Inspection on 13/08/07 for Knights Luxury Retirement Home

This inspection was carried out on 13th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 Luxury Retirement Home 22/07/08

Knights Luxury Retirement Home 16/10/06

Knights Luxury Retirement Home 17/01/06

Knights Luxury Retirement Home 06/07/05

Knights Luxury Retirement Home 30/09/04

Knights Luxury Retirement Home 11/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Knights Luxury Retirement Home 365/367 Clifton Drive North St Annes On Sea Lancashire FY8 2PA Lead Inspector Denise Upton Unannounced Inspection 13th August 2007 09:20 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 Luxury Retirement Home DS0000009758.V343194.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 Luxury Retirement Home DS0000009758.V343194.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Knights Luxury Retirement Home Address 365/367 Clifton Drive North St Annes On Sea Lancashire FY8 2PA 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) 01253 720421 01253 782037 knights@arc-homes.co.uk Aegis Residential Care Homes Limited Jean Kilburn Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places Knights Luxury Retirement Home DS0000009758.V343194.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 31 service users to Include:*Up to 31 service users in the category of Op (Old age not falling within any other category). 16th October 2006 Date of last inspection Brief Description of the Service: The Knights Retirement Home is one of a number of homes owned and operated by Aegis Residential Care Homes Limited. The home is registered to accommodate up to 31 older people who do not require nursing care. The Home is a none smoking establishment that is clearly identified in the written information provided to residents and prospective residents. The Knights Retirement Home is a detached property located on a main thoroughfare of St Annes and conveniently situated in close proximity to the main shopping centre, community facilities and resources and the promenade. Communal areas of the home are very comfortably furnished and allow for activities to be undertaken in one area while providing a quiet area for those who do not wish to participate. The majority of residents are accommodated in single bedroom en-suite accommodation except for individuals who have made a positive choice to share twin accommodation. There is a passenger lift to access all areas of the internal environment and a ramped access to the front of the building. Although the home does not provide garden areas, there is a public park in close proximity that residents can access with ease and a patio area to the front of the property that is provided with seating to enable people living at the home to sit out in the summer months. Knights Luxury Retirement Home DS0000009758.V343194.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit to the home took place over a midweek day and in total spanned a period of almost nine hours. All of the key national minimum standards were assessed along with a reassessment of the recommendations made at the last inspection. At the time of the site visit, there were twentynine people in residence at the Knights Care Home. Discussion took place with the registered manager, chef, a senior carer, a care assistant and the administrator. In addition, individual discussion took place with three people living at the home. These people gave a good overview of their experiences of living at The Knights. A period of time was also spent speaking informally with a number of other residents in a communal area of the home. A number of records were examined and a partial tour of the building took place. Prior to the inspection, four people living at the home completed the Commission For Social Care Inspection survey forms. Survey forms were also received from two relatives/carers. This provided further information on how people using the service and their relatives/carers felt that The Knights Care Home was meeting the needs and requirements of people who lived there. The majority of comments made were very positive with a few constructive criticisms. Limited information was also gained from the Annual Quality Assurance Assessment completed by the registered manager. The total key inspection process focused on the outcomes for people living at the home and involved gathering information about the service from a wide range of sources over a period of time. The current scale of charges at The Knights Care Home range from £332.00 to £598.00 per week. What the service does well: There is a good system in place to make sure that new staff are properly recruited and vetted before being offered employment at the home. This helps to protect residents living at The Knights Care Home. Residents spoken were very pleased with the quality and variety of the meals served. Residents’ help to plan what they would like to be included on the Knights Luxury Retirement Home DS0000009758.V343194.R01.S.doc Version 5.2 Page 6 menu and staff were seen to be sensitive and helpful when somebody needed help during the course of the midday meal observed. A varied programme of monthly activities is arranged that residents enjoy. Family and friends are always made welcome and people living at the home are encouraged to enjoy local community activities either independently or with the support of staff. The knights Care Home is very well maintained and provides a comfortable, attractive and welcoming place to live. All individual bedrooms offer an ensuite facility and people living at the home were all very pleased with their personal bedroom accommodation and communal areas of the home. What has improved since the last inspection? What they could do better: The manager and staff at The Knights Care Home continue to work hard to make sure that the needs of people living at the home are well met and residents feel comfortable living there. However there are a number of things identified at the previous inspection and this inspection that could be improved. Pre admission assessments that take place prior to a new resident being admitted could be more detailed. The assessment form should clearly show what the person’s current individual needs and requirements are and whether the home could meet them. Written information is not always detailed enough to be clear about this. Since the last inspection there has been some improvement to the information provided on individual plans of care. However this is an area that still required Knights Luxury Retirement Home DS0000009758.V343194.R01.S.doc Version 5.2 Page 7 further development to ensure that staff are provided with clear directions to ensure a consistent service is provided. This does not however detract from the good quality of care provided at The Knights Care Home on a day-to-day basis. Formal supervision that all care staff should receive at least six times a year has not been taking place as regularly as it should. This helps to support staff and monitor what they do and their understanding. It is understood that some infrequent group supervision and ‘ad-hoc’ staff supervision does also take place but this is not recorded. It has been recommended that all supervision be formally recorded and that formal one to one supervision takes place more frequently. Staff spoken with were however very clear about the work that they do and how they should do it. 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 Luxury Retirement Home DS0000009758.V343194.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Knights Luxury Retirement Home DS0000009758.V343194.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. The written pre admission assessment information to identify what the prospective resident can do well and what help may be required should be holistic in content and sufficiently detailed to clearly identify if the home could meet current needs and requirements. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents are only admitted to the home if their current, individual needs and requirements can be met. It is routine policy at The Knights that all prospective residents are visited in their current environment by the registered manager in order to undertake an initial assessment of current strengths and needs and to provide further information in respect of the home and facilities and services provided. Knights Luxury Retirement Home DS0000009758.V343194.R01.S.doc Version 5.2 Page 10 This is coupled with an invitation for the prospective resident and/or their family to undertake an introductory visit to the home to assess the accommodation for themselves, meet staff and existing residents in order to make informed choice about living at the home. The pre admission assessment carried out by the registered manager, is in some instances, further supplemented by information made available from professional assessments undertaken by Care Managers or through hospital discharge information. This combined information is then collated and provides a basis for the initial care plan. One of the resident’s spoken with individually, confirmed that this process had been undertaken in respect of her admission to The Knights Care Home and confirmed that sufficient written information had been provided to enable her to have some idea of what to expect. The same resident also stated that, “the carers are very good”. Although there is no suggestion that the needs and requirements of newly admitted people are not been met, the written information recorded during the pre admission assessment is currently limited and should be more detailed. The written information from the pre admission assessment process should be holistic in content and sufficiently detailed to clearly identify if current strengths, needs and requirements could be fully met by the home. Knights Luxury Retirement Home DS0000009758.V343194.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. There is a routine care planning system in place. However care plans do not necessarily provide sufficient detail or give specific guidance to staff in order for them to provide a consistent service. The health care needs of people using the service are well met with evidence of good multi disciplinary working taking place on a regular basis. The medication in this home is well managed promoting good health. Personal support is provided in such a way as to promote and protect the privacy, dignity and independence of residents. This judgement has been made using available evidence including a visit to this service. Knights Luxury Retirement Home DS0000009758.V343194.R01.S.doc Version 5.2 Page 12 EVIDENCE: Whilst some improvement was noted regarding the development of care plans, this is an area that still requires further attention. All care plans should be sufficiently detailed to provide staff with clear directions as to the actions required in order to fulfil an identified objective. For example, one care plan observed stated that the resident was “a nice lady, worries about things very easily”. However there was nothing to tell staff what strategies should be used to reassure this lady when she was worried. Another comment was “ encourage (resident) to do more things for herself”, but again nothing was written to advise staff as to what was to be encouraged or how the resident was to be encouraged. This could easily lead to staff providing an inconsistent service. Some staff could interpret the information to mean one thing and other staff something else. Some of the information written was also inconsistent. In the ‘Eating and Drinking’ section of one care plan was written “ (resident) is independent in this area” but then went on to say, “(resident) needs food cut up as has difficulty with having a stroke”. Another care plan observed gave similar conflicting information. For example, in one section was recorded that “normally goes to bed around 10.00pm” However in a different section on the same page was written, “normally goes to bed around 9.00pm. It was difficult to establish from the written care plan whether any of the entries were the result of an amendment to the original care plan. There was no evidence of a formal monthly review system in place that reviewed each element of the care plan and individual risk assessments in place. The individual resident, wherever possible, should be invited to the formal review of their strengths and needs in order to give opportunity to express their views and opinions. It is understood from the registered manager that the key worker notes were considered to be the formal review, however these were minimal in content and very similar to the brief, daily diary record rather than providing clear evidence of a full review of the plan of care. Risk assessments evidenced were often lacking in detail and not always personalised to the individual. Two risk assessments observed in respect of bed sides for individual residents were pre populated with typed information about the risks that may be evident in the physical environment but nothing about any possible risk to the specific individual if the bed rails were in place. Nothing had been written to explain why bed rails may have been appropriate or any information of any other strategies that may have been considered. Knights Luxury Retirement Home DS0000009758.V343194.R01.S.doc Version 5.2 Page 13 Another risk assessment in respect of ‘bathing activities risk assessment’ stated that the risk was ‘high’ but nothing was recorded about the actual resident or how the outcome had been determined as ‘high’. It is essential that a formal risk assessment be undertaken when ever a risk is identified. All risk assessments should be personalised to the individual resident with outcomes clearly incorporated in the individual care plan. It was also noted that not all entries in the care plans had been signed and dated by the person completing the record. It is important that who ever makes a record in the care plan signs and dates their contribution in order to take ownership of the recording. Likewise, residents should always have their care plan explained to them and invited to sign their individual care plan as acknowledgement and acceptance of the content. In instances where the resident does not have capacity or understanding to sign the document or does not wish to become involved, with the resident’s permission, a family member could be approached and invited to sign the document or alternatively a reason should be given as to why the care plan had not been signed. As previously stated, there has been some improvement to the actual content included in the care plan and the registered manager has now introduced a monthly care plan audit. This has enabled an evaluation to take place to ensure staff complete all elements of the care plan. Unfortunately this is not necessarily in sufficient detail. It is essential that care plans are easy to read, up to date, comprehensive and clearly identify exact requirements, wants and wishes. The current documents used to record care planning appear complicated and cumbersome and do not easily lend themselves to developing a good quality care plan suitable for the needs of a care home. Never the less it was clearly evident that resident’s individual needs are being addressed very well in practice. Staff spoken with were very familiar with the preferences and wishes of each resident and residents spoken with were very pleased with the quality of care provided. Through discussion with residents and staff and observation of documentation, it was clear that resident’s health care needs are fully met. There is a good relationship with health and social care professionals in order to maintain health and social well-being. Comments on the Commission for Social Care Inspection, survey forms also confirmed that residents felt that they receive the medical support that they needed when they needed it. The home has good systems in place for the administration and recording of medication. Medication administration records observed were accurate and well maintained. Medication administered by staff, is stored in a locked medication Knights Luxury Retirement Home DS0000009758.V343194.R01.S.doc Version 5.2 Page 14 trolley that is secured to the wall. All residents who wish to are enabled to selfadminister their own prescribed medication following the outcome of a specific risk assessment to ensure that the individual is competent to do so. A locked facility is provided in individual bedroom accommodation for the safe storage of medication. All staff with responsibility for medication administration have received medication training and are expected to adhere to the company’s procedures for the receipt, recording, storage, handling, administration and disposal of medication to ensure the safe administration and recording of medication. There is also a good system in place to ensure that a corporate monthly medication audit takes place. Evidence was available that the recommendations of the most recent medication audit had been put into practice. Residents spoken with were very clear that they felt that their privacy and dignity was well respected while living at The Knights Care Home and that “staff are very good”. Policies and procedures in respect of privacy and dignity are available to guide staff to make sure that these values are not compromised. All staff receive training in respect of maintaining privacy and dignity during induction training, National Vocational Qualification (NVQ) training and through formal and informal supervision. A number of staff have also completed a three-month ‘Equality and Diversity’ training course that also incorporated issues of privacy and dignity and how these should be maintained. Knights Luxury Retirement Home DS0000009758.V343194.R01.S.doc Version 5.2 Page 15 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, 13, 14 & 15 Quality in this outcome area is good. A variety of monthly social activities are arranged to enable users of the service to enjoy social interaction and stimulation. People who live at the home are encouraged to maintain contact with the local community and their family and friends to ensure these relationships are sustained. Dietary needs of people who live at the home are well catered for with a balanced and varied selection of food available that meets individual taste and choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Several residents spoken with confirmed they are able to exercise choice in all aspects of their daily life and choose to do what they want to do. As observed at the time of the visit, social relationships are encouraged either through Knights Luxury Retirement Home DS0000009758.V343194.R01.S.doc Version 5.2 Page 16 family/friends visiting at a time of the resident’s choice or social stimulation in the wider community either independently or accompanied by relatives/friends. . It was clearly evident that people who live at the home can entertain visitors of their choice at a time to suit them either in a communal area of the home or individual bedroom accommodation. A friend of a resident was visiting and explained that he visited the home on a very regular basis and was always made welcome. A programme of monthly ‘in-house’ activities is arranged that this month has included a cream tea, tea party, scrabble afternoon, hair make over, tai chi, and a manicurist. In addition, a number of residents enjoy independent outings in the local community either individually or with friends. There is also a monthly newsletter published that includes comments from the Managing Director and Care Manager’s, contributions from residents, birthdays and celebrations, comings and goings of residents, a quiz, the monthly activities schedule and any other topics of interest. With regard to resident’s birthdays, one relative commented on a Commission for Social Care Inspection survey form that “ When ** celebrated her 100th birthday the home were excellent on all counts – obviously the publicity was good for the home but for ** it was a most magical time”. The registered manager explained that a designated activities coordinator had just been appointed. Once this person has taken up post and is actually working at the home, it is intended that a further range of activities will be introduced to supplement the existing monthly events. The new activities will be designed around the interests of people living at the home and kept flexible in response to what people would like to do at any given time. There is also regular communal worship that takes place in the home for residents who would like to attend. People living at the home are encouraged to maintain control of their own financial affairs for as long as they wished to be or assisted in this task by their family or advocate. Information regarding the local advocacy service is made freely available in communal areas of the home to enable residents and relatives to access independently if they so wish. From observation when speaking with a number of resident’s in their individual bedroom accommodation, it was clearly evident that residents are encouraged to bring some of their own possessions with them into the home to make their individual bedroom feel more homely and comfortable. As at previous inspections, residents spoken with were very complementary about the quality and variety of meals served at The Knights. This was also confirmed by the comments made on the Commission for Social Care Knights Luxury Retirement Home DS0000009758.V343194.R01.S.doc Version 5.2 Page 17 Inspection survey forms returned. A relative had written, “The Knights provides a warm and friendly environment. Aunty * enjoys the food mostly and the companionship”. A varied and well-balanced menu is provided that is designed round the likes and dislikes of people living at the home. From observation of the resident forum minutes, food and meals served are a regular feature for discussion. Suggestions from residents for inclusion of different meals on the menu have been incorporated. A new chef has recently been appointed who is currently updating and expanding the wide range of foods offered. Fresh fruit and vegetables are served on a daily basis and specialist diets in respect of religious, medical or cultural needs and requirements can be accommodated. During the course of the visit, the mid day meal was observed. Residents were comfortable, unhurried and clearly enjoying the meal served. The food was well cooked and well presented and staff were seen to be sensitive, encouraging and discrete when offering assistance. Knights Luxury Retirement Home DS0000009758.V343194.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. The Knights Care Home has a satisfactory complaints system with evidence that residents feel their views are listened to and acted upon. Staff have received training in respect of adult protection issues that helps protect people living at the home from potential abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Knights Care Home has a corporate complaint policy and procedure. There was clear evidence that any complaint/concern raised is taken seriously. A small number of mostly very minor complaints have been made since the last inspection. Each complaint/concern was investigated with a written record maintained of the complaint/concern, how this was investigated and the outcome of the investigation. The person making the complaint/concern had been informed of the findings. The relationship observed between staff and residents is relaxed and friendly and residents spoken with all stated they would have no hesitation in raising any concern or complaint directly with the registered manager. Knights Luxury Retirement Home DS0000009758.V343194.R01.S.doc Version 5.2 Page 19 The home also has a policy in place, which contains robust procedures for responding to an allegation of abuse. Since the last inspection an issue was raised under the adult abuse procedures regarding a resident who was living at the home. This issue has yet to be concluded. The management team at the home have however fully co-operated in the investigation and it is hoped that this matter will come to close in the near future. All staff undertake mandatory adult abuse training. Discussion with a member of the care staff team confirmed that she was aware of what to do if a complaint was made to her or if there was an allegation of abuse. Knights Luxury Retirement Home DS0000009758.V343194.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is excellent. The standard of the environment within this home is very good and provides residents with an attractive, homely and well-maintained place to live This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents at The Knights Care Home continue to live in very comfortable, well maintained and homely accommodation. The layout of the home provides residents with opportunity to move freely round the building and access all areas with ease. Bedrooms are all provided with an en-suite facility and are comfortably furnished and personalised to reflect the needs and wishes of the occupant. Residents have a choice of the colour and style of their individual bedroom and residents are encouraged to take into the home personal items of furniture that is agreed prior to admission. Communal space is spacious and Knights Luxury Retirement Home DS0000009758.V343194.R01.S.doc Version 5.2 Page 21 welcoming consisting of a large combined lounge/dining room and a second lounge. There is a passenger lift for ease of access throughout the building. The home is conveniently situated on a main thoroughfare, close to the town centre and local community resources and facilities. There is a raised patio area to the front of the home that is provided with seating that residents can enjoy in the summer months and a ramped access facility for those who have restricted mobility. There is also a small conservatory/entrance area where residents frequently enjoy sitting and watching the world go by. The Knights is a none smoking home and residents and prospective residents are provided with this information by way of the written information provided and verbal discussion. People spoken with were all pleased with the communal accommodation provided and their personal space. As recommended at the last inspection, attention has now been given to the laundry to make sure that this area is well maintained and easily cleanable. The laundry is situated in the basement area of the home and does not intrude on residents accommodated. The home remains clean, pleasant and hygienic with a variety of policies and procedures to advise staff in the control of infection. As identified in the Annual Quality Assurance Assessment completed by the registered manager, eleven members of staff have received infection control training. However all relevant staff should receive this important training. It is understood that steps are being taken to address this issue. There is an on-going maintenance and renewal programme with records kept. The Knights Care Home complies with the requirements of the Environmental Health Department and Fire Service. Fire alarm tests and fire drills are conducted on regular basis Since the last inspection, further bedrooms have been refurbished to a high standard and now only a small minority of bedrooms are yet to be refurbished. New dining tables have been purchased and also new curtains to the large lounge/dining room. It is understood that some new ski chairs have been ordered and that the kitchen area is to be repainted in the near future. As identified at the last inspection, a number of individual bedroom doors have not as yet been provided with an appropriate lock to ensure privacy for the occupant. It is understood that residents were asked if they would like a lock on their bedroom door and the majority declined. Never the less there is an expectation that all bedroom doors in resident accommodation be routinely provided with a suitable lock. It is recommended that when a bedroom becomes vacant, a suitable lock be fitted before a new resident occupies the room. In instances when a lock may not be appropriate, this should be determined through the outcome of a formal risk assessment and reviewed on a regular basis. Knights Luxury Retirement Home DS0000009758.V343194.R01.S.doc Version 5.2 Page 22 The vast majority of radiators in resident accommodation have either a low temperature surface or are fitted with a radiator guard. However a small minority of residents have refused to have a radiator guard fitted in their bedroom accommodation. In these instances formal risk assessments are in place to ensure as far as possible that any risk is minimised. Knights Luxury Retirement Home DS0000009758.V343194.R01.S.doc Version 5.2 Page 23 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 & 30 Quality in this outcome area is good. There is a good mix of staff offering consistency of care within the home. The arrangements for the induction and more advanced National Vocational Qualification (NVQ) training in care are good with staff demonstrating a clear understanding of their roles. Induction training is compliant with ‘Skills For Care’ induction training standards and provided to newly appointed care staff within the first six weeks of employment. There is a structured process for the recruitment of staff that includes obtaining satisfactory references and clearances in order to protect people living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a good skills mix of staff at The Knights Care Home with staffing levels determined in accordance with the individually assessed needs of residents accommodated. Additional staff are on duty at peak times of activity and there are sufficient ‘waking watch’ night staff employed to ensure that the needs of Knights Luxury Retirement Home DS0000009758.V343194.R01.S.doc Version 5.2 Page 24 residents are met. There is also sufficient ancillary staff employed to ensure standards in respect of domestic and catering are maintained. At the time of inspection three new members of the care staff team had very recently been appointed and were waiting for full Criminal Records Bureau clearances to be received before actually taking up post. In addition, a designated part time activity co-ordinator had been appointed who was again waiting to take up post at the home. The registered manager explained that once these people were in post she felt confident that staffing levels would be sufficient to ensure that a high quality service would be consistently maintained. Consideration is also being given to creating a new management, head of care post. Whilst the majority of people spoken with were very positive in their comments regarding the staff group and the level of care and support provided, one resident did write on a Commission for Social Care Inspection survey form that “I wish the staff did not appear to be so busy- it often prevents me from asking for help”. With the additional members of staff about to take up post, this should help to alleviate this person’s feelings about staff and encourage her to always ask when assistance is needed. Since the last inspection further members of the care staff team have achieved a nationally recognised qualification in care. At present 50 of the care staff team have now achieved this qualification. Whilst this fulfils the minimum recommendation for the number of care staff who should have achieved this award, it is understood that a further number of staff will have achieved this qualification in the near future. In addition, a number of none care staff have undertake an NVQ qualification in business and administration and domestic care. The staff group also undertake a variety of other ‘short course’ training opportunities relevant to their role. Recent staff training has included diabetes training and incontinence training. In addition, further staff training is planned that includes dementia care, customer care and tissue viability awareness training from the District Nursing team. The Knights Care Home has in place a structured, corporate recruitment policy and procedure that helps protect residents. Since the last inspection, some new members of staff have been appointed. From observation of two recently appointed staff member’s personnel file, it was evident that the recruitment policy and procedures had been followed. This included an application form, health questionnaire, formal interview, references and a Criminal Records Bureau (CRB) clearance had been obtained prior to the applicant actually taking up post at the home. Knights Luxury Retirement Home DS0000009758.V343194.R01.S.doc Version 5.2 Page 25 A newly appointed member of staff confirmed that these procedures had been followed and she was not allowed to take up post at the home until satisfactory references and a CRB (POVA) clearance had been received. The same recently appointed member of staff also confirmed that she had received ‘Skills for Care’ nationally recognised induction training standards when she commenced working at the home and had been asked about her willingness to undertake a National Vocational Qualification training course in care. The interaction observed between staff and those living at the home was warm, friendly and comfortable which helped to make residents feel happy, safe and secure. There was a good rapport between residents and staff that helps to create a supportive and caring environment. Knights Luxury Retirement Home DS0000009758.V343194.R01.S.doc Version 5.2 Page 26 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 36 & 38 Quality in this outcome area is good. The manager is qualified, experienced and supported by the senior staff in providing clear leadership throughout the home. The home regularly reviews aspects of its performance through a good programme of self-review and consultations, which include seeking the views of residents, staff and other stakeholders. Financial procedures in respect of residents’ monies and the safekeeping of valuables are robust to protect the interests of people accommodated. Formal one to one staff supervision should taken place at least six times a year. This would provide opportunity for individual discussion including practice issues, career development needs and the values of the home. Systems are in place to ensure as far as possible the health and safety of people living at the home, staff and visitors. Knights Luxury Retirement Home DS0000009758.V343194.R01.S.doc Version 5.2 Page 27 This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager at The Knights Care Home is experienced and well qualified in managing a care home for older people. The registered manager has achieved an NVQ Level 4 qualification in care and management, the Registered Managers award, BTEC introduction to management qualification and has completed a wide variety of other courses relevant to the care of older people. In the main staff spoke positively about the registered manager and felt well supported. However one person did say that they would be pleased when the registered manager’s office was relocated to the ground floor area as this would enable the registered manager to provide more immediate ‘back up’ when addressing issues with staff. Effective quality monitoring and quality assurance systems are in place and the home has achieved the ‘Investors In People’ award. The home regularly reviews aspects of its performance through a good programme of self-review and consultation. This includes resident feedback questionnaires to elicit the views of residents accommodated and other interested parties such as relatives. At present there is no formal system for eliciting the views of professional staff who visit the home however views are sought through informal discussion. It is suggested that this is an area that could be developed further to help inform the internal quality audit. Resident surveys are sent out corporately direct to the individual resident. Once completed the individual surveys are sent direct to the company’s head office where the information is collated. The registered manager at The Knights is then asked to address any issues raised in the surveys before submitting any proposals back to head office for approval. The outcome of the surveys is then provided to all individuals who completed the questionnaire. In addition there is a monthly newsletter and regular residents forums that take place every 6-8 weeks. This also provides an opportunity for residents to have their say about living at the home and influence change. To supplement the formal process, informal processes are in place that includes daily dialogue between staff and residents. The Knights Care Home ensures safe working practices are maintained through observing policies and procedures and staff training in respect of health and safety issues. Knights Luxury Retirement Home DS0000009758.V343194.R01.S.doc Version 5.2 Page 28 All members of the staff team receive mandatory health and safety training covering a variety of topics appropriate to their role. Environmental risk assessments are in place. There are clear lines of accountability within the home and external management. Resident’s financial interests continue to be safeguarded by the financial procedures adopted by the home. People living at The Knights are, wherever possible, encouraged to remain financially independent or assisted in this task by a family member or independent advocate. When the home does retain any monies or valuables in respect of a resident, this is appropriately recorded and secure facilities are provided for the safe keeping of monies and valuables held on behalf of the individual. The company also undertake a six weekly financial audit in order to protect residents with monies or valuables held in safekeeping. Whenever a resident is unable to sign the record of their personal expenditure a second member of staff signs the document to confirm the transaction is accurately recorded. Since the last inspection, formal documented staff supervision has taken place less frequently than before. When planned one to one formal staff supervision does take place the person to be supervised is provided with a supervision form to complete prior to the meeting. These were evidenced. However the registered manager explained that in addition to formal supervision, ‘ad hoc’ supervision and group supervision also takes place but this is not recorded. Individual annual staff appraisal does take place and all staff are informally supervised as part of the day-to-day management role. It is important that all supervision be recorded. When occasional group supervision does take place, the record of this supervision should be placed on each individual member of staff’s personal file who attended the group supervision. The registered manager explained that formal one to one staff supervision will be reintroduced to take place at least six times a year that will cover at minimum all aspects of practice, philosophy of care in the home and career development needs. The Knights Care Home ensures safe working practices are maintained through observing the policies and procedures of the home and staff training in respect of health and safety issues. All members of the staff team receive mandatory health and safety training covering a variety of topics appropriate to their role. At present further refresher health and safety training is being undertaken that consists of a training pack and workbook that staff need to complete. Only by reading and understanding the written material provided can the workbook be completed. Recently appointed members of staff are also undertaking this training. By the Knights Luxury Retirement Home DS0000009758.V343194.R01.S.doc Version 5.2 Page 29 end of this process all staff will have received up to date mandatory training including manual handling training, fire safety, food hygiene, health and safety, adult protection, first aid, and infection control training. Maintenance records were available to confirm that various routine health and safety checks are maintained on a regular basis to the internal and external environment of the home. It was also noted that equipment is regularly serviced. In addition, risk assessments are available in respect of fire, health and safety issues that are regularly reviewed. Knights Luxury Retirement Home DS0000009758.V343194.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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 2 X 3 Knights Luxury Retirement Home DS0000009758.V343194.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action 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 OP3 Good Practice Recommendations The pre admission assessment document should be more detailed to provide a holistic account of current strengths and needs and evidence that The knights can meet requirements. Service user care plans should be further developed to provide staff with a detailed account of all strengths, needs, wants and wishes and the action needed to fulfil these requirements. Risk assessments should be personalised to the individual with significant outcomes incorporated in the care plan. All care plans/risk assessments should be routinely reviewed on at least a monthly basis. All individual bedroom accommodation should be provided with an appropriate locking mechanism to protect the privacy of the individual. If a bedroom becomes vacant DS0000009758.V343194.R01.S.doc Version 5.2 Page 32 2. OP7 3 OP24 Knights Luxury Retirement Home that does not have a lock provided, a lock should be fitted before a new person occupies the room. 4. 5 OP33 OP36 Consideration could be given to developing a questionnaire for visiting professional staff to supplement the informal system already in place. Formal one to one staff supervision should take place at least six times a year. All group supervision and ‘ad-hoc’ supervision should be recorded. Knights Luxury Retirement Home DS0000009758.V343194.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Knights Luxury Retirement Home DS0000009758.V343194.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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