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Inspection on 03/01/06 for Knightwell House

Also see our care home review for Knightwell House for more information

This inspection was carried out on 3rd January 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

A number of comment cards were received from other healthcare professionals before the inspection, giving their views on the service provided. One comment card said "staff are very helpful and approachable``. "I am more then satisfied with the home``. There were eight comment cards received from healthcare professionals that gave a positive view of the service.

What has improved since the last inspection?

Requirements from the last inspection have been addressed. Recreational activities continue to be a part of every day life for the residents.

What the care home could do better:

There were a number of comment cards received before the inspection from healthcare professionals. There were no comment cards received from residents. No quality assurance system was seen during the visit to be able to use the information from residents about the service provided. Information pertaining to incidents that have occurred is not passed on to the appropriate authorities. Records pertaining to recruitment in one staff file did not meet Schedule 2 of the National Minimum Standards. New employees are not supervised to coincide with induction. Risk assessments were not reviewed or dated when completed. On 4 January 2006, a letter of Serious Concern was sent to the Responsible Individual and Registered Manager and a referral was made to the Duty Social Work Team under Adult Protection concerning inappropriate methods used in respect of Managing Challenging Behaviour. Other concerns were staff had not received training in Managing Challenging Behaviour and Physical Intervention. The Manager had not notified the appropriate authority when an incident occurred. Further information can be found in the main body of the report under Standard 23.The Commission is awaiting an action plan as to how the Responsible Individual and Registered Manager will address the concern raised by the Inspector.

CARE HOME ADULTS 18-65 Knightwell House 734 Washwood Heath Road Ward End Birmingham West Midlands B8 2JD Lead Inspector Susan Scully Unannounced Inspection 3rd January 2006 09:00 Knightwell House DS0000016890.V267758.R01.S.doc Version 5.0 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 Knightwell House DS0000016890.V267758.R01.S.doc Version 5.0 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 Adults 18-65. 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. Knightwell House DS0000016890.V267758.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Knightwell House Address 734 Washwood Heath Road Ward End Birmingham West Midlands B8 2JD 0121 327 3623 0121 327 3623 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) Ms Trina Smith Mr Brian Armstrong Care Home 13 Category(ies) of Learning disability (13) registration, with number of places Knightwell House DS0000016890.V267758.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents must be aged under 65 years Date of last inspection 18th November 2004 Brief Description of the Service: Knightwell House is registered to provide care and accommodation to 13 adults with a learning disability. The home is staffed on a 24-hour basis. Knightwell House is a large three-story building and includes seven single and three double bedrooms. Communal rooms comprise of a small lounge and dining room with an adjoining sitting area. There are toilet and bathing facilities on each floor. The home has limited off road parking. There is a large and wellmaintained garden located at the rear of the property. The home is located near to main shopping facilities and main bus service to Birmingham City Centre. Knightwell House DS0000016890.V267758.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced visit took place over a one-day period. Records were sampled pertaining to residents daily records, care plans, risk assessments and healthcare needs. Other records seen included staff files, health and safety records, policies and procedures and records pertaining to staffing levels. The Manager was present throughout the inspection. What the service does well: What has improved since the last inspection? What they could do better: There were a number of comment cards received before the inspection from healthcare professionals. There were no comment cards received from residents. No quality assurance system was seen during the visit to be able to use the information from residents about the service provided. Information pertaining to incidents that have occurred is not passed on to the appropriate authorities. Records pertaining to recruitment in one staff file did not meet Schedule 2 of the National Minimum Standards. New employees are not supervised to coincide with induction. Risk assessments were not reviewed or dated when completed. On 4 January 2006, a letter of Serious Concern was sent to the Responsible Individual and Registered Manager and a referral was made to the Duty Social Work Team under Adult Protection concerning inappropriate methods used in respect of Managing Challenging Behaviour. Other concerns were staff had not received training in Managing Challenging Behaviour and Physical Intervention. The Manager had not notified the appropriate authority when an incident occurred. Further information can be found in the main body of the report under Standard 23. Knightwell House DS0000016890.V267758.R01.S.doc Version 5.0 Page 6 The Commission is awaiting an action plan as to how the Responsible Individual and Registered Manager will address the concern raised by the Inspector. 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. Knightwell House DS0000016890.V267758.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Knightwell House DS0000016890.V267758.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 4 Residents’ needs are assessed before admission including aspirations and objectives. Residents are invited to the home before admission. The Manager must inform any prospective service users in writing whether Knightwell House is able to meet their needs. EVIDENCE: The Statement of Purpose indicates that all service users are invited to the home for an overnight stay. A representative from Knightwell House completes an assessment before admission. One assessment had recently been completed and showed information pertaining to present and past illness, likes, dislikes and other information. Records did not show when the residents had visited the home, or a letter confirming Knightwell House could meet their needs based on the assessment. Knightwell House DS0000016890.V267758.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Care plans give detailed information to enable staff to meet residents’ needs. Residents make decisions on a daily basis with support from staff when required. Risk assessments do not have dates when they were completed making it difficult to establish if the risk is current. EVIDENCE: Care plans show how residents’ needs are assessed. There is significant information available to enable staff to meet the goals and objectives identified by residents. There are no strategies in place for Managing Challenging Behaviour resulting in inappropriate methods being used when there is a problem. Risk assessments are completed but did not identify when they were completed or when they were reviewed, therefore making it difficult to identify if the risk is current. There is no quality assurance system. Discussions are held with residents regarding choice, and reviews take place with residents regarding their care. Knightwell House DS0000016890.V267758.R01.S.doc Version 5.0 Page 10 To enhance the communication between residents and management a quality assurance system must be developed. Knightwell House DS0000016890.V267758.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 16 Residents are fully consulted about social and recreational activities. Participation depends on the level of interest and the residents’ ability. EVIDENCE: Daily records showed what activities the residents participated in, such as going out to shops, clubs and maintaining relationships with family and friends. There were no menus available for inspection. The Manager said this is normally decided each day by asking residents what they want, sometimes the residents eat out. It depends on what activities they are doing. Knightwell House DS0000016890.V267758.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 Residents’ healthcare needs are monitored and reviewed. Progress has been made with adequate recording of information pertaining to healthcare. EVIDENCE: Information is recorded of how residents like to be cared for and by whom. Preferences, likes, dislikes, activities, medical information and visits by other healthcare professionals are recorded in individual plans of care. Information contained in care plans has improved significantly for staff to be able to meet the needs of residents. Files sampled show how residents were consulted about the care they received. Medical assessments, likes and dislikes, activities, risk assessments and wishes in the event of death are recorded. On a separate document, there were details of when residents had visited dentists, doctors, and the involvement of other healthcare professionals. Knightwell House DS0000016890.V267758.R01.S.doc Version 5.0 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 Residents are being placed at risk due to training not being completed in the relevant areas in relation to the work staff perform. EVIDENCE: When sampling residents’ files it was identified that an incident had occurred. Staff have not received training in Managing Challenging Behaviour resulting in inappropriate methods being used when a problem occurred with one resident. There were no protocols in place for staff to adhere to. A letter of Serious Concern was sent to the Provider and Manager and a referral was made to the Duty Social Worker under Adult Protection by the Inspector. At the time of writing the report an action plan had been received from the Provider indicating training in Managing Challenging Behaviour would take place on 31 January 2006. The Manager had also failed to notify the Commission and make a referral to the Duty Social Worker under Adult Protection when the incident occurred. The Provider and Manager must report incidents to the appropriate authority. Failure to do so may lead to the Commission taking further action. Knightwell House DS0000016890.V267758.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 30 Residents are encouraged to furnish their bedrooms with personal belongings of their choice. The environment is clean, fresh and satisfactorily maintained. Residents’ bedrooms have been decorated to their personal taste. Risk assessments for the environment did not demonstrate adequate recording in identifying hazards and control measures and these must be dated and reviewed. Adequate infection control is maintained. EVIDENCE: The home was clean and fresh. Residents’ bedrooms were personal and decorated to a satisfactory standard. The communal lounge was nicely maintained. In general, the home was in a good state of repair. Risks assessments that had been completed pertaining to the environment were not dated. The hazards identified did not show how the risk was managed Knightwell House DS0000016890.V267758.R01.S.doc Version 5.0 Page 15 and reviewed. There was an Infection Control Policy in place and COSHH materials were adequately stored. Knightwell House DS0000016890.V267758.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, 36 Recruitment practices are not sufficient and place residents at risk. Significant improvement must be made to ensure the safety of residents. Supervision and induction for all new employees is not completed and places residents at risk. Training in the appropriate protocols to be used in Managing Challenging Behaviour is not adequate and action must be taken to safeguard residents from harm. EVIDENCE: Staff training is required in Managing Challenging Behaviour and Physical intervention. A recent incident that had occurred was inappropriately handled resulting in an Adult Protection referral being made by the Inspector. A full audit of training records was not completed. It was of concern that a recent employee had commenced employment in December 2005 with no Criminal Records Bureau Disclosure being received. The member of staff had not received regular supervision or induction. One staff file sampled showed inconsistence in employment history that the Manager had not identified. The Manager must ensure appropriate recruitment practices are completed with all the relevant checks and information being obtained before the commencement of employment. Knightwell House DS0000016890.V267758.R01.S.doc Version 5.0 Page 17 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39, 42 There was no quality assurance seen during the visit to ensure residents’ views are sought and interlinked with the running of the home. Health and safety is maintained pertaining to regular servicing of equipment and appliances. Risk assessments for the environment must be reviewed and dated to show how the hazard identified is being managed. EVIDENCE: Meetings with residents take place and one resident said he would voice his views. A system must be produced to record information concerning residents’ views and be in a format so the Manager can audit for reoccurring issues. During the visit there were no Health and Safety issues identified. Regular checks are completed for Fire Safety, fire drills and testing of electrical equipment. Risk Knightwell House DS0000016890.V267758.R01.S.doc Version 5.0 Page 18 assessments had been completed but did not show the dates when they were undertaken. It was not possible to know if they were current. Knightwell House DS0000016890.V267758.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X 3 X Standard No 22 23 Score X 1 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X 3 X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 3 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 2 X 1 2 2 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Knightwell House Score 3 3 X X Standard No 37 38 39 40 41 42 43 Score X X 2 X X 2 X DS0000016890.V267758.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard YA9 YA20 Regulation 13(4)(c) 13(2) Requirement Risk assessment must be signed and dated. All prescriptions must be seen prior to dispensing, checked and a system installed to check against incoming medication. Previous requirement not assessed. The medicines, dose and quantities of all medication received must be recorded on the MAR chart. Previous requirement not assessed. Policies and procedures must be developed for dispensing medication. Previous requirement not assessed. Any service users wishing to self-administer their own medication must be encouraged to do so. Regular risk assessments must be completed. Previous requirement not assessed. The purchase of a controlled drugs cabinet that complies with the Misuse of Drugs (Safe Custody) Regulations 1973 is DS0000016890.V267758.R01.S.doc Timescale for action 01/02/06 01/02/06 3 YA20 13(2) 01/02/06 4 YA20 13(2) 01/02/06 5 YA20 13(2) 01/02/06 6 YA20 13(2) 01/02/06 Knightwell House Version 5.0 Page 21 7 8 YA23 YA24 9 10 11 12 13 YA32 YA34 YA35 YA36 YA39 14 YA42 required. Previous requirement not assessed. 13(4)(c) All incidents must be reported to the appropriate authorities. 13(4) (c) Risk assessments that are completed in respect of the building must be signed and dated. 18(1)(a) Training must be completed relevant to the work staff perform. Sch2 Recruitment practise must be in 13(4)(c) line with Schedule 2 of the National Minimum Standards. 18(1)(c) Training must be completed in Managing Challenging Behaviour and Physical Intervention. 18(2) Supervision of staff must be completed in line with induction. 24(1)(a,b) A quality assurance must be developed to enable service users to contribute to the running of the home. 13(4)(c) Risk assessments must be completed to show identified hazards are monitored and reviewed. 01/02/06 01/02/06 01/02/06 01/02/06 01/02/06 01/02/06 01/02/06 01/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Knightwell House DS0000016890.V267758.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Knightwell House DS0000016890.V267758.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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