.doc Version 5.2 Page 24 understanding of what the home does well and what needs to be improved. Plans are in place to achieve the improvements identified. In particular the manager plans to continue with the work already started to improve ‘person centred care’. This should also help to address and improve issues relating to equality and diversity. During this inspection we identified that these issues need to be addressed in relation to ensuring that people’s diverse needs are met (see Health and Personal Care), that there is equality in relation to meeting social needs (see Daily Life and Social Activities) and that the environment may not be providing equality of access in some areas (see Environment). The manager has already started to address some of the issues raised when feedback was given to her following the site visit. This demonstrates a real desire to continually improve the standard of all care offered by this service. Comments about the manager include ‘she’s a breath of fresh air’ and ‘she’s very good and will turn her hand to anything’. One visitor and a member of staff commented that staff morale had improved. They believe this has resulted from the stability provided by the manager’s appointment and from her skills. Staff say they feel well supported, that there is more structure to their work and that they better understand their roles and responsibilities. The people who live here, relatives and health care professionals have nothing but praise for the manager. They say she is approachable, listens, has a good understanding of every aspect of the home and that she is continually working to improve standards of care. Staff say it is great that they know what needs improving, but even better they know what they need to do and how to do it. Since the last inspection residents’ meetings have recommenced and people who live here have been consulted regarding their thoughts on the support and services offered. At the last inspection the manager reported that questionnaires had been sent to people which focussed on gaining peoples views about the food and activities. There is clear evidence that people’s satisfaction with the food has improved significantly. Staff receive mandatory training to help keep people safe and this includes fire training, infection control and moving and handling and the manager keeps a record of this to ensure that all staff receive updates as needed. Good practices in relation to food and hygiene were observed in the kitchen. However, it was noted that staff had been recording the temperature of one fridge as below 0C which is too low. In addition eggs, which are ordered weekly, are being stored at room temperature and not in the fridge. Environmental Health advise is that it is good practice to store eggs in the fridge, although not a requirement. Equipment is clean and in good repair, although the floor looked as though it needed a deep cleaning, which the Knappe Cross Care Centre DS0000061403.V338113.R01.S.doc Version 5.2 Page 25 manager said would be done later in the week, and wall plaster is beginning to crack in one area. The temperature of bathing water is controlled by thermostatic valves to prevent scalding. The manager reports that the water running into some sinks is very hot and there are signs at the sinks identifying this. She has not carried out risk assessments in relation to all these areas which she needs to do to ensure that all people, especially those with communication problems, are protected from scalds. We checked the accounts of 3 people whom the home supports to manage their monies. Good records are kept along with receipts ensuring that all accounts are auditable and monies accounted for. Knappe Cross Care Centre DS0000061403.V338113.R01.S.doc Version 5.2 Page 26 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 2 X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Knappe Cross Care Centre DS0000061403.V338113.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes 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. 1. Standard OP7 Regulation 15 (1) Requirement All the people who live here should have a care plan that details how their health and welfare needs are to be met in a person centred way. This particularly relates to those people with communication and/or mental health needs. To ensure that people receive their medicines safely: All creams prescribed for people must be signed as being applied by the person who did this. A record should be kept of the use by date of all medications with a limited shelf life, so that they are not used beyond this date. All medications in the home that are no longer used (e.g. because the person for whom they were prescribed has died) must not be kept in the home for any longer than necessary. Knappe Cross Care Centre DS0000061403.V338113.R01.S.doc Version 5.2 Page 28 Timescale for action 31/01/08 2. OP9 13 (2) 31/08/07 3. OP12 16 (m) All the people who live here should have their social and engagement needs met in a way that suits them. This particularly applies to those people who are frail, bedbound or who have dementia or communication problems. Previous timescale of 30/10/05 and 30/04/06 not met). This requirement was partially met at the key inspection in May 2006 and continues to be partially met. People who live here should be supported to continue with the faith of their choice and to attend religious services of their choice. The manager must ensure that all the people who live here can move safely around the home. Any hazards, such as creased carpets or hot water, or hazards posed to people with cognitive problems who like to walk around the home should be identified and dealt with. For the safety of the people who live here, the manager must ensure that the fridges work properly and as a result that all food stored in fridges is stored at the appropriate temperature. 31/01/08 4. OP12 16 (3) 30/09/07 5. OP19 23 (2) 30/09/07 6. OP38 16 (2) (j) 31/08/07 Knappe Cross Care Centre DS0000061403.V338113.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP22 OP27 Good Practice Recommendations The manager should ensure that people with mobility problems have access to appropriate seating in the areas of the home that they use. The manager should continue to review and alter the deployment of staff or increase staffing levels as necessary to ensure that there are enough staff on duty to ensure that the people who live here have all their needs met. The manager should continue to work towards ensuring that 50 of care staff hold a National Vocational Qualification (NVQ) in care to level 2 or above to ensure that the people who live here will have their needs met. The manager should ensure that staff receive training that helps them to meet all the needs of the people who live here. This might include training in caring for people with dementia, caring for people who are visually or hearing challenged, helping to meet people’s social needs and supported people with communication problems to have a conversation. Any training provided to staff to help them to care for people with dementia should meet the specifications set out by ‘Skills for Care’. The floor in the kitchen should be cleaned and the area in the kitchen where the plaster is peeling should receive attention to ensure that all food is stored and prepared in a clean and safe environment. It is recommended by Environmental Health that eggs are stored in a fridge. 3. OP28 4. OP30 5. 6. OP30 OP38 7. OP38 Knappe Cross Care Centre DS0000061403.V338113.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@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. 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