Inspection on 22/07/08 for Knights Luxury Retirement Home

This inspection was carried out on 22nd July 2008.

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

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 13/08/07

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 08/11/2008.

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 22nd July 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Knights Luxury Retirement Home DS0000009758.V365445.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.V365445.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 Ltd Vacant 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.V365445.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). 13/08/07 Date of last inspection Brief Description of the Service: The Knights Retirement Home is owned by Pearlcare but operates under the previous company name of 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 non-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.V365445.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection took place during the course of one day and looked at all the key National Minimum Standards plus supervision arrangements for staff. At the time of this inspection there were 22 people resident at the home, including two who were in hospital. At the time of the site visit the registered manager post was vacant. Therefore the head of care provided most of the information about the home and the systems in place. Discussions took place with the care manager, three members of staff and five people living at the home. A number of records and documentation were viewed and a partial tour of the building took place that included all communal areas of the home, laundry facilities, the medication storage area, and some random bedroom accommodation. Time was also spent observing staff and those living at the home as they engaged in daily dialogue. Commission for Social Care Inspection questionnaires inviting feedback about The Knights Care Home were received from eight people living at the home, seven relatives and five members of staff. The inspector ‘case tracked’ the care of a number of people living at the home during the site visit, but this was not to the exclusion of other residents. This key inspection focused on the outcomes for people living at the home. During the course of the site visit three residents were ‘case-tracked’. This means that the written records of these people were looked at in detail to make sure that the information recorded was detailed, up to date and relevant. The current scale of charges for residential care at The Knights Care Home range from £366.00 to £580:00 per week. Knights Luxury Retirement Home DS0000009758.V365445.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: There are a number of ways that the home could improve to make sure that residents receive a good quality service. Care plans that tell staff what the person can do for themselves and what help may be needed should be more detailed to advise staff. A formal risk assessment must be in place whenever a risk is identified. This helps to protect people living at the home and keep them safe. Knights Luxury Retirement Home DS0000009758.V365445.R01.S.doc Version 5.2 Page 7 The way medication is recorded and managed needs to be improved to make sure residents are safeguarded. All radiators in resident accommodation must be provided with a radiator guard to prevent the risk of accidental injury. All bedroom accommodation should be provided with an appropriate lock to ensure privacy for the occupant. 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.V365445.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.V365445.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. Standard 6 was not assessed as the Knights Care Home is not registered to accommodate people in the intermediate care category. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. 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. EVIDENCE: The knights Care Home has in place a formal admission procedure. A preadmission assessment of strengths and needs is undertaken by a senior member of staff that includes visiting the prospective resident in their own home or hospital, talking with relatives, and taking into account any recent health or social services assessments. This is to make sure that the home could meet the current needs and requirements of the prospective new resident. Knights Luxury Retirement Home DS0000009758.V365445.R01.S.doc Version 5.2 Page 10 However, the pre-admission assessment records seen were often not detailed or provided sufficient written information to confirm that the needs of the individual could be met. For example, in respect of one resident recently admitted, in the physical wellbeing section was written ‘good spirits’. It is difficult to understand how this related to physical well-being. In the personal care needs section was written ‘assistance of one carer’, but there was no indication of what one carer was required for. The pre-admission assessment document was often incomplete with minimal, if any, information recorded about social, religious or cultural care needs. In another instance, on the pre-admission assessment was written ‘not to go out of the home without an escort, could get lost. There was no indication of how this opinion had been formulated or who had reached this decision. It is essential that the pre-admission assessment document be completed in full prior to the prospective new resident being admitted to the home. Only when all the facts are known can a decision be taken as to whether The Knights Care Home could meet the individual needs and requirements of a particular person. Whilst the needs of recently admitted people to the home were, in the main, being met, there is a requirement that any person who has been assessed for possible admission to a care home must receive written information following the pre-admission assessment. This should confirm the outcome of the preadmission assessment and that the prospective resident’s current needs and requirements could be met at the home. This should be provided prior to admission. There was no evidence that this had occurred. Knights Luxury Retirement Home DS0000009758.V365445.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 adequate. This judgement has been made using available evidence, including a visit to this service. There is a routine care planning system in place. However, the care plans seen did not provide sufficient detail or guidance to staff in order for them to provide a holistic or consistent service. Promotion of health is taken seriously. The welfare of residents is closely monitored and health needs were met. The medication in this home is generally well managed, however there were some inconsistencies that could potentially be detrimental to residents’ health and welfare. Residents felt that staff respected their privacy and dignity, however this was not always evidenced. Arrangements for maintaining privacy and dignity could be improved. Knights Luxury Retirement Home DS0000009758.V365445.R01.S.doc Version 5.2 Page 12 EVIDENCE: Through case tracking and discussion with the head of care it was evident that each resident had a plan of care. The care plans of the three people ‘case tracked’ were viewed. Although the care document covered a range of needs and requirements it was difficult to establish just what was an assessment of long term needs and what was an actual care plan. In some instances, a photograph of the resident was not available, there was often little if anything written about social, religious or cultural needs, wants and wishes and nothing about current medication. On some occasions a risk had been identified but a formal risk assessment relating to that risk was not available. The outcomes of any formal risk assessments were not incorporated in the care plan but held separately in a folder. This meant the staff had to access not only the assessment/care plan but also the risk assessment folder in order to understand the specific strategies in place to minimise or eliminate risks for an individual. Formal risk assessments could not always be evidenced even when a risk had been identified. It was evident that one resident has dementia. This was clearly recorded. However, there was no risk assessment in place regarding the effects of the dementia. For example, it was evidenced from written information that this person can become agitated, there was no formal risk assessment in place regarding this matter. Nothing was written in the care plan about how this was to be managed or of the strategies to be adopted when agitation was evident. This does not provide staff with relevant information to ensure a consistent approach when assisting the resident. This same person has also exhibited some inappropriate behaviour, due to the effects of the dementia. Again, there was no risk assessment evident to identify what the risk was, how this was a risk and who it was a risk for. No strategies were formally in place for managing the risk. This person was also described as ‘wondersome’. There was no evidence that a formal risk assessment had taken place in respect of keeping this person safe. The care plan did not advise staff of how this issue was to be addressed. Care must also be taken to explain what staff meant when they complete a written record. A member of staff had used the term ‘getting nasty’ in a written recording about the behaviour of one resident. This term is meaningless unless the statement is qualified to clearly identify what was meant by ‘getting nasty’, what precipitated the event, what action was taken by the staff member at the time of the event and what action was taken as a result of the incident. Knights Luxury Retirement Home DS0000009758.V365445.R01.S.doc Version 5.2 Page 13 In respect of another resident admitted in May 2008, although obvious risks had been identified, the head of care confirmed that no specific risk assessments had been undertaken in respect of this person other than a routine moving and handling tick box risk assessment and a nutritional risk assessment. Both scored high but the outcomes were not incorporated in the actual care plan. The conclusion of the nutritional risk assessment indicated that the manager should seek dietetic advice. However, no evidence could be found on the care plan to establish if this had actually been done or what the outcome was. It is of particular concern that specific risk assessments other than the routine moving and handling and nutritional risk assessment had not been undertaken. It was recorded that this person cannot stand, has ‘highs and lows of depression’, often does not sleep in a bed at night and has potential to be socially isolated as she does not come out of her bedroom. As previously stated, whenever a risk is identified a formal risk assessment must be undertaken with significant outcomes incorporated in the actual care plan. Residents are at risk if staff do not have sufficient written information or guidance to assist people safely or to provide the level of holistic care required. There must be clear distinction about what is an assessment document and what is the actual care plan. The long-term assessment needs document in use is predominately an assessment tool rather than an actual care plan. Little guidance was given as to how an objective is to be achieved. This has clear potential for an inconsistent service to be provided with different carers interpreting how an aim is to be achieved. For example, on the pre-admission assessment of one resident, it was identified that this person enjoys walking as a hobby. In the long-term assessment document it says that this same person ‘use to enjoy boxing and walking’. There was nothing written to show what strategies are in place to ensure that this gentleman is enabled to pursue these interests, who has responsibility for enabling this person to enjoy these pursuits, what actual assistance is required by staff to ensure these interests are catered for, any identified risks regarding these interests and when actual assistance was provided for this gentleman to enjoy these activities. In another instance, it was recorded that one particular resident ‘cannot always communicate effectively because of dementia’. There was no direction for care staff to follow of how to respond to this or how staff could reassure this person. Knights Luxury Retirement Home DS0000009758.V365445.R01.S.doc Version 5.2 Page 14 In another instance, it was written in the daily dairy notes that this person had ‘low mood’, refusing meals’. Nothing was written in the care plan about this. Another daily diary recording, dated 24th January 2008, stated that a particular resident was ‘not washing or changing clothes, carers have been informed and --- will be monitored and assisted to wash and dress’. The care plan in respect of this person had not been updated. Staff were relying on written information in a daily record from seven months earlier to find out what the changed needs of this person were. The care plan was clearly out of date, inaccurate and did not provided staff with the detailed information they needed. In respect of another resident, bedsides were in situ. On this person’s assessment/long term care plan, was a policy in respect of bedsides, a family signed consent form for the provision of bedsides, a risk assessment dated 16th December 2007 but no evidence that this risk assessment had ever been reviewed. Residents were however, in the main, satisfied with the level of care and support provided. One person had written in answer to the question, “Do you receive the care and support you need’, “Team work of staff excellent”. However, a relative, while confirming that, “I believe the staff do the best they can” then went on to say, “On a personal level for my mother, making sure that her hands and mouth are checked and washed after every meal, as she is incapable of checking for herself”. The home could improve on this. This same person went on to say that the staff give support as far a possible but “I have had to keep asking for her to have her hair done (washed) on a number of occasions. Her eyes have become very sticky and she cannot attend to them herself. I have to bathe them myself on a number of occasions and asked them to be checked by the doctor”. As stated in the last inspection report there is no evidence of a formal review system in place to reassess the holistic needs and requirements of each individual resident. The key worker records were very similar in content and length to a daily diary entry, not always completed on a monthly basis and appeared to give a somewhat limited overview of what the resident had done over the past month. For example, one key worker record stated, “___ a bit agitated today wandering around the home, was asked to sit and relax and was happy to do so”. This is clearly not a holistic monthly review of each element of the care plan and risk assessments in place. Knights Luxury Retirement Home DS0000009758.V365445.R01.S.doc Version 5.2 Page 15 There must be a clear record of a monthly review system in place. This must show that each area of the care plan had been reassessed, the actual care plan updated as required and any risk assessments also reviewed as part of this process with changes identified in the care plan. Care staff require clear updated direction in order to provide a good standard of care. One carer spoken with commented that care plans were not always easy to follow. If any member of staff has difficulty in understanding the individual care plan, it will not be used as intended and become simply a paper exercise. The individual resident, wherever possible, should also be invited to the monthly formal review of their strengths and needs in order to give opportunity to express their views and opinions. It is again understood from the head of care that the key worker notes were considered to be the formal review. This is clearly insufficient and does not meet the requirements of the standard. It is disappointing that little attention has been given to this matter since the last inspection. The issues identified at this inspection with regard to care plans, risk assessments and a review system are very similar to issues raised at the last inspection. Priority should be given to addressing these matters in order to ensure residents are safeguarded and staff provided with sufficient information to provide a consistent and good quality service. It was evidenced through discussion with staff and residents and observation of a number of records the health needs of people living at the home are met. It is understood that there is a good relationship with health and social care professionals in order to maintain health and well-being. Residents who completed a Commission for Social Care Inspection (CSCI) survey confirmed that they felt well cared during periods of ill health and that medical assistance was sought when required. The Knights Care Home has an adequate policy and procedures for the receipt, recording, storage, handling, administration and disposal of medication. However, the actual way medication is managed should be improved. The head of care explained that a full medication audit is completed on a monthly basis and also that a partial medication audit is completed twice daily. It is also understood that all staff with responsibility for the administration of medication have received appropriate medication training. The medication records of the three people ‘case tracked’ were observed. Knights Luxury Retirement Home DS0000009758.V365445.R01.S.doc Version 5.2 Page 16 It was noted that there were occasional dose omissions without explanation. In one instance, the drug administration record indicated that a certain drug had been given as prescribed on two consecutive days but the medication was still in the medication cassette. This could have serious consequences and suggests that staff are not checking the medication before the medication is given and not signing the medication administration record immediately after the medication had been given. On a number of occasions there was a hand written instruction on the drug administration record that a certain medication was to be given PRN but this instruction was not on the dispensing label. The hand written entry was not signed or dated nor gave any indication as to who had given the instruction for the medication to be given PRN or the date the instruction was given. There were no PRN medication protocols in place to advice staff under what circumstances PRM medication should given. In another instance, there was a hand written entry in the drug administration record that was not the exact replica of the pharmacy label supplied by the dispensing chemist. The entry had not been signed or dated or countersigned by a second member of staff to confirm accuracy of the recording. This was also the case in respect of another resident, although the entry had been dated but not signed or countersigned. It is essential in order to protect residents that any hand written record be signed and dated by the person making the entry to take ownership of the recording and checked and countersigned by a second member of staff to confirm accuracy of the recording. In respect of one resident it was clear that a drug had not been given as prescribed. The head of care explained that the GP had changed the dosage of the medication but there was no indication of this on the drug administration record. This could have serious consequences. One resident was prescribed inhalers that she self-administered. There were no risk assessments in place to ascertain if this person had capacity to understand the pharmacy instructions, administer the medication as directed or store the medication safely. Another resident had a drug prescribed but there was no evidence of the drug in the medication cabinet or evidence of the drug having been returned to the pharmacy for disposal. The only record was on the drug administration record that may or may not have been accurate. On further investigation the head of care said the drug had been discontinued that day and sent back to the pharmacy. There was no record on the drug administration record of who had given authorisation for the drug to be discontinued or when. Knights Luxury Retirement Home DS0000009758.V365445.R01.S.doc Version 5.2 Page 17 The controlled drug register was observed. It is strongly recommended that a specimen of the signature of staff that have responsibility for the administration of drugs be retained at the front of the book. Staff signatures were not clear. The name of one member of staff was completely obliterated by what appeared to be a line through the signature, making it impossible to read. A small number of entries had not been signed or dated. There was some crossing out of hand written information. This should not be happening. The controlled drug register must be accurate, completed in full and clearly records who has administered the medication, countersigned the medication and when the administration occurred. It is recommended that the internal medication audit continue to take place on a regular basis. This should assist in quickly highlighting any medication recording errors that may occur. The evidence obtained could then be used to identify areas of concern and assist in advising staff of the correct procedures to be followed. An amended Regulation has recently been introduced with regard to the storage of controlled drugs in care homes. The requirements of the amended Regulation were explained to the management team. These requirements must be put into place within a specified timescale. The head of care stated that he would ascertain if the current controlled drug storage facility complied with the recently introduced regulation, and take any necessary action required. Residents spoken with felt that their privacy and dignity was respected by staff at The Knights Care Home. However, it was observed that on a number of occasions staff were not always mindful of these values when assisting residents. On several occasions staff were seen to knock on a resident’s bedroom door and then walk straight in. The resident was not given opportunity to express an opinion as to whether they wanted a staff member to enter their bedroom at that moment or otherwise. On another occasion a senior member of staff shouted to a resident in a dining room full of other people about a personal matter that did not concern other people. This compromised confidently, privacy and the dignity of the resident concerned. One member of staff was seen to enter a resident’s bedroom as she wanted her inhalers. The resident did not know where they were. The carer immediately picked up the lady’s handbag and rummaged inside it until the inhalers were found. At no point did the carer ask the resident if she minded him looking in her handbag or picked up and offered the resident her own handbag to look for the inhalers herself. Knights Luxury Retirement Home DS0000009758.V365445.R01.S.doc Version 5.2 Page 18 It is recommended that all staff receive privacy and dignity training to equipment them with the skills and understanding to recognise when privacy and dignity is being compromised. Knights Luxury Retirement Home DS0000009758.V365445.R01.S.doc Version 5.2 Page 19 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. This judgement has been made using available evidence, including a visit to this service. Residents are encouraged to maintain contact with the local community and their family and friends to ensure these relationships are sustained. Residents generally enjoy a lifestyle that satisfies their social or recreational interests and needs. Dietary needs of people who live at the home are well catered for with a balanced and varied selection of food available that generally meets individual taste and choice. EVIDENCE: Visitors are made welcome at any time and residents can entertain their guests in any communal area of the home or in the privacy of their own individual bedroom. One relative that visited her relative living at the home very frequently had written, “I never feel in the way. The staff are very approachable and friendly”. Knights Luxury Retirement Home DS0000009758.V365445.R01.S.doc Version 5.2 Page 20 Since the last inspection an activities co-ordinator has been appointed with designated responsibility to arrange and provide a wide range of activities for residents to enjoy. This has made a real difference to the social and intellectual stimulation made available within the home. Activities are arranged that takes into account the differing needs and capabilities of people living at the home and are incorporated in a programme of planned monthly activities. The monthly events programme, made available in larger print, is provided to every bedroom and on the notice board. Activities are arranged over a five day period and include poems, ‘my music’, film club, craft, crossword club, coffee morning also attended by visitors, scrabble and puzzles, reminiscing game, YMCA exercise, bingo, quiz’s, and an activities afternoon each Wednesday that sometimes includes afternoon music at Lowther Gardens. In addition, there is a manicurist and chiropodist who visit on a monthly basis and a hairdresser who visits weekly. The activities co-ordinator explained she also provided one to one activity with people who preferred to remain in their bedroom and for people that did not enjoy group activities. It was explained that residents enjoy visits out of the home with staff for a coffee in local cafes or to places of interest in the local community, however this was often restricted by transport difficulties and not enough care staff on duty to assist. A resident also commented “I think more ‘days out’ would be a welcome departure form the day to day environment”. A relative also said “A lady is employed to help keep interests in various activities such as making festive cards, a weekly quiz, crossword club, books, etc. There are not many outings and too few staff to take any residents in the nearby park if they are in a wheelchair. The recruitment of a dedicated activities co-ordinator has been much appreciated by the residents”. A variety of mentally stimulating activities of various kinds are regularly enjoyed. The activities co-ordinator has a number of activity suggestion books that are well used. This also ensures that the activities undertaken are not too frequently repeated and that people do not become bored and lose interest. Some people just enjoy a chat rather than any formal activity and this is also provided for within the monthly programme. As stated in previous reports and confirmed through discussion with the care manager, all residents are encouraged to maintain control of their own financial affairs for as long as they wished to or be assisted in this task by their family or advocate. Information regarding a local advocacy service is made freely available for residents and their relatives in communal areas of the home to enable them to access independently if required. Knights Luxury Retirement Home DS0000009758.V365445.R01.S.doc Version 5.2 Page 21 The Knights Care Home provides a varied and balanced menu that is designed round the known likes and dislikes of people living at the home. Menus are discussed at the bi-monthly residents meetings that include input from the manager and chef and menus are changed accordingly. Specialist diets in respect of religious, cultural or medical need can be accommodated and as observed, hot and cold drinks and snacks are made available throughout the day. Residents spoken with and comments on the CSCI surveys, in the main, confirmed that meals were enjoyed and people were satisfied with the quality and variety of the meals served. Each resident has a breakfast card and breakfast can be taken by tray to the individual resident’s bedroom. Alternatively, a cooked full English breakfast is always available in the dining room at 9:30am each morning. There is a choice of menu for main meals with residents selecting their choice before the meal is served. A wide range of foods is offered that includes fresh fruit and vegetables. Knights Luxury Retirement Home DS0000009758.V365445.R01.S.doc Version 5.2 Page 22 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 adequate. This judgement has been made using available evidence, including a visit to this service. The home has a satisfactory complaints system with some evidence that residents feel their views are listened to and acted upon. A number of staff have received training in respect of adult abuse issues but some staff have not. It is essential that all staff receive adult protection training as this helps protect residents from potential abuse. EVIDENCE: The Knights Care Home continues to have a comprehensive corporate complaint policy and procedures, which outlines the home’s commitment to resolving complaints within 28 days. The complaints procedure is incorporated in the Statement of Purpose and Service Users Guide to inform residents and their relatives how to make a complaint should the need arise. Two people spoken with stated they would have no hesitation about speaking with the registered manager if they had a concern and felt confident that any concern would be taken seriously and acted upon. From information contained in the Annual Quality Assurance Assessment (AQAA) completed by the registered manager prior to the site visit, seven complaints had been received by the home in the last 12 months. These were investigated using the home’s complaint procedure and found to be unsubstantiated. Knights Luxury Retirement Home DS0000009758.V365445.R01.S.doc Version 5.2 Page 23 One adult safeguarding issue had been received. This is currently under investigation. The home has fully co-operated in the investigation and it is hoped that this matter will come to a speedy conclusion. From discussion with the head of care, it was confirmed that The Knights Care Home continues to have available a variety of policies and procedures for the protection of residents. These include an Adult Protection Policy based on the ‘No Secrets In Lancashire’ document. This helps to protect people from abuse or discrimination and there is also a whistle blowing policy to inform staff of their responsibility in respect of any suspected abuse. Policies are also available in respect of residents’ monies, gifts, wills and aggression. Any items held for safekeeping are secured in a locked environment with appropriate records kept. During the course of the site visit, a staff-training matrix was observed. This covered a range of training needs that had been provided. However, it was unclear just how up to date the training matrix was. The last entries were dated May 2008. It was however evident from the training matrix, that a substantial minority of staff had not been provided with adult protection training. Of the 21 staff members identified on the staff-training matrix, only 11 had received adult protection training. There is a requirement that, in order to protect both resident and staff, all care staff must receive mandatory adult protection training. It is however recommended that all staff that work in the home be provided with this training in order to ensure that all staff understand what adult abuse is, how adult abuse is prevented and their role and responsibility in ensuring adult abuse does not occur. It is also important that staff understand the local protocols in respect of safeguarding adults to ensure they know what they should do if an allegation is made to them or alternatively what they must not do. Knights Luxury Retirement Home DS0000009758.V365445.R01.S.doc Version 5.2 Page 24 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 in part, 25 in part & 26 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service The standard of the environment within this home is good and provides residents with an attractive, homely and well-maintained place to live. However, a number of safety devices have not been provided in a minority of bedrooms. EVIDENCE: The Knights Care Home continues to provide a well-maintained environment that is domestic in character and has been designed to meet the individual and collective needs of residents accommodated. The home is conveniently situated 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 and their visitors can enjoy in the summer months and a ramped access facility for those who have restricted mobility. Knights Luxury Retirement Home DS0000009758.V365445.R01.S.doc Version 5.2 Page 25 The layout of the home gives people opportunity to move freely round the building and access all areas with ease. The Knights is a non-smoking home that is tastefully decorated and offers alternative lounges and a large dining room. There is a passenger lift to access bedroom accommodation located on the first and second floors of the building. The AQAA indicated that a number of improvements have been made to the physical environment of the home since the last inspection. This includes: redecoration to the laundry, basement corridors and staff rooms. A bedroom has been redecorated and a new shower installed. New dining room tables and chairs including some that have been fitted with skies, new curtains and pictures have also been provided. A loop line system is available for those who are hard of hearing and a new music system has been purchased. The entrance area has been modernised and the kitchen repainted. The head of care also explained that two further rooms are in the process of redecoration, the lift has been refurbished and new pressure vessel had been provided for the boiler, as the water pressure was getting too low. The AQAA also indicated that, as at the last inspection, not all bedrooms have been provided with a door lock. An appropriate door lock suitable for the person occupying the bedroom should be fitted to every bedroom door to provide privacy for the occupant. It is the resident’s choice whether or not they use the door lock. Only in very exceptional circumstances a door lock may not be appropriate. In these instances, a full risk assessment should be undertaken to clearly identify why a door lock may not be appropriate with the significant outcome incorporated in the care plan. This outcome should be regularly reviewed. The bedroom accommodation of the three people ‘case tracked’ was viewed. The head of care had previously explained that all bedrooms with, the exception of one, had been provided with a radiator guard. Two of the bedrooms observed were not provided with a radiator guard. Neither of these bedrooms was the bedroom known not to have a radiator guard. The occupant of the first bedroom had been recently admitted. There was no risk assessment in place to identify why a radiator guard had not been fitted. The care manager could not confirm that the radiator had a guaranteed low temperature surface. Knights Luxury Retirement Home DS0000009758.V365445.R01.S.doc Version 5.2 Page 26 The second bedroom was a smaller bedroom. The occupant of this bedroom has a condition that could prevent him from recognising danger. This radiator in this bedroom was also unguarded. There was an unsigned and undated environmental risk assessment with regard to the radiator that said “To cover the radiator with a guard would restrict the main bedroom door from opening sufficiently. This would be a greater hazard than leaving the radiator unguarded. Decision – not to fit a radiator guard”. There was no risk assessment evident in respect of the danger to the resident by not providing a radiator guard. There seems to have been no consideration given to re-site the radiator in another area of the bedroom or to provide a more compact radiator. This radiator did not appear to be of a guaranteed low surface temperature type. Given that it was known that this radiator was unguarded, it is unclear why a resident with a condition that could easily prevent him from recognising danger or removing himself from a dangerous situation was accommodated in this bedroom. It is essential that this matter be given urgent attention in order to protect the resident and to provide a safe bedroom environment. All pipe work and radiators in residents’ personal space and communal areas of the home must be guarded or have guaranteed low temperature surfaces. In an exceptional circumstance, if a radiator in a resident’s bedroom is unguarded for a specific reason, there must be a risk assessment in place that is personal to the occupant. This must be regularly reviewed. Once that bedroom is vacant, there is an expectation that the radiator in the bedroom will be guarded before a new occupant takes up residence. Policies and procedures have been developed to ensure the home is clean, pleasant and hygienic and adequate measures are taken for the control of infection. A number of residents spoken with commented on the cleanliness of the home and felt that a good standard of accommodation was been provided. A relative said, “The environment is very pleasant, the rooms (lounges) spacious. The cleanliness of rooms has improved under the present manager. There were no dedicated cleaners, happily this has now changed.” A resident simply said, “cleanliness excellent”. Since the last inspection, the laundry area has received some attention and is now of an acceptable standard. Knights Luxury Retirement Home DS0000009758.V365445.R01.S.doc Version 5.2 Page 27 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 adequate. This judgement has been made using available evidence, including a visit to this service. The arrangements for National Vocational Qualification (NVQ) training in care should be strengthened to ensure that at least 50 of the care staff team has achieved this qualification. 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. However there were inconsistencies that could potentially be detrimental in protecting people living at the home. EVIDENCE: Staff spoken with considered that a good standard of care was provided to residents. However, one of the carers also said that since the new owners had taken over, although staff do manage to provide good basic care, there was not always time to provide for social interests when the activities co-ordinator was not working. Knights Luxury Retirement Home DS0000009758.V365445.R01.S.doc Version 5.2 Page 28 The AQAA states that, “We ensure staffing levels are in accordance with occupancy numbers of residents for 24 hour care”. This was also confirmed through discussion with the head of care. However, staffing levels should always be determined by the individual dependency needs and assessed requirements of residents rather than the number of people that are accommodated. Residents did however confirm on the CSCI survey forms that they always or usually received the care and support they need when they needed it. One person had written, “teamwork excellent and always kindly”. Another person commented, “Some outstanding listeners obviously there are variants”. A relative also commented that the home “Employs passionate staff who have looked after several residents until they died, going above and beyond the brief you would expect of a residential home”. A third relative said, “Staff very kind and well meaning”. However another relative also said that, “Some members of staff are more helpful than others”. Whilst residents, in the main, were positive about the staff group and the help and support provided, one resident spoken with did say that some staff shout, especially if a resident was not doing what the member of staff wanted them to do. This resident also went on to say that residents do become upset if they are shouted at. An employee at the home also confirmed that some staff do shout at residents sometimes because they are hard of hearing but that this was not necessarily always the case. Staff must be mindful of the effect of what they are saying and how they say it can have on residents. Residents have the right to refuse to do what a carer would like them to do. If a member of staff does shout at a resident or use inappropriate language or offensive language, this could constitute verbal abuse. As previously stated, it is essential that all staff receive up to date adult protection training that provides staff with understanding of all aspects of abuse and how to prevent abuse from occurring. The staff-training matrix did not provide information regarding the number of care staff that had achieved a National Vocational Qualification (NVQ) in care. However the AQAA indicated that only five of the 14 care staff employed at the home had achieved this qualification. It is understood that a further seven members of staff are currently working towards this award. There is a recommendation that at least 50 of the care staff team achieve this award to help ensure that a good quality of care is provide to residents. Knights Luxury Retirement Home DS0000009758.V365445.R01.S.doc Version 5.2 Page 29 Care staff also undertake a number of other courses, such as diabetes training and promoting continence training, to further increase their skills and knowledge in order to provide a good service. The head of care explained that a number of staff have also completed a dementia awareness training course, although this could not be evidenced from the staff training matrix and no training certificates were seen at the time of the site visit. Given that an increasing number of residents admitted to care homes have a degree of dementia, it is recommended that all care staff be provided with this important training. It is also essential that senior staff through supervision and close observation monitor staff to ensure that the recent learning has been put into practice. The staff files of two recently appointed staff were viewed. Observation of the first file evidenced an application form, interview notes, CV, personal details, medical declaration form, equal opportunities monitoring form, POVA First and CRB clearance. There is a requirement that two satisfactory references must be obtained before a new member of staff takes up post at the home. However, in this instance, only one reference however could be evidenced. The CRB clearance only contained personal details not the remainder of the clearance. As identified in the last inspection report, it is essential that the full CRB clearance certificate sent to the home be held until the next inspection takes place to enable the inspector to observe the document. Following this, the full CRB clearance certificate can be destroyed although a brief record should be made of the date the clearance was requested and received and if the clearance was satisfactory. In order to protect residents it is also essential that both written references are returned and deemed to be satisfactory before a recently appointed employee actually takes up post at the home. The second recently appointed employee staff file contained the above information. It is understood that this member of staff has yet to commence employment at the home because of a delay in the CRB clearance. However, although there were two references on file, one of them was from an employee of the home and best friend of the applicant. There was no indication why a second professional reference had not been secured especially as this applicant had been employed by a large corporate organisation until last year. Unless there is good reason not to request two professional references with the reason clearly recorded, references from other employee at the home and a friend of the applicant should be avoided. Knights Luxury Retirement Home DS0000009758.V365445.R01.S.doc Version 5.2 Page 30 From information in the AQAA and discussion with the head of care it is understood that all newly appointed care staff are provide with induction training that is compliant with ‘Skills for Care’ common induction standards. Knights Luxury Retirement Home DS0000009758.V365445.R01.S.doc Version 5.2 Page 31 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 adequate. This judgement has been made using available evidence, including a visit to this service. 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. However all staff must be provided with essential health and safety training. Knights Luxury Retirement Home DS0000009758.V365445.R01.S.doc Version 5.2 Page 32 EVIDENCE: The registered manager at The Knights Care Home has recently terminated her employment at the home. At the time of the site visit there was no registered manager in post. However, it is understood that a new manager has now been appointed and will shortly be taking up employment at the home. This person will have to demonstrate that they have the experience, skills and qualifications to manage a care home for older people in order to be registered with the Commission for Social Care Inspection. There is a range of internal and external quality assurance systems in place to ascertain if the home is well managed and fulfils residents’ expectations. The Knights Care Home has achieved the Investors in People Award. There are clear lines of accountability within the home and external management. Internal systems include residents’ forums, a now bi-monthly newsletter, informal discussion, staff meetings and staff supervision. In addition, a quality assurance questionnaire is provided on an annual basis that is completed by resident and/or their family. The completed questionnaires are sent directly to the Operations Director, analysed, referred back to the home’s manager for action and the outcome of the questionnaires displayed on the notice board. The questionnaire results from January 2008, confirmed that residents were generally pleased by the quality of care provided but that some people needed to be reminded of how they could make a complaint. Residents’ financial interests are safeguarded by the financial procedures adopted by the home. All residents, wherever possible, are encouraged to remain financially independent or assisted in this task by a family member. As again observed during the course of the inspection, when the home does retain monies or valuables in respect of a resident, this is accurately recorded and secure facilities are provided for the safekeeping of monies and valuables held on behalf of the individual resident. There was evidence on the staff files observed, of staff supervision taking place on a regular basis until the beginning of 2008. More recent supervision records could not be evidenced at the time of inspection. However, the AQAA, completed by the previous manager, indicated that staff appraisals and supervision does take place on a regular basis. All care staff should receive formal one to one staff supervision at least six times a year. This should cover at minimum all aspects of practice, philosophy of care and career development needs. It is essential that all staff that supervises others have the knowledge, skills and abilities to undertake the task. Knights Luxury Retirement Home DS0000009758.V365445.R01.S.doc Version 5.2 Page 33 The Knights Care Home continues to have available a variety of policies and procedures to ensure the health, safety and welfare of residents, visitors and members of staff. At the time of inspection, various records, maintenance records and certificates relating to equipment and instillations were examined and found to be up to date and in good order. All staff are expected to undertake a variety of mandatory health and safety training, however the staff-training matrix indicated that some staff have not received all of this required training. All care staff must receive manual handling and first aid training. In addition, all appropriate staff should receive, at minimum, fire safety training, food handling training and infection control training. Knights Luxury Retirement Home DS0000009758.V365445.R01.S.doc Version 5.2 Page 34 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 2 10 2 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 2 3 X X X X 2 2 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score N/A X 3 X 3 2 X 2 Knights Luxury Retirement Home DS0000009758.V365445.R01.S.doc Version 5.2 Page 35 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. 1 Standard OP3 Regulation 14 (d) Requirement Following the pre-admission assessment, written confirmation must be provided to a prospective resident that their current needs and requirements could be met at the home. There must be a clear, up to date and detailed care plan in place in respect of all residents. A formal risk assessment must be undertaken if a risk has been identified. The significant outcome of the risk assessment process must be incorporated in the care plan. The storage of controlled drugs must be maintained in line with the recently amended regulation. All staff that have not done so must receive adult protection training. Timescale for action 15/09/08 2 3 OP7 OP7 15 13(c) 15/09/08 15/09/08 4 5 OP9 OP18 13(2) 13(6) 22/10/08 30/11/08 Knights Luxury Retirement Home DS0000009758.V365445.R01.S.doc Version 5.2 Page 36 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. 6 Standard OP25 Regulation 13(4)(b) Requirement All radiators in resident accommodation must be fitted with a radiator guard or have a guaranteed low surface temperature. In the very exceptional circumstances where a radiator guard is not fitted for whatever reason, there is an expectation that a radiator guard will be fitted prior to a new resident occupying that bedroom. At a minimum two satisfactory references must be obtained before a new employee takes up employment at the home. The full CRB clearance must be retained at the home until the next regulatory inspection takes place. Care staff who have not done so must receive manual handling training and first aid training. Timescale for action 31/10/08 7 OP29 19(1) 22/09/08 8 OP29 19(1) 31/08/08 9 OP38 13(4)(5) 30/11/08 Knights Luxury Retirement Home DS0000009758.V365445.R01.S.doc Version 5.2 Page 37 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. There should be a photograph of each resident in a relevant place to help identify the individual. Care plans should provide detailed guidance about how an aim is to be achieved and who has responsibility for this to make sure that a consistent and individualised service is provided. Wherever possible the individual resident and/or relative (with the resident’s prior consent) should be invited to the formal review of their care plan. All drug administratiopn records should be completed immediately after the administration of medication to each individual resident. Staff with responsibility for the administration of medication should always check that the correct drugs are given to the resident as prescribed, prior to the person actually taking the medication. All hand written entries on the drug administration record must be signed, countersigned and dated. All hand written entries on the drug administration record should be the exact replica of the pharmacy label. Any amendments to the pharmacy label on the drug administration record should be signed, dated and indicated who has given the updated instruction. Any changes to the dosage of medication should be clearly identified on the drug administration record, signed and dated. A formal risk assessment should be in place when ever a resident is self administering their prescribed medication. This should be regularly reviewed. 2 3 OP7 OP7 4 5 6 OP7 OP9 OP9 7 8 9 10 11 OP9 OP9 OP9 OP9 OP9 Knights Luxury Retirement Home DS0000009758.V365445.R01.S.doc Version 5.2 Page 38 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 12 13 Refer to Standard OP9 OP9 Good Practice Recommendations Specimen signatures of all staff that have responsibility for the administration of medication should be retained with the drug administration record. Hand written information should not be crossed out on any drug administration record. If a mistake has been made this should be highlighted and the correct information provided. It is recommended that the medication audits continue to take place on a regular basis to highlight any areas of concern. Staff should always be very mindful about respecting the privacy, dignity and confidentially of each individual resident. Staff should be provided with privacy and dignity training. There should be sufficient staff on duty to ensure that resident’s assessed social care needs can be met especially with regard to accessing the local community All individual bedroom accommodation should be provided with an appropriate locking mechanism to protect the privacy of the individual. If a bedroom becomes vacant that does not have a lock provided, a lock should be fitted before a new person occupies the room. The staffing ratios should be determined by the assessed needs and requirements of residents rather than the number of residents accommodated. All staff should be mindful of the possible effects to residents of what they are saying and the way they are saying it. Resident retain choice as to what they wish to do. At least 50 of the care staff team should achieve at minimum Level 2 in care. It is recommended that all care staff be provided with dementia awareness training. Where ever possible two professional references should be requested in respect of a new employee rather than a reference from a friend. DS0000009758.V365445.R01.S.doc Version 5.2 Page 39 14 15 OP9 OP10 16 17 OP12 OP24 18 19 OP27 OP27 20 21 22 OP28 OP28 OP29 Knights Luxury Retirement Home RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 23 24 Refer to Standard OP36 OP38 Good Practice Recommendations Formal one to one staff supervision should take place at least six times a year. It is recommended that all appropriate staff receive fire safety training, food handling training and infection control training. Knights Luxury Retirement Home DS0000009758.V365445.R01.S.doc Version 5.2 Page 40 Commission for Social Care Inspection Lancashire Area Office Unit 1, 3rd Floor Tustin Court Port Way 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.V365445.R01.S.doc Version 5.2 Page 41 - 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!