Inspection on 27/01/06 for Knappe Cross Care Centre

This inspection was carried out on 27th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 24/05/06

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 Unannounced Inspection 10:00 27th & 30 January 2006 th 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.V270753.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.V270753.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.V270753.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 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 Date of last inspection Brief Description of the Service: Knappe Cross is a 42 bedded care home (with nursing) situated in Exmouth. The house is a Grade 2 listed and extended building situated in its own extensive grounds with ample parking and some views to the sea. The home has several lounges, a dining room and an elegant ‘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. A Nurse Manager manages the home and there are Registered Nurses on duty throughout the day and night. Knappe Cross Care Centre DS0000061403.V270753.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The first day of this inspection was planned as part of the normal programme of inspection. As it is the second planned inspection, the report should be read in conjunction with the report following the inspection undertaken in August 2005. The second day of this inspection was undertaken in response to a complaint received by CSCI. The complaint was not upheld although some areas for improvement were identified. Both inspections were undertaken unannounced. Two inspectors were at the home on one day from 10:00am until 5:00pm, and one inspector spent a further three and a half hours in the home between 3.30pm and 6.00pm. The inspectors spoke with or saw all the residents (5 residents were spoken with in depth), with 1 visitor, the Manager, Director of Operations, 5 members of care staff and with the laundress. Records in relation to recruitment, staffing, training, care planning, assessment, medication, safe working practices and residents monies were inspected. The manager provided a preinspection questionnaire and six comments cards were received, four from relatives and two from residents. All communal areas and bedrooms were seen. The inspectors gained the majority of the information they required through case tracking. This means that the inspectors measured the extent to which this service is meeting the National Minimum Standards by looking, in the main, at the care and accommodation offered to five residents. What the service does well: Visitors to Knappe Cross are warmly welcomed and staff help them to meet with their relatives in private if they so wish. New residents are all assessed prior to admission. Staff are well liked and appreciated by the residents and the staff report they really enjoy working with the residents. Comments about staff included ‘staff are kind, caring and helpful’, ‘staff are efficient, friendly and attentive’ and ‘the staff have made my relative very welcome’. Staff demonstrate a good understanding of adult protection issues and residents’ monies held by the home are clearly recorded. Residents’ bedrooms are very homely, individualised and clean. Meals are nutritious, appetising, well presented and much enjoyed by residents. Descriptions include ‘lovely’ and ‘excellent’. Knappe Cross Care Centre DS0000061403.V270753.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.V270753.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.V270753.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): (3) There is a clear assessment process in place for assessing residents’ needs. EVIDENCE: The assessments and care plans of five residents were inspected. All had undergone assessment by a Registered Nurse prior to admission using a standard format intended to identify needs. However care plans resulting from these assessments are of poor quality indicating that the quality of assessments could be improved. This Standard will be kept under review. Knappe Cross Care Centre DS0000061403.V270753.R01.S.doc Version 5.1 Page 9 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) Little progress has been made on improving care planning. This means that residents cannot be assured that their needs, including healthcare needs, will be met or that they will be met in a way that suits their preferences. Some practices and recording in relation to the administration of medicines have the potential to place residents at risk of harm. EVIDENCE: Residents expressed their liking and gratitude for staff and felt, on the whole that they were well cared for. One comment card from a relative expressed ‘complete satisfaction with care’. Three members of staff said that the best thing about their job was the residents, and that the staff genuinely cared about them. However, in general the five care plans inspected demonstrate that there is incomplete assessment information, in particular in relation to the prevention and treatment of pressure ulcers, managing nutritional needs, preventing falls and moving and handling of some residents. Care plans do not provide care staff with the information they need to ensure that the individual needs of each resident are met and are poorly monitored with care staff sometimes being instructed to continue with treatments and care where there is clear evidence that interventions are not bringing about the intended outcome. Care staff are Knappe Cross Care Centre DS0000061403.V270753.R01.S.doc Version 5.1 Page 10 not given written information on how to meet the nutritional needs of frail residents who require assistance to eat and drink, although the manager reports that this instruction is given verbally. One care plan indicated that the resident had experienced an acute medical episode. This has resulted in obvious changes to health and personal care needs, but the care plan has not been revised to include the actions which staff need to take to meet these needs. A Registered Nurse had written in one care plan that it was ‘completely irrelevant and needs updating’ when a complaint from a relative regarding care was received. The care plan was not updated. This resident developed a pressure sore within 2 days of this entry. In addition, there is no evidence in care plans to demonstrate that residents, or their supporters, have been meaningfully involved in care planning. And there was some confusion between one relative and staff as to how certain care decisions had been arrived at. One member of staff said that they felt that writing care plans is problematic due to a lack of training, although the home’s management said this had been provided. Medication is, on the whole, managed well with sound policies and procedures in place. However these are not always being followed. For example, not all hand written entries on medication charts are signed by two people and not all residents have their photographs stored with the medication chart placing residents at risk of receiving the wrong medication. A tablet was seen by the inspectors in a medicine pot in an unlocked and unattended office. There were instructions written on a piece of paper towel as to who this tablet belonged to. Some residents are receiving medication such as painkillers and anti anxiety medication on a ‘when needed’ basis. Care plans do not indicate how well or if these treatments are working. The care plan of the resident receiving an anti anxiety medication does not include clear instructions about when this medication should be used. One resident had been prescribed eye drops for a limited amount of time. This resident said he no longer had eye drops but described his eyes as sore indicating that inadequate monitoring of health conditions is taking place. Knappe Cross Care Centre DS0000061403.V270753.R01.S.doc Version 5.1 Page 11 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, 15) Able residents benefit from organised activities but the provision for assessing and meeting individual social activity needs of frailer residents is poor. Able residents have their rights to make choices upheld but less able residents are not as well supported to do this. The food served at Knappe Cross is nutritious, appetising and is enjoyed by residents. EVIDENCE: Organised activities take place at Knappe Cross on Mondays, Wednesdays and Fridays and include Arts and Crafts, Keep Fit and Bingo. On Tuesday and Thursday there are ‘visits to rooms’ by the activities co-ordinator. The list of activities is posted up in bedrooms and communal areas and there is an activities co-ordinator on duty between 2pm and 5pm on weekdays. Residents say they enjoy the activities and some have formed a crossword group which visitors also enjoy. Less able residents have limited capacity to join in with these activities. One comment card from a relative was very complimentary about staff but expressed a desire that staff had more ‘quality time’ to spend with their relative who is not able to join in with the organised activities. Knappe Cross Care Centre DS0000061403.V270753.R01.S.doc Version 5.1 Page 12 Care plans include documentation intended to assess residents’ needs in relation to social activity and to help residents identify their social goals. Those forms that are completed do not all contain sufficient information to indicate likes, dislikes and preferences and do not all identify goals. Where are identified they are general, are not reviewed and appear to be decided by the staff and not the resident. Objectives include ‘to integrate into the home’, ‘enjoys a walk outside’. According to the latter care plan this person had been taken outside for a walk once since November. One resident who has a dementia type illness enjoys classical music and it is reported by a visitor that the staff always ensure this is playing. However in general, there are no special activities or considerations given to those people with dementia type illnesses. Visiting to the home is flexible and visitors say they are always made welcome. Able residents report that they make decisions in their daily lives and if they want something they can just ask. However, it is unclear how other residents are helped to make decisions about their lives. Care plans of non-verbal or less able residents do not contain information regarding for example, what time they like to go to bed, what time they like to get up, what they like to eat or what their interests were or are. Without this type of information staff cannot help residents to maintain a degree of control over their lives. One resident said they would like to go to bed in the afternoon and then get up again but goes to bed early as they feel staff are too busy. A complaint was received by the Commission relating to residents being put bed between 3pm and 4pm. This complaint was not upheld. However, number of issues were raised with the home and requirements were made relation to meeting frailer residents’ needs and the individual residents’ role deciding how this should be achieved. to a in in Residents are very complimentary about the food served at Knappe Cross saying it is well presented, hot and appetising. One comment card described it as ‘excellent’. The home offers a four-week menu which is varied and menus detail what is for lunch. Although a choice of meals is not offered on a daily basis, the menu does remind residents that they can ask for an alternative if they want one. Staff tell residents on the day what is for supper, and this is served at 5.15pm. Able residents say they receive sandwiches, biscuits and cake later in the evening but it is less clear how the nutritional needs of less able residents are met after 5.15pm supper (see Standards 7 and 8). Knappe Cross Care Centre DS0000061403.V270753.R01.S.doc Version 5.1 Page 13 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): (18) Residents are protected by staff’s general knowledge in relation to the protection of vulnerable adults. EVIDENCE: Three members of staff were asked about their knowledge of the protection of vulnerable adults. Two had received training on this subject in 2005. All could recognise abusive practice and were clear about their responsibility to challenge and report to seniors and ultimately the manager. The Director of Operations reports that policies in relation to Whistle Blowing and what to do if abuse is alleged are in place. Knappe Cross Care Centre DS0000061403.V270753.R01.S.doc Version 5.1 Page 14 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, 25) Improvements have been made to the general environment and is ongoing ensuring that the home is adequately maintained. EVIDENCE: Although the home does not keep a record of planned maintenance the manager and Director of Operations are aware that some areas of the home are in need of decoration. However, they have explained that finding a decorator to work at the required times had been problematic. They advised that new carpets have been ordered for the smallest lounge and that there are plans to re -carpet the extension but this would have to be put ‘on hold’ until the decoration could be completed. The management have also been advised that the carpet outside the lift in the extension is rucked. Staff report that some of the call bell units could become locked so that answered call bells could not be cleared from the system, meaning they continued to ring. During the inspection, the manager arranged for a company to come and fix these. Knappe Cross Care Centre DS0000061403.V270753.R01.S.doc Version 5.1 Page 15 Residents’ rooms are personalised, well furnished, clean and odour free. The Director of Operations reports than many have been redecorated as they have become free. The manager confirmed that all residents’ rooms have guarded radiators to promote the safety of residents but a spot check showed not all upper floors windows have restrictors, which are another safety feature. These were fitted within 3 days of this inspection. Residents do not all have lockable spaces in their bedrooms in which to store private possessions, but the Director of Operations reports that this is offered to all residents. Knappe Cross Care Centre DS0000061403.V270753.R01.S.doc Version 5.1 Page 16 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, 30) Staffing levels mean that minimum care needs of residents are met, however better individual care could be delivered. Poor recruitment practice and lack of training for care staff lead to residents potentially being at risk of receiving a poor standard of care. EVIDENCE: The majority of comment cards received were complimentary about the staff, describing them as helpful and kind. The duty rota showed that there are two Registered Nurses on duty in the morning together with six care assistants; in the afternoon and evening there are two Registered Nurses and four care assistants and at night one Registered Nurse and three care assistants. Some members of staff work long hours but the manager said she had checked with residents and this had not affected the quality of their work. Two members of staff felt there were sufficient numbers of staff on duty but another did not. The latter said that the home was struggling to find regular and committed staff and that this affected resident’s choice, for example, which lounge they sat in because of their need to be monitored. One resident said she is left on the commode for long periods of time. Three of the four comment cards received from visitors said that there were not always enough staff on duty, the fourth said that there was enough staff most of the time. One commented that there was always sufficient Registered Nurses on Knappe Cross Care Centre DS0000061403.V270753.R01.S.doc Version 5.1 Page 17 duty but that there have been occasions when ‘carers appear to have been in short supply’. Another comment card said that their relative ‘seems lonely sometimes and says she doesn’t see anybody much’. The pre-inspection questionnaire states that 30 of the health care assistants have are trained to NVQ Level 2 or above, which is under the recommended level of 50 which should have been achieved by 2005. Four staff recruitment/training files were seen. None had all of the required recruitment information carried out at the required times. One file had no training or recruitment records. This member of staff had been employed through an agency and the home had not requested confirmation from the agency regarding Criminal Record Bureau (CRB) check or training given. Details of the agency were not available in the home. In another file a character reference which should have been supplied prior to employment had been received four months after commencement of employment. Another file contained only one reference instead of the required two; it described the person as having ‘poor communication skills’ which was not followed up. This employee works closely with residents. The manner in which the job application had been completed did not give specific dates of employment meaning that gaps in employment could not be identified and accounted for. This employee had been employed before a clear POVA or CRB had been received. Another file showed that the POVA and CRB checks had been requested after the person had started working at the home (this had taken place prior to the employment of the current manager). It was apparent that the manager had tried to address the deficits in this recruitment file by requested references nine months retrospectively. Training was looked at for these four members of staff. One person had no training record despite working at the home for at least six months. The manager was unaware of what training had been arranged by the agency who supply a number of staff to the home. Two other members of staff had received Moving and Handling training from an external agency but a third had not. However, when asked about Moving and Handling some staff said that nothing was written down about techniques but if they thought they would hurt their back they would ask a senior for advice. No other training was recorded on the staff files, such as food hygiene, infection control, health and safety, protection of vulnerable adults or specialist training i.e. the care of people with a dementia type illness. Three members of staff confirmed that training was not a regular event. Knappe Cross Care Centre DS0000061403.V270753.R01.S.doc Version 5.1 Page 18 Only one of three staff files looked at included an induction record. One that was on record had all been completed on one day and the needs of residents were not listed. On speaking with three staff, one was unclear if she had received induction; another said a senior health care assistant had observed her work. Another member of staff said nursing staff normally provided inductions. Knappe Cross Care Centre DS0000061403.V270753.R01.S.doc Version 5.1 Page 19 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): (34, 35, 37, 38) Poor record keeping and record management, and a lack of safety and fire checks, plus delayed fire training all combine to potentially place residents at risk. EVIDENCE: Seven residents were chosen to check the management of their personal allowances. Three people managed their own money but had no lockable storage space in their rooms. The manager confirmed this. (See standard 24) Three residents’ personal allowances balanced. Receipts are kept and only two people have access to the personal allowances. Care planning records are not maintained according to the guidance issued by The Nursing and Midwifery Council. (for details see Standards 7 and 8). Records for the effective and efficient running of the business, such as maintenance contracts and programmes and recruitment records are not well understood, managed or maintained. For example, there are no records that Knappe Cross Care Centre DS0000061403.V270753.R01.S.doc Version 5.1 Page 20 portable electrical appliances had been tested and there is no copy of the electrical wiring certificate. Invoices were seen for the servicing of hoists, lifts and for repairs to the call systems. The manager explained that they had tried to arrange for the service of the gas central heating system but this had been problematic. One of the boilers has since broken down and the manager advised that the servicing would take place when this was repaired. The last time an external trainer for fire safety visited the home was in 2004. A staff member has been trained to deliver fire training to staff (this is the first training in six months) but the manager advised that only a quarter of the staff had attended so far, resulting in staff fire training being out of date for the remaining three quarters of the team. Fire extinguishers had their last annual service on 6/4/05. However, there are no records of monthly inspections to ensure their correct positioning and lack of damage/use. Safety lighting should be checked monthly but records show this only occurred in February 2005, September 2005 and January 2006. The fire alarms were last tested on 25th January 2006. Window restrictors were not on all upper floor windows potentially posing a risk to some residents. Three days later the manager reported that these had been fitted. One carpet poses a risk as it has a ruck and residents or staff could trip on this. The home has insurance in place up until June 2006. Knappe Cross Care Centre DS0000061403.V270753.R01.S.doc Version 5.1 Page 21 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 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X 2 X 3 3 X STAFFING Standard No Score 27 3 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X 3 3 X 2 1 Knappe Cross Care Centre DS0000061403.V270753.R01.S.doc Version 5.1 Page 22 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 Timescale for action 30/04/06 2. OP7 15 (2) b 3. OP8 14 (2) 4. OP8 17(1)(a) Sch3(3) (k) The registered person must prepare a written plan as to how the service users needs in respect of his health and welfare are to be met. (Previous timescale of 30/09/05 not met). The care plan must be kept 30/04/06 under review (Previous timescales of 31/03/05 and 30/09/05 not met) The registered person shall 30/04/06 ensure that the assessment of the service users needs is a) kept under review and b) revised at anytime when it is necessary to do so having regard to any change of circumstances. (Previous timescale of 30/09/05 not met). The registered person must keep 30/04/06 a record of any nursing provided to the service user, including a record of his/her condition and any treatment or surgical intervention. Knappe Cross Care Centre DS0000061403.V270753.R01.S.doc Version 5.1 Page 23 5. OP9 13 (2) 6. OP12 16 (m) 7. OP12 16 (n) 8. OP22 23 (2) (c) 9. OP29 19 Schedule 2 The registered person must make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. 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 not met). The registered person must consult service users about the programme of activities arranged by or on behalf of the care home. (Previous timescale 30/10/05). The registered manager must ensure that equipment provided at the care home for use by service users is maintained in good working order. (This relates to the call bell system). The registered person shall not employ a person to work at the care home unless he/she has obtained in respect of that person the information and documents specified in paragraphs 1-9 of Schedule 2. (Staff files must contain all the required checks and information i.e. two written references. Staff must not commence work until a clear POVA has been received by the home). 30/04/06 30/04/06 30/06/06 30/04/06 30/04/06 10. OP30 18 (1) (c) The registered person must 30/06/06 ensure that staff receives training appropriate to the work they perform. (This relates to mandatory training and specialist training to meet the needs of all residents). DS0000061403.V270753.R01.S.doc Version 5.1 Page 24 Knappe Cross Care Centre 11. OP37 17 (1a) (2) (3a) 12. OP38 13(4)(a) 13. OP38 23(4) (c)(d) The registered person must 30/04/06 maintain in respect of each service user a record which includes the information, documents and other records specified in Schedule 3 and in Schedule 4 and should ensure that care these records are kept up to date. The registered person must 30/01/06 ensure that all parts of the care home to which service users have access are so far as reasonably possible free from hazards to their safety. (This relates to the need identified on the day of inspection to have window restrictors fitted which was complied with within the agreed timescale). The registered person must 30/04/06 make adequate arrangements for testing fire equipment and for people working at the care home to receive suitable training in fire prevention. 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 OP8 OP8 Good Practice Recommendations The incidence of pressure sores, their treatment and outcome, should be recorded in the service user’s individual plan of care and reviewed on a continuing basis. Nutritional screening should be undertaken on admission and subsequently on a periodic basis, a record maintained of nutrition, including weight gain or loss, and appropriate action taken. Opportunities should be given for appropriate exercise and physical activity and appropriate interventions should be carried out for those identified at risk of falling. DS0000061403.V270753.R01.S.doc Version 5.1 Page 25 3. OP8 Knappe Cross Care Centre 4. 5. OP9 OP12 6. 7. 8. 9. 10. OP14 OP15 OP27 OP28 OP37 Staff should monitor the condition of service users on medication and prompt the review of medication on a regular basis. Residents’ interests should be recorded and they should be given opportunities for stimulation through leisure and recreational activities both inside and outside the home. Those with dementia type illnesses should be given particular consideration. The home should be conducted to maximise residents’ capacity to exercise personal autonomy and choice. A snack should be offered to residents in the evening and the interval between this and breakfast should be no more than 12 hours. Staffing should be reviewed to ensure that there are enough staff on duty to provide for all aspects of residents care. A minimum ratio of 50 of care staff should be trained to NVQ Level 2 or over. Records for the efficient and effective running of the business should be maintained, kept up to date and be accurate. Knappe Cross Care Centre DS0000061403.V270753.R01.S.doc Version 5.1 Page 26 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.V270753.R01.S.doc Version 5.1 Page 27 - 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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