Inspection on 12/03/07 for Knights Court Nursing Home

This inspection was carried out on 12th March 2007.

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

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

Other inspections for this house

Knights Court Nursing Home 16/04/09

Knights Court Nursing Home 06/05/08

Knights Court Nursing Home 30/07/07

Knights Court Nursing Home 21/06/06

Knights Court Nursing Home 25/01/06

Knights Court Nursing Home 06/06/05

Knights Court Nursing Home 07/02/05

Knights Court Nursing Home 11/07/04

Knights Court Nursing Home 22/01/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Knights Court Nursing Home 105-109 High Street Edgware Middx HA8 7DB Lead Inspector Mr Ram Sooriah Key Unannounced Inspection 12th March 2007 10:00 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 Knights Court Nursing Home DS0000022931.V326258.R03.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. Knights Court Nursing Home DS0000022931.V326258.R03.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Knights Court Nursing Home Address 105-109 High Street Edgware Middx HA8 7DB 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) 020 8381 3030 020 8381 3040 knightscourt@lifestylecare.co.uk Life Style Care PLC Manager post vacant Care Home 80 Category(ies) of Dementia - over 65 years of age (40), Old age, registration, with number not falling within any other category (40) of places Knights Court Nursing Home DS0000022931.V326258.R03.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st June 2006 Brief Description of the Service: Knights Court Care Centre is a purpose built care home and was opened on the 27th November 1998. It is part of Lifestyle Care Plc, a provider of care homes mostly for the elderly. Lifestyle care Plc has been taken over by Southern Cross Healthcare from the 26th February 2007. The home is found off the Edgware High street and it is easily accessible by buses, the underground and by car. The bus and tube station is about five minutes walk away. The home benefits from a large parking facility for at least ten cars. There are shops, coffee shops, restaurants and other local amenities in close proximity of the home. The home consists of a main 3-storey building with a 2-storey wing on each side. It provides accommodation for 80 residents in 4 units. Each unit is selfcontained and has a kitchenette area, lounge/dining areas, bathrooms and toilets. All the rooms are single and are en-suite. The Camelot and Avalon units are on the ground floor and the Merlin and Excalibur units are on the 1st floor. The Merlin unit is registered for twenty elderly residents with dementia requiring nursing. The Excalibur unit has also recently been registered for twenty service users with dementia care needs, when it was previously registered to provide care for elderly service users requiring nursing. The other two units can each accommodate twenty elderly residents with nursing needs. The 2nd floor contains the laundry, kitchen, managers office and staff areas. The fees charged by the home are: £750-£800 for private elderly care service users depending on the needs’ assessments, £900 for private service users requiring dementia care, £600 for service users funded by Harrow Social Services, £605 for service users requiring dementia care and £577 for elderly care service users funded by Barnet Social Services. There were 58 service users in the home during the inspection. The Excalibur unit was empty after it had been recently redecorated in preparation for the change in category of registration. Knights Court Nursing Home DS0000022931.V326258.R03.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the second key unannounced inspection of the home for the period 2006-2007. It started on Monday 12th March from 10:00-19:00 and continued on Wednesday 14th March 10:00-16:00. The last key announced inspection was on the 14th June 2006. It was noted during that inspection that a number of requirements from previous inspections remained unmet and a number of requirements were also made during that inspection. The random unannounced inspections on the 11th September 2006 showed that the home has made little progress in meeting past requirements. Enforcement action against the home was then initiated. An enforcement notice and a condition to cease admission to the home were imposed on the home. The random inspection on the 19th December 2006 showed that the home complied with the enforcement notice and met the requirements as stipulated in the Condition on the Registration Category of the home. The condition was removed from the registration category of the home after a commitment to continue improvement in the home was received from Lifestyle Care plc. The home has since change its category of registration and is now registered to provide care for 40 service users requiring dementia care and 40 elderly service users requiring nursing. The findings of this inspection are based on a tour of the premises and inspection of a sample of care, personnel and training, and health and safety records. The inspector also observed care practices and talked to some visitors to the home, some service users, members of staff and the manager. An immediate requirement was imposed on the home for failure to comply with Regulation 19(1) of the Care Homes Regulations 2001, requiring that appropriate checks are made before a person is offered work in the home. The inspector would like to thank all the service users and visitors to the home who gave feedback to him and the manager and all her staff for their support and assistance during the inspection. What the service does well: Service users and their representatives are offered the appropriate information to decide if the service users want to live in the home. They are also offered the opportunity to visit the home and to meet staff and other service users. Knights Court Nursing Home DS0000022931.V326258.R03.S.doc Version 5.2 Page 6 Service users’ needs are assessed by experienced members of staff prior to the home deciding to accept the service users. Once admitted the needs of service users are comprehensively assessed and comprehensive care plans are prepared with the involvement of the service users or of their representatives. Risk assessments are drawn up for the protection of service users in consultation with them or their representatives and the relevant healthcare professionals such as the GP and chemist. The home has a quality assurance procedure in place and appropriate customer satisfaction surveys are conducted. The management of service users money and personal belongings is good. There is appropriate monitoring of all accidents to ensure the safety of service users and staff and that action can be taken to prevent recurrence of similar accidents in the future. What has improved since the last inspection? What they could do better: Knights Court Nursing Home DS0000022931.V326258.R03.S.doc Version 5.2 Page 7 The monitoring of the condition of service users, when they are not well, has to be improved to ensure that action can be taken as soon as deterioration is noted. The monitoring must be comprehensive and must be carried out according to an agreed plan of care. Staff could initiate more positive conversations with service users to improve the interactions of members of staff with service users. To enable them to do this they need more training in developing communication skills. The instructions with regards to the administration of some medicines, which are administered as required, must be clear with regards to the circumstances when these medicines are to be administered. Recruitment procedures must be followed to ensure compliance with Schedule 2 of the Care Homes Regulations 2001, including ensuring that all members of staff have two appropriate references before they work in the home. Induction must be provided to all new members of staff at the right time and according to their job. Induction records must be kept as required. All food items in the fridges in the kitchenettes areas must be labelled and dated to ensure that service users are not offered food, which have not passed the expiry dates and which do not belong to them. 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. Knights Court Nursing Home DS0000022931.V326258.R03.S.doc Version 5.2 Page 8 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 Knights Court Nursing Home DS0000022931.V326258.R03.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1-4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and their representatives are provided with sufficient information to enable them decide if the home would be suitable for the service users. The needs of service users are also appropriately assessed to ensure that that the home only admit service users whose needs can be met in the home. The needs of service users who are accommodated in the home are on the whole being met. EVIDENCE: The service users’ guide was available for inspection in the foyer of the home. A copy is also provided to all new service users in an information pack. The service users’ guide has been recently updated by the current manager. It contained sufficient information to give people an indication of the type of service that it provides. There was also information about how the fees are to be paid, what the fees cover and about the free nursing care contribution. However it did not yet contained information about the range of fees charged Knights Court Nursing Home DS0000022931.V326258.R03.S.doc Version 5.2 Page 10 by the home. The manager stated that the SUG would be updated with additional information now that the home is part of Southern Cross Healthcare. Copies of contracts were seen being prepared for newly admitted service users. The inspector was informed that contracts/statements of terms and conditions are provided to all service users including those who are publicly funded. The care plan of a newly admitted service user was inspected. It was noted that the deputy manager had carried out a comprehensive assessment of the service user’s needs. The needs assessment included an assessment of the mental health needs of service users. The needs’ assessment of the funding authority was also available on file. The manager stated that the pre-admission assessments of service users are normally carried out by the deputy manager or by herself. Service users in the home presented as being appropriately cared for. Feedback from service users and visitors showed that they were generally pleased about the way the service users were being cared for. There was evidence that a range of training has been provided to staff to ensure that they were competent in meeting the needs of service users. Care plans of service users contained information about the cultural and ethnic needs of service users and staff were on the whole aware of these needs. The relative of a service from an ethnic minority was happy with the way that the home was addressing the cultural aspects of the care of the service user and that staff were more aware of this. There has been progress in ensuring that this aspect of care is addressed in care records. The home is commended for this. Knights Court Nursing Home DS0000022931.V326258.R03.S.doc Version 5.2 Page 11 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): 7-11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans addressed the needs of service users and these were drawn up with the involvement of the service users/representatives. A few issues needed to be addressed to ensure that the healthcare needs of service users were being fully met. Medicines management was mostly appropriate. The arrangements in place and the wishes and instructions of service users with regards to end of life care were appropriately recorded. EVIDENCE: Care plans were comprehensive and the needs of service users were appropriately assessed. The care plans were reviewed at least monthly and were on the whole comprehensive enough to enable someone reading the care plan, understand the needs of the service user and how these can be met. Audit forms and a programme of audits showed that the manager carried out regular audits of the care plans. Identified issues were then addressed in the form of an action plan. Knights Court Nursing Home DS0000022931.V326258.R03.S.doc Version 5.2 Page 12 Care plans contained a number of risk assessments. There were general risk assessments and more individualised risk assessments according to the needs of service users. Risk assessments and care plans were agreed with service users or with their representatives where that were possible. There was evidence of the involvement of service users or of their representatives in the review of care plans and risk assessments. Relatives of service users said that they have seen the care plans and that they are kept up to date with the conditions of service users. Service users presented as well cared for, clean and appropriately dressed. Feedback from a number of visitors and observations of the inspector showed that interaction of members of staff with service users needed improvement. Very often members of staff carried out interventions with service users but did not explain what they were doing to the service users and there was little conversation, albeit they were doing something useful for the service user. For example members of staff did not always thoroughly explain what they doing when using the hoist or even when wiping the mouth of service users after their meals. The manager stated that she was aware of the above issues as she had asked the activities coordinator to conduct a training session with regards to the right approach that need to be adopted by members of staff when caring for service users, who might already have communication impairments. There was one service user with pressure ulcers in the home. There was evidence that the ulcers were healing. Records about wound care were good and included photographs and regular wound progress notes. It was noted that some service users at risk of pressure sores were on repositioning charts, but the service user with pressure sores did not have a repositioning chart. The repositioning charts kept for other service users have also not been completed comprehensively to make these useful and valid documents. The inspector noted that two service users were seen by the emergency doctor on the day before the inspection. The vital signs of one of the service users were monitored on one occasion on the day before the inspection and there were no monitoring during the night. The other service user’ condition was not monitored on the day before the inspection but was being monitored on the day of the inspection. The inspector was informed that a care plan was being put in place for one of the service user who did not have a care plan to address the management of this need. The vital signs were also not being thoroughly monitored, as the respiration rate was not being recorded. It was noted that the teeth of one service user was in poor condition. It was not very clear from records and from enquiries with staff if the service user or other service users have recently been seen by the dentist. A visitor mentioned that his/her relative has not seen the dentist for a while. This issue must Knights Court Nursing Home DS0000022931.V326258.R03.S.doc Version 5.2 Page 13 therefore be clarified. It is required that a review be undertaken of all service users who might benefit from the input of a dentist. Medicines management was inspected on the Avalon unit. All records were in good condition and all medicines charts were signed as appropriate. There were records about monitoring the fridge temperatures and the temperature of the clinical room, which was air-conditioned. Risk assessments were noted for those service users who self-administer and it was noted that in these cases appropriate storing arrangements for the medicines were in place. The management of controlled medicines on the Avalon unit was also appropriate. It was noted that the instructions for the administration of some medicines to be administered when required, were not very clear with regards to the circumstances for administration. This could pose a problem for new nurses working on the unit. There has been marked improvement in the content of care records with regards to addressing the end of life care of service users or of their relatives and their wishes and instructions with regards to death. There was evidence that this information is gathered at the point of admission or review of the care records with service users. This is good practice and involves an open discussion about a sensitive aspect of the care of service users. The manager and her staff are commended. The resuscitation status of service users was also addressed in the care records. One of the five service users’ records sampled said that ‘if very serious-no need’. This instruction was judged not to be very clear and ambiguous and therefore needed clarification. Knights Court Nursing Home DS0000022931.V326258.R03.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have the opportunity to choose from a number of activities. They are also supported in keeping contact with the local community according to their abilities. The home provides appropriately prepared and varied meals to suit the needs of service users. EVIDENCE: The social and recreational needs of service users were recorded in the care records and care plans were in place addressing the recreational needs of service users. There were two activities coordinators in post and service users and their relatives were on the whole pleased with the provision of activities in the home. A programme of activities was available on notice boards and boards in the lounges were in place to inform service users of the events happening on the day. The inspector was informed that outside entertainment is also arranged on special occasions. A notice showed that an entertainer has been booked for St Patrick’s Day. Knights Court Nursing Home DS0000022931.V326258.R03.S.doc Version 5.2 Page 15 On the day of the inspection, there was a session of light exercises and ball throwing in the morning and a quiz session and the ‘gentleman club’ in the afternoon. There were two volunteers helping with the activities. The inspector was informed that the ministers from the local churches visit the home to offer spiritual support to service users accommodated in the home according to their faith. A programme was available to demonstrate that. On the day of the inspection lunch consisted of spaghetti Bolognese, cabbage, carrots. There were also potatoes for those who did not want spaghetti. Cajun fish was available as the second choice and there was jam roly-poly and custard or yogurts/ice-cream for desert. Cakes baked in house were provided to service users with tea. The home has recently introduced a catering forum to discuss the provision of meals in the home. The first meeting was held in March and minutes were available for inspection. This was positive and showed that the home was willing to listen to feedback to improve the provision of meals in the home. Service users and relatives were complimentary about this initiative. The home is commended for that. Knights Court Nursing Home DS0000022931.V326258.R03.S.doc Version 5.2 Page 16 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints and allegations and suspicions of abuse are taken seriously and are dealt with appropriately. EVIDENCE: The complaint procedure is included in the service users’ guide, which is available in all bedrooms. A copy is also available in the foyer of the home. It includes all the necessary information with regards to making a complaint. The manager stated that the complaint procedure would need reviewing following the take over of the home by Southern Cross. The complaints register was inspected. There have been four complaints since January. Those complaints, which have been resolved, were all acknowledged, investigated and responded to as appropriate. One complaint was still being dealt with. There has not been any allegation of abuse since January 2007, but there have been five referrals to the safeguarding Adult coordinator from the last Key inspection in June 2006. The home has been subject to an Establishment Review within the Safeguarding Adults procedure of Harrow, the Local Authority where the home is situated. Local authorities including Barnet and Harrow had been concerned about the standard of care in the home and have initiated the establishment review. This process has now been completed after Knights Court Nursing Home DS0000022931.V326258.R03.S.doc Version 5.2 Page 17 the Local Authorities have satisfied themselves that the level of care in the home has improved and that service users were safe in the home. There was evidence that staff have had training in the protection of vulnerable adults and were aware of what constituted abuse. Accidents and incidents are closely monitored by the manager and investigated to rule out any possibilities of abuse. The recruitment procedures however have not been followed correctly to ensure the correct vetting of all members of staff before they work in the home (see section under staffing). This is necessary to ensure the safety of vulnerable service users at all times. Knights Court Nursing Home DS0000022931.V326258.R03.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a warm, clean, maintained and personalised environment. EVIDENCE: The car park areas and the grounds in the front and on the side of the home were tidy. The exterior of the building was in good condition. The interior of the home was bright, clean, maintained and free from odours. There has been redecoration and maintenance in the home since the last inspection. It was noted that the Merlin unit has been redecorated with a colour scheme and approach to suit the needs of the service users with dementia care needs who are accommodated on that unit. There has also been progress in the personalisation of the bedrooms and staff are more aware of Knights Court Nursing Home DS0000022931.V326258.R03.S.doc Version 5.2 Page 19 the needs to encourage visitors to bring personal items and to contribute in personalising the bedrooms of service users. The Excalibur unit has undergone a full redecoration to prepare the unit for the change of category that has been envisaged for that unit, from elderly care to dementia care. The unit is now ready to receive the first service users. The toilets and bathrooms are clearly identified for service users to use and all toilets close to the lounges are now fully accessible to service users. The bedrooms of service users were personalised and were clean. A number of duvets were in use to make the bedrooms of service users more homely. A few pillows were noted which were stained and some have been in the wash and no longer held their shapes. Two lockers were noted to be slightly broken and the manager stated that she would get these repaired. The home was clean and domestic staff were employed as necessary to ensure that the home remains clean. Knights Court Nursing Home DS0000022931.V326258.R03.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were adequate numbers of staff on duty to care for service users. Recruitment procedures were not always strictly adhered to with regards to ensuring that staff have appropriate references before they work in the home. Training is provided to members of staff to ensure that they are competent to meet the needs of the service users, but appropriate inductions records were not always available for new members of staff to demonstrate that they have had an appropriate induction. EVIDENCE: Three of the four units were occupied at the time of the inspection. There was one trained nurse and three carers on each of the three units during the day, except on the Merlin unit where there was an extra carer. At night there are one trained nurse and once carer on each of the units. Records provided by the home showed that 36 persons have left their jobs and that 27 have started the jobs with the home. The numbers were adequate at the time of the inspection as the home was running with only three of the four units occupied, but recruitment will have to be stepped up should service users start to be accommodated on the Excalibur unit. Knights Court Nursing Home DS0000022931.V326258.R03.S.doc Version 5.2 Page 21 The manager stated that the home has 80 of its care staff trained to NVQ level 2 or more. She confirmed that they were already qualified. There was evidence that the home has arranged for training for care and nursing staff to ensure that they would continue to be up to date with up to date knowledge with regards to caring for older people and for older people with dementia. The personnel records of four members of staff were inspected. These were mostly for new members of staff. Most records as per schedule 2 of the Care Homes Regulations 2001 were in place. The work histories of applicants were appropriately recorded either on the application forms or on CV’s. CRB checks were also in place for people who were offered to work in the home. However one new member of staff who has been recruited for a senior post in the home, did not have appropriate professional references in place. An immediate requirement was imposed at the time of the inspection to address this issue. Two of the five members of staff, whose induction records were sampled, lacked appropriate induction records. It was noted that a care worker completed an induction record in February after she started work in November. There was no evidence that the common standards had been started as part of the induction for this carer. A new trained nurse who was working for the first time as a trained nurse on one unit had never worked as a trained nurse on that unit and has not had an induction to the unit where she was allocated to work. She started as a carer and had an induction for a carer but did not have an induction as a trained nurse. As a result she did not know the service users very well, as was demonstrated when the inspector asked about the care of a specific service user. Knights Court Nursing Home DS0000022931.V326258.R03.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is experienced and runs the home to ensure that the aims and objectives of the service are met. There is a quality management system in place to ensure continuous improvement. Service users’ personal money is managed appropriately by the home. Health and safety issues are taken seriously and are addressed appropriately. EVIDENCE: The manager has now lodged her application to be the registered manager for the home. She has, with the support of her line managers, addressed past requirements and ensured that these were met. She is familiar with the home and communicates well with visitors and service users in the home. Service users who spoke to the inspector knew the manager and visitors said that they Knights Court Nursing Home DS0000022931.V326258.R03.S.doc Version 5.2 Page 23 had confidence that if there was something that was raised with the manager, then the issues would be addressed. The condition imposed on Knights Court by the Commission to cease admission to the home was lifted on the guarantee that the home would continue to improve and that the home would be using its own quality system to monitor the quality of the service that it provides and to detect any poor aspects of the service with a view to address these promptly. This included thorough assessment of the service during monthly visits by the provider as part of the regulation 26 visits. Satisfaction questionnaires are sent annually by the service and reports are produced following the surveys, which are accessible to all stakeholders. Action plans are produced following the surveys to address poor areas where the home did not do very well. Lifestyle care plc is ISO 9002 accredited and Southern Cross has its own quality assurance procedure. Part of the quality control in both organisations consists of a system of audits some of which are self-assessments which are validated by a third party, or when some of the actual audits are conducted by third parties. The management of personal money in the home is normally left to the relatives/representatives of service users. The inspector was informed that only one service user keeps money with the home. Any expenditure made on behalf of service users are paid by the home and then reimbursed by invoicing service users or their representatives. The home had some money and valuables of service users who were no longer in the home. The administrator said that attempts are continuously being made to contact the relatives/representatives of these service users to collect the money and the valuables. Copies of letters were seen on file to evidence that this was happening. The home had copies of maintenance certificates of equipment and of safety certificates such as the gas safety, electrical wiring and the chlorination certificate. A fire risk assessment was in place but a fire emergency plan was not in place. The manager showed the inspector documentation to show that she has started preparing one for the home. Evidence was seen with regards to checks on the fire detector systems, emergency lights, water temperature and wheelchairs. Records about accidents management in the home were seen. The manager has completed the audit of accidents for January and was still working on the audit for February, which she had not completed as she had been on leave. There was evidence of probing and investigation when the causes of accidents/incidents were not clear and of action plans being put in place to ensure that similar accidents/incidents did not occur again. For example a Knights Court Nursing Home DS0000022931.V326258.R03.S.doc Version 5.2 Page 24 service user who was at risk of falls was being referred to the Falls Specialist. This is good practice. The inspector noted that the fridge in the kitchenette of one of the units contained items of food which were not labelled with the name of the service users and dates of opening. These included cheese and fruit juices. One item of food was noted to have expired. The inspector has during past inspections found that fridges in the kitchenettes have not been always been regularly checked to ensure that all the food items were labelled and dated to ensure, that they have not passed the expiry date. If this is not carried out diligently there is a risk that service users may have food poisoning. Knights Court Nursing Home DS0000022931.V326258.R03.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 3 X x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 2 11 2 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 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Knights Court Nursing Home DS0000022931.V326258.R03.S.doc Version 5.2 Page 26 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 OP8 Regulation 12(1) Requirement The registered person must ensure that the repositioning regimes of service users at risk of pressure sores or of those who have pressure sores are regularly reviewed and addressed in the care records. In cases where repositioning charts are being used, then these must be completed comprehensively. The vital signs of service users who are unwell must be monitored comprehensively according to an agreed plan of care. It is required that a review be undertaken of all service users who might benefit from the input of a dentist and that the arrangements are made to ensure that this happens. The instructions for the administration of all medicines must be clearly recorded. The registered person must ensure that there is appropriate communication between members of staff and service users particularly when care is DS0000022931.V326258.R03.S.doc Timescale for action 15/05/07 2 OP8 12(1) 15/05/07 3 OP8 12(1) 15/05/07 4 5 OP9 OP10 13(2) 12(1) 15/05/07 31/05/07 Knights Court Nursing Home Version 5.2 Page 27 6 OP11 15(1,2) 7 OP29 19(1) 8 OP30 18(2)(c) 9 OP38 13(3,4) being provided. The resuscitation status of service users must be clarified in the relevant section of the care plan. (Previous requirementtimescale 28/02/07 mostly met). The registered person must ensure that all records as per schedule 2 of the Care Homes Regulations 2001 are in place before a person can work in the home, including having professional references. The registered person must ensure that all new members of staff have induction relevant to the areas where they will work with records kept. All food stored in the fridges of the kitchenettes must be appropriately labelled and dated when opened. Regular checks must be made to ensure that all food are labelled and dated as appropriate. 15/05/07 15/05/07 15/05/07 15/05/07 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 OP24 Good Practice Recommendations The registered person should ensure that the pillows, which are provided to service users, are fit for purpose. Knights Court Nursing Home DS0000022931.V326258.R03.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 Knights Court Nursing Home DS0000022931.V326258.R03.S.doc Version 5.2 Page 29 - 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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