Inspection on 31/08/05 for Knappe Cross Care Centre

This inspection was carried out on 31st August 2005.

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

Other inspections for this house

Knappe Cross Care Centre 02/07/07

Knappe Cross Care Centre 24/05/06

Knappe Cross Care Centre 27/01/06

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 Home Brixington Lane Exmouth Devon EX8 5DL Lead Inspector Mandy Sharp Unannounced 31 August 2005 st 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 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 Home D54 D06 S61403 Knappe Cross V213936 310805 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Knappe Cross Care Home Address Brixington Lane Exmouth Devon EX8 5DL 01395 263643 Telephone number Fax number Email 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 (with nursing) 42 Category(ies) of OP Old age (42) registration, with number of places Knappe Cross Care Home D54 D06 S61403 Knappe Cross V213936 310805 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 16 November 2004 Brief Description of the Service: Knappe Cross is a 42 bedded care home(with nursing) situated in Exmouth. It is a Grade 2 listed building situated in its own grounds. It has several lounges, a dining room and an elegant function room. Bedroom accomodation is in an extension and the main house. There are two passenger lifts. There are extensive gardens and car parking. There are 34 single rooms and 4 shared rooms; only 2 single rooms do not have ensuite facilities. The home offers general nursing care for up to 42 older people, and also may take service users requiring personal care only. The maximum number of service users accomodated is 42. The nursing and personal care is supervised by a nurse manager and there are qualified nurses on every shift, and care assistants. All meals and laundry services are provided. The home is owned by Ashdown Care Limited and the Responsible Individual is Mr Arif Pradhan. Knappe Cross Care Home D54 D06 S61403 Knappe Cross V213936 310805 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 6 hours by 2 inspectors. The focus of the inspection was to look at previous requirements made and in particular to look how health and personal care needs of service users were met. The inspectors met with 19 of the 35 service users, 6 members of staff, 3 relatives and the new manager, Bridget Hill. She has been in post for 7 weeks. They looked around some parts of the building and a number of records, including care documentation of 6 service users. There have been 4 complaints made to CSCI since the last inspection. These mostly involved issues in relation to health and personal care needs not being met. 1 was upheld, 2 were partially upheld and 1 is being investigated by the home. The new manager had already identified the majority of issues raised in this report and was already working closely with staff to ensure that the National Minimum Standards and Regulations are met at all times. All previous requirements had been met, apart from one in relation to care planning. What the service does well: What has improved since the last inspection? The qualified staff say that the appointment of the new manager has greatly improved working at the home, which has a positive effect on the care given to service users. Staff are well supported at the home. Service users who were in bed because of physical frailty are well cared for. Most staff have now had protection of vulnerable adult training. The cleanliness of the home is better. A questionnaire has been distributed and returned to the new manager regarding the quality of care, and the answers are being collated. Knappe Cross Care Home D54 D06 S61403 Knappe Cross V213936 310805 Stage 4.doc Version 1.20 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Knappe Cross Care Home D54 D06 S61403 Knappe Cross V213936 310805 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Knappe Cross Care Home D54 D06 S61403 Knappe Cross V213936 310805 Stage 4.doc Version 1.20 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 standard(s) None of these standards were inspected at this inspection EVIDENCE: Knappe Cross Care Home D54 D06 S61403 Knappe Cross V213936 310805 Stage 4.doc Version 1.20 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 standard(s) 7,8,10, Limited progress has been made on improving care planning and this does mean there is a potential to place service users at risk. However on the whole personal and health care needs are being met and in a respectful way. EVIDENCE: Many of the service users and all 3 relatives were very complimentary about the staff and how care is given. ‘ If Mum wants anything they get if for her’, ‘ I am full of praise for them’ ‘ The girls are very good’ ‘Everyone is kind and thoughtful’ ‘ I get plenty to drink and someone helps me to eat’ ‘ They couldn’t be nicer’. Service users felt that on the whole they are treated with respect. There were a few comments about the variability of the staff but these comments were in the minority and on the whole service users felt like they were treated with respect. Mr Pradhan wrote to service users recently telling them about the new changes with the management and the manager now writes an individual card to each new service user welcoming them to the home. The inspectors met with several service users who were in bed and they were comfortable, warm and had sufficient drinks available. Some did not have their call bells near them, although these particular service users were unable to use them. Relatives and service users said that they are able to see the doctor Knappe Cross Care Home D54 D06 S61403 Knappe Cross V213936 310805 Stage 4.doc Version 1.20 Page 10 whenever they wish and there was good evidence of regular visits from health care professionals, such as doctors, tissue viability nurses, chiropodists. Six care records were scrutinized and these continue to lack sufficient detail in relation to the actual care to be delivered. Not all care plans had been reviewed monthly. There was incomplete assessment information (pressure ulcer, nutritional and manual handling assessments) and care planning in a recent admission, despite obvious changes in health care and personal care required since admission. Knappe Cross Care Home D54 D06 S61403 Knappe Cross V213936 310805 Stage 4.doc Version 1.20 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 standard(s) 12 The arrangements and provision for social activities is currently poor, meaning that service users’ social and psychological needs are not always met EVIDENCE: The ‘activities organiser’ is often working in the kitchen and therefore the amount of activities available has decreased. There have not been any trips out this summer, but the new manager is determined to rectify this. Some service users are fortunate in that family assist them on trips out of the home, but for others this is not the case. The care staff and some vocal and more able service users commented on the lack of activities. Care staff have little time to give to social activity after completing basic care tasks. There was minimal reference to social stimulation in the care notes, although it is being addressed in new documentation produced by the company. For service users in their rooms, they had access to their television, radio, books or newspapers. Those that were able said that they preferred being in their rooms and were happy with the arrangements in place. One service user mentioned a member of staff who would visit with her children, which she really enjoyed. The provision of meals was not inspected but the vast majority of service users were very happy with the food provided. Knappe Cross Care Home D54 D06 S61403 Knappe Cross V213936 310805 Stage 4.doc Version 1.20 Page 12 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 standard(s) 16,18 The home has a good complaints system and now shows that service users’ and relatives’ views are acted upon. Staff have a satisfactory understanding of how to protect their service users. EVIDENCE: There are 2 complaints folders at the home, the second one started in July 2005 when the new manager started at the home. There were 9 complaints in the 2 folders. 4 complaints have been made to CSCI since the last inspection. 2 of these had been made in July this year. 1 was investigated by the Operations Manager who found that the complaint was partially upheld. The second is currently under investigation by the company. Relatives and service users felt comfortable in talking to the new manager about any concerns they may have. One service user said she had written into her recent questionnaire what her concerns were and these were being dealt with. A previous requirement had been made about staff needing to attend Protection of Vulnerable Adults training, and the majority of staff have now completed this. They showed a reasonable understanding of what constitutes abuse and would report to the manager if they witnessed anything directly involving a service user. Knappe Cross Care Home D54 D06 S61403 Knappe Cross V213936 310805 Stage 4.doc Version 1.20 Page 13 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 standard(s) 23,26 Service users enjoy living in a clean and hygienic setting, in rooms that suit their personal and social needs. EVIDENCE: The areas of the home that were seen by the inspectors were clean and tidy. Bins were empty; soap dispensers were full. The service users commented on how clean their rooms were, and that despite cleaner shortages at the moment the cleaning staff were working very hard to maintain a good level of cleanliness. Some service users and staff mentioned that curtains needed washing, and that they hadn’t been washed for many years. The inspectors went in approximately 20 bedrooms. These were all very personalised and reflected the person living there. One service user had chosen to fund the refurbishment of their own room, which they really enjoyed being involved in. The relatives spoken to all felt that the bedroom their relative lived in suited them. The manager actively tries to ensure that service users are offered a variety of bedrooms to meet their particular circumstances. Knappe Cross Care Home D54 D06 S61403 Knappe Cross V213936 310805 Stage 4.doc Version 1.20 Page 14 The manager is also trying to encourage care staff to take pride in their particular work area in the home, which has a positive outcome for the service users. The inspectors met the staff member currently responsible for carrying out the laundry. She understood her role well and was familiar with infection control measures. Service users’ clothes were very well laundered and cared for well. Knappe Cross Care Home D54 D06 S61403 Knappe Cross V213936 310805 Stage 4.doc Version 1.20 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,30 The deployment and number of staff meets the basic needs of the service users but needs to increase to ensure that psychological and social needs are also fully met. Recent training has improved the knowledge base of some staff, but further training planned will further improve how care is delivered. EVIDENCE: There are 35 service users at the home, with 7 vacancies and therefore the number of staff on has decreased. 22 of the 35 have nursing care needs. The manager has changed some deployment issues to increase efficiency but it is clear that numbers on duty will need to increase as soon as the number of residents increases. Service users had varying opinions on how long the call bells took to be answered, from ‘very quickly’ to ‘a long time’. The inspector witnessed one call bell taking 8 minutes to answer, and the manager has also been monitoring this and speaking to staff when lengths of time are unacceptably long. There are tensions amongst some staff about some changes in shift allocations. Staff say that they are not able to spend much one to one time with service users, and some service users confirmed this. There are usually 2 trained and 5 care assistants in the morning, 2 trained and 4 care assistants in the afternoon and 1 trained and 3 care assistants at night. This is inline with previous Health Authority guidelines. However, in order to fully meet the social and psychological needs and as soon as the numbers of service users increase, the staffing levels should be increased accordingly. The manager is supernumerary and works mainly on the floor so as to supervise and deliver care. Knappe Cross Care Home D54 D06 S61403 Knappe Cross V213936 310805 Stage 4.doc Version 1.20 Page 16 There is no allocated time for handovers unless staff come in on their own time. This has the potential to place service users at risk if staff do not have a handover and also some say that they have little time to read care plans. The training records show that there had been some training and updating since the last inspection in November 2004. Staff have now attended some mandatory training. Marlene Butler the Director of Operations for the company is going to carry out a training needs assessment for the home and then set up some training in the period Jan – June 06. The manager said there were some training sessions staff were attending in September, such as tissue viability, health and safety, palliative care and fire safety. One care assistant said she had just passed her NVQ level 2. The manager is looking at ways to provide clinical supervision for the trained nurses and to ensure that they are keeping up to date with their clinical practice. Knappe Cross Care Home D54 D06 S61403 Knappe Cross V213936 310805 Stage 4.doc Version 1.20 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33, The home is well managed by the new manager and there is clear leadership, guidance and direction to encourage staff to consistently provide quality care. The systems for service user involvement are improving with more evidence that their views are being sought and acted upon. EVIDENCE: Although the manager has only been in post for 7 weeks she was clearly able to explain the changes she had put in place to improve care. She works in an open and transparent way and the qualified staff in particular were very grateful for her support, leadership and hands on approach. The manager will also spend time with the team of care assistants to listen to their views. She is available at all times for staff to talk to. Service users and relatives were all aware of the new manager and were complimentary about her management style. She has carried out a quality audit and has had an excellent response (35 returned) and is collating the responses. This will be sent to the Commission when completed. She said that she had already attended to some of the more pressing issues that had arisen from the survey. Knappe Cross Care Home D54 D06 S61403 Knappe Cross V213936 310805 Stage 4.doc Version 1.20 Page 18 One anxiety expressed to the inspectors from service users, relatives and staff is the unreliability of one of the lifts that breaks down, and how they would like a chair lift installed as a back up. (Written as a recommendation under NMS 22) The manager also feels very well supported by Marlene Butler and Arif Pradhan. Knappe Cross Care Home D54 D06 S61403 Knappe Cross V213936 310805 Stage 4.doc Version 1.20 Page 19 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 x COMPLAINTS AND PROTECTION x x x 2 3 x x 3 STAFFING Standard No Score 27 2 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 3 x x x x x Knappe Cross Care Home D54 D06 S61403 Knappe Cross V213936 310805 Stage 4.doc Version 1.20 Page 20 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard NMS 7 Regulation 15 (1) Requirement The registered person shall prepare a written plan as to how the service users needs in respect of his health and welfare are to be met The care plan must be kept under review ( Previous timescale of 31/03/05 not met) The registered person shall 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 The registered person shall consult service users about their social interests and make arrangements to enable them to engage in local, social and community activities The registered person shall consult service users about the programme of activities arranged by or on behalf of the care home Timescale for action 30.9.05 2. 3. NMS 7 NMS 8 15 (2)b 14 (2) 30.09.05 30.09.05 4. NMS 12 16 (m) 30/10/05 5. NMS 12 16 (n) 30.10.05 Knappe Cross Care Home D54 D06 S61403 Knappe Cross V213936 310805 Stage 4.doc Version 1.20 Page 21 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 NMS 22 Good Practice Recommendations Review the provision of the small passenger lift following comments from service users and staff, so that service users needs are fully met. Look at alternative measures in case lift breaks down such as a chair lift Review and increase as necessary the staffing numbers at the home to ensure that there are enough staff on duty to provide all aspects of care 2. NMS 27 Knappe Cross Care Home D54 D06 S61403 Knappe Cross V213936 310805 Stage 4.doc Version 1.20 Page 22 Commission for Social Care Inspection 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 Home D54 D06 S61403 Knappe Cross V213936 310805 Stage 4.doc Version 1.20 Page 23 - 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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