Inspection on 24/05/06 for Knappe Cross Care Centre

This inspection was carried out on 24th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 02/07/07

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 Announced Inspection 24th May 2006 09:15 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.V289889.R01.S.doc Version 5.1 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.V289889.R01.S.doc Version 5.1 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 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 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.V289889.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Knappe Cross may admit up to three residents who are aged between 45 years and 65 years outside the registration category of OP but not within any other category of registration. The home must have knowledge of the National Minimum Standards relating to Younger Adults and apply these as good practice where appropriate. The maximum number of persons accommodated at the home, including these 3 residents, will remain at 42. 31st August 2005 2. 3. 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. As at April 2006, the fees range from £306.00 to £860.00 per week. There are additional charges for transport and some social activities. Knappe Cross Care Centre DS0000061403.V289889.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit was undertaken by two inspectors with two days notice given. It started at 9.15am and finished at 8pm. During that time the inspectors concentrated on tracking the care, services and accommodation offered to six residents who live at Knappe Cross Care Centre. They spoke with other residents, two visitors, care and auxiliary staff, the temporary manager and the Director of Operations. As part of the inspection the home completed and provided a pre-inspection questionnaire; survey forms were sent to Social Services care managers (one was returned); one was sent to a healthcare professional who has visited the home (returned); five surveys were sent to GP’s (one returned). Fifteen staff were asked to complete survey forms and all were returned. Thirteen residents were asked to complete survey forms and four were returned. Records relating to recruitment, training, fire safety and risk assessments were also viewed. This home has undergone many managerial changes over the past two years. The company has recognised this as an issue and are commended for appointing a temporary manager whilst advertising for a permanent post. They are hopeful that they have now made an appointment. What the service does well: Knappe Cross Care Centre has a staff group that has remained committed and supportive to residents during a prolonged period of change. The temporary manager and the Director of Operations have put in place a development programme that they are implementing at a pace that the staff team can work with. Residents say the staff are ‘caring’, ‘friendly’, ‘kind’, ‘100 polite’ and always try their best even when busy. Residents who returned surveys said they could see a doctor when they wanted and care managers (social services) said they were happy with the care given to residents. One said ‘I have absolutely no complaints whatsoever’. Staff say the best thing about working at Knappe Cross is the residents. Visitors are warmly welcomed and offered refreshments. Bedrooms are very homely and have many personal items to help individualise them. Residents say they particularly enjoy going into the gardens and grounds on fine days and one talked of the lovely view into the garden from their bedroom. The manager has an open attitude to complaints and the manager views it as part of good quality assurance. Staff demonstrate a good knowledge of adult protection issues and the manager demonstrates a good knowledge of the procedure to be followed if it were needed. Residents’ monies are held securely and the recording system is tidy and easily auditable. Residents say they enjoy the food and the variety offered. Laundry is particularly well cared for and one resident thought the laundress deserved special mention for the care she takes. Knappe Cross Care Centre DS0000061403.V289889.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: 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. Knappe Cross Care Centre DS0000061403.V289889.R01.S.doc Version 5.1 Page 7 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.V289889.R01.S.doc Version 5.1 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. Some assessments of service users are adequate but some do not contain sufficient information to enable staff to fully understand each service users needs. EVIDENCE: Knappe Cross Care Centre has produced a Statement of Purpose that requires some updating to ensure that residents know what they can receive for the fee they pay. Some residents weren’t aware that outings are not included in the fees, however The Director of Operations has written to say that they are made aware in the service user guide. It is also suggested that the Statement of Purpose includes information on one of the bedrooms, the use of which is potentially restrictive. Residents (or their relatives) report that they received information prior to moving into the home. Although the Director of Operations reports that the Statement of Purpose is discussed during the induction of staff, staff spoken with say they have not seen this information. For this reason, they cannot ensure that they deliver what residents and their families have been come to expect through the Statement of Purpose. Knappe Cross Care Centre DS0000061403.V289889.R01.S.doc Version 5.1 Page 9 Before moving into Knappe Cross Care Centre a Registered Nurse carries out a needs assessment on prospective residents. During this assessment basic information is obtained. And for those residents who are care managed through social services, a copy of their assessment is obtained. Some assessments have adequate information whilst others are less detailed. However, it is worth noting that of the six assessments looked at five had been undertaken prior to the last inspection when it was recommended that these should be improved for residents admitted in the future. The one assessment carried out since the last inspection and looked at by the inspectors did not demonstrate improvement. This means that staff do not have sufficient individual details for each new resident such as information on manual handling needs. The home is not registered to provide care for people with dementia, although there are some residents who have needs related to this condition. It was good to see that some staff have received some training in this area, and it would be further good practice to ensure this meets ‘Skills for Care’ guidance that would help to ensure the promotion of person centred care for all residents. Knappe Cross Care Centre DS0000061403.V289889.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. However, there are areas of care practices and monitoring which are potentially compromising the safety of some residents. This judgment has been made using available evidence including a visit to the service. The care planning process and delivery of care has improved but requires further improvement to ensure that good care is delivered consistently in relation to those residents who are at risk of poor nutrition and those residents who have complex needs. The storage of some medications requiring refrigeration puts residents receiving this medication at risk. Personal support is offered in such a way as to promote the privacy and dignity of residents. EVIDENCE: The assessments and care planning records of six residents were inspected. There have been some improvements since the last inspection in January. Reviews are taking place and there is some evidence of person centred care. Examples include ensuring one very disabled resident gets the ‘tipple’ of her choice; balancing the safety needs and right to choose for another resident in Knappe Cross Care Centre DS0000061403.V289889.R01.S.doc Version 5.1 Page 11 relation to mobilising independently and ensuring another resident was able to make her own healthcare decisions in relation to resuscitation. Health and social care professionals who completed surveys (three) were happy with the quality of care provided and residents who completed survey forms (four) said they could see a doctor when needed. Of the four resident surveys received, three indicated that they usually get the care and support they need, staff usually listen and act on what residents say and are usually available when needed. The fourth said they were completed happy with the care provided. One care plan demonstrates that the resident is meaningfully involved in planning care. However, whilst other care plans contain forms to be signed by residents if they wish to be involved in care planning reviews (some were signed and some were not), they do not contain evidence of meaningful involvement. For example, they did not include details of resident’s preferences in relation to foods, drinks and bed times. Health care needs are generally well addressed, but nutritional and fluid intake need improved monitoring to ensure that frail residents receive sufficient fluids and an adequate diet. Goals for the daily fluid intake of residents who are at risk of dehydration or urinary tract infections are not set or their fluid intake recorded. It appeared that one bed-bound resident was not given a drink throughout the morning of the inspection. Beakers of drink and a water jug were out of reach. Staff were unable to confirm what the resident had had to drink that morning. Another resident identified at risk of malnutrition and who reports having a poor appetite cannot sit up properly to eat her meals because of the bed she is nursed in. Although it has an adjustable back rest, staff said that she still cannot sit up properly because the pressure relieving mattress loses pressure when it the back rest is angled to the semi upright position. It is reported that this resident can sometimes spill her meals and that her food is not always cut up adequately. This residents dislikes are recorded for the kitchen but there is no record of what foods might tempt her to eat or what staff should do when she does not eat. One member of staff says that she reports to the Registered Nurse when this resident does not eat but that ‘some staff are better at doing this than others’. Fluid charts are not kept for this resident’s intake but the Director of Operations informed the inspector that daily records do refer to her dietry and fluid intake. This residents teeth had not been cleaned and her glasses had not been put within her reach. At the last inspection the (then) management team said they were planning and still plan to introduce a new nutritional assessment tool (MUST). Staff are currently using an alternative. However, the plans for meeting the needs of those residents identified as ‘at risk’ do not contain enough detail to ensure this happens- such as for residents who are not eating well, a care plan identifying in detail the actions to be taken by the staff to promote nutritonal Knappe Cross Care Centre DS0000061403.V289889.R01.S.doc Version 5.1 Page 12 intake and also for residents (particularly those at risk) likes to be displayed in the kitchen. The information in one care plan was not fully understood by staff. The record said this person should be nursed in bed on alternate days (this is not good practice in relation to maintaining skin integrity, meeting social needs or delivering person centred care based on choice). The registered nurse said that this instruction was out of date and that this person is nursed for short periods in and out of bed. A carer thought that the plan of care for this person was to stay in bed on the days another resident was allowed out of bed. On this day this resident was in bed throughout the inspection (and the other resident identified was cared for in the lounge all day). Her radio was tuned to the radio station of her choice (as detailed in the care plan), she was singing along to this and showed signs of well-being. It is unclear how and if the home is meeting the needs of another resident who is being cared for in their bedroom by themselves because of behaviour that is challenging to the service. This person was heard calling out throughout the day. The call bell in the bedroom worked intermittently and although this resident could use the call bell when reminded how, she did not appear to be able to initiate this. Staff were kind and gentle when with her and said that she calls out because she wants company. The manager said she had liaised with family and health care professionals about the care of this resident and other professional advice is being sought. The care plan of one resident who is a diabetic contained insufficient information regarding normal blood sugars for this resident and did not include an action plan as to what staff should do if blood sugar levels fall outside this range. One nurse spoken with could not confirm what a ‘normal’ result is for this resident. Blood sugars checks are checked daily without a clear rationale. Staff are not yet using the Diabetes Care for Life Guidelines produced by East Devon Primary Care Trust, although they plan to do this. This document recommends that where blood sugars are stable, it may sufficient to check them once or twice weekly. The medication records of six residents were inspected. These showed that the majority of medications are being managed well. However, important medication that requires refrigeration is not being stored adequately and it is possible that this medication may not be as effective. This is an area of significant concern that the manager has agreed to address as soon as possible. The home has since purchased a dedicated fridge for these medicines. Staff demonstrated a good understanding of how to promote privacy and dignity and examples of how they do this were seen. Health and social care professionals confirm this happens in returned surveys (three) saying they see residents in private. Staff knocked on bedroom doors; one member of staff Knappe Cross Care Centre DS0000061403.V289889.R01.S.doc Version 5.1 Page 13 dealt respectfully and sensitively with a resident who was confused ; bathroom and bedroom doors were closed during the delivery of personal care and staff report that this important area of care is covered during induction training. Knappe Cross Care Centre DS0000061403.V289889.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. Progress has not yet been made in relation to meeting the social and lifestyle needs and expectations of less able residents. Residents are helped to maintain contact with family and friends. Although residents are offered a wholesome balanced diet, they are not always able to receive this at times that necessarily suit them or in a relaxed environment. EVIDENCE: Some able residents described the friendships developed at the home and obviously enjoy daily variation and stimulation. They said that visitors are made welcome and this was confirmed by a visitor. One resident hosts a regular tea party for friends from the local community. The home has a fairly new appointed activities co-ordinator (20 hours per week) who has many ideas for enhancing the lives of residents. She (understandably) is yet to have a real impact in achieving this. Some residents are unaware that outings outside the home are not included in the fee paid, although the Director of Operations says this information is included in the guide to the home. There are activities organised on three afternoons in the Knappe Cross Care Centre DS0000061403.V289889.R01.S.doc Version 5.1 Page 15 week. These include bingo, keep fit and craft. Those that attend say they enjoy them and some talked of how those with little or no sight have used flowers and herbs to help them recall and talk about their memories. One resident said they enjoyed the exercise sessions and another was proud of a drawing they had completed. On the other two afternoons of the week the activities co-ordinator visits with residents in their rooms, although it is noted and confirmed by staff that she also gives out teas in the lounge during this time. Residents report that ‘she is a natural’ in her role. Not all residents are able to participate in the organised activities and it is less clear how meaningful social engagement is achieved with these residents. The Statement of Purpose says that ‘staff will assist residents to utilise their skills and develop new ones’ which will be partly achieved ‘through understanding the residents previous life experience’. Care plans did not all include this important information and there was no evidence that activities are based on the skills of individual residents. The Director of Operations said that new assesment documentation will cover this area in greater depth. Current residents will also need to have their social needs assessed individually. Whilst some residents said they are happy with the activities on offer, others said they would like more company. Two bed bound residents had little social contact on the day of inspection and another (according to the care plan) required ‘occupation in the morning’ to reduce the risk of falls. These residents were observed to be unsupervised and unoccupied for lengthy periods of the morning. One resident who has significant communication difficulties has a written assessment, which should have been completed with more sensitivity. The person who carried out this assessment acknowledged this as a shortcoming and the Director of Operations is confident that new documentation will help to overcome such issues in the future. This is part of the home’s development plan and is yet to be fully operational (See Management and Administration). Able residents are supported to make decisions about their daily lives and staff report that they try to make sure that less able residents are offered the same opportunities for choice by, for example choosing what time they go to bed and get up. They also report that this is not always possible because of their personal care needs. For example, some people get tired and are put to bed earlier. The majority of residents say that they enjoy the food served at Knappe Cross Care Centre. Much of it is home-made including pasties and cakes. One resident thinks that there is too much chicken; others think the menu is varied. Some residents said that although lunch is meant to be served at 12.30pm that they can sometimes wait up to 40 minutes to be served. Knappe Cross Care Centre DS0000061403.V289889.R01.S.doc Version 5.1 Page 16 It was noted that staff are very busy during the lunchtime period with only one member of staff available to serve the eight residents using the dining room (three of whom needed some assistance). One survey returned by a resident also highlighted this. Up to 19 other residents who eat in their bedrooms need some sort of assistance during meals (according to records) and it is hard to see how this can be adequately achieved during one sitting. One relative reported that staff do not always provide sufficient assistance during meals and a resident said that sometimes staff just put food in front of her and do not pay attention to ensuring that she can actually eat it. One carer was observed helping a resident to eat with real sensitivity and engagement. Knappe Cross Care Centre DS0000061403.V289889.R01.S.doc Version 5.1 Page 17 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. Residents are able to make complaints, which are acted upon. They are protected by the homes policies and practices in relation to the prevention of abuse. EVIDENCE: Knappe Cross Care Centre has a complaints policy that is easily accessible as it is kept in the hall. A summary of it is also included in the Statement of Purpose. Residents said that if they were unhappy they would speak with someone – either a member of staff they knew or one of the nurses. The Commission have received no complaints since the last inspection. The manager has received two formal complaints since the last inspection, has responded to them within the timescale, has upheld them and has taken action to overcome any shortcomings identified. The manager reports that she sees complaints as part of the quality assurance process. Residents say they feel safe at Knappe Cross Care Centre. Staff demonstrate a good understanding of abuse and would report any concerns to a Registered Nurse or the manager. The manager demonstrated a good understanding of the procedures to be followed. The majority of staff have received training in the prevention of abuse. Knappe Cross Care Centre DS0000061403.V289889.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24 and 26. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. Improvements to the environment continue with more improvements planned. Residents’ needs are not always met by the equipment provided. EVIDENCE: The Management team are aware that some improvements to some of the communal areas at Knappe Cross Care Centre are needed and have developed a programme of redecoration. Residents and staff report that some carpets are stained. Some are due for renewal and the cleaners are working hard on others to remove stains. The seating arrangements in the lounges have been changed to help meet residents needs and to prevent overcrowding in certain areas of the home. One of these areas is now more restful and the inspector saw residents sitting here for example who had visitors or who wanted some ‘quiet time’. Knappe Cross Care Centre DS0000061403.V289889.R01.S.doc Version 5.1 Page 19 One bedroom has restricted use and potential residents/commissioners should be made aware of this possibly in the guide to the home. The housekeeper from a sister home now works part time at Knappe Cross overseeing induction training of housekeeping staff and the cleaning programme. One visitor reported that the annexe ‘could smell sweeter’ and the housekeeper agrees. She has bought in new cleaning products and machinery and is confident this will improve. The laundry is well equipped and organised. One person is responsible for the laundry and obviously takes pride in the work she undertakes. Towels are fluffy and residents say their clothes are well cared for. One resident felt she deserved a special mention for the care she takes. There is a system in place for dealing with soiled laundry, which reduces the risk of infection. Since the last inspection the call bell system has been serviced. However, two call bells are not working or work intermittently (See Health and Personal Care). One call bell had been swapped with the bell belonging to an empty room and staff said they would swap the second one too. Residents enjoy the gardens and grounds on fine days and one resident said ‘there is a lovely view into the garden’. Knappe Cross Care Centre DS0000061403.V289889.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. Practice in relation to staff training, recruitment and the deployment of staff are combining to put residents at risk of not having their needs met. EVIDENCE: Whilst the majority of staff surveyed and spoken with indicate that they think training is adequate, analysis of the training provided does not support this. Although the majority of care staff have now received training in manual handling, and in general the delivery of training has improved, the management team are aware there are other gaps and plan to ensure that all staff receive relevant training. This will include raising the percentage of staff who are trained to NVQ Level 2 or above from 33 to 50 . Staff working at the home deliver some training. This includes fire training, manual handling and dementia. Staff report this is adequate and that they feel competent following this training. A significant number of staff surveys indicate that staff feel unable to completely meet residents’ needs in the time available. Some residents and visitors said that staff are busy. One complaint received by the home is that that staff are ‘constantly rushing from one task to the next’. One resident said that at night he could wait a long time for a staff member after ringing his bell. Knappe Cross Care Centre DS0000061403.V289889.R01.S.doc Version 5.1 Page 21 This resident has an agreement with staff that he can continue to refuse bed rails as long as he rings his bed to request assistance to get in and out of bed at night. Lunchtime is particularly busy and staff struggle to assist all residents requiring help with their meals (see Daily Life and Social Activities). The Activities Co-ordinator gives out the afternoon teas on the days she is meant to be visiting residents in their bedrooms shortening the time she has to meet with residents who stay in their bedrooms. One healthcare professional reports it takes a long time for the phone and door to be answered. One relative said ‘the staff are always busy’. A resident said ‘I have waited 35 minutes for help on occasion’. One member of staff said that one carer and one nurse are expected to care for 12 residents, nine who need total care and three who need two staff to provide their care. These issues were discussed with the management team who feel that there are staff deployment issues as opposed to a staffing number problem. Staff are described as good and comments include ‘I get excellent care from the nursing sisters and most of the carers’, ‘staff come immediately when I fall’ and ‘nice women look after me’. Three staff files were inspected to check recruitment procedures. Two application forms were not fully completed. All files contained references but one gave cause for concern. The acting manager reported she had followed this up verbally but had not recorded this information. Two of the three staff had undergone Criminal Record Bureau (CRB) checks. The third had undergone a POVA (Protection of Vulnerable Adults) check as is good practice whilst waiting for the CRB check as it potentially places residents at risk. However, this person works unsupervised ( delivering personal care on their own)and should not be doing this prior to the receipt of a full CRB. The Director of Operations reports that there have been delays due to changes in internal arrangements with CRBs. In the main staff induction records are complete. Knappe Cross Care Centre DS0000061403.V289889.R01.S.doc Version 5.1 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. Since the last inspection the management of this home has improved with efficient systems and development plans in place. Further improvements are required to ensure the safety of residents. EVIDENCE: Since the last inspection a temporary manager has been appointed and a new permanent manager has recently been recruited (but has yet to start work). The current manager intends to remain at Knappe Cross following this appointment to ensure that the new manager is supported to continue with the plan of improvement that is being implemented. Knappe Cross Care Centre DS0000061403.V289889.R01.S.doc Version 5.1 Page 23 Systems for managing information and the home have been set up and appear to be working. All the information required to undertake this inspection was readily available. The management team have recognised what needs to be done at Knappe Cross and have undertaken a great deal of work to achieve this in a short space of time. Development programmes have been designed to further improve the care and services delivered and internal timescales have been set. The Director of Operations talked of how her first priority is to create a strong team who are proactive. She further talked of increasing staff confidence, in line with the development plan. The inspector was able to feedback that staff surveys indicate that staff feel supported and part of a strong team. As part of this programme of development the Director of Operations report that quality assurance questionnaires have been distributed to residents, professional colleagues and family. These are generic and have also concentrated on particular areas as priorities. The areas the home are currently concentrating on are meals and activities. Residents say they have completed these forms and have been very honest. Some residents report that they would like a residents meeting to discuss general issue and improvements. This information has been passed to the management team. The last report is situated on the hall table and some residents said they had read it. The home handles small amounts of monies on behalf of some residents. These are kept safely and access to it is limited to two members of staff. Three accounts were checked and were found to be in order. The system for recording monies is easily auditable and clear. Many significant improvements have been made in relation to management, administration and training. Training however is not up to date in relation to safe working practices. This includes fire drills and training, first aid, food and hygiene and infection control. The home recently passed an inspection by the Environmental Health Officer. The central heating is due for an upgrade (June 2006) and the Director of Operations has therefore delayed any servicing contracts and has yet to ensure that hot water is delivered at a temperature near to 43C. Fire equipment has been checked and serviced. The gas cooker has one fault and the manager is checking what action might need to be taken. Knappe Cross Care Centre DS0000061403.V289889.R01.S.doc Version 5.1 Page 24 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 2 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 2 X 2 X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 3 X 1 Knappe Cross Care Centre DS0000061403.V289889.R01.S.doc Version 5.1 Page 25 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 The registered person must consult with the resident and must prepare a written plan as to how the service users needs in respect of his health and welfare are to be met. On this occasion, this refers to the plans of those identified at risk of malnutrition and dehydration, those with behaviour that challenges the service and insulin dependent diabetics. Previous timescale of 30/09/05 and 30/04/06 not completely met. The registered person must ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of residents. On this occasion this refers to meeting the health care needs of those identified at risk of malnutrition, insulin dependent diabetes, and to those who challenge the service. It also refers to the need to ensure that all staff understand how health and welfare is to be promoted). DS0000061403.V289889.R01.S.doc Timescale for action 30/10/06 2. OP8 12 (1)(a) 30/07/06 Knappe Cross Care Centre Version 5.1 Page 26 3. OP9 13 (2) 4. OP12 16 (m) 5. OP29 19 (b). Schedule 2. 23 (4) (d)(e) 6. OP38 7. OP38 13 (4) 8. OP38 16 (2) 9. OP38 13 (4)(a) The registered person must ensure that all medication is stored appropriately and safely. On this occasion this refers to the storage of insulin. Previous timescale in relation to a different issue 30/4/06. The registered person must consult service users about their social interests and make arrangements to enable them to engage in local, social and community activities. Previous timescale of 30/10/05 and 30/04/06 not met). This requirement has been partially met. The registered person must not employ a person to work at the care home unless the relevant information is gained. The registered person must make arrangements for all staff to receive suitable training in fire prevention and receive fire drills and practices. Previous timescale 30/04/06. This requirement has been partially met. The registered person must make suitable arrangements for the training of staff in first aid (one person on each shift should be trained in first aid). The registered person must make suitable arrangements for training staff in food hygiene and infection control. (The laundress should also receive training in the latter). The registered person must ensure that all parts of the care home are free from hazards to their safety (the manager needs to check what action needs to be taken in relation to one ‘fail’ when the gas cooker was checked.) DS0000061403.V289889.R01.S.doc 26/05/06 30/11/06 30/06/06 30/06/06 30/10/06 30/11/06 30/06/06 Knappe Cross Care Centre Version 5.1 Page 27 10. OP38 13 (4) (c) The registered person must ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. (This refers to the delivery of hot water, which is currently above 43C). 30/07/06 Knappe Cross Care Centre DS0000061403.V289889.R01.S.doc Version 5.1 Page 28 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. Refer to Standard OP1 Good Practice Recommendations The Statement of Purpose should include information about one bedroom that has limited use. Staff should be knowledgeable about the information in this document to help ensure they meet the expectations of residents. Prospective residents should undergo a full assessment prior to moving into the home. This should form the basis of the care plan. Nutritional screening should be undertaken and a record should be maintained of nutrition and appropriate action taken. Where needed adjustable beds should be provided. Mealtimes need to be organised so that they are not rushed and residents do not have to wait to be served for long periods (unless there are exceptional circumstances). 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 provide all aspects of care for residents. 50 of care staff should be trained to NVQ Level 2 or above. Training provided to staff should meet the specifications set out by ‘Skills for Care’ in this instance, in relation to dementia. 2. 3. 4. 5. 6. OP3 OP8 OP8 OP15 OP27 7. 8. OP28 OP30 Knappe Cross Care Centre DS0000061403.V289889.R01.S.doc Version 5.1 Page 29 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 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. Extracts may not be used or reproduced without the express permission of CSCI Knappe Cross Care Centre DS0000061403.V289889.R01.S.doc Version 5.1 Page 30 - 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. 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