Inspection on 21/06/06 for Knights Court Nursing Home

This inspection was carried out on 21st June 2006.

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

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

Other inspections for this house

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 12/03/07

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 7FH Lead Inspector Mr Ram Sooriah Key Unannounced Inspection 21st June 2006 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.V301072.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Knights Court Nursing Home DS0000022931.V301072.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Knights Court Nursing Home Address 105-109 High Street Edgware Middx HA8 7FH 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 Life Style Care Plc Care Home 80 Category(ies) of Dementia (20), Old age, not falling within any registration, with number other category (60) of places Knights Court Nursing Home DS0000022931.V301072.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th January 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. 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, while the other three 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 residents depending on the needs’ assessments, • £900 for private residents requiring dementia care, • £600 for residents funded by Harrow Social Services, • £605 for residents requiring dementia care and £577 for elderly care residents funded by Barnet Social Services. There were 71 residents in the home during the inspection. Knights Court Nursing Home DS0000022931.V301072.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report has been produced following a key inspection, which took place on the 21st June 2006 from 10:15 to 19:15 and on the 22nd June from 10:00 to 16:45. The key inspection looks at all the key standards as identified in this report and is the first for the period 2006-2007. During the course of the inspection, the inspector spoke to some residents, some visitors to the home, Val O’Brien, the manager of the home, and some members of staff. The inspector also looked at a sample of care, training, personnel and health and safety records, toured some of the premises and observed care practices where possible. The inspector is grateful to all the residents and visitors who spoke to him and would like to thank Val O’Brien and all her staff for their support and cooperation during the inspection. What the service does well: What has improved since the last inspection? There has been some progress with regard to making care plans more comprehensive and individualised. The management of medicines has improved. A few issues were however noted which need to be addressed. A part time activity coordinator has been appointed for the Merlin Unit to organise activities for residents requiring dementia care. The standard of general cleanliness in the home has improved. There were no odours in the home. Staff’s and residents/relatives’ views are sought in a range of meetings which is arranged by the manager. Knights Court Nursing Home DS0000022931.V301072.R01.S.doc Version 5.2 Page 6 What they could do better: The assessments of the needs of residents must be completed comprehensively. Once the needs of residents have been identified care plans must be put in place without delay. For example residents with pressure sores and with unpredictable behaviour must have care plans to address these needs. Risk assessments must also be in place in cases where residents are facing risks in activities that they are involved in and control measures must also be identified to manage the risks. Without the above there is a danger that the home will not be able to demonstrate that residents’ needs are being met appropriately in the home. Fluid balance charts and turning charts must be completed accurately and rigorously to ensure that the information that these forms contained can be relied upon. Without this the information might not be reliable and verifiable. Residents who have pressure sores or who are at high risk of developing pressure sores must be turned in bed according to the regime, which has been agreed in their risk assessments and care plans. The seating regime of residents with pressure sores and those at high risk of pressure sores must also be addressed in the care plans. Residents who sits out for long period of times even on pressure relief cushions, could develop pressure sores or could suffer from a deterioration of existing pressure sores. There must be a review of the time that residents get up in the morning. They must only be helped out of bed early (for example at 06:00) if it is the choices of the resident to get up. The practice of getting residents up early in the morning should not be to accommodate the working routine of staff. A number of findings in this report suggest that staff may not find the time to care for residents appropriately and to complete all the required records. As a result staffing levels may need to be reviewed to ensure that there are adequate numbers of staff to meet the needs of residents. A number of staff have also not had updates with regard to statutory training in fire training and manual handling. The grounds of the home were not being kept as tidy and as clean as they should be. More sustained input is required with regard to the maintenance and redecoration of the home. A number of safety certificates were not available for inspection. Up to date records with regard to fire alarm tests, emergency lights test and fire exit tests were also not available for inspection. As a result residents may be facing unnecessary risks Knights Court Nursing Home DS0000022931.V301072.R01.S.doc Version 5.2 Page 7 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. Knights Court Nursing Home DS0000022931.V301072.R01.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.V301072.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service The residents’ needs are assessed prior to admission. The assessments of residents’ needs are not always updated and reviewed once residents are admitted into the home. As a result there is no guarantee that the needs of residents would be met. A number of issues were identified which suggest that the needs of residents were not always being met appropriately. EVIDENCE: The home provides a service user’s guide and a brochure to all residents. Copies of these were available in the bedrooms of residents. The inspector noted that a number of these have not been updated with regard to the names of the current manager and people working in the home. The manager stated that the administrator and herself were in the process of updating all these records. Residents who were admitted to the home have their needs assessed prior to being offered a bed. Evidence in the care records of a sample of residents Knights Court Nursing Home DS0000022931.V301072.R01.S.doc Version 5.2 Page 10 showed that the manager or her deputy have completed assessments of the needs of the residents prior to the residents coming into the home. The inspector was also informed that the residents are encouraged to visit the home where possible and that in some cases it is the relatives or friends of the residents who visit the home. During the course of the inspection, the inspector was able to observe visitors being shown around the home and the facilities that the home provides prior to residents being admitted. The assessments of the needs of residents carried out by the placing authorities were also available on file. The care plans of ten residents were inspected. While progress was noted in the content of a few of them, there was still a lot of room for improvement. During the last inspection of 21st January 2006, the inspector was informed that the manager wanted to start a new way of completing care plans whereby residents have a needs assessment on admission and then care plans are formulated for each activity of daily living and for needs which have been identified. On this occasion the inspector noted that not all residents have this format yet and that the home was still in the process of meeting the above objective. It was also noted that while a few care plans were very well completed, a few needs’ assessments of residents were not always completed as comprehensively as they should have been, despite the timescales of past requirements having elapsed. As a result the needs’ assessments of residents were not always comprehensive enough to identify all the needs of the residents. Care records continue to lack basic information with regard to likes and dislikes of residents, times to go to bed and to wake up, aspects of communication and information about the cultural and ethnic background of residents. For example the care plan of a resident from an ethnic minority did not contain much information about the culture of this resident. For example there was no information about the likes and dislikes of this resident with regard to food and information about the arrangement for death and the rites to observe at the time. Another resident from a different ethnic background did not have any information about the language spoken by this resident and ability to understand English. A resident recently admitted to the unit for dementia care did not have a comprehensive assessment of his mental health needs, although there was evidence that staff were aware of these and that there was the involvement of other healthcare professionals in the care of the resident. A number of issues have been identified during the inspection which would suggest that the staffing level on each unit need to be reviewed urgently particularly at busy times of the day such as in the mornings to ensure that the needs of residents are continuously being met. As will be shown in the next section a number of shortcomings was identified: residents were not always being turned regularly or taken to the toilet, records such as fluid balance charts, turning charts, needs’ assessment and care plans were not being kept Knights Court Nursing Home DS0000022931.V301072.R01.S.doc Version 5.2 Page 11 up to date, residents were got up early in the mornings by night staff to ease the workload of the day staff rather than this being dictated by the choice and wellbeing of the residents. Knights Court Nursing Home DS0000022931.V301072.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6-11 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service Care plans were not comprehensive enough to address all the needs of residents. Shortcomings with regard to the care of residents were identified which could potentially affect the wellbeing of the residents. Medicines’ management was generally good with few issues identified. Although the death of residents is appropriately managed in the home, records did not always address the wishes and instructions of the residents/relatives with regard to end of life care. EVIDENCE: The standard of care plans was in a few cases good, but in other cases not so good. There was evidence of the manager’s input in care plans. In some cases she has written the care plans so that staff would be able to use these care plans as models to write other care plans. It seems that there has been some improvement in the care plans but not as much as the manager anticipated. It was noted that care plans were not always formulated when needs have been identified. As mentioned in the section ‘Choice of Home’ a resident with clear mental health needs did not have a care plan in place to address the management of these needs. Records about the hourly checks on the Knights Court Nursing Home DS0000022931.V301072.R01.S.doc Version 5.2 Page 13 behaviour of the resident who was being monitored were however regularly maintained. One resident had been unwell a few days prior to the inspection and had been placed on antibiotics. It was noted that there was no care plan in place to address this problem and that there was no regular monitoring of the vital signs of the resident. A second set of vital signs was taken twenty-eight hours after the first set and it was noted that not all vital signs were monitored. The resident was eventually transferred to the hospital. On starting the inspection on the Merlin unit, the inspector observed a resident in the kitchenette on her own with the door closed. There was no one directly supervising the resident. Members of staff were in the lounge just outside the kitchen. Inspection of the care records showed that a risk assessment was not in place with regard to managing the risks that may be faced by this resident being alone in the kitchen. The approach to risk management and the safety of this resident in this case was not adequate. Some care plans were signed by residents or by their relatives when these were drawn, but these were not always signed when the care plans were reviewed. The manager stated that she has introduced a form which should be completed when care plans are reviewed. From the ten care plans seen, only one was noted to have been completed with the full input of the relatives, the rest showed varying degree of residents/relatives involvement ranging from none to some involvement. The home had three residents with pressure sores. The pressure sores were all grade 2. Two of the residents did not have care plans addressing the actions to take to ensure healing of the pressure sores. One resident sustained the sore in the home and two came into the home with pressure sore(s). There were photographs of the sores for the two residents, but care plans dealing with the management of the sores were not in place. The turning chart of one of the residents who developed pressure sores indicated that he used to get out of bed at 06:00 even after he developed pressure sores. He sat out in his chair until about 02:00 pm when he was put back to bed. The turning chart does not indicate that he was being moved for pressure relief or taken to the toilet although staff stated that he was being taken to the toilet. On the first day of the inspection, it was observed that another resident with a pressure sore was not provided with a pressure relief cushion at the start of the inspection. Staff apparently used this resident’s cushion on the chair of another resident. It was also noted that the resident with pressure sore sat out in a chair from the start of the inspection till after supper, when she was helped to bed. Another resident who was being nursed in bed was noted to have been on the same side from about 10:30 to 15:30 although turning charts indicated that the resident should have been on the right instead of on the left side where the inspector found the resident. The care plan and turning charts of that resident Knights Court Nursing Home DS0000022931.V301072.R01.S.doc Version 5.2 Page 14 said that she should be turned two hourly. Another resident was noted to be on his back from 10:15 to 14:10 when his care plan said ‘turn two hourly’. The tissue viability care plans of residents did not always address their seating arrangements (e.g. amount of time to sit out and frequency to move to relieve pressure) particularly if they were at high risk of developing pressure sores or if they already had developed pressure sores. Inspection of the turning charts showed that these documents were not filled comprehensively enough to ensure that these were valid and useful documents. Similarly fluid balance charts and food charts contained gaps and were not always completed comprehensively to ensure that the information that these contained was useful and reliable. Care records and conversation with staff showed that residents were referred to the relevant healthcare professionals such as the dentist, optician, dietician and tissue viability nurse when this was required. Continence assessments were in place and where continence needs were identified care plans were drawn up to address the needs of the residents. However the plans were not always followed such as in the case of the resident who stayed in her chair from breakfast time until after suppertime. The inspector was informed that as the resident was incontinent she therefore could not go to the toilet and that she needed her ‘incontinence pad to be changed when this becomes wet’. Residents presented as clean and appropriately dressed. The hairdresser was in the home on the day of the inspection and a number of residents had their hair done. Staff attended to residents who required nursing or personal care in the privacy of the bedrooms of the residents. Most residents were given a call bell and those ones who were not offered a call bell had risk assessments in place. Risk assessments were in place for activities where rights of residents may have been affected. On the inspection day the manager stated that she would ensure that residents would have a jug of water on the Merlin unit unless specific risk assessments have been identified. Risk assessments were also in place for residents who bruised easily to ensure that extra care is taken to prevent bruising and that all bruising is carefully recorded. Two residents were noted without slippers in one of the lounges on the Merlin unit. One resident apparently refused to wear them. However there was a wooden flooring in the dining area and it was therefore important to take this into consideration while carrying out the falls risk assessment. The other resident did not have a pair of slippers despite this having been mentioned during the last inspection. Staff said that they would request the relatives to bring a pair of slippers for the resident. The inspector looked at the management of medicines on the Camelot and the Excalibur unit. It was noted that the temperature of the clinical room for the Knights Court Nursing Home DS0000022931.V301072.R01.S.doc Version 5.2 Page 15 Camelot/Avalon units was at times over 250 centigrade. A lot of manufacturers have indicated for example on medicines containers that these medicines should be stored under 250 centigrade. There was an ‘air cooler’ in the room, but this was not sufficient to keep the temperature constant and below 250 centigrade for the storage of medicines. The fridge temperature was also running nearer to 80 centigrade. As a result the registered person must consider measures such as the use of ‘air conditioning’ in the clinical room to ensure that the temperature for the storage of medicines is always below 250 centigrade. The management of medicines in the home was in the main appropriate. Medicines were recorded when received, administered (with few omissions of signature) and disposed of. A few issues were however identified which needed to be addressed. It was noted that a few of residents were having feeding through a percutaneous gastrostomy tube (PEG) and were also having their medicines by this route. The medicines records of two of these residents were checked. Risk assessments were in place for one resident where medicines in the form of a tablet and a capsule were being administered via the PEG tube after they were dissolved in water, but not for another resident. There was an article in front of the folder containing the medicines sheets, describing the process to follow when medicines were being administered in an altered state. Despite this and previous requirements with regard to the above a risk assessment was not available for inspection. An antibiotic was being administered at 08:00, 12:00 and 18:00. This means that the resident would go without a tablet for about 14 hours causing a dip of the medicine in the blood serum. It was noted that residents were not receiving some creams at the frequency that they were prescribed and that the location for administering these medicines were not always clarified in the medicines administration records (MAR) charts. The home has an arrangement for the disposal of medicines. On one unit medicines that were returned for destruction were recorded on a sheet, but the names of the residents were not always recorded. The home being a nursing home had a number of residents who were poorly at the time of the inspection. Staff were clear that relatives and friends could visit their relatives/friends at any time and could stay with them. They also stated that they would contact relatives/friends of the residents to keep them informed of the condition of the residents. It was noted that records and care plans did not always contained information about the wishes and instructions of residents with regard to the management of the death and did not always take into consideration the cultural and ethnic backgrounds of the residents. The Commission is kept informed of all deaths in the home. According to the notifications, deaths are appropriately managed in the home. Knights Court Nursing Home DS0000022931.V301072.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service While records with regard to the individual social and recreational needs of residents require improvement, the home provides on occasions a range of activities including outings for residents with some involvement of care staff. The meals provided in the home are in the main appropriate to meet the needs of residents. EVIDENCE: The home has appointed a part-time activities coordinator specifically for the Merlin unit, where residents with dementia are accommodated. She received support from the more experienced and full time activities coordinator. On the first day of the inspection, the inspector observed little interaction with residents and staff on the Merlin unit. There were no activities on that unit on that day. Staff were sitting in the communal areas but not ‘with’ the residents. On the second day of the inspection, there was better interaction between residents and members of staff. The activities coordinator for the Merlin unit was on duty on the day and was involving residents in some activities. It was therefore noted that progress can be achieved in this area and that this depended to some extent on staff who were on duty. Knights Court Nursing Home DS0000022931.V301072.R01.S.doc Version 5.2 Page 17 The home had an activities programme and there was a calendar for major events being arranged in the home. A garden party has been arranged and a number of flowerpots arranged by residents were on sale to raise money for the residents’ fund. It was noted that there has been a little improvement with regard to records about the assessment of the social and recreational needs of residents and care plans to meet these needs and that much more improvement was needed in this area. The home has a number of chairs, tables and parasols in the grounds of the home to enable residents to sit outside the home. The inspector was informed that the home was in the process of arranging a trip to the seaside at the end of July. A garden party had been organised a few days prior to the inspection. Residents are also able to go for walks/trips in the local community and visit the local facilities shops. They are accompanied mostly by their relatives and on some occasions by members of staff. There was evidence that religious leaders from a number of religions regularly visit the home to carry out services and to provide spiritual support for residents. Some residents are able to attend church services with the help of their relatives, volunteers from the church, and members of staff. On the first day of the inspection lunch consisted of sweet and sour chicken, mash potatoes, broccoli and swede. The second choice consisted of Jacket potatoes and fillings. The manager stated that the home carried out a survey of residents’ choices in February which was then incorporated in the menus. Other residents were observed having salads for their lunches. Residents’ choices were recorded on menu sheets and members of staff referred to them while serving lunch. Supper on that day consisted of spaghetti on toasts. While this may well be suited to the tastes of some residents, this meal consists mostly of carbohydrates and with little protein. It is recommended that the registered person review some of the meals provided in the home, particularly the suppers to ensure that the meals are well balanced. Knights Court Nursing Home DS0000022931.V301072.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service Residents and/or their representatives can be confident that their complaints and concerns will be taken seriously and dealt with appropriately. Any allegations or suspicions of abuse are acted upon and referred to the appropriate agencies. EVIDENCE: The complaint procedure was included in the SUG and provided to new residents. A copy was available in the bedroom of each resident and was also available in the foyer of the home. Records provided by the manager showed that there have been six complaints since the last inspection in February 2006. Two were from residents and fours were from the relatives of residents. The complaints were all about different aspects of the service that Knights Court provides, except for two of the complaints which referred to the length of time that residents had to wait before being attended to after they had rang the call bell. The complaints were substantiated as staff were busy attending to other residents. The complainants were satisfied with the explanation provided by the home. Since February 2006 there have been two new referrals which were dealt with, within the Borough’s of Harrow multi-agency policies and procedure for the Protection of Vulnerable Adult. In one case there was an allegation of abuse and in the second case there was an allegation of negligence. These matters were appropriately investigated and discussed within the inter-agency context. Actions plans identified during the meeting were accepted by the home to be implemented. Knights Court Nursing Home DS0000022931.V301072.R01.S.doc Version 5.2 Page 19 Staff spoken to during the inspection were familiar with the procedure to follow in cases of allegations or suspicions of abuse. Knights Court Nursing Home DS0000022931.V301072.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While the home was generally in good order at the time of the inspection, there was evidence of a lack of input to ensure that the home continues to provide a high quality environment for residents. EVIDENCE: The grounds in front of the home were generally maintained. The lawn was short and bushes and shrubs were kept trimmed. The back of the home was very different. There was a large number of items that were being kept at the back of the home awaiting disposal. These items included old bed rails, old bed mattresses, zimmer frames and old equipment that were no longer in use in the home. This was hazardous and could be a breeding ground for pests. The inside of the home was generally clean and free from odours. The general décor of the home was on the whole appropriate to meet the needs of the residents, but with a handyman not being in post, there was little evidence of Knights Court Nursing Home DS0000022931.V301072.R01.S.doc Version 5.2 Page 21 redecoration since the last inspection. There has been a part time person who has been redecorating some of the bedrooms. The wallpaper in the Merlin unit was changed in February of this year. Some areas of the wallpaper were however looking in poor condition and needed to be redone. There were items of minor repair which needed attended to such as a broken dado rail, a broken radiator on the Merlin unit, small holes in the plaster of some bedrooms and broken drawers in the lounge on the Camelot unit. One of the rooms on the Camelot unit was in need of repainting as the paint was flaking off. In conclusion, it was noted that the home was in need of input to prevent deterioration of its physical condition and standard of decoration. The manager stated that the home was in the process of appointing a handy man. The manager forwarded a redecoration programme to the inspector. It addressed the redecoration of the rooms and of the communal areas. There has been some progress with the personalisation of the bedrooms. This was being addressed partly by the activities coordinator supported by care staff. The activities coordinator first finds out about the background of the residents and then reflects this in the décor of the bedroom. As she also has other responsibilities, progress has been slow in this area and there is still a lot of work to be done. It was noted that the home had purchased pictures to enhance the décor of the home. The inspector noted that the headboard from a divan bed was not in place. He also observed that divan beds continue to be in place for residents who were confined to their beds and had clear nursing needs. Some of the beds were positioned against the wall and it was difficult for carers to pull the beds, to attend to the resident on either side of the beds as these did not always have castor wheels. The manager stated that the home has acquired a number of adjustable beds to replace the divan beds and that the home has plans to replace all the divan beds by the end of the year. The home was on the whole clean and with no odours. Carpet was mostly clean. There was a programme in place for the shampooing of carpets. The inspector commends the home with regard to progress which has been achieved in relation to the cleanliness of the home. Wheelchairs are used for the transfer of residents from one area of the home to another and to increase the independence of some residents with regard to mobility. It was noted that a lot of them were not clean. The sides of the chairs and the cushions were dirty/stained for example with spillages of food. There was also no evidence that the wheelchairs were being checked at least monthly. Knights Court Nursing Home DS0000022931.V301072.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service A number of issues noted during this inspection points to the fact that at times staffing may not be enough to meet the needs of the residents. Procedures around the recruitment of staff were generally good but could be tightened further. Training is provided to staff to ensure that they are able to care for residents, but a significant number of them have not had yearly updates in all of the mandatory training. The home has 50 of its care staff trained to NVQ level 2. EVIDENCE: On the first day of the inspection there were one trained nurse and three carers for each of the Camelot, Avalon and Excalibur units during the day. On the Merlin unit there were one trained nurse, three carers for 08:00 to 20:00 and an extra carer to assist in specialising a resident from 08:00 until 17:00. On the first day of the inspection, one of the carers on the Merlin unit went for training around 14:00, and the extra carer finished her shift at 14:00. The trained nurse went for a lunch break at about 15:00. Each of the two remaining carers had to stay in one of the two lounges while supervising other residents who were in the corridor. They also had to make and serve tea to residents and assist other residents who needed help with personal care. At that time it seemed that there was probably not enough staff in the afternoon on that unit. It also raised the question of taking staff away from the unit for Knights Court Nursing Home DS0000022931.V301072.R01.S.doc Version 5.2 Page 23 training purposes while they were part of the numbers of staff to care for the residents. This report has identified a number of issues which can be linked to a certain extent to the number of staff on duty at busy times of the day. For example residents were not being turned when they were due for turning, residents were not taken to the toilet according to their care plan, residents were got out of bed early in the morning (06:00) by night staff to facilitate the workload of day staff and care plans and other records were not being completed appropriately by care and nursing staff. As a result of the above the registered person must review staffing levels and continue to supervise and monitor the care of residents to determine if the staffing is adequate to ensure that residents receive the care as they require and according to their individual care plans. The personnel records of four members of staff were inspected. They were all mostly appropriate. There was evidence that most of the checks as per schedule 2 were in place and that CRB checks had been initiated for all of these members of staff. A few individual issues were identified where practice could be improved. The work history of one member of staff was not fully explored with records kept; one member of staff who has been in post for a number of years only had one reference, but the manager was aware of this case and was following this through; and another member of staff recently appointed had one of her two references from a friend. According to figures provided by the manager twenty-one members of staff already have an NVQ qualification in care and seven are in the process of completing the NVQ level 2 in care. The home has about thirty-forty carers and it is possible to conclude that the home has 50 of its care staff qualified to NVQ level 2. Information was available about training which has been organised for staff in the home. There has been training on challenging behaviour, dementia care, bereavement, falls prevention and other statutory training. Individual training records were found in the personnel file of staff. Inspection of the training grid kept by the home showed that about 50 members of staff out of 75 have not had manual handling training during the past year (prior to 21/6/6) and that 41 out of the 75 have not had fire training during the past year. A number of them have also not had infection control training. The manager stated that she has arranged for all these training to take place. As a result of the above it is possible to conclude that a significant number of staff have not had yearly update training in manual handling and fire training and have not had training in infection control. Knights Court Nursing Home DS0000022931.V301072.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service The manager runs the home in an open and transparent manner. She is not yet the registered manager. The home has a quality assurance procedure to ensure a quality service. Health and safety issues in the home were not being addressed appropriately therefore putting residents and staff at risk. EVIDENCE: The manager has been in post for about 7-8 months. She previously worked in a management position in other care homes. Prior to her appointment to Knights Court, the home did not have a permanent manager for a few months. At the time of this inspection it was noted that the home has started to turn around and that the manager has started to address a number of issues in the home. However there was still a lot of work to be done. The manager is a trained nurse but does not yet have a qualification in management. The Knights Court Nursing Home DS0000022931.V301072.R01.S.doc Version 5.2 Page 25 Commission has not yet received the application of the manager to be the registered manager. The manager stated that she had sent the application pack twice and that it had not been received by the Commission’s Central Registration Team for London. Minutes of a range of meetings were available for inspection. There were minutes from health and safety meetings, nurses meetings, carers meetings, head of department meetings and relatives and residents meetings. This demonstrated that the manager runs the home in an open and inclusive manner. The inspector was unable to inspect the management of the personal money of residents. The administrator was on annual leave. The home is accredited to ISO 9002 quality system. There is a number of audits that are carried out by the organisation and by the ISO 9002 accredited assessor. The audits look at how the policies and procedures devised by the organisation are being implemented by staff in the home to ensure a quality service. The provider also arranges for regular monthly visits as per regulation 26. Reports, which are produced as a result of these visits, are regularly sent to the Commission. These are detailed and informative. Annual customer surveys are carried out directly by the head office. Results are then sent to individual homes. Results of the last survey were seen on notice boards and the manager stated that these are available for all stakeholders to see. The management of the home also formulate action plans to address areas where the home needs to improve. The manager carries out regular audit of the accidents in the home and prepares a detailed analysis of the type of injury sustained by residents. Risk assessments were noted to be in place for residents who bruised easily. It was however observed that one resident had a bruise on the shin about which staff were not aware of, despite her having been woken up, dressed and transferred to the lounge in the morning. The bruise was recorded when the inspector pointed this to the trained nurse. The inspector looked at the content of the fridge in the kitchenette on the Merlin unit. It contained cartons of fruit juices with no date of opening with at least one belonging to a resident, but with no name of the resident. Part of a cake was also seen in the fridge with no date when the cake was first opened and with no name of the owner of the cake. The content of the fridges on the other units was appropriate. During a tour of the premises, it was noted that paints were being kept under the stairs at the back of the home. It was also noted that there was a large number of broken items or items which needed to be disposed of which have Knights Court Nursing Home DS0000022931.V301072.R01.S.doc Version 5.2 Page 26 been placed at the back of the home. These included old mattresses, bed rails, broken furniture, fans, vacuum cleaners and wheelchairs. The following up to date safety certificates were not available for inspection: an electrical wiring certificate, a chlorination certificate and LOLER certificates for lifting equipment such as for the hoists, bath hoists and the lifts. It was noted that there were no records about recent fire alarm checks (last done 17/3/6), emergency lights test (last done (17/3/6), fire exit checks (last done 20/3/6), fire testing equipment and call bell testing (last done 9/3/6). Knights Court Nursing Home DS0000022931.V301072.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 2 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 18 2 x x x x 2 x 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x x x x 1 X 3 Knights Court Nursing Home DS0000022931.V301072.R01.S.doc Version 5.2 Page 28 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 OP3 Regulation 14(1,2) Requirement The registered person must ensure comprehensive assessments of the needs of all residents in the home, including assessments of the mental health needs (Previous requirement- timescale 15/5/5, 30/4/6 not fully met) and that these are reviewed as and when the needs of residents change. The registered person must review staffing levels in the home in line of the findings of this report and must monitor the care of residents to determine if the staffing levels are adequate to ensure that residents receive the care that they require and according to their individual care plans. The resident’s plan must set out in detail the actions that need to be taken to meet the health, personal and social care of residents. (Previous requirement-timescale 30/04/06 not met). Risk assessment must be in DS0000022931.V301072.R01.S.doc Timescale for action 31/08/06 2 OP4 OP27 18(1)(c) 31/08/06 3 OP7 15(1) 31/08/06 4 OP7 13(4)(b) 31/08/06 Page 29 Knights Court Nursing Home Version 5.2 5 OP7 17 6 OP8 12(1) 7 OP8 17(1)(a) 8 OP9 13(2,4) 9 OP9 13(2,4) 10 OP9 13(2,4) 11 OP9 13(2,4) place in cases where residents are engaging in potentially dangerous activities. That fluid balance charts, food charts and turning charts are completed accurately and comprehensively to ensure that the information contained in these records is reliable. Residents’ vital signs must be monitored within appropriate intervals of time, when they are unwell, such as in cases when they have chest infections or urinary tract infections (Previous requirementtimescale 31/03/06 not met). Short term care plans must also be put in place when residents are unwell. There must be care plans in place for residents with pressure sores. The care plans must describe the pressure relief equipment in place and the arrangements in place for seating. The registered person must ensure that appropriate risk assessments are in place when medicines are being administered in an altered state and that the route of administration is clearly identified on the medicines chart (Previous requirementtimescale 31/03/06 partly met). The names of the residents must be recorded as well as the medicines when these are being returned for disposal. The location for administering creams and lotions must be clarified and these must be administered at the frequency that has been prescribed. The registered person must DS0000022931.V301072.R01.S.doc 15/08/06 15/08/06 15/08/06 15/08/06 15/08/06 15/08/06 15/09/06 Page 30 Knights Court Nursing Home Version 5.2 12 OP9 13(2,4) 13 OP10 12(1) 14 OP11 15(1,2) 15 OP12 16(2) (m,n) 16 OP19 13(4) 17 OP24 16(2)(c,d) 23(1) consider measures such as the use of ‘air conditioning’ in the clinical room to ensure that the temperature for the storage of medicines is always below 250 centigrade. The fridge temperature must also be under 80 centigrade and ideally be 3-50 centigrade at all times. The registered person must, in consultation with the relevant healthcare professionals, consider that medicines be administered at an interval of time which would ensure a constant serum level of the medicines as far as possible. All residents must be dressed appropriately (Previous requirement- timescales 15/8/5, 31/03/06 partly met) including the use of appropriate footwear. The registered person must ensure that the care plans of residents contain comprehensive information about the wishes and instructions of residents with regard to end of life care and about managing the death of residents (Previous requirement- timescale 31/8/5, 30/04/06 not met). There must be a comprehensive assessment of the social and recreational needs of residents and a care plans must be in place when needs have been identified (Previous requirement- timescale 31/8/5 not fully met). The grounds of the home including the back of the home must be kept tidy and must be maintained. The bedrooms of residents must be personalised to a high standard according to the tastes DS0000022931.V301072.R01.S.doc 15/08/06 15/08/06 31/08/06 31/08/06 31/08/06 15/09/06 Knights Court Nursing Home Version 5.2 Page 31 18 OP24 23(2)(n) 19 20 OP26 OP29 13(4) 19(1) 21 OP30 18(2)(c) 22 OP38 13(3,4) 23 OP38 13(4) 12(1) of the residents (Repeated requirement- timescale 31/05/06 partly met). Adjustable beds must be provided for residents requiring nursing. The registered person must also consider positioning the beds to allow access to staff on either side of the bed. Appropriate headboards must also be provided for these beds (Repeated requirementtimescale 31/05/06 partly met). The wheelchairs of residents must be kept clean as far as possible. The registered person must ensure that the work history of all members of staff is fully explored at the interview stage. One of the applicant’s references must be from the last employer and the second reference must be from one of the previous employers or from people who have known the applicant in a professional capacity. The registered person must ensure that all members of staff have annual updates of statutory training such as for fire training and manual handling. 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. (Repeated requirement- timescale 30/03/06 partly met). The registered person must ensure that all accidents in the home, including unexplained injuries to residents, are appropriately investigated and monitored for the safety of DS0000022931.V301072.R01.S.doc 15/09/06 15/08/06 31/08/06 31/10/06 15/08/06 15/08/06 Knights Court Nursing Home Version 5.2 Page 32 24 OP38 13(4) 25 OP38 23(2)(c) 26 OP38 23(4) residents (Repeated requirement- timescale 30/04/06 mostly met). The registered person must ensure that flammable items, including paints are not stored under the stairs. The registered person must ensure that all health and safety certificates including an electrical wiring certificate, a chlorination certificate and LOLER certificates for lifting equipment such as for the hoists, bath hoists and the lift, are up to date and available for inspection. The registered person must ensure that records are kept about the testing of the fire detection system, fire fighting equipment, emergency light system and fire exits as per the schedule approved by the LFEPA and that these are available for inspection. 15/08/06 31/08/06 31/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP15 OP31 Good Practice Recommendations The registered person should review the menu particularly with regard to the content of the meals for the suppers to ensure that the meals are well balanced and nutritious. The manager should start a course in management such as the registered manager’s award as soon as possible. Knights Court Nursing Home DS0000022931.V301072.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Knights Court Nursing Home DS0000022931.V301072.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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