Inspection on 29/11/06 for Knellwood

This inspection was carried out on 29th November 2006.

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

The inspector 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

Knellwood 31/07/08

Knellwood 01/08/07

Knellwood 30/01/06

Knellwood 18/08/05

Knellwood 27/09/04

Knellwood 06/04/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Knellwood 83 Canterbury Road Farnborough Hampshire GU14 6QN Lead Inspector Beverley Rand Unannounced Inspection 29th November 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Knellwood DS0000012340.V322631.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Knellwood DS0000012340.V322631.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Knellwood Address 83 Canterbury Road Farnborough Hampshire GU14 6QN 01252 542169 01252 541153 mailto:knellwood@aol.com http:/www.knellwood.co.uk/ Farnborough (War Memorial) Housing Society Limited Ms Janet Gover Care Home 52 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) Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (52) of places Knellwood DS0000012340.V322631.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Knellwood is a large home situated in its own extensive grounds located in Farnborough and within easy access to shops, local amenities, railway station, bus routes and the M3 motorway. The home is under the management of a non profit making charity and provides accommodation for up to 52 service users over the age of 65. Responsibility of the day to day running of the home is with the registered manager who is responsible to the homes board of management. The home charges between £358 and £423 a week, exclusive of personal items such as hairdressing, chiropody, newspapers, escort duties and toiletries. This information was provided on 29/11/06. Knellwood DS0000012340.V322631.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection. The inspector toured the building, spoke with three residents, one visitor, one staff member and the manager. The inspector also looked at records such as recruitment checks and care plans. As well as a visit to the home we have reviewed information sent to us from the home. What the service does well: What has improved since the last inspection? What they could do better: Some careplans need to include more detail about residents’ individual support needs so that all staff are fully aware of individual goals. Certain aspects of the medication administration procedure must be changed, to ensure it is in line with best practice which is considered safer than their current practice. Recruitment checks must be in place before new staff begin work to ensure Knellwood DS0000012340.V322631.R01.S.doc Version 5.2 Page 6 staff are safe to work with vulnerable people. A risk assessment must be undertaken regarding the storage of the cleaning fluids and any necessary action taken. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Knellwood DS0000012340.V322631.R01.S.doc Version 5.2 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 Knellwood DS0000012340.V322631.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 does not apply to Knellwood. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager ensures that new residents have been assessed and that the home can meet their needs. EVIDENCE: The manager visits prospective new residents in hospital or at home to undertake an assessment. Prospective residents are also encouraged to spend some time at the home so that they can be assessed in the environment. The manager also seeks other assessments from doctors or local authority adult services. The inspector looked at three assessments and found them to contain appropriate detail. Knellwood DS0000012340.V322631.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home ensures residents have access to healthcare professionals and that their privacy and dignity is respected. Careplans could be improved and residents could be involved. Some medication procedures pose a potential risk to residents. EVIDENCE: The inspector asked to see three careplans. One had not yet been written as the resident had very recently moved into the home. Another resident had low levels of support needs and the careplan reflected this. The third one did not reflect mental health and nutrition needs, which had been verbally explained to the inspector. The manager showed the inspector an additional care plan, and this was seen to be completed in more detail. The inspector and manager discussed what improvements needed to be made to some careplans. Careplans are reviewed every month, but the home does not include residents in the review. The inspector asked two residents about whether the staff supported them with personal care in a consistent way. One said it depended Knellwood DS0000012340.V322631.R01.S.doc Version 5.2 Page 10 on their personality, another said they would follow a particular routine if asked but neither was overly concerned. The home has links with healthcare professionals such as doctors, district nurses and continence advisors. A resident said the doctor visits the home regularly. Residents go out to visit their own dentists and optician. A chiropodist visits, seeing some people every two months and some every three months as necessary. Staff gave examples as to how they respected resident’s privacy and dignity and the inspector observed practice, such as staff knocking on people’s doors before entering. All residents who spoke with the inspector said the staff were good. The home has a private telephone booth so residents can make calls in private. The home has a medical room and trolleys are used to take around the home to dispense medication. The inspector found that day time records for medication were correctly filled in. One of the residents was asked specifically about their tablets which needed to be taken before food, and they said they were always given them on time. The home has a system whereby the senior staff take the 10pm and 7am medication out of the original labelled and named box and put it into an individual named tablet bottle for the night staff to administer. The manager said the reason for this was to do with numbers of staff, the size of the home and the drugs storage. The senior dispensing will sign the record as being dispensed, and the night staff should sign the record when they administer the medication. This double dispensing practice is an outdated and unsafe practice and is not in line with best practice as described in The Administration and Control of Medicines in Care Homes and Children’s Services, produced by The Royal Pharmaceutical Society of Great Britain. This practice was also described as frequently associated with medication errors in a report by the Department of Health, Building a safer NHS for patients. The inspector looked at five night records, all of which were signed as being dispensed, but found that three showed gaps in the administration signatures. It was therefore not known whether the resident had taken the drugs or not. Two records were complete. During the inspection the manager started to address this issue. The home does not have an audit procedure in place to ensure they can account for all medication. Some residents are prescribed controlled drugs such as Temazapam yet it was not possible to see how many should have been in the home as the number in had not been recorded and the night records showed gaps. All staff who handle medication have had appropriate training, including the night staff. Knellwood DS0000012340.V322631.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home offers residents a range of activities and choices in everyday life. Visitors are always made welcome. EVIDENCE: One resident who spoke with the inspector was busy knitting and said staff brought wool in for her. Games such as Scrabble are available and some residents play each other. One resident said she really enjoyed the miniature farm which visited the home, and that staff took a lovely photograph of her with a kitten. Other activities include bingo, crafts, making Christmas cards and tags, concerts, theatre trips, going to the garden centre, the coast, or museums. The home always has a service of remembrance in the main hall which is also attended by the mayor or deputy mayor and members of the British Legion. All the residents who spoke with the inspector had manicured nails, done by staff. Three staff have completed an activities course and notices about planned activities are displayed around the home. There are two electric organs and a piano in the main lounge which are available for anyone to play. The home also has a trolley shop selling goods such as toiletries and sweets. Knellwood DS0000012340.V322631.R01.S.doc Version 5.2 Page 12 The inspector spoke with a visitor who said they always felt welcome at the home and could visit at any time. There is a room available which can be used for visitors who may wish to stay the night, as well as private toilet facilities. The manager said although they generally ask people to be mindful of meal times, they do appreciate some visitors will come from some distance, and they will be offered a meal. During the tour of the home it was evident that residents can bring their own ornaments and furniture as bedrooms were individualised. The manager said that their maintenance man always takes all picture hooks down when a room is vacated, and fills the holes, so that the new residents can have things where they would like them. Some residents have their own telephone line and could purchase fee paying television if they wished. All residents who spoke with the inspector found the food to be good, although two felt the second option was frequently the same. This was discussed with the manager who agreed to discuss with residents. The menu is based on a four week rolling menu and is changed twice a year. The cook speaks to everyone in the morning to see what they would like and would be happy to provide something different to the two dishes on the menu if it were asked for. There were fresh fruit and vegetables in the kitchen and the cook uses a local butcher for meat. The cook makes homemade cakes and this was evident on the day of the inspection. A cooked breakfast is always available. One resident is currently having food pureed and the manager said each food item was pureed separately. The manager told the inspector that there was not a very strict budget for food, which meant more flexibility with the menus. Knellwood DS0000012340.V322631.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements for protecting service users and responding to their concerns are satisfactory. EVIDENCE: The home has a complaints procedure which has been given to residents. The home has not received any complaints since the last inspection, and all the residents who spoke with the inspector said they felt able to raise complaints with the manager if they needed to. They were confident that she would deal with any complaints appropriately. The home has appropriate procedures in place should there be an allegation of abuse and the manager is aware of how the process of an investigation works. The staff have had training in the protection of vulnerable adults and were clear as to what they would do if they suspected abuse. Knellwood DS0000012340.V322631.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents benefit from a well decorated and clean environment. EVIDENCE: One resident who was asked said the, ‘cleaning is perfect’ and another said their room was, ‘nice and clean with a lovely view’. On the day of the inspection three cleaners were working in the home and the home was clean with no unpleasant odours. The manager said the bedrooms were cleaned every day. The home is partly a Victorian house and has an ongoing programme of redecoration and re-furbishment. Currently, scaffolding has been erected to allow the front external walls to be painted. The mouldings and corbels are also being replaced. The large windows have been sympathetically replaced with double glazing. The home has large communal areas: a hallway with seating, Knellwood DS0000012340.V322631.R01.S.doc Version 5.2 Page 15 two dining rooms, a main lounge, a ‘quiet’ lounge without a television and a conservatory with views over the garden. All these rooms are decorated and furnished to a high standard. There are three kitchenette rooms in the home, where residents could make drinks, but these are not currently used. Individual bedrooms are well decorated and are re-decorated when they become vacant. All rooms have lockable storage and electric door closures which means residents can have their doors open safely. All rooms have an ensuite basin facility, some have toilets. All baths and basins which are used by residents are fitted with thermostatically controlled valves so that residents are not scalded. Call bells are situated in the bedroom and en-suite toilets, and are also portable so residents can move them around the room, or take around the house. Some facilities have equipment adaptations as necessary: one room has recently been fitted with a specialist shower. One resident who was asked said staff responded to the call bell very quickly. There are seven bathrooms and all are fitted with appropriate hoists. The home sits in large grounds which are tended by the gardener. In summer residents can sit on the patio. During the inspection some residents were seen to be independently walking in the garden. The home also has dedicated rooms for healthcare and hairdressing. Staff have a staff room, a changing room, washing facilities and lockers for their belongings. There is also a room for training. The home employs a laundress nearly fulltime. The laundry appeared organised with clothes on named hangers. Washing machines were commercial and suitable for the task. There is a separate sluice room. Staff spoken with were clear about the procedures to follow regarding infection control, and said there was always a good supply of disposable gloves and aprons. All staff carry a bottle of alcohol based skin disinfectant. Knellwood DS0000012340.V322631.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does not have robust systems in place to ensure there are safe and trained staff working at the home. The home does meet the standard regarding qualified staff. EVIDENCE: On the day of the inspection the staffing was comprised of a senior carer, four carers, (including one agency worker), two kitchen staff, three cleaners, the maintenance man and the laundress. The manager was also in the home. The manager said this was typical of the planned rota. The rota is a rolling one, but inevitably changes are made on a daily basis. These changes were not recorded on the rota. The manager explained it would be possible to trace who worked at any given time, but that these records were not kept for more than six months. Accurate records of who worked at the home must be kept for three years. The manager revised her system on the day of the inspection in order that this regulation can be met. The manager told the inspector that staffing numbers was reviewed as necessary, for example, more staff could be on the rota if a resident needed additional support. The home has a recruitment procedure which involves obtaining references, Criminal Record Bureau, (CRB) checks and Protection of Vulnerable Adult, (POVAFirst) checks. The inspector looked at recruitment files for three new Knellwood DS0000012340.V322631.R01.S.doc Version 5.2 Page 17 staff. One file contained the appropriate checks which were completed prior to the person starting work. One started work before the POVAFirst check was returned and with only one reference. The third did not have a reference from the current employer. None of the references stated the date they were returned, which is necessary to evidence that they were returned prior to people starting work. The manager was unable to explain the lack of checks and said that it was her usual practice to conduct them appropriately. New staff undertake induction and foundation training based on the National Training Organisation, Skills for Care which senior staff facilitate this. The home does not keep a record of what training staff have had and the only way to find this out was to look at individual’s certificates. Therefore a sample was studied. New staff undertake a basic induction related to the home and the environment, soon after they start work. One was seen for a new staff member and this was signed and dated. However, there was not one for another staff member who started in the summer. A more thorough induction is done later for staff new to the care sector. A Moving and Handling course had been run earlier in the year, and the sample of certificates showed several staff had attended. A course in Infection Control was offered and some staff attended: some chose not to. The manager thought that all staff except the very new staff had attended Food Hygiene. Three staff have done training in Activities and the continence nurse has also done training at the home. The manager did not have a system in place for ensuring staff received the training or refreshers at appropriate intervals and no training was booked. The home employs twenty care staff and seven of these have achieved a National Vocational Qualification, (NVQ) Level 2 or above and two are currently studying. A further three are qualified nurses which means the home meets the standard for qualified staff. Knellwood DS0000012340.V322631.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ health, safety and financial welfare is safeguarded but residents may benefit from safer storage of cleaning fluids. EVIDENCE: The manager has managed the home for almost ten years and has achieved the Registered Manager’s Award. She has undertaken a course in the Promotion of Continence and updated fire training. Residents and staff who spoke with the inspector said the manager was approachable. However, there are issues as detailed above regarding care plans, staff recruitment and the monitoring of training. Knellwood DS0000012340.V322631.R01.S.doc Version 5.2 Page 19 The home distributes questionnaires to residents, their families and staff, seeking their views on the home. The manager did not know how often this was done but the last one was done in August. The results are then analysed by someone other than the manager. Regulation 26 visits, (which look at various quality issues) are completed monthly, on a rota system by people from the board of management. The home also uses an annual formal quality assurance system. The home looks after small amounts of money for some residents who request them to do so or who are unable to do so themselves. The inspector looked at records for two people and found that receipts were kept, residents sign where possible and the records matched the amount of money held. The home keeps a list of fire safety training and this is held twice a year, with all staff attending. Fire safety equipment such as alarms and emergency lighting are tested regularly and records are kept. Maintenance certificates were available for equipment such as hoists. Dangerous chemicals are locked away but cleaning materials are kept in a locked cupboard with the key next to it. The manager was not aware of there being a risk assessment in place regarding this arrangement. Knellwood DS0000012340.V322631.R01.S.doc Version 5.2 Page 20 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Knellwood DS0000012340.V322631.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? N/A 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) (2,c,d) Requirement Careplans must set out in detail the action which needs to be taken to ensure that all aspects of care needs are met. Residents must be involved in reviewing careplans. The practice of double dispensing must cease. All medication records must be completed accurately. A record of medication brought into the home must be kept, so that an audit trail can be followed. All recruitment checks must be in place before a new staff member begins work. The registered manager must have a robust training programme in place to ensure that staff attend training when necessary. Records must be kept which evidence this. The registered manager must ensure a risk assessment is completed regarding the key being kept beside the cleaning cupboard, and action taken accordingly. DS0000012340.V322631.R01.S.doc Timescale for action 28/02/07 2 OP9 13 (2) 28/02/07 3 4 OP29 OP30 19 18 (c,i) 31/01/07 28/02/07 5 OP38 13 (4, a, c) 31/01/07 Knellwood Version 5.2 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Knellwood DS0000012340.V322631.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Knellwood DS0000012340.V322631.R01.S.doc Version 5.2 Page 24 - 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. 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