Inspection on 16/04/09 for Knights Court Nursing Home

This inspection was carried out on 16th April 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Knights Court Nursing Home 06/05/08

Knights Court Nursing Home 30/07/07

Knights Court Nursing Home 12/03/07

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 15/11/2009.

Key inspection report Care homes for older people Name: Address: Knights Court Nursing Home 107 High Street Edgware Middx HA8 7DB The quality rating for this care home is: One star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Ram Sooriah Date: 2 4 0 4 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • Be safe • Have the right outcomes, including clinical outcomes • Be a good experience for the people that use it • Help prevent illness, and promote healthy, independent living • Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • 3 stars – excellent • 2 stars – good • 1 star – adequate • 0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement They reflect the Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Knights Court Nursing Home 107 High Street Edgware Middx HA8 7DB 02083813030 02083813040 knightscourt@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Southern Cross (LSC) Ltd Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration Category(ies): dementia old age, not falling within any other category Number of places (if applicable): Under 65 40 0 Over 65 0 40 care home 80 Additional conditions: The Registered Person may provide the following category of service only: Care home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP (maximum number of places: 40) Dementia - Code DE (maximum number of places: 40) The maximum number of service users who can be accommodated is: 80 Date of last inspection: D D M M Y Y Y Y Care Homes for Older People Page 4 of 32 Brief description of the care home: Knights Court Care Centre is a purpose built care home and was opened on the 27th November 1998 by Lifestyle Care Plc. Lifestyle Care Plc became a part of Southern Cross Healthcare on the 26th February 2007. The home is found off Edgware High street and 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 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 accomodates 20 residents, is self-contained and has a kitchenette area, lounge/dining areas, bathrooms and toilets. All the rooms are single and are en-suite. Camelot and Avalon units are on the ground floor and accomodate residents with frail elderly care needs requiring nursing. Merlin and Excalibur units are on the 1st floor and accomodate elderly residents with dementia care needs requiring nursing. The 2nd floor contains the laundry, kitchen, managers office and staff areas. The home charges 575 to 900 pounds depending on the needs of the residents and the pricing policy of the funding authorities. There were 68 residents in Knights Court at the time of the inspection. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: One star adequate service How we did our inspection: The key unannounced inspection took place on Thursday 16th April 2009 at 10:2019:00, continued on Friday 17th April at 12:30-17:25 and finished on the 24th April at 10:00-14:00. During the course of the inspection we observed care practices on all the units, talked to at least ten members of staff, eight residents and four visitors to the home. The last key inspection took place on the 6th and 7th May 2008 when the home was rated a 1 star service. At the time the home did not have a manager. Carmen Warner was appointed manager in September 2008 and has been running the home since then. Care Homes for Older People Page 6 of 32 The manager completed an Annual Quality Assurance Assessment (AQAA) that has been used where possible to inform this report. The Commission received ten questionnaires from residents that we have incorporated in the findings of the inspection. Other information made available to the commission after the inspection and before writing this report has also been used where possible in this report. We would like to thank all those who contributed to the inspection and the manager and all her staff for their kind support during the inspection. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? The standard of pressure area care and wound management has improved. We noted that these areas are addressed appropriately in care plans. We spent at least three hours on each of the units. We noted that staff interacted appropriately and related well with residents and that residents during the day watched appropriate programmes on the television or listened to appropriate music. Few issues are noted with the management of medicines. All records in relation to medicines management are kept as required and audits are carried out to make sure that the standard of medicines management is maintained. Staff are commended for the progress that they have achieved in this area. The home was generally clean and bedrooms were tidy, except for the wardrobes and drawers of residents which could have been tidier. Recruitment of staff is carried out robustly and all the necessary checks are made before offering employment to applicants. Once a new employee starts work in the home, they are offered induction according to national guidelines. Training is offered to all staff to make sure that they are skilled and competent to care for residents. The home has more than 50 of its care staff qualified to at least NVQ level 2. Feedback from management and staff showed that all staff are offered supervision and have the opportunity to meet their supervisor to discuss issues about support, training and performance. The home now has a full time manager and a deputy manager to make sure that the home meets its stated aims and objectives. They are supported closely by line management from Southern Cross. Care Homes for Older People Page 8 of 32 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. As far as possible, the home provides the necessary information to residents and their representatives for them to decide if the home can meet their support and accommodation needs. The needs of residents are assessed whenever possible before they are offered a place in the home, but in cases where this is not possible the home does not always seek comprehensive information about the needs of the prospective residents from the placing authority. As a result there is no guarantee that the home will be able to meet the needs of these residents. Evidence: The home has a service users guide (SUG) and a statement of purpose that are given to all people who are admitted to the home. These documents were found in the bedrooms of residents and were mostly up to date. Residents are normally referred to the home for long term care or for respite care. Some residents are also referred to the home for emergency admission. In most instances residents or their representatives are able to access information about the home or even visit the home before deciding if they would like to live in the home. In cases of emergency admissions, residents and their representatives normally learn about the service that is offered by the home, after the admission of the residents. Some residents are admitted according to a contract that the home has with the social services department of the local authority. In these cases the opportunity for people to Care Homes for Older People Page 11 of 32 exercise choice is limited. These findings are reflected to some extent in the survey that we conducted. 7 residents said that they had received information about the service before admission and 3 said that they had not. In addition to the information that is contained in the SUG, residents also receive and have to agree to the homes contract about the terms and conditions of stay in the home. We checked these for two residents and noted that these were in place. The needs of residents, who are referred to the home, are normally assessed by a senior member of staff from the home prior to them coming in. In cases of emergency admission, the assessment of the needs of residents prior to admission is not always easy or possible, however the home should get as much information as possible from the placing authority such as, the needs assessment or the care plan of the social services department, for staff to be aware of the needs of the residents and for them to decide if they would be able to meet the needs of the residents. In one case that was referred to the safeguarding adult team of the local borough, the home did not get enough information about the needs of a resident. Subsequently it was noted that the lack of information about the needs of the resident led to some of the needs not being fully met. This report will show that staff generally have the knowledge and skills to meet the needs of the residents, including their social and spiritual needs. However, the staffing levels that are provided by the home at times seem to hamper the delivery of a good service. Results from the survey that we carried out, show that the majority of people (7) were usually satisfied with the care and support that that they got in the home, only 2 said that they were always satisfied and 1 said sometimes. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans of residents did not address their needs in a comprehensive manner and staff did not always follow the care plans of residents to meet the needs of the residents. Residents are not always supported appropriately with their personal and healthcare needs. Medicines management is of a good standard and ensures the safety of residents from that aspect of care. Although the end of life care of residents is generally managed appropriately by the home, the resuscitation status of residents and the wishes and instructions of residents with regards to end of life care, are not always recorded comprehensively. Evidence: We looked at the care plans of six residents on the various units, talked to staff about these residents and met the residents to find out about their care and whether they were receiving the care that was planned for them. Care records showed that residents needs are assessed and recorded once admitted to the home. One recently admitted resident did not have a physical and social assessment form completed and a few others did not have the same form fully completed. Areas that were not well completed included communication, sexuality and dying. Residents normally have care plans for a set number of needs and any additional needs that may have been identified. Examination of the care plans showed that some were comprehensive. There were examples of good practice such as the care plans Care Homes for Older People Page 13 of 32 describing the action to take for people who were diabetic. In some cases however, the care plans could have been more accurate to contain clearer detail of the action to take to meet the needs of residents. One resident who needed monitoring because they were prone to a particular infection said to monitor vital signs regularly and observe signs and symptoms. The care plan did not make clear what was regularly, what were the signs and symptoms to observe for and did not say what action to take if anything unusual was noted. As a result the home was not doing enough to monitor the condition of the resident to make sure that prompt action would be taken if an infection was suspected. The relatives felt that they had to monitor the condition of the resident and informed staff if they thought that there was something unusual, for staff to take action. Although care plans were in place when the needs of a resident have been identified, there were a few examples when these were not always followed. One residents care plan said that they should be wearing their glasses during the day. We noted that they did not have their glasses on, on either of the two days of the inspection when we saw them. One resident had a care plan about their personal care and their daily care, but we noted during a safeguarding adult meeting held shortly after the inspection, that the care plan was not being followed by care staff. The home has introduced a new format to record the manual handling of residents in more detail. There had been a referral to the safeguarding adult team of the local borough when a resident had not been moved according to their assessment. The manual handling risk assessment and care plan are supposed to record in detail the way that residents are to be moved. In some cases these were detailed, but in some instances these did not clarify how residents were to be moved in bed and turned. We also noted that staff at times used a standing hoist and at other times used a sling hoist to move the same resident. The records however did not make clear when each item of equipment was indicated. It is important that the instructions about the use each of these items of equipment are made very clear, to ensure the safety of residents as, accidents could occur if the right equipment is not used. The care plans and risk assessments were seen by residents or their representatives during the review meeting that is organised by the home. Review meetings are normally arranged six weeks after admission and then every six months. While residents or their representatives are informed about the care plans and are able to give their views about these during the review meetings, it is not clear to what extent they are involved when care plans are being drawn up. Most residents presented with a good standard of personal hygiene. However, one resident was not shaved and he said that he could do with a shave, when we talked to him. We observed on one unit that two male residents did not have any socks and four female residents did not have any stockings or tights. The records for the personal hygiene of residents were not completed to show whether residents were having regular baths, but we were informed that a list of people who have had baths or showers were kept in the bath and shower room. Clothing in the bedrooms of residents was not arranged tidily and some items of clothing did not looked very well ironed. To ensure the dignity of residents it is important to ensure that they are always dressed appropriately and well presented. Care Homes for Older People Page 14 of 32 The records for healthcare professionals showed that residents are seen by the GP and other healthcare professionals such as the dentist, optician and chiropodist, when this is required. The chiropody service is provided by age concern as the home had some difficulty accessing the NHS chiropody service to visit frail elderly residents in the home. There was also evidence that residents have been referred to specialised clinics when that was needed. 4 residents said that they always receive medical support, 5 said usually and 1 said sometimes. The feedback that we got from nurses, when we spoke to them about the way they monitor residents condition so that they can take prompt action by referring the residents to the GP, showed that they would monitor residents condition but at times get very busy and do not get a chance to do that. Residents have care plans to manage continence. The toileting regime of residents were identified but it is not very clear to what extent staff complied with the identified toileting regime. One visitor stated that their relative is very often wet and that chairs of other residents are also often wet. At least part of a complaint that had been received by the home had been about a resident being wet and smelly. On the day of the inspection one resident had a strong odour of urine. When we asked staff about this they said that they would soon change the resident. It seemed that the resident had not been changed for some time and as a result there was an odour of urine. There is 1 trained nurse and three carers on duty on each unit. Normally the trained nurse is busy doing nursing duties, one carer stays in the lounge supervising residents, therefore it is left to the two other carers to toilet all the residents. Each unit accommodates twenty residents and the majority of them need to be taken to the toilet and require the assistance of two persons to move them. This therefore implies that care staff are very busy during the day and could explain why some residents might not be toileted according to their toileting regime and end up with wet clothes. In a few cases where residents were incontinent, the incontinence aid to use to manage the incontinence were not always identified. Feedback from 2 relatives said that that staff do not always use the right incontinence pads on residents, as they sometimes run out of the appropriate incontinence pads.This results in the residents getting wet more often. There were three residents in the home with pressure ulcers. We sampled the records of one resident with pressure ulcers and noted that an appropriate care plan was in place. There was evidence of a body map and photographs to monitor progress of the pressure ulcers. The equipment to use for pressure relief was also recorded and there was evidence that the items of equipment were regularly checked to make sure that these were working properly. Pain charts were used as part of the records to monitor residents pain. End of life care was addressed in 4 of the 6 care plans that we looked at. Where these were in place, the plans of care addressed the wishes and instructions of residents with regards to death and dying and also took the spiritual and cultural aspects of the needs of residents into consideration. The home has also introduced a new form to record the resuscitation status of residents. We noted that this form had not been completed for all the six residents whose records were inspected. Care Homes for Older People Page 15 of 32 Notifications that are sent to the commission about the death of people showed that the death of residents in the home is generally managed appropriately. We looked at the management of medicines on the Merlin, Excalibur and Avalon units. We found that the practice with regards to the management of medicines was on the whole good. The amount of medicines that was received in the home was recorded and there were also records of the amount of medicines that was carried forward. The medicines record charts were signed as required and codes were used as necessary in cases when medicines were not administered. The temperature of the clinical rooms and of the medicines fridges were monitored and the air conditioning units in these areas were working appropriately. The rooms however could have been tidier. There were about 10 sharp boxes in the clinical rooms that needed to be disposed of. A few residents had their medicines crushed if these were in tablets form because of swallowing difficulties or because of residents refusal to take these. Appropriate risk assessments were generally in place. In one case however, while the risk assessment addressed the concealing of the medicines, it did not address the crushing of the medicines. The management of controlled medicines in the home was of a good standard and appropriate records were kept. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the home provides activities to suit the general social and recreational needs of residents, it is not clear to what extent these reflect the individual needs of residents as, a life story of residents is not always available. The home in the main provides varied and nutritious meals for residents. Some of the meals could be improved by the use of fresh ingredients rather than powdered ingredients. Evidence: The home has a full time and a part time activities coordinators. The part time activities coordinator is mostly located on the Merlin unit and worked with the residents with dementia care needs. The home had a programme of activities and we were informed of some of the activities that have taken place in the home. For example, residents are offered exercise to music, film and sing-a-long sessions. Some have gone for outings such as on the first day of the inspection when a trip was organised to a local theatre, to see a play. Residents who went to the show said that they enjoyed their day out, which was a change to their daily life. We noted that the degree that care records addressed the social and the recreational care needs of residents varied from resident to resident. Some were good but others were not so good. The social profile of residents was in the main completed, but the section on the life story of residents was not always recorded. The life story of residents is an integral part of person centred care and good dementia care and this gives a perspective on the person in the resident. Care Homes for Older People Page 17 of 32 There were care plans in place addressing the social and recreational needs of residents, but it was not clear to what extent these actually reflect the needs and actual wishes and likes of residents as the life history of residents was not always available. 2 residents said that there were always activities that they could join in, 3 said usually and 5 said sometimes. We indeed noted a positive and proactive attitude to the provision of activities on the part of all staff. However, care staff who spoke to us, said that they are busy and at times the units are short staffed, and therefore do not always have the time to sit down and engage with residents. The home has a programme in place for the visit of representatives from the main churches. Those residents who do not belong to the main religious denominations are supported by their relatives in meeting their spiritual needs. The religious and spiritual beliefs of residents are generally addressed in care records. We noted a number of visitors in the home and they all seem to know staff well and interacted well with them. On the dementia care unit a few people who visited during lunch time said they visit at this time to enhance the dining experience of residents and to help their relatives with their meals. Lunch on the first day of the inspection consisted of lentil soup, Irish stew, carrots and peas, spiced vegetable pilau, mashed potatoes and rice pudding for desert. We also noted that the chef prepared another meal that was not on the menu for a resident. Residents were asked about their meals and their choices were recorded. We noted that fresh ingredients were not always used for the soup or for the mashed potatoes. However, the home had an agency chef who was not that familiar with the kitchen and the mixer was also broken. Meals were served appropriately by members of staff in the dining areas that were prepared to provide a congenial environment. Residents could choose where they had their meals but in the main residents were encouraged to use the dining area. Some were observed having their meals in the lounge areas with very few having their meals in their bedrooms. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their complaints are taken seriously and are addressed appropriately. The home robustly follows the safeguarding adult procedure of the local borough to ensure the protection of people who use the service. Evidence: The complaints procedure is found in the SUG and is available in the foyer of the home. Our survey shows that the overwhelming majority of people were aware of the procedure and would use it, if required. 8 people said that they knew how to make a complaint, 1 did not know and 1 did not respond to that section. Residents also said that they always or usually knew who to speak to if they had a concern. There have been 5 complaints made to the home since the beginning of the year and according to the AQAA 18 were received in the 12 months before February 2009. All were acknowledged, investigated and responded to, as required. According to the AQAA, 3 out of the 18 complaints received prior to February 2009 were substantiated. The home has made 4 referrals to the safeguarding adult department of the local authority prior to February 2009 and another 2 since then. Generally the home is proactive and reports all allegations and suspicions of abuse according to the safeguarding adult procedure of the local borough. We have also noted that the manager and her staff work in a cooperative manner with all safeguarding adult investigations to ensure that these are promptly and appropriately investigated. We spoke to 3 members of staff about the whistleblowing procedure and the safeguarding adult procedure. All 3 were hesitant about the whistleblowing procedure and its name but, could in broad terms describe the purpose of this procedure and how to use it. They were however, clear of the action to take when they come across allegations or suspicion of abuse. Care Homes for Older People Page 19 of 32 Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were a number of areas that needed addressing to improve the quality of the environment that the home provides. These included the redecoration of the communal areas and replacement of some of the furniture in these areas, maintaining the grounds of the home and addressing an odour problem. Evidence: The grounds of the home were not so well maintained. The bushes and shrubs were not trimmed and there were weeds in the flower beds. The lawns have been trimmed but looked like they would benefit from another trim. We were informed that the home does no longer have a gardener and that the handy man does all the gardening for the home. This is in addition to all his other duties of maintenance, checking and decorating the bedrooms. The exterior of the building was in an acceptable condition. Patio areas were in good order and we noted that residents used the areas to sit out during the day when the weather was nice. We were informed that the home plans to make these areas more pleasant with more flowers and colours. The decor of some of the communal areas in the home did not look very good and needed to be addressed. These included the communal areas on Avalon and Merlin units. We noted that three radiator covers were broken in the lounge of the Merlin unit and that the material of a few armchairs were torn or worn off in some areas, exposing the foam material of the armchairs. We observed that some games and other items of equipment for activities were on the floor behind a sideboard, instead of in the sideboard, where these items should have been stored. Part of the sideboard was instead, used to store some bags. The carpet was stained in one of the smaller lounges of the Merlin unit and the carpet Care Homes for Older People Page 21 of 32 on the Avalon unit looked as needing to be replaced. The ceiling in the lounge of the Avalon unit was stained in some areas and was in need of redecoration. We were informed that all the communal areas and corridors of the home will be decorated by external decorators in June 2009. The home was on the whole clean except, for the carpet that needed cleaning or replaced particularly in the communal areas. We were informed that the home has not had a carpet shampoo machine for some time as, these were broken. We found out that a new carpet shampoo machine was received just before the inspection after, it had been on order since December. During our tour of the premises, we noted a strong odour particularly on the Merlin unit and to a lesser extent, on the Avalon unit. The odour issue must be addressed before this permeates other parts of the home. The bedrooms of residents were on the whole in good order. These are normally decorated by the handyman while the communal areas and corridors are decorated by the company decorators. We were able to see the redecoration programme and noted progress with the redecoration of bedrooms. Some of the bedrooms were well personalised and some progress was noted on the Merlin unit. A few bedrooms on the Excalibur unit were however not that well personalised and were quite bare. Furniture and fixtures and fittings were generally in good order but we noted that at least two beds had backrests that were broken or had come off. Some residents had their own bed linen and duvet. One questionnaire and a visitor said that the homes bed linen was not in good order and not of good quality and that was why they brought their own bed linen. We discussed this with the manager and she said that the home has adequate quantity of linen. The home ensures that staff receive training in infection control. According to the AQAA, 72 of the staff team have received training in infection control. We also discussed training in infection control for new members of staff. We noted that this training is covered as part of the induction of all new staff to the home. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are indication that the staffing levels that are provided in the home are not adequate to meet the needs of residents. In addition to this there are times when the number of staff that is provided are below the normal staffing levels that should be in the home. New members of staff are only recruited after the home has carried out all the necessary checks to ensure the safety of residents. Staff receive training and supervision to make sure that they are appropriately supported to do their job. Evidence: The home has carried out a staffing review as we requested during the last inspection. The outcome of the review was that the home provides adequate staffing levels to meet the needs of residents that are accommodated in the home. We looked at the duty rosters for March and February to get information about the staffing levels that have been provided in the home. The home generally provides 3 carers and 1 trained nurse for each unit, except for the Merlin unit where there is an additional carer for the morning shift. At night there are 1 trained nurse and 1 carer. At the time of the inspection there was a vacancy of 2.5 full time posts for trained nurses and 4 full time posts for care workers. The vacant shifts were covered by the homes own bank and permanent staff who did additional hours. The AQAA states that the home has not used any agency for the 12 months period prior to February 2009. Examination of the duty rosters shows that there were many times when the home did not have the usual staffing levels that it purports to provide. There were many occasions in March when staffing on the Avalon unit consisted of 1 trained nurse and 2 carers instead of 3 carers. For example there are 5 days during the week starting 20th March to 26th March when there were 1 trained nurse and 2 carers. On a number of occasions there were only 3 carers on the Merlin unit instead of 4 in the morning. At Care Homes for Older People Page 23 of 32 night we also noted that very often there were 3 trained nurses on duty instead of 4. In these cases one trained nurse was responsible for two units with an additional carer floating between the two units. There were also at least one occasion when there were 1 trained nurse and 1 carer on the Excalibur unit, and 1 trained nurse and 1 carer on the Camelot unit in February 2009 for the day shift, instead of 1 trained nurse and 3 carers on each of the units. The above showed that at times some of the units did not have the necessary numbers of staff that are usually needed to meet the needs of residents. These was confirmed by at least 2 members of staff who said that they have worked on many occasions with less number of staff that should have been on duty. They said that they tried to do their best for the residents but could only do so much. Feedback about the staffing levels from the residents survey suggests that at times there were not enough staff. At least three questionnaires mentioned that there were times when there were no staff in the communal area to supervise residents. We also noted that, there were no staff in the communal area of one unit when we visited that unit on the first day of the inspection. We inspected the personnel files for three members of staff that have been employed since our last inspection. All the three members of staff have had the necessary employment checks before they were offered employment in the home. They all had a reasonably well completed application form, references, proof of identify and of eligibility to work in the UK, and a CRB check. New members of staff also received induction according to Skills for Care. We noted that the induction package for Southern Cross is based on the common induction standards from Skills for Care. Two new members of staff confirmed that they were given the induction package and were in the process of completing the induction. The manager stated in the AQAA that the home has a supervision planner and that all staff are allocated a supervisor. Members of staff that we spoke to confirmed that they have supervision and supervise more junior staff, if that is within their remit. According to the AQAA, 50 of the care staff team have an NVQ qualification or above. The training matrix showed that staff were mostly up to date with mandatory training. Care and nursing staff also receive training in pressure area care, customer care, care planning and dementia awareness. We noted from the training matrix that most of the first aid training was provided in May 2005 and beginning of 2006 to staff. As these certificates are valid for three years, member of staff must now have refresher training in first aid. Out of 13 people who have done first aid training, only one person was up to date. Care Homes for Older People Page 24 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager of the home is experienced and sufficiently skilled to run the home. The personal money of residents is managed appropriately to safeguard residents. The home has a quality management system that is used to monitor the quality of the service that the home provides. Maintenance and health and safety issues are addressed as required to ensure the safety of all people who use the premises. Evidence: The manager is a nurse and has a Registered Managers Award. She stated that she has more than 20 years experience in managing care homes and has been managing Knights Court since September 2008. She is not yet registered but has started the process to be registered. She is supported by the deputy manager and the operations manager. There was evidence that meetings are arranged with staff and with residents and their relatives to involve them in discussion about issues in the home. Feedback from staff seems to suggest a delay in getting some items of equipment. We were informed that a shampoo machine had been ordered since December and was delivered a day before the inspection. Some members of staff said that they waited for more than a month to get their uniform. Two bins have been without lids for about a Care Homes for Older People Page 25 of 32 month, while new bins have been ordered. The records about the personal money of residents were checked with the regional administrator and the homes administrator. The home has a main residents account that is subdivided in sub accounts. Each resident, who has money with the home, is allocated a sub account where they can start earning interest straight away. We looked at the records for two residents and noted that good records were kept and that receipts were kept for all expenses. This was good practice. The property and valuables record forms were on the whole completed appropriately when residents were admitted to the home, with the consent of residents or their representatives whenever possible. The home uses the quality management system for Southern Cross Healthcare. There are in house audits monthly and validation audits are carried out every two months. The home was mostly up to date with audits. The home has an action plan that reflects the findings of the audits and any other action that needs to be taken to address issues in the home. The home has carried out a customer satisfaction survey and was awaiting the results of the survey. Records showed that all the necessary maintenance and safety checks were carried out in the home within a timely manner. These included fire detector tests, emergency light tests, wheelchair checks and hot water temperature checks. Fire drills were also carried out and the training matrix showed that most members of staff have had the opportunity to take part in a fire drill. The home has a gas safety certificate, a portable appliances test certificate and evidence that the water system was treated and monitored for legionella disease. The electrical wiring test certificate was also up to date. The home has a fire emergency plan and a fire risk assessment that were kept under review. A health and safety risk assessment was also available for inspection. The hoists in the home were maintained and checked for safety every six months and so were the passenger lifts. Care Homes for Older People Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes √ No Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 4 14(1,2) To make sure that the needs of residents are being met, the home must be able to demonstrate that residents are accepted in the home according to their assessed needs and placed in a unit according to their individual needs. Residents care records must address the end of life care of residents and their hopes, fears and wishes for the future to make sure all the needs of residents are fully addressed. 30/06/2008 2 11 15(1,2) 31/07/2008 Care Homes for Older People Page 27 of 32 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 In cases when it is not possible to carry out a full assessment of the needs of a prospective resident, the home must avail itself of all the necessary information about the needs of the prospective resident from the placing authority before making a decision to accept the prospective resident. To make sure that the home will be able to meet the needs of the prospective resident. 17/08/2009 2 7 12 The care plan and risk assessment with regards to manual handling must be clear about the action to take to move residents, the equipment to use and the circumstances when to use each item of equipment, when a number of items of equipment are indicated. To make sure that safe practices are in place when moving residents. 17/08/2009 Care Homes for Older People Page 28 of 32 3 7 15 The care plans of residents must fully address the needs of residents and these must be followed by staff to ensure that they are fully meeting the needs of the residents. To provide a guarantee that the needs of residents are being met. 17/08/2009 4 8 12 Residents condition must be monitored if required to ensure that any deterioration or changes are noted promptly so that the necessary action can be taken to promote their welfare. To ensure the welfare of residents. 17/08/2009 5 8 13 There must be a review of the promotion of continence and the management of incontinence in the home. To make sure that the home provide a high standard of care for people who are incontinent. 17/08/2009 6 8 12 Residents must have a high standard of personal hygiene and must be dressed appropriately. To ensure the welfare of residents. 17/08/2009 7 11 15 The home must address the resuscitation status and the end of life care of residents in a comprehensive manner in the care records of residents. To make sure that the end of life care needs of 17/08/2009 Care Homes for Older People Page 29 of 32 residents will be met according to their wishes and instructions. 8 19 23 The grounds of the home must be maintained to a good standard. To provide a pleasant environment for residents to enjoy. 9 20 23 The communal areas of the home must be maintained and decorated to a high standard. Furniture in the communal areas must be in good order. To provide a pleasant environment for residents to enjoy. 10 24 23 The beds of residents must be in good order. To make sure that the residents are comfortable and safe. 11 26 16 The home must be as free from odours as possible. To provide a pleasant environment for residents to enjoy. 12 27 18 The home must always 18/10/2009 provide the staffing levels that are required to meet the needs of the residents. To ensure that residents are always cared for and supported as required. 17/08/2009 17/08/2009 17/08/2009 13/07/2009 Care Homes for Older People Page 30 of 32 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 That residents or their representatives are involved in the care planning process not only during the review of the care of the residents but also when the care plans are being drawn up. There must be comprehensive multi-disciplinary risk assessment not only for concealing medicines but also for the crushing of medicines, when these are in tablet form. The sharp boxes in one of the clinical rooms should be disposed as soon as possible. The life story of residents should be recorded as part of the assessment of the social and recreational needs of residents. The home should provide as far as possible, meals made from fresh ingredients rather than powdered ingredients. The mixer should be repaired to enable the preparation of home made food. The responsible person should review the process of ordering items of equipment and other items that may be needed in the home to ensure that there is a minimum delay in getting these items. 2 8 3 4 9 12 5 15 6 31 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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