Inspection on 30/07/07 for Knights Court Nursing Home

This inspection was carried out on 30th July 2007.

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

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

Other inspections for this house

Knights Court Nursing Home 16/04/09

Knights Court Nursing Home 06/05/08

Knights Court Nursing Home 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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Knights Court Nursing Home 105-109 High Street Edgware Middx HA8 7DB Lead Inspector Mr Ram Sooriah Key Unannounced Inspection 30th July 2007 15:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Knights Court Nursing Home DS0000022931.V340840.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.V340840.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 7DB Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8381 3030 020 8381 3040 knightscourt@lifestylecare.co.uk Life Style Care PLC Manager post vacant Care Home 80 Category(ies) of Dementia (40), Old age, not falling within any registration, with number other category (40) of places Knights Court Nursing Home DS0000022931.V340840.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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) 2. Dementia - Code DE (maximum number of places: 40) The maximum number of service users who can be accommodated is: 80 21st June 2006 Date of last inspection Brief Description of the Service: Knights Court Care Centre is a purpose built care home and was opened on the 27th November 1998. It is part of Lifestyle Care Plc, a provider of care homes mostly for the elderly. Lifestyle care Plc has been taken over by Southern Cross Healthcare from the 26th February 2007. The home is found off the Edgware High street and it is easily accessible by buses, the underground and by car. The bus and tube station is about five minutes walk away. The home benefits from a large parking facility for at least ten cars. There are shops, coffee shops, restaurants and other local amenities in close proximity of the home. The home consists of a main 3-storey building with a 2-storey wing on each side. It provides accommodation for 80 residents in 4 units. Each unit is selfcontained and has a kitchenette area, lounge/dining areas, bathrooms and toilets. All the rooms are single and are en-suite. The Camelot and Avalon units are on the ground floor and the Merlin and Excalibur units are on the 1st floor. The Merlin unit is registered for twenty elderly residents with dementia requiring nursing. The Excalibur unit has also recently been registered for twenty residents with dementia care needs, when it was previously registered Knights Court Nursing Home DS0000022931.V340840.R01.S.doc Version 5.2 Page 5 to provide care for elderly residents requiring nursing. The other two units can each accommodate twenty elderly residents with nursing needs. The 2nd floor contains the laundry, kitchen, managers office and staff areas. The fees charged by the home are: £750-£800 for private elderly care 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 residents needing nursing care funded by Barnet Social Services. There were 63 residents from Knights Court and 15 residents from Willesden Court in the home during the inspection. Willesden Court is part of Southern Cross and the residents from that home were admitted following an emergency. Knights Court Nursing Home DS0000022931.V340840.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced key inspection started on Monday 30th July at about 15:1519:15 and on the 31st July from 09:30-17:00. I was accompanied by Julie Schofield, regulation inspector, on the second day of the inspection. In this report ‘I’ will refer to Ram Sooriah and ‘we’ will refer to both inspectors. As mentioned in the summary of this report, the home was accommodating 15 residents from another home because of an emergency. These residents were mostly on the Excalibur unit and a few were on the other units where there were vacancies. Their needs were for personal care and the staff that normally care for them in Willesden Court were working in Knights Court to care for them. The inspection did not focus on them, but on the lives of the residents who normally live in Knights Court. An Annual Quality Assurance Assessment (AQAA) was completed by the home and forwarded to the Commission. 30 comments cards were also sent to residents and their relatives to get their views about the service. 7 comment cards from relatives and visitors and 4 comment cards from residents were received. The feedback from the comments cards has been used where possible in this report. During the inspection I also spent about 1¾ hour observing residents in one of the lounges of the Merlin unit to get some insight into the care that people with dementia receive in the home. After the inspection we were able to give feedback to Angie Knight, operations manager, and Wendy Bristow, the registered manager of the home. We are grateful to all people who spoke to us during the inspection and to those who have returned comments cards. We would also like to thank Southern Cross Healthcare and the home for returning the completed AQAA and the manager and all her staff for their support and assistance during the course. What the service does well: Residents and their relatives receive the necessary information to decide if the service will be able to meet the needs of the residents. A contract/statement of terms and conditions is provided to each resident/representative to make them aware of their rights and obligations. The needs of prospective residents are assessed by the manager or her deputy, to make sure that the home is suitable for the residents that are admitted. Knights Court Nursing Home DS0000022931.V340840.R01.S.doc Version 5.2 Page 7 Residents looked well cared for and on the whole care records demonstrated that they are also well cared for. ‘All aspects of care and nursing are dealt with in a caring manner’ (extract from comment card). The home has made the residents from Willesden Court welcome and the residents were complimentary about the service being received. Their choices and wishes were respected and promoted. Feedback from all parties suggests that members of staff are caring and work hard to meet the needs of residents. ‘Staff are always smiling and happy’. ‘They would do everything well considering that they are busy’ (extracts from comment card). Members of staff benefit from a good standard of training in relation to the work that they do to ensure that they are able to care for the residents who are accommodated in the home. The manager is appropriately qualified and has experience in running care homes. She is assisted by her deputy and is supported by the management structure of Southern Cross. The home has an effective quality management system in place and regular audits are carried out. Satisfaction surveys are also carried out yearly. Regular monitoring of the service also takes place by the responsible individual. All accidents/incidents to residents in the home are appropriately investigated. Care plans and risk assessments are drawn up as required in order to prevent recurrence. There are systems in place to ensure that residents’ money and property are managed appropriately. All equipment in the home is appropriately maintained and health and safety issues are taken seriously and addressed as appropriate, to make sure residents, visitors and staff are safe. What has improved since the last inspection? The service users’ guide has been updated to include information about the registered manager and about the range of fees charged by the home. This is available in audio formats for those who require it. The records with regards to residents with pressure ulcers have improved including the repositioning charts to show that residents’ position were being altered as required to promote good pressure area care. Knights Court Nursing Home DS0000022931.V340840.R01.S.doc Version 5.2 Page 8 The vital signs of residents are on the whole monitored appropriately. The care records of one resident showed this was not being monitored to promote the comfort of the resident. A dentist has visited the home to review residents following a requirement made during the last inspection. The interaction of members of staff with residents, particularly on the dementia care unit have improved. Staff were more aware of what type of interaction was appropriate for residents and the need to communicate effectively with residents even if they dementia. As a result there was a marked improvement in the atmosphere on the Merlin unit. The instructions for the administration of medicines were generally clear except for creams/topical medicines. The information on care records about the end of life care of residents and the wishes and instructions of residents about death and funeral arrangements has improved. As a result staff were more aware of what needed to be done in cases when residents have end of life care needs. The resuscitation status of residents have also been clarified in care records. New members of staff were receiving induction according to the standards which have been formulated by Skills for care. According to figures provided by the home, it now has 50 of its care staff trained to NVQ level 2 or above. The fridges, which are situated in the kitchenettes on each unit, are regularly monitored for cleanliness and to ensure that food is not kept beyond their expiry dates. What they could do better: The format for the assessment of needs could be made more comprehensive to include a tool/prompts for the assessment of the dementia care needs of residents. To demonstrate that the needs of residents are being met, care plans must include all the action to take to meet the needs of residents. New plans of care must be drawn up when new needs of residents have been identified. Care plans must as far as possible take the cultural, religious and ethnic aspects of residents into consideration. When residents are not well they must be monitored for any signs of discomfort and medicines must be administered if prescribed, to make residents more comfortable according to a plan of care. To promote the safety of residents with regards to medicines administration a few issues needed to be addressed. Changes made to the doses or instructions for administering medicines must be dated to record when the changes were Knights Court Nursing Home DS0000022931.V340840.R01.S.doc Version 5.2 Page 9 made. The actual amount of medicines administered must be recorded in cases of variable does of medicines. The instructions for the administration of creams/topical medicines must be clear about the location for the administration of these medicines. The life history/life profile and the social and recreational needs of residents must be completed comprehensively. A note must be made when this is not possible. The provision of activities in the home and in the community should be reviewed to identify areas where improvement can be made. That the action that has been taken to investigate complaints, the outcomes of the investigations and the feedback given to complainants are clearly recorded to demonstrate that the complaints have been appropriately investigated and responded to. Residents must be offered the opportunity to make and receive phone calls from the privacy of their bedrooms, such as in cases when they are in bed to ensure that they are able to maintain contact with their friends and family. The furniture in the right lounge of the Camelot unit must be reviewed to ensure it suitability in the communal areas where residents are seated. They seemed to be in poor condition and may detract from the good work that the home does. Other minor items with regards to redecoration must be attended to as required. The home must ensure that there are appropriate numbers of staff at all times to ensure the safety of residents and that their needs are attended to as documented in their care records. All new applicants must have two appropriate references before they are offered employment in the home as required by legislation. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Knights Court Nursing Home DS0000022931.V340840.R01.S.doc Version 5.2 Page 10 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.V340840.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1-4 Residents who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents receive appropriate information prior to them moving into the home to make sure that they are aware of what the service provides. The needs of the residents are also assessed to ensure that the home will be able to meet the needs of the residents who it offers a place to. EVIDENCE: A copy of the statement of purpose is kept in the reception area. A copy of the service users’ guide (SUG) is placed in each bedroom. Both the contents of the statement of purpose and the SUG have been recorded onto an audiocassette and are available to those who request for these. The SUG has been updated to contain information about the registered manager. She added that the SUG contains an annexe with information about the range of fees, which is charged by the home. Knights Court Nursing Home DS0000022931.V340840.R01.S.doc Version 5.2 Page 12 I checked whether a contract/statement of terms and conditions were provided to residents by looking at the files of 2 residents chosen randomly. I noted that the contract/statement of terms and conditions were in place for the 2 newly admitted residents and concluded that this is offered to all residents/representatives to make them aware of their rights and obligations. The home uses a pre-admission assessment form which is completed for all residents referred to the home to assess them for their needs prior to the home deciding if they could be admitted. The preadmission assessments are carried out by the manager or her deputy. These were appropriately completed and contained information about the needs of prospective residents. The format could have been more comprehensive with regards to the assessment of the dementia care needs of residents who are referred to the home for dementia care. This was also noted in the AQAA by the manager. Following the preadmission assessment of the needs of residents, a letter is sent to the residents and their relatives to confirm that a placement is to be offered. The letter confirms the suitability of the service to meet the needs of the resident. 4 comments cards from relatives/visitors to the home said that residents’ needs are always met and 3 said that the home usually meet the needs of the residents. Staff in the home have been in post for a number of years and were familiar with the needs of the residents. Those members of staff working on the units for residents with dementia have also had training in dementia care. Eight members of staff have recently completed the Alzheimer’s Society training package. Observation of the care of residents in one of the lounges of the Merlin unit also showed that most engagements and interactions of staff with residents who have dementia were positive. The residents were being supported as required in a respectful and appropriate manner. 4 comments cards from relatives/visitors to the home said that staff have the right skills and experience to look after residents properly and 2 said that they usually look after residents properly. 1 did not respond. Staff in the home were also aware of the cultural, religious and ethnic aspects of the care of residents. Care plans were in place addressing these needs hence demonstrating that the delivery of care was not only aimed at meeting the physical needs of residents but also aimed at meeting these aspects of care. Knights Court Nursing Home DS0000022931.V340840.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7-11 Residents who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The care records are comprehensive, except on a few occasions when these have not been amended to take into consideration changes in the needs of residents. The healthcare needs of residents are met most of the times, but records to demonstrate if one resident’s healthcare needs were being met were lacking. The end of life care of residents is addressed in records and there is therefore some guarantee that these needs will be met if required. Medicines management in the home is generally good to ensure the safety of residents. EVIDENCE: I looked at the care records of five residents. The needs of residents were on the whole assessed as required and if information about the needs of residents were not available in the assessment section of the needs of residents, then this was available in the actual plan of care. It was noted that the format did not have a section for the assessment of the dementia care needs of residents. For example the level of cognition of residents were not always clear as the Knights Court Nursing Home DS0000022931.V340840.R01.S.doc Version 5.2 Page 14 home did not use a tool to assess the level of cognition of residents. Southern Cross has such a format and as identified in the AQAA, the home has plans to address this point. Care plans were on the whole put in place once the needs of residents have been identified. One of the five sampled residents did not have a care plan/risk assessment with regards to managing the urinary catheter of a resident as he had a particular behaviour with regards to the catheter. One resident care plan was not clear about the manual handling practices. The care plan only described the manoeuvres for transferring from bed to chair but contain no information about manual handling manoeuvres when the resident is in bed. The cultural practices and religious beliefs of residents were addressed quite well in the care records on the Camelot and Avalon units but not so good on the Excalibur unit. On the Camelot and Avalon units these were well described and incorporated in the care plans of residents and focussed on the likes and dislikes of residents and on the end of life care needs of residents. 5 relatives/visitors said that the service usually meets the different needs of people who live in the home from an equality and diversity point of view and 2 said that the home always meet these needs. This was one area in the comment cards where the home scored less in relation to other issues. There was therefore room for improvement in this area. Residents and their relatives were involved in drawing up care plans and risk assessments. They were also involved in the review of care records. Areas discussed at client care review meetings include times of rising and retiring, the menu, cultural and religious needs, activities and risk assessments. A comment card from a relative said that ‘my father is not always shaved’. However during the inspection all residents presented as being appropriately cared for. They were dressed appropriately and appeared to be benefiting from a good standard of personal care. Staff on the whole related appropriately to residents as was demonstrated during the time spent to observe the way residents were being cared for and the interaction of members of staff with the residents. One comment from a relative said that the ‘interaction with residents is fairly good-considering that some residents are demanding’. Observation of the care of residents on the Merlin unit also suggests that residents are being appropriately cared for on the dementia care units. On the whole staff appropriately attended to residents and most interactions of staff with residents were appropriate. They were involved in various activities to engage residents. Residents were most (about 66 ) of the time in a good state of wellbeing. When they were not in a good state of wellbeing, staff attended to residents to support them. The majority (89 ) of staff interaction with residents was good. Knights Court Nursing Home DS0000022931.V340840.R01.S.doc Version 5.2 Page 15 Residents’ care records showed that they were attended to by various healthcare professionals as required. The GP visits the home weekly and make referrals to other healthcare professionals as required. There was evidence that the dentist, optician and chiropodist visited the home as required. One comment card said that ‘there is good communication between staff, GP and any follow-up’. 3 residents in the home had pressure ulcers. 2 of the residents developed the pressure ulcers in the home and 1 resident was admitted to the home with the pressure ulcers. All the residents had appropriate care plans in place detailing the treatment in place and the equipment required for the management of the pressure ulcers. Records about the evaluation of the ulcers provided information about the progress of the ulcers. The home did not have ‘hard’ photos of the sores, but the pictures were stored on a digital camera awaiting printing. One resident has been unwell for some time. She had been having a fever but it was not clear if she still had a fever at the time of the inspection, as the last vital sign observation was done 5 days prior to the inspection, when she had a low grade temperature. The care plan was not clear about how often this should be monitored. She also had a number of pressure ulcers. The resident was on antibiotics but there was no evidence that she was being given any medication at the time of the inspection, such as paracetamol or containing paracetamol, to make her feel more comfortable even though such a medicine was prescribed in her medicines chart to be given when required. The resident also had a care plan about ‘disturbed sleep due to pain’. She last had medicine to manage her pain a week prior to the inspection. While the resident may have had some end of life care needs and may not have been able to communicate to express whether she was comfortable or not, there was no evidence that she was being monitored and that a tool such as a pain chart was in use to demonstrate that the resident was comfortable. Residents wishes, instructions and arrangements with regards to end of life care and death were addressed in the care records. This was either discussed in the assessment section or in a plan of care addressing this need. Further information about various religious beliefs was included in the care records as a source of information to staff. The resuscitation status of residents was also recorded in the care records where appropriate, as well as any instructions of the residents/representatives with regards to this aspect of care. The management of medicines was inspected on the Avalon and the Excalibur unit. The clinical rooms were air-conditioned and the temperature of the rooms and the medicines fridges was monitored regularly. A record is kept of the assessment of competence of nurses in relation to administering medication. It is signed and dated by the manager. Knights Court Nursing Home DS0000022931.V340840.R01.S.doc Version 5.2 Page 16 Medicines charts were mostly completed and signed appropriately. Instructions for the administration of medicines were on the whole clear, except for a few creams/topical medicines where the instructions were not very clear about where these should be applied. A number of changes in the medicines charts about the doses of medicines were noted but these were not always dated to show from when did residents receive a change in medication. The amount of medicines administered in cases of variable doses was not always recorded. The management of controlled medicines was also inspected and was noted to be of a good standard. Knights Court Nursing Home DS0000022931.V340840.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides recreational activities to residents but comments from relatives and residents suggest that there is room for improvement. While contact of residents with their relatives and friends in the community is generally promoted by the home, a phone to enable residents make and receive phone calls from the privacy of their rooms is not available. Meals are provided to meet the nutritional needs of residents. EVIDENCE: Care records had some information about the social and recreational needs of residents. Out of the five care records inspected, four did not have a fully completed ‘life history’ sheet. It is well recognised that to be able to care for residents who have cognitive needs effectively, a life history of the residents is important to understand the behaviour and some of the care needs of the residents. The home had a programme of activities, which was available on notice boards on all the units. In the entrance hall details of activities taking place on each day of the week were on display. There is 1 full time and one part time activities-coordinators in post. The part-time activities coordinator is mostly Knights Court Nursing Home DS0000022931.V340840.R01.S.doc Version 5.2 Page 18 located on the Merlin unit and the full time activities coordinator cover the other units. During the inspection an outing had been arranged for the Gentleman’s Club to Brent Cross. The library trolley was also visiting the units in the morning. We also observed one to one interaction of members of staff and residents on the units where we went. Other activities on the programme include a knitting club, a picture quiz, hand massage, bingo, arts and crafts, keep fit, a ladies coffee morning and religious services. Birthdays and special days e.g. father’s day are celebrated. It was noted that the usual yearly gardening/plant growing activities did not take place in the home this year. There have also not been outings to places of interest such as the seaside as there has been in the past. As stated above a few trips have been arranged for residents, such as on the day of the inspection when there was an outing to Brent cross. We were however informed that a previous trip for the ladies club had been cancelled. When commenting about what could be improved in the home, three out of the five comments made by relatives and visitors were about improving activities and facilities to provide more activities and one was about ‘staff spending more time with residents’. Residents’ comment cards showed that 2 were always happy with activities 1 usually and 1 sometimes. This is an area, which scored less in relation to other areas in the comment cards and suggests room for improvement. It therefore seems that the provision of activities should be reviewed in the home to see whether these are suitable to meet the needs of the residents. Three respondents to relatives/visitors comment cards said that the home always supports residents to make contact with their relatives and four said that this happens usually. One respondent said that if her relative could get to the phone, he/she would have been able to keep more in touch with his/her more often. It was then noted that the home does not have a facility for residents to make and receive phone calls from their beds should they be in their beds. The home maintains an open visiting policy and a number of visitors were observed in the home. Members of staff communicated appropriately with visitors and it was also noted that members of staff knew regular visitors well and related appropriately to them. There is a room with en-suite facilities on the second floor that is made available to families when they want to be near their relative/friend who is poorly and is receiving end of life care. The home has information about advocacy services in the local authority. Residents’ choices are recorded in the care records and are taken into consideration by staff who ask residents about their choices whenever Knights Court Nursing Home DS0000022931.V340840.R01.S.doc Version 5.2 Page 19 possible. It was noted that the residents that were enjoying a temporary stay at Knights Court after having to leave their own care home, were able to exercise choice about how they spent their day and about what they wanted to do. It was noted that some of the residents went shopping locally and had the code to the key pad system so that they could open doors independently and leave the unit, or the home, when they wished. We were informed that the menu in the home has been drawn up using Southern Cross policies and procedures to take into consideration the contents of the meals and nutrients to ensure that these are appropriate to the needs of the residents. Inspection of the menu showed that there was a four weekly cycle of menu with choices available for each meal. The content of all meals looked suitable and nutritious. A vegetable option was available daily. The manager confirmed that African-Caribbean dishes were included on the menu and that vegetarian alternatives were available. A copy of the menu for the day was on display in the units and choices forms with the choices of residents for their meals were available for viewing. Menu forms are used to record choices for the next day. We were informed that extra portions are prepared to allow residents to change their mind when the meals are ready to be served. Lunch was observed on the Merlin unit and residents were encouraged to use the dining area. Hoists were used as necessary to transfer residents to the dining area. This is good and commendable practice and makes meal times social occasions so far as possible. As comparison most residents on the Avalon unit stayed in their armchairs for supper. Residents and all relatives and friends who send comment cards said that the meals usually meet their needs. One said that ‘the meals are excellent’. Knights Court Nursing Home DS0000022931.V340840.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. A complaints procedure was in place but records must be complete to demonstrate that complainants have been listened to and the concerns investigated. Protection of vulnerable adults training for staff and familiarity with the home’s procedure and the interagency guidelines contribute towards the safety of residents. EVIDENCE: All relatives/visitors who responded to comment cards said that they know how to go about if they have a complaint to make. A copy of the complaints procedure is on display in the reception area on the ground floor. There was also a box in which family members or visitors to the home were encouraged to post any suggestions or concerns. A form was provided for this purpose. A copy of the complaints’ procedure is included in the SUG, which is available in all bedrooms. The complaints record book was examined. It included an audit form for each month of the year. This enabled the manager to check for any trends or patterns occurring and to act on these. It was noted that a complaint recorded in January 2007 did not record the outcome of a review meeting or note the date that it eventually took place. (The date had been changed at the request of the local authority). The manager confirmed that the meeting had taken place and was able to give details of the outcome. Another complaint made in May 2007 had been investigated but there was no record of a letter being sent to the relative informing them of the outcome. An Knights Court Nursing Home DS0000022931.V340840.R01.S.doc Version 5.2 Page 21 anonymous complaint had been made in June to a local authority social service’s department and to the Commission for Social Care Inspection about lack of staff and how care was affected as a result. The complaint was investigated by the organisation and was not substantiated. The manager visits each unit daily so that residents have the opportunity to discuss any concerns with her. In addition she holds a surgery on the first Tuesday of the month between 17:00 and 19:00 for relatives to speak if they have any concerns or to discuss the care of the residents. There is a protection of vulnerable adults procedure in place and there are links with the whistle blowing procedure. Guidance for home managers is available. The home has a flow chart, which covers the action to be taken in the event of an allegation of abuse being made and it includes making contact with the social worker, adult protection co-ordinator and the Commission for Social Care Inspection. The manager said that no allegations or incidents of abuse have been recorded since the last inspection. Refresher training for staff is included in the annual training plan for the home. There was evidence on the 2 staff files for members of staff not recently employed that they had received protection of vulnerable adults training. Induction training for new staff includes protection of vulnerable adults awareness. Knights Court Nursing Home DS0000022931.V340840.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents enjoy comfortable surroundings that are maintained to a good standard. Residents are assured of hygienic surroundings as good standards of cleanliness prevail. EVIDENCE: The home is situated close to Edgware High Street and benefits from having its own large car park area, close to the front entrance. There is a large garden area to the front and to the side of the home and residents were enjoying sitting outside on the day of the inspection, which was warm and sunny. Garden furniture is provided. The garden is well maintained and at the start of the inspection the grass was being cut. There is level access to the home and there are lifts to aid movement within the home. An Occupational Therapy report of the home in 2005 commented in its summary “it is considered that this home meets the criteria of Standard 22 of the Care Homes for Older People”. Knights Court Nursing Home DS0000022931.V340840.R01.S.doc Version 5.2 Page 23 During the inspection a tour of the premises took place. The home was well furnished and decorated and the home has a programme of redecoration that is currently ongoing. The programme covers May 2007 to August 2007 and is in respect of 3 of the units as Excalibur unit was refurbished in January 2007. At the time of the inspection corridors were being repainted. Knights Court is furnished and decorated in a homely manner. The dementia care units have been redecorated to take into consideration best practices in the care of people with dementia: to provide a homely and familiar environment to residents and to facilitate orientation of residents. It was also noted that there were pictures and sensory boards on the walls of the dementia care units, which aid recognition, reminiscence and provide stimulation. The manager said that these had been introduced following the advice of a dementia care specialist. All bedrooms are single and each has its own ensuite facility. They were personalised according to the residents/representatives’ wishes with the encouragement of staff. The level of personalisation of the bedrooms varied, but continuous improvement was noted particularly on the dementia care unit. Inspection of a sample of the environment showed that some minor repairs were required. There was a gouge in the wall in Room 11, one of the legs of the divan bed in Room 49 was bent and there were stains on the carpets of Rooms 8, 43 and 53. I however noted that the carpet was being cleaned in one of the rooms in the afternoon of the inspection and the manager stated that the carpets are cleaned as soon as they become dirty. The carpet shampoo machine was however not working properly and cleaning staff had to brush the carpet to remove the stains. The standard of furniture in one of the lounges of the Camelot unit was not so good. Handles were lacking to the chest of drawers and the back of the TV unit was coming off. The doors of the cabinet of the TV unit did not close properly and handbags and clothes were stored in the cabinet. There were some shoes at the back of the cabinet. These areas must be maintained a resident areas and a good standard of furniture must be provided as well as ensuring that these are used appropriately. It was noted during the inspection that the home was clean and tidy and free from any offensive odours. Domestic staff were on duty during the inspection. There is an infection control policy in place in the home and it was recorded on the Annual Quality Assurance Assessment that 21 members of staff have received training on the prevention of infection and management of infection control. Laundry services are carried out in-house and laundry assistants are employed as required. Equipment is in good order to ensure a good standard of laundry service. Knights Court Nursing Home DS0000022931.V340840.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are cared for by appropriate numbers of staff on most occasions to ensure that their needs are met. They benefit from a service provided by carers that have demonstrated their skills and understanding through NVQ training. On the whole the recruitment process, which includes checks and references, promotes and protects the safety and wellbeing of residents although accepting “open/testimony” references could put residents at risk. A comprehensive programme of training for staff encourages good working practices. EVIDENCE: During the day there is a nurse and 3 carers on duty in the Camelot and Avalon each. There is 1 nurse and 3 carers on the Merlin unit with an extra carer in the morning. The Excalibur unit is staffed with 1 trained nurse and 2 carers for the 10 residents who are admitted to Knights Court. Since there are an additional 10 residents who are temporarily in the home, the 3 care staff who normally look after them in Willesden Court, their normal place of stay, are based on that unit. On the day of the inspection, the staffing level as above was maintained except on the Avalon unit where there was one carer short. A trained nurse who came to do an induction in the home on that day was allocated to work on the Excalibur unit. There 16 residents on that unit on the Knights Court Nursing Home DS0000022931.V340840.R01.S.doc Version 5.2 Page 25 day of the inspection. The manager stated that staff on that unit said that they could cope with meeting the needs of the residents At night the staffing is one trained nurse and 1 carer for each of the four units. Inspection of the duty rosters, kindly provided by the manager, showed that the staffing level of 4 trained nurses and 4 carers were provided on a few occasions (e.g. twice during week 27th July-2nd August) and that most of the times there were 3 trained nurses and 5 carers and at times 6 carers. The two units on the ground floor were then staffed with 1 trained nurse and a carer each. When there were six carers there was a trained nurse supervising 2 units on the first floor and 2 carers working on each unit and when there were five carers there were 2 carers on one unit and the nurse and a carer on the other unit but the nurse provided nursing care to residents on both units of the first floor. On one occasion there were 2 trained nurses and 4 carers on duty for the night shift. This left the Camelot and the Avalon unit with 1 carer each and a trained nurse supervising both units. This raises issues with regards to the manual handling of residents particularly those who need to be attended with 2 persons. Nurses and carers commented that at times when there were shortages of staff, they had to care for residents with reduced numbers and that the home does not use agency staff. This then put additional pressure on them. From the one month duty roster (July), which was inspected it was noted that while staffing levels were sufficient on most occasions to meet the current needs of residents accommodated in the home, there were isolated occasions when staffing levels were less than desirable to ensure that all the needs of residents were being met as required. The duty roster also showed that at times it did not contain the full names of members of staff and that entries of two names of members of staff in one of the cells of the table, where individual names should be entered, could cause some confusion as to who worked in the home. As these are legal documents, all entries must be clear to anyone looking at these records. One comment card said ‘considering that they (staff) are so busy they do a wonderful job’. Another said that ‘Staff are always smiling and happy’. In addition to care staff there are administrative staff, domestic, catering, laundry and maintenance staff employed in the home. There are also 2 activities co-ordinators. A record was available of the last check of nurses’ pin numbers, which was carried out for 16 persons, in June 2007. Figures were provided to the Commission about the number of NVQ trained staff in the home. The home has 35 carers in total. 6 are already qualified to NVQ level 2 and 12 have completed the course and are waiting for their certificates. As a result the home does have 50 of its care staff trained to NVQ level 2. Knights Court Nursing Home DS0000022931.V340840.R01.S.doc Version 5.2 Page 26 Four staff files were examined. Two files belonged to carers and 2 files belonged to nurses. One of the nurses was born outside the UK and there was evidence that the nurse had gained a pass from the international English language testing system. Each file contained an application form with a photograph of the member of staff. Files contained proof of identity i.e. passport details and 2 references although on one file one of the references was an “open/testimony” reference from a previous employer and supplied by the applicant. This was against company policy and against good practice. During the last inspection a member of staff did not also have appropriate references before she was offered work in the home. An enhanced CRB disclosure was held for each of the members of staff. Where necessary evidence of right of residence and right to work was kept on the file. A copy of the General Social Care Council’s “Codes of Practice” was available in the home. A copy of the training plan for 2007 was made available. This included training in respect of safe working practices i.e. moving and handling, food hygiene, fire safety and infection control. It included training in health and safety and related topics e.g. COSHH substances and prevention of accidents/falls. Training in relation to the client group was provided e.g. communication and interaction, yesterday/today and tomorrow and dementia care. Training in respect of the residents’ health and wellbeing was provided i.e. promoting continence, first aid, prevention of pressure ulcers, medication administration, epilepsy awareness, wound care management and tissue viability. Training was also offered in protection of vulnerable adults procedures and in care planning. Each member of staff has a training file. New members of staff had an induction training record in their file and it was noted that where these had been absent for staff recruited some years ago the manager has ensured that these are to be completed. Records are signed (by the manager and the member of staff) and dated. The induction training included fire safety, health and safety, manual handling, protection of vulnerable adults and first aid. Knights Court Nursing Home DS0000022931.V340840.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35,37 and 38 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager uses her knowledge, skills and understanding to provide a service that is responsive to the needs of residents. Information gained through the quality assurance systems is used to shape the development of the service and ensure that the changing needs of residents are met. Support is given to residents who need assistance in managing their finances so that residents’ financial interests are protected. Some Records containing information about residents were available in the lounges and could easily be accessible to third parties, therefore undermining confidentiality and constituting a possible breech of data protection legislation. Training for staff in safe working practice topics promotes the health and safety of residents, staff and visitors to the home. Testing and servicing of equipment and systems in the home demonstrate that they continue to be safe to use. EVIDENCE: Knights Court Nursing Home DS0000022931.V340840.R01.S.doc Version 5.2 Page 28 The manager is a qualified nurse with managerial and postgraduate educational and nursing qualifications. She has successfully completed the NVQ level 4 in management. She took over the management of the home in September 2006 and after 19 years experience in the private health sector. She is assisted by the deputy manager, who is a qualified nurse and is experienced with caring for elderly people and for those who have dementia care needs. She is also supported by the management structure of Southern Cross. The operations manager was present while giving feedback to the manager. All visitors to the home have the opportunity to record any concerns or suggestions they have and to post these in a box held in the reception area. The manager has an “open door” policy and visits each unit on a daily basis for feedback from residents, relatives visiting the home or from members of staff. Relatives and residents are also able to make any comments they have regarding the quality of the service provided in the residents’ review meetings that are held on a 6 monthly basis. In addition the home invites residents and relatives to take part in an annual satisfaction survey and the results of the survey carried out in 2006 were available. The format includes a comparison with other care homes within the company. The lowest score received was in relation to laundry services while the highest score received was in relation to the approachability of the manager or nurse in charge. Copies of monthly Regulation 26 inspection reports were available and monthly audits of various aspects of the running of the home, completed by the manager, are validated on a 2 monthly basis by the service manager. All audits include action plans for improvement. The home is also ISO accredited. Most of the residents receive assistance from their relatives with managing their personal finances. However the company is the appointee for 1 resident and 2 residents that are funded by a local authority have their personal allowance paid to the home. Although there are secure facilities for safe keeping money or valuables in the home the personal allowances are paid into an account held at head office. The home has access to a monthly spreadsheet that details all monies held and records the interest paid each month on the money held. There is a system for requesting money from this account, on behalf of the resident. When relatives leave money on behalf of residents, receipts are given and there is a record of all items of expenditure, with the receipts, and the balance remaining. In months where purchases have been made a statement is sent to the relative. I noted a number of residents’ records that were kept in the lounges. Among these there were carers’ entries in care records, fluid and food charts, turning charts and observation charts. These were kept in the lounge to make these Knights Court Nursing Home DS0000022931.V340840.R01.S.doc Version 5.2 Page 29 records easily accessible and so facilitate records keeping, but at the same time, these were easily accessible to any third parties and could be a breech of residents’ confidentiality and data protection legislation. The home maintains a record of all health and safety matters in the home. Files contained valid certificates for the checking/servicing/inspection of the gas boilers and gas installation and there was a Landlord’s Gas Safety Record. There were certificates for the lifts and for the hoists. The inspection of the electrical installation had identified some remedial work that was required and there was evidence that this had been carried out the next month. There was a certificate for the portable electrical appliances, the fire extinguishers, fire alarms, nurse call system and emergency lighting. Risk assessments were in place in respect of fire and for legionella’s disease. The letter following the visit by the Environmental Health officer in February 2007 confirmed that the home had a “well run kitchen with excellent controls and documented records”. Inspection of the fridges in two of the units showed that all food was labelled as required with an expiry date. There was no food passed the expiry date. The last visit by the LFEPA in 2005 confirmed, “the workplace was deemed to comply with the regulations”. There was evidence on staff training files that staff have received training in manual handling, fire safety, first aid, food handling and infection control. Records of accidents were examined. Quarterly summaries are prepared. Between March and May 35 accidents occurred in the home 23 of which were falls. One accident required a RIDDOR notification and this had been made. It is the policy in the home that if a resident is having a number of falls the GP refers the resident to the falls clinic. Records included details of how an accident had occurred and what measures would be put in place to minimise the risk of this happening again. Knights Court Nursing Home DS0000022931.V340840.R01.S.doc Version 5.2 Page 30 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 3 3 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X 3 X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 3 Knights Court Nursing Home DS0000022931.V340840.R01.S.doc Version 5.2 Page 31 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 OP7 Regulation 15(1,2) Requirement Timescale for action 31/10/07 2 OP7 14(1) 3 OP8 12(1) To demonstrate that the needs of residents are being met, care plans must include the action to take to meet the needs of residents. New plans of care must be drawn up when new needs of residents have been identified. Care plans must as far as possible take the cultural, religious and ethnic aspects of residents into consideration. To make sure that residents’ 30/10/07 needs are fully assessed, particularly for residents with dementia, consideration must be given to using a format to support the assessment of the dementia care needs for those residents who have dementia 30/09/08 The vital signs of residents who are unwell must be monitored comprehensively according to an agreed plan of care (Repeated requirement-timescale 15/05/07 partly met). When residents are not well they must be monitored for any signs of discomfort, such as by the use of a pain chart, and medicines must be administered if prescribed, to DS0000022931.V340840.R01.S.doc Version 5.2 Knights Court Nursing Home Page 32 4 OP9 13(2) 5 OP12 14(1) 6 OP13 16(2)(b) 7 OP16 22(4) 8 OP19 23(2) make residents more comfortable according to a plan of care. The instructions for the administration of creams/topical medicines must be clear about the location where these are to be administered to make sure that these are administered in the right places. Changes in the medicines charts about the doses/instructions for administration of medicines must be dated to show when the changes actually started. In cases when variable doses of medicines are prescribed the actual amount administered must be recorded. The life history/personal profile and the social and recreational needs of residents must be completed as far as possible. A note must be made when this is not possible. The provision of telephone facilities in the home must be reviewed to enable residents make or receive phone calls from the privacy of their bedrooms. The registered person must ensure that the complaints records include the outcome of the investigation/action taken and evidence that this has been relayed to the complainant to demonstrate that complainants are listened to and that appropriate action is taken to improve the quality of service. The registered person must ensure that the minor repairs (detailed in section under ‘Environment’) are carried out so that residents enjoy a safe and comfortable environment. The furniture in the right lounge on the Camelot unit and their use DS0000022931.V340840.R01.S.doc 30/09/07 31/10/07 30/11/07 30/09/07 30/09/07 Knights Court Nursing Home Version 5.2 Page 33 9 OP27 18(1)(a) 10 OP29 19(1) 11 OP37 17(1)(b) must be reviewed to ensure that residents are able to benefit from furniture which is in a good condition. That staff are provided in appropriate numbers at all times to ensure that the needs of residents are being met according to their care plans. Duty rosters must be clear (2 names of staff should not be entered in the same slot) and must contain the full names of members of staff. The registered person must ensure that all records as per schedule 2 of the Care Homes Regulations 2001 are in place before a person can work in the home, including having professional references (Repeated requirementtimescale 15/05/07 partly met). The registered person must only accept references where they are satisfied of their authenticity to ensure that unsuitable persons are not recruited to work in the home. The registered must review the availability of residents’ records in communal areas to ensure compliance with data protection legislation and confidentiality of residents’ records. 30/09/07 30/09/07 30/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP12 Good Practice Recommendations A review of the range and provision of activities in the DS0000022931.V340840.R01.S.doc Version 5.2 Page 34 Knights Court Nursing Home 2 OP26 home and in the community should be conducted to ensure that the activities are arranged so far as possible to provide a lifestyle that would meet the needs and choices of residents. That an assessment of the home’s current infection control management is carried out using the Department of Health guide “Essential Steps”. Knights Court Nursing Home DS0000022931.V340840.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Harrow Area Office 4th Floor, Aspect Gate 166 College Road Harrow London HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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