Inspection on 02/03/06 for Knotty Ash Residential Home

This inspection was carried out on 2nd March 2006.

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

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

Other inspections for this house

Knotty Ash Residential Home 02/09/08

Knotty Ash Residential Home 25/09/07

Knotty Ash Residential Home 06/02/07

Knotty Ash Residential Home 29/09/05

Knotty Ash Residential Home 13/03/05

Knotty Ash Residential Home 02/07/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Knotty Ash Residential Home 69 East Prescot Road Liverpool Merseyside L14 Lead Inspector John McCabe Unannounced Inspection 09:30 2 . March 2006 nd 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 Knotty Ash Residential Home DS0000025353.V285213.R01.S.doc Version 5.1 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. Knotty Ash Residential Home DS0000025353.V285213.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Knotty Ash Residential Home Address 69 East Prescot Road Liverpool Merseyside L14 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) 0151 254 1099 Knotty Ash Home Ltd Debra Margaret Murphy Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Knotty Ash Residential Home DS0000025353.V285213.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th September 2005 Brief Description of the Service: Knotty Ash is a residential care home providing 24-hour personal care and accommodation for 30 older people. The home is privately owned. There have been several changes of manager in the past eighteen months. The current acting manager had been had been in post for two months at the time of this inspection. The home is located in a residential area, within close proximity of the Old Swan shopping area of Liverpool. The home is a purpose built twostorey building that was opened in 1997. All bedrooms have en-suite facilities. Communal space within the home consists of a conservatory area, a large main lounge and a separate dining room. Knotty Ash Residential Home DS0000025353.V285213.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took fours; the acting manager of the home was present throughout the inspection. A full tour of the building took place, which included, bedrooms, kitchen, laundry resident’s bedrooms and garden spaces. Residents and staff files were reviewed, and other documents relating to the safety of the residents and the building. The home was clean and tidy, and staff were courteous and polite to residents at all times. Residents and staff were spoken with on the conduct of the home. What the service does well: What has improved since the last inspection? The resident’s pre admission documents and the residents care plans have improved since the last inspection, though the home preadmission document needs to be more robust. The requirements from the last report have been achieved, the home has a new Statement of Purpose and all residents have a contract and terms and conditions, placed in their personal file. Knotty Ash Residential Home DS0000025353.V285213.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Knotty Ash Residential Home DS0000025353.V285213.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Knotty Ash Residential Home DS0000025353.V285213.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5. The Homes Statements of Purpose is up to date and ensures that the home stays within the category of resident agreed with the commission, and prospective residents have some knowledge of the home before they decide to move in on a permanent basis. The resident’s pre-admission assessment documentation has improved since the last inspection, this helps ensures that the skill mix of the workforce in the home can meet the residents identified care needs. EVIDENCE: All residents in the home are provided with a statement of terms and conditions, plus a contract when they move in to the home on a permanent basis. Residents are able to visit the home or have an overnight stay before they move in on a permanent basis. Knotty Ash Residential Home DS0000025353.V285213.R01.S.doc Version 5.1 Page 9 The homes senior carers undertake a pre-admission assessment on residents before they are admitted to the home, to ensure care needs are identified. However, the homes pre admission assessment document needs to be more robust and include more information on the psycho/social and cognitive care needs of the resident before being admitted to the home. Other health care professionals known to the resident should be involved in the assessment. Care staff in the home undertakes some special care training i.e. dementia, cognitive impairment, diabetes and stroke, which is ongoing, to ensure that the assessed and changing care needs of the residents are met. Intermediate Care is not offered in the home. Knotty Ash Residential Home DS0000025353.V285213.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11. Resident’s individual health, personal and care needs are clearly recorded, and provides care staff the information they need to meet the residents care needs. EVIDENCE: All residents in the home have an individual care plan, which is formulated on admission to the home, and reviewed by the senior carers on a monthly basis. Residents and family also contribute to the formulation of the plan, when possible the residents should be consulted on the plan and should sign the completed document. Daily health records are documented for each resident, this also includes any critical incidences plus any visits from GPs, specialist nurses etc. No resident in the home self medicates, all medications for residents are administered by the senior carers in the home. The protocols for the receipt, storage disposal, and documentation of medications in the home are not in accordance with the guidelines issued by the Royal Pharmaceutical Society Knotty Ash Residential Home DS0000025353.V285213.R01.S.doc Version 5.1 Page 11 Currently, labels from resident’s medication bottles are being photocopied by care staff, and then stapled on to an already existing resident MARS. This is unsafe practice; a new MARS should be obtained from the supplying pharmacist. Staff should be reminded that all entries into the resident’s files should be in black ink, and should be accompanied by a twenty-four hour clock recording . Currently, there are no pressure sores on any of the residents. All residents in the home can access their NHS entitlements, which include dentists, opticians and chiropodists. Knotty Ash Residential Home DS0000025353.V285213.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Residents should be encouraged to exercise choice and flexibility how they spend their day in the home. Residents should be allowed to pursue leisure and educational activities according to their choice and preferences. This helps allows independence and individuality for each resident, and possibly prevent boredom and frustration. Residents receive a balanced diet offering variety while reflecting resident’s preferences. EVIDENCE: Cuurently, residents in the home are not asked on admission, about their lifestyle, choice of foods, and choices and preferences of the social activities that they would like to participate in. On admission to the home the resident with help from a family member should complete a “Getting to know you” questionnaire, which is a “Work life History” of the resident, and includes schooling, work, hobbies, food likes and dislikes etc. This information is then used to facilitate organised activities for the resident, and implement the activities for the residents. Knotty Ash Residential Home DS0000025353.V285213.R01.S.doc Version 5.1 Page 13 When residents participate in organised activities it should be recorded in their personal files, how they participated in the activity. Visitors are allowed in the home at any reasonable time of day, residents may entertain their visitors, in the communal lounges, or in their own bedroom. Residents told the inspector that they enjoyed the variety of food in the home and were looking forward to gammon and vegetables. Some of the residents prefer to take their meals in their own room rather than go to the dining room. Residents who had just transferred from another care home told the inspector that home was good, and staff where always courteous and kind when dealing with them. Knotty Ash Residential Home DS0000025353.V285213.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18. The home has a satisfactory complaints system with evidence that residents feel their views are being listened to and acted upon. The homes policy and training programmes for POVA, and Whistle blowing, ensure that the homes residents are protected from any abuse. EVIDENCE: There have been one internal complaint, and one complaint to the commission since the last inspection. At present a member of staff is suspended from duty pending an investigation. The home has robust complaints procedures, which is documented in the residents guide and the staff handbook. Many of the residents in the home use their postal vote in the Local Elections. The care home has up to date information on the Protection of Vulnerable Adults (POVA), There was evidence that some of the staffs in the home had undertaken training on POVA protocols, and the Whistle Blowing Policy. Knotty Ash Residential Home DS0000025353.V285213.R01.S.doc Version 5.1 Page 15 Staff spoken with were aware of the “Whistle Blowing” procedures and said they would not hesitate to inform if they witnessed and abusive behaviours towards residents. Knotty Ash Residential Home DS0000025353.V285213.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26. The standard of decor within this home is good, with evidence of some continuing improvements, through maintenance and planning. The home does present as a homely, safe and comfortable environment for the residents. EVIDENCE: Knotty Ash is accessible, safe and maintained to a good standard both inside and out. On the day of this unannounced inspection the home was clean, odour free and the domestic style furniture and fittings result in a comfortable homely and pleasant environment. All residents have bedrooms, which have en-suite facilities. The bedrooms reflect residents individual tastes and preferences and contain a number of their treasured possessions. Knotty Ash Residential Home DS0000025353.V285213.R01.S.doc Version 5.1 Page 17 Knotty Ash care home, is accessible, safe and maintained to a good standard both inside and out. Residents can cess all parts of the home via stairs, lift, or ramps. All corridors are fitted with handrails. Communal spaces are light bright and comfortable, a small lounge is available for those residents who smoke. The home has residents who have been medically diagnosed as having cognitive impairment/dementia. Therefore, the acting manager must risk assess those residents to ascertain whether or not they are safe with liquid soap products in their rooms, and whether these products should be openly stored in communal bathrooms to avoid any possible serious accidents if residents accidentally ingest the liquids Also, bedroom windows in resident’s bedrooms need to have restrictors placed on them to ensure the safety of the residents. During the inspection, the hairdressers room was unlocked and unattended, again there is potential danger for residents if they can access the room especially if hair products and chemicals are not locked securely away. Knotty Ash Residential Home DS0000025353.V285213.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. The staff have a good understanding of the service user’s support needs. This is evident from the positive relationships, which have been formed between the majority of staff and service users. The standard of vetting and recruitment practices is safe and helps to ensure that appropriate checks being carried out on all new staff. This means that the residents are not put at risk. Staff personnel files did not contain all the appropriate documentation needed to comply with Equal Opportunities and the National Minimum Standards (NMS). EVIDENCE: Staff personal files were reviewed, all staff working in the home has up to date CRB/POVA enhanced certificates, all staff had been instructed on Adult Protection protocols. It could not be evidenced that new members of staff had a formal induction course when commencing at the home. Newly employed staff are entitled to at least three days inductions course so as to familiarise, and understand the way the home is conducted. Knotty Ash Residential Home DS0000025353.V285213.R01.S.doc Version 5.1 Page 19 Staff personnel files did not contain a photograph, terms and conditions and a contract for the staff member. Also no interview notes are kept for each prospective employer to the home. All staff files should contain the above. Mandatory and some specialist care training for staff is ongoing as evidenced from the personal files of the staff. Knotty Ash Residential Home DS0000025353.V285213.R01.S.doc Version 5.1 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37,38. Staff morale is high in the care home, resulting in an enthusiastic workforce that works positively with residents to improve their whole quality of life, plus the turnover of care staff is low. Staff is well supervised and the health and safety of the residents and staff is promoted and protected EVIDENCE: The homes manager has over ten years experience in home care management. She has successfully completed an NVQ Level4 management programme. All staff in the home have documented supervision six times per year, this ensures that all staffs have the opportunity to discuss with the manager, and other senior carers, any issues that can effect or improve the care provided. Knotty Ash Residential Home DS0000025353.V285213.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 2 3 3 2 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 2 Knotty Ash Residential Home DS0000025353.V285213.R01.S.doc Version 5.1 Page 22 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 OP9 Regulation OP1213 Requirement The registered person must ensure that photocopying of residents details on medication bottles, and stapling the photocopy on to the residents MARS is stopped immediately, and a new MARS is obtained for the resident from the supplying pharmacist. The registered person must ensure that residents are formally consulted about their social interests and arrangements made for them to engage in local, social and community activities. The registered person must ensure that when residents engage in social activities, it is recorded how they participated in the activity. The registered person must ensure that a risk assessment is undertaken to ascertain whether or not those residents with cognitive impairment/dementia can have liquid soap products in their bedrooms/and or in the communal bathrooms. DS0000025353.V285213.R01.S.doc Timescale for action 31/03/06 2 OP12 16 31/03/06 3 OP12 12 31/03/06 4 OP21 13 31/03/06 Knotty Ash Residential Home Version 5.1 Page 23 5 OP21 13 6 OP24 12 7 OP29 19 8 OP30 19 9 OP38 23 The registered person must ensure that the hairdressing room is locked at all times when unattended and soaps and chemical are secured. The registered person must ensure that window restrictors are fitted to window in resident’s bedrooms, so avoiding possible accidents. The registered person must ensure that all newly appointed staff to the home are supplied with a contract and terms and conditions of work The registered person must ensure that all newly appointed staff to the home have an Induction Course. The registered person must ensure that the home certificate of worthiness for the homes electric supply and installations is in date and valid. A copy of the satisfactory certificate is forwarded to the Liverpool/Wirral CSCI office. 31/03/06 31/03/06 31/03/06 31/03/06 31/03/06 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 Knotty Ash Residential Home DS0000025353.V285213.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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. 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