Inspection on 06/06/05 for Knights Court Nursing Home

This inspection was carried out on 6th June 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

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 21/06/06

Knights Court Nursing Home 25/01/06

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 Middlesex HA8 7FH Lead Inspector Ram Sooriah Unannounced 06 June 2005, at 10:00h00 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 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 G62-G11 S22931 Knights Court NH V231890 060605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Knights Court Nursing Home Address 105-109 High Street Edgware Middlesex HA8 7FH. 020 8381 3030 020 8381 3040 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Life Style Care Plc CRH N Care Home with nursing 80 Category(ies) of DE Dementia 20 registration, with number OP Old Age 65 Years and over 60 of places Knights Court Nursing Home G62-G11 S22931 Knights Court NH V231890 060605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 7th February 2005 Brief Description of the Service: Knight’s 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 and the underground. The bus and tube station is about five minutes walk away. 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 service users in 4 units. Each unit is self-contained and has a kitchenette area, lounge/dinning 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 2nd floor contains the laundry, kitchen, manager’s office and staff areas. The Merlin unit is registered for 20 elderly service users with mental health needs requiring nursing, while the other three units can each accommodate twenty elderly service users with nursing needs. There were 79 service users in the home during the inspection. Knights Court Nursing Home G62-G11 S22931 Knights Court NH V231890 060605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on Monday the 6th of June 2005. It is one of the two statutory inspections for the period 2005-2006. It started at about 1000 and lasted until about 1930. The inspectors were Gail Freeman (regulation manager) and Ram Sooriah (regulation inspector). During this inspection the ‘inspectors’ would refer to both inspectors and the ‘inspector’ would refer to Ram Sooriah. During the inspection the inspectors were able to engage service users, visitors to the home, staff and the manager. They also looked at a sample of records, observed care practices and inspected the premises. The last inspection took place on the 7th February 2005. The manager at the time was Ishbell Read. She left the company shortly after the inspection and Wendy McDonough, the previous manager has been managing the home. She agreed that the home was going through a period of change at the time, which cause some uncertainty and destabilisation. She has since been able to stabilise the home and address the issues, which were raised during the last inspection. The inspectors would like to thank the service users, visitors to the home, the manager and her staff for their cooperation and support during the inspection. What the service does well: What has improved since the last inspection? The moral among staff seemed to have improved and they seemed to have clear directions about what was expected of them. The provision of training in the home has improved. There has been progress in meeting statutory requirements imposed following past inspections. Knights Court Nursing Home G62-G11 S22931 Knights Court NH V231890 060605 Stage 4.doc Version 1.30 Page 6 What they could do better: 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 G62-G11 S22931 Knights Court NH V231890 060605 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Knights Court Nursing Home G62-G11 S22931 Knights Court NH V231890 060605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 4 The needs of service users were not always comprehensively assessed. Without this there is no assurance that the needs of service users will be met. The numbers and skills of staff on one of the units indicated that the care provided was not always individualised and was more of a task-orientated nature. EVIDENCE: The inspectors looked at five care records. There was evidence that new service users to the home have had a pre-admission assessment either by the manager or by the deputy-manager. There was also evidence of the receipt of the needs’ assessment by the placing authority in most cases. The inspectors noted that that the assessments of the needs of service users were completed to varying degree of comprehensiveness. While there has been improvement on some units where the needs’ assessments were comprehensively completed, there has not been much improvement on the other units where the assessments were not so well completed. The section for communication in one of the assessments stated ‘very confused’ which did not give an indication of whether the service user was able to express herself or Knights Court Nursing Home G62-G11 S22931 Knights Court NH V231890 060605 Stage 4.doc Version 1.30 Page 9 understand verbal commands; another assessment mentioned that the sleep pattern was ‘poor’ but did not describe what the sleeping pattern was. The assessment of the mental health needs of service users continue to be lacking particularly on the Merlin unit, which specialises in the care of service users with mental health needs. These sections were being used to describe the medical condition of the service users rather than describing how the mental illness affected the lives of the service users and what were their needs as a result. Without a comprehensive assessment of the needs of service users the home is unable to demonstrate that it is meeting all the needs of the service users. Service users and visitors spoken to by the inspectors were mainly happy about the care that service users receive in the home and conversations with staff showed that they knew the service users well. The inspectors however spent some time on the unit for service users with mental health needs and observed care practices. They noted that the provision of care to service users were not always individualised. They looked at the management of continence in the home. While records were not always clear about the management of the incontinence they also did not reflect the individualised nature of care in this area. They noted that staff approached care in a task-orientated manner rather than looking at the individualised needs of the service users. For example instead of using a hoist to transfer a service user, staff physically lifted the service user using an unacceptable manual handling technique, even though the care records said to use a hoist. During lunch, the meals were left in front of two service users who were sleeping in their chair. They were not offered assistance with their meals, which were going cold in front of them. This was because staff were busy assisting other of service users (see standard 15). The inspectors also noted little interaction between staff and service users other than when this was linked to direct care giving. They observed a number of service users on the Merlin unit who were quite mobile, but who nevertheless required some degree of supervision to enhance their safety. It was not clear how staff were providing this supervision. The above issues therefore seemed to be linked to the numbers and partly to the skills and experience of staff on the unit. As a result the registered person must review the numbers, skills and experience of care staff on the units of the home to ensure that the needs of service users are being met. Knights Court Nursing Home G62-G11 S22931 Knights Court NH V231890 060605 Stage 4.doc Version 1.30 Page 10 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 standard(s) 7, 8, 10 and 11. Service users had appropriate care plans in most cases. In a few cases a care plan was not in place where new problems have been identified to ensure that they will receive the necessary care. Although the manager and her staff were aware of the healthcare needs of service users, records did not always demonstrate that the home was meeting all the healthcare needs of service users. Service users are treated with respect and their right to privacy is upheld. Records about the future of service users and about their wishes and instructions with regard to death and funeral were not always comprehensive to ensure that the needs of service users with regard to this aspect would be met. EVIDENCE: The inspector noted some improvement in the content of some care plans. Some were simple and clearly described the actions to take to meet the needs of the service users. Some however were still lacking. For example a service user who was on antibiotics for a wound, which was infected, did not have a plan of care about that. The registered person must ensure that care plans are drawn to address all the needs of service users, where these have been Knights Court Nursing Home G62-G11 S22931 Knights Court NH V231890 060605 Stage 4.doc Version 1.30 Page 11 identified. Another service user’s care plan said that he should be weighed weekly. Records of weights showed that he was not being weighed weekly. There was evidence that reviews were taking place in cases where care plans have been formulated or where risk assessments were in place. The manager stated that nursing staff were trying hard to ensure the involvement of service users or that of their relatives in drawing and in reviewing care plans. The inspectors acknowledged that this might be difficult in some cases. When consultation of service users or of their representatives is not possible, a note should be made to this effect. From looking at a number of care records the inspectors found that there was not much evidence to show whether service users or that their representatives were consulted about the care plans and risk assessments or that it has not been possible to consult with anyone. There was a range of risk assessments for service users including cases where service users were unable to use a key to their rooms, a call bell or have a jug of water. A few service users had pressure sores and all of them had pressure relieving devices and care plans in place. Photos and wound mapping were being used in most cases to monitor the progress of the sores. In one case the inspectors observed that a service user who had a wound on the hand did not have a dressing on the wound. It was not clear what attempts have been made with regard to ensuring that the dressing was secure and to ensure that the service user would not remove the dressing. The inspectors looked at the care records of a service user whose antipsychotic medicine has recently been increased apparently to manage his mental health needs. They noted that there were no records of the monitoring of his behaviour to identify the trends and patterns, which could then be used as a justification for the review of the medicines. Care plans showed that service users were referred to a range of healthcare professionals as necessary. This was evident in cases where service users who have lost weight. They were referred to the GP and dietician. The service users in general appeared well cared for. Most were clean, appropriately groomed and dressed. The inspectors however observed that two service users sitting in the dining room of the Merlin Unit just after breakfast did not have any slippers on and that two other female service users did not have any stockings on. The instructions and wishes of service users with regard to their future, death and funeral arrangement were not always recorded. The manager stated that care staff have been trying to get the information from service users and relatives where possible. The inspector noted that there were various correspondence on the file of a service user about living wills, but the information was not always transferred to the sections of the care plans dealing with death and fear for the future. While there is no doubt that this is an area where it is difficult to obtain information, caring for the dying is an inevitable aspect of care in a care home and must be addressed. Where there is no information about the wishes and instructions of service users or from Knights Court Nursing Home G62-G11 S22931 Knights Court NH V231890 060605 Stage 4.doc Version 1.30 Page 12 their representatives about this aspect of care, then a record must be made about this. Knights Court Nursing Home G62-G11 S22931 Knights Court NH V231890 060605 Stage 4.doc Version 1.30 Page 13 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 standard(s) 12,13,14 and 15 The activities coordinator ensures that there is a range of activities for service users. Care staff could do more to interact with service users who require oneto-one input with regard to meeting their social and recreational needs. Service users are generally happy about the range of meals provided by the home. EVIDENCE: The assessment of the social and recreational needs of service users were not always comprehensively recorded. Some were very good others not so good. The registered person must ensure that the social and recreational needs of service users are recorded comprehensively and addressed in care records. In cases where this is not possible a note must be made to this effect. The home has a full time activities coordinator. A plan for activities was available on the notice board in each unit. The inspectors were informed of social activities that were being arranged for the summer, such as a gardening competition, an outing to the seaside and a summer fete. While service users who are able to take part in the above activities enjoy these, there are other more dependent service users who rely more on one-to-one interaction. This is where care staff have to step in, to interact with these service users on a one-to-one level. The manager stated that staff are aware of this and that they try and interact with service users when possible. Knights Court Nursing Home G62-G11 S22931 Knights Court NH V231890 060605 Stage 4.doc Version 1.30 Page 14 The home has an open visiting policy. There were a number of visitors to the home and service users were able to see them either in their bedrooms or in the communal areas. A few service users stated that they are able to go out in the local community with their relatives. There are a few cafes, restaurants and shops close to the home, which they are able to visit. Service users are asked about their meals and about their choices. These were recorded in most cases. The bedrooms of service users were personalised to varying degrees. The inspectors were informed of attempts to personalise the bedrooms of service users on the Merlin unit. They were told of cases where staff have found out about the things that service users like through the life history of the service users and how these were taken into consideration when trying to personalise the bedrooms of the service users. This is good practice and should continue. There was also evidence of the personalisation of the corridors with murals and with a ‘sensory board’. While relatives and friends can and should be encouraged to bring the personal effects of service users, this may not always happen for a number of reasons. This however does not deflect from the registered person(s)’ responsibility to provide an appropriate and homely environment for service users. The inspectors recognised progress being made in this area and noted that there was more work to do to ensure that the bedrooms of the service users are made more personalised, homely and welcoming. The inspectors observed lunch being served. There was a record of the choices of the service users for the meals. Some service users confirmed that they are asked about their choices for the meals. The lunch consisted of Steak and Kidney Pie, mixed vegetables, mashed potatoes and rice pudding for desert. The second choice was vegetable burgers. Service users in the home were generally pleased with the meals. The inspectors noted that the meals were placed in front of some service users who needed assistance with feeding, but staff were not ready to feed them. As a result the food was getting cold. It is advised that the meals of service users who need to be fed are only brought to them when staff are ready to feed them to ensure that the meals remain warm. Knights Court Nursing Home G62-G11 S22931 Knights Court NH V231890 060605 Stage 4.doc Version 1.30 Page 15 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 standard(s) 16 and 18 The home listens to complaints and deals with them in an appropriate manner. The home takes allegations or suspicions of abuse seriously and follows the appropriate procedure in dealing with them. EVIDENCE: The home has an effective complaints procedure. Copies were available in the foyer and in the service users’ guide. The manager stated that she has also addressed the relatives and residents meetings about how to access the complaint procedure, as during the last announced inspection a significant number of respondents to comments cards mentioned that they were not aware about how to access the complaint procedure. The home has been informing the inspector of the complaints that have been lodged against the service. He has noted that these have been appropriately dealt with by the home. Since the last inspection allegations and suspicions of abuse have also been appropriately dealt with by the home. The home has a comprehensive policy on abuse. The inspector noted that no training has been arranged on abuse for the period starting February 2005 to the end of November 2005. It is also not clear if all staff in the home have had training on abuse. This is particularly relevant to new members of staff who may be in need of this training in recognising and understanding issues in relation to abuse and about how to deal with cases where abuse is alleged or suspected. The registered person must ensure that training on abuse is addressed in the training programme particularly for new staff and for updating staff who already have had training in this area. Knights Court Nursing Home G62-G11 S22931 Knights Court NH V231890 060605 Stage 4.doc Version 1.30 Page 16 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 standard(s) 19, 20, 24 and 26 Service users live in a safe and well-maintained environment. Some areas of the home could have been cleaner. EVIDENCE: The grounds of the home were maintained and were kept clean. The home had a redecoration plan and records of areas, which have been redecorated. These have been sighted in the past and there was evidence that the home was being maintained to a good standard of decoration. A plan for the renewal of fabric, fixtures and fittings was not available for inspection. A list of furniture items for repair was later sent to the inspector. To ensure a high quality environment for service users at all times, it is recommended that the home has a refurbishment plan to ensure a systematic and planned approach to the renewal/replacement of fixtures, fittings and furniture in the home, taking into consideration the life cycle of these, rather than approaching this subject on an ‘as required’ basis. Knights Court Nursing Home G62-G11 S22931 Knights Court NH V231890 060605 Stage 4.doc Version 1.30 Page 17 Bedrooms of service users were appropriately decorated, but some of them required more personalisation. The manager and her staff mentioned that they were working on this aspect of the home. Some of the divans beds have been replaced, but there were more beds, which needed to be replaced particularly in cases where service users were frail, very dependent and who required nursing. The inspector noted one such service user and the manager stated that she would arrange for the replacement of the bed on the same day. The bed was later replaced. The inspector noted that the adjustable bed in one of the bedrooms had a headboard, which did not fit the bed properly. He also noted that a number of service users did not have a bed table. The manager stated that there are plans to order new bed tables for service users. The inspector observed that 2 bedside cabinets in the bedrooms of service users were slightly broken. These were later repaired as shown by the list refurbishment plan. Some units of the home seemed to be cleaner than others. The inspector noted that the carpet in some areas of the Merlin unit was dirty/stained. There were some food spillages on the wall in the lounge of the Merlin unit near the kitchenette. Washing bowls in some of the rooms were dirty with lime scale and white residue. These must be cleaned thoroughly after use. There was also some lime scale on the work surfaces of the kitchenettes of the Merlin unit. The inspectors also noted that some of the bed frames were covered with dust. As a result of the above the registered person must ensure a high level of cleanliness in all areas of the home. There was evidence that the home had arranged training in infection control for staff, however training records show that 26 out of 70 members of staff have not had training in that area. The registered person must ensure that all care staff, staff working in the laundry and support staff have training in infection control. Knights Court Nursing Home G62-G11 S22931 Knights Court NH V231890 060605 Stage 4.doc Version 1.30 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30 The number of staff on duty did not always seem adequate to meet the needs of the service users. EVIDENCE: The home was fully staffed on the day of the inspection. There were some issues with regard to the numbers and skills of staff on the Merlin unit, which are described under the heading ‘Choice of Home (standard 4)’. The inspector noted that the home carries out a dependency analysis of the needs of service users. At present the monitoring of the dependencies of service users is not linked to changes in the staffing levels. It is recommended that the registered person consider the use of the dependency analysis tool as an instrument to the adjustment of staffing levels in the various units of the home as and when required. The home has a full complement of support staff. The home did not have a training plan available for inspection, but there was a programme of training that has been arranged for staff in the home. This and a training grid were later provided to the inspector. The inspector noted good progress with regard to ensuring that all staff receive statutory training. For example 64 out of 70 members of staff were up to date with regard to fire training. There were however some areas where more could be done. For example 17 out of 70 staff have not had manual handling training and 26 out of 70 have not had infection control training.6 of the 44 who have had infection control training have not had it in the past year. The inspector also noted that Food Hygiene training has been conducted by a senior member of staff Knights Court Nursing Home G62-G11 S22931 Knights Court NH V231890 060605 Stage 4.doc Version 1.30 Page 19 probably for 1-2 hours session. The Chartered Institute of Environmental Health (www.cieh.org.uk ) and the Royal Institute of Public Health (www.riph.prg.uk )recommend that all members of staff who handle food have at least the foundation/basic certificate in Food Hygiene, which is a one day course (at least 6 hours) and a widely recognised certificate. It is therefore recommended that all staff who handle food have at least the Foundation Certificate in Food Hygiene and that the short courses are used for updates by an accredited trainer. It is also required that the registered person ensures that all staff have all the statutory training as necessary, including infection control. The manager stated that a number of staff were studying for the NVQ level 2 or above and that the home would be close to having at least 50 of its care staff trained to at least NVQ level the end of 2005. Knights Court Nursing Home G62-G11 S22931 Knights Court NH V231890 060605 Stage 4.doc Version 1.30 Page 20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 36 and 38 The home is well managed and appropriately run to ensure that the home meet the needs of service users. The home ensures the health and safety of service users, staff and visitors to the home. EVIDENCE: At the time of the inspection, Wendy McDonough was managing the home. She has been managing the home for a number of years but became a regional manager at the end of last year/beginning of this year. A new manager was appointed for the home but she left after a short while. Wendy McDonough has since been managing the home, while the company restarted recruiting for a new manager. The inspector has been informed that a new manager has since been appointed for the home. The manager stated that the home has just had an ISO 9002 accreditation visit as part of maintaining its accreditation to this quality system. A copy of a Knights Court Nursing Home G62-G11 S22931 Knights Court NH V231890 060605 Stage 4.doc Version 1.30 Page 21 recent satisfaction survey was also sent to the inspector. This showed that the home is committed to ensuring that it provides a quality service. The manager stated that supervision of care staff is a weak area, which needed to be consolidated. She added that this was an area that she was addressing. As a result the requirement with regard to ensuring that supervision of all care staff takes place at least every two months or six times yearly remains to be met. As was noted during the last inspection, changes in management can cause some destabilisation in the home in relation to confidence and moral of staff, of service users and of their representatives. It is recommended that the registered person consider ways of making the change as smoothly as possible to ensure that moral and confidence remains high in the home. The training grid provided to the inspector after the inspection showed that statutory training in areas such as manual handling, infection control, food hygiene and health and safety (see standard 30) were not always provided for members of staff. Health and safety records for the home were generally appropriate for the home and the management of the home has in the past been proactive with regard to keeping all maintenance work up to date and with regard to risk assessments. Standard 38 has been assessed as almost met, because not all staff have had the statutory training with regard to health and safety. Knights Court Nursing Home G62-G11 S22931 Knights Court NH V231890 060605 Stage 4.doc Version 1.30 Page 22 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 3 3 x x x 2 x 2 STAFFING Standard No Score 27 2 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 x 3 x x 2 x 2 Knights Court Nursing Home G62-G11 S22931 Knights Court NH V231890 060605 Stage 4.doc Version 1.30 Page 23 No Are there any outstanding requirements from the last inspection? 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 that the assessments of the needs (including the mental health needs) of service users are comprehensive. (Previous requirement- timescale 15/5/5 not met) The registered person must review the numbers, skills and experience of care staff on the units to ensure that all the needs of service users are being met in an individualised manner. The registered person must ensure that care plans are drawn to address all the needs of service users, where these have been identified. Once a care plan is in place, staff must follow the care plan. The registered person must ensure that service users/representatives are involved in formulating and reviewing care plans and that a note is made if that is not possible. All wounds must be covered by a dressing as far as possible, unless there has been specific instructions to leave the wound Timescale for action 31/8/5 2. OP4 and OP27 18(1)(a) 15/8/5 3. OP7 15(1) 15/8/5 4. OP7 15(1,2) 30/9/5 5. OP8 12(1) 15/8/5 Knights Court Nursing Home G62-G11 S22931 Knights Court NH V231890 060605 Stage 4.doc Version 1.30 Page 24 uncovered. 6. OP8 12(1) The registered person must ensure that accurate records are kept about the monitoring of service users behaviour in cases where the service user is exhibiting changes in behaviour or inappropriate behaviour. The registered person must ensure that service users are dressed appropriately at all times. The registered person must ensure that care plans contain comprehensive information about the arrangement and instructions of service users/representatives with regard to death and funeral arrangements. There must be a comprehensive assessment of the social and recreational needs of service user and a care plan must be in place in cases where particular needs have been identified. The registered person must ensure that the meals are only placed in front of service users who need to be fed, when staff are ready to feed them to prevent the meals from getting cold. The registered person must ensure that training on abuse is addressed in the training programme particularly for new staff and for updating staff who already have had training in this area. The registered person must ensure that all furniture provided in the bedrooms of service users are in good order and appropriate at all times (Please see 2rd paragraph on page 17) The registered person must 15/8/5 7. OP10 12(1) 15/8/5 8. OP11 15(1,2) 31/8/5 9. OP12 16(2) (m,n) 31/8/5 10. OP15 16(2)(j) 31/7/5 11. OP18 13(6) 30/9/5 12. OP24 16(2)(c) 31/8/5 13. OP26 23(2)(d) 15/8/5 Page 25 Knights Court Nursing Home G62-G11 S22931 Knights Court NH V231890 060605 Stage 4.doc Version 1.30 14. OP26 13(3,4) 15. OP30 18(1)(c) 16. OP30 18(1)(c) 17. OP36 18(2) ensure a high level of cleanliness in all areas of the home to include the washing bowls, the carpet, the bed frames and the kitchenettes. The registered person must ensure that all care staff, staff working in the laundry and support staff have training in infection control. It is required that the registered person ensures that all staff have all the statutory training as necessary. The home must have a training and development plan to reflect on the individual training profiles of each member of staff. The registered person must ensure that staff have supervision at least every two months or at least six times a year. 31/8/5 31/10/5 30/9/5 30/9/5 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 OP19 Good Practice Recommendations To ensure a high quality environment for service users at all times, it is recommended that the home has a refurbishment plan to ensure a systematic and planned approach to the renewal/replacement of fixtures, fittings and furniture in the home, taking into consideration the life cycle of these, rather than approaching this subject on an as required basis. It is recommended that all staff who handle food have at least the Foundation Certificate in Food Hygiene and that the short courses are used for updates by an accredited trainer. It is recommended that the registered person consider ways of making changes in management as smoothly as possible to ensure that moral and confidence of service users, of their relatives and of staff, remain high. G62-G11 S22931 Knights Court NH V231890 060605 Stage 4.doc Version 1.30 Page 26 2. OP30 3. OP31 Knights Court Nursing Home Knights Court Nursing Home G62-G11 S22931 Knights Court NH V231890 060605 Stage 4.doc Version 1.30 Page 27 Commission for Social Care Inspection 4th Floor, Aspect Gate 166 College Road Harrow, Middlesex 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 G62-G11 S22931 Knights Court NH V231890 060605 Stage 4.doc Version 1.30 Page 28 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!