Inspection on 02/09/08 for Knotty Ash Residential Home

This inspection was carried out on 2nd September 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Knotty Ash Residential Home 25/09/07

Knotty Ash Residential Home 06/02/07

Knotty Ash Residential Home 02/03/06

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 26/11/2008.

CARE HOMES FOR OLDER PEOPLE Knotty Ash Residential Home 69 East Prescot Road Liverpool Merseyside L14 1PN Lead Inspector Julie Garrity Key Unannounced Inspection 2nd September 2008 10:00 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 Knotty Ash Residential Home DS0000025353.V367789.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. Knotty Ash Residential Home DS0000025353.V367789.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Knotty Ash Residential Home Address 69 East Prescot Road Liverpool Merseyside L14 1PN 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 knottyashhome@hotmail.co.uk Knotty Ash Home Ltd Mr Andrew Feeney Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places Knotty Ash Residential Home DS0000025353.V367789.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only: Code PC, to people of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category: Code OP The maximum number of people who can be accommodated is: 33 Date of last inspection 25th September 2007 Brief Description of the Service: Knotty Ash is a residential care home providing personal care and accommodation for 30 people with an age related condition. The home is purpose built with 26 bedrooms on the ground floor and 3 bedrooms on the top floor. There are handrails and a lift to assist people in accessing all areas of the home. A dining room, a separate smoking room and two lounges provide a variety of different areas for people living in the home to use. All bedrooms have ensuite facilities. Knotty Ash is located in a residential area, within walking distance of the Old Swan shopping area of Liverpool. The home is on a one way street and located near Alder Hey Hospital it can only be accessed in one direction due to the oneway dual carriage way. There is parking at the front of the building and a signpost at the entrance helps visitors easily identify the home. There are gardens surrounding the building and a large park is located at the adjacent to the home. The fees for Knotty Ash are at Local Authority rates although private residents can be accommodated. The current rate of fees range from £345.50 to £445 and this depends on the individual’s needs and the services that they require. Knotty Ash Residential Home DS0000025353.V367789.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. The site visit was carried out over a single day. We (the commission) arrived at the home at 10:00 and left at 18:00. The manager was on leave for the site visit and the deputy manager represented Knotty Ash. Arrangements had been made by the manager to make sure that all documents needing to be reviewed were accessible, these were requested from the deputy during the site visit as needed. We spoke with four relatives, twelve people living in the home and six staff. We completed the inspection by a site visit to Knotty Ash Residential Home; a review took place of many of the records available in Knotty Ash Residential Home and our offices. Additionally a pharmacist from the commission had visited the home earlier in the year to look at medications, information from this is included within this report. Surveys were sent to the service for both staff and people living in the home none were returned. We also looked at a self-assessment completed by the service before our visit. This is known as an AQAA and details what improvements the service has made and what their plans are for the future. All of the key standards were covered in this site visit; the findings and evidence are detailed in the report. Feedback was given to the deputy manager and the administrator through out the day and at the end of the site visit. The arrangements for equality and diversity were discussed during the visit and are detailed throughout this report. Particular emphasis was placed on the methods that the home used to determine individual needs, promote independence and support to make informed decisions in line with individual choices. What the service does well: A good standard of personal care is provided for people living in the home. They are able to access services such as hairdressers many of the people spoke with thought that this was vital to helping them feel good about themselves. One person said, “I like having my hair done”. We noted that individuals clothes were very well treated and this help all the people living in the look well turned-out for. Knotty Ash has a staff team some of whom have worked there for many years. Staff see themselves as a supportive team who work well together. They think that this has supported the individuals to feel safe in the home and form Knotty Ash Residential Home DS0000025353.V367789.R01.S.doc Version 5.2 Page 6 positive relationships with the staff team. People spoken with and their families felt safe and well cared for. The home was well presented and decorated in a domestic manner. A variety of communal spaces, such as dining room and lounges are available to support people to decide where they would prefer to spend their day. What has improved since the last inspection? What they could do better: Progress in improving the quality of the service remains slow. The service has not developed any active plans that look at the quality of the service. The service will find it difficult to increase the quality without making sure that the manager is aware of the areas that need to be improved. The policies and procedures available in the home as guidance to the staff had not been updated for four years. As such the guidance available to staff is out of date and does not support them to carry out their job roles. Care plans that describe to staff how to meet the needs of people living in the home have not been reviewed monthly or up date as individuals living in the homes needs have changed. This means that the care plans available to care staff are inaccurate. A lack of clear instructions to staff places people living in the home at risk of receiving incorrect care. Although improving, the management of medications needs additional development in order to maintain safety. We noted that records were not always clear and staff had not given medications to one individual without a clear reason. Risk assessments for people who managed their own medications were not in enough detail to tell staff as to how the risk will be reduced. Knotty Ash Residential Home DS0000025353.V367789.R01.S.doc Version 5.2 Page 7 Training for staff is still in need of further development and there are staff that have not had training to keep them up to date. Not all the staff are fully checked before they start working in the service and this places individuals at risk. 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. Knotty Ash Residential Home DS0000025353.V367789.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 Knotty Ash Residential Home DS0000025353.V367789.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): Standards reviewed 1,and 3. Standard 6 is not applicable. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Assessments are not in enough detail to make sure that the individuals wishing to move in the home have all their needs recognised. Without good assessments and good criteria for admissions the individuals wishing to move into the service will not have the information they need to determine if the service can meet their needs. EVIDENCE: We looked at assessments done before people move into the home. Assessments are done to find out what people’s needs are and if the service can meet their needs. We noted that assessments are not always done to enough detail for the service to identify if they can meet individual needs. There are no areas within the assessment to explore individual’s preferences, choices, social and equality and diversity needs. A recently admitted individual did not get the opportunity to have a full assessment. The admission was not Knotty Ash Residential Home DS0000025353.V367789.R01.S.doc Version 5.2 Page 10 an emergency and the assessor did not have enough time to complete the assessment as the individual had made other arrangements. The service did not take the opportunity to complete the assessment before the person moved in the home. None of the assessments we viewed were signed by the individual coming to live in the service or their family. One family member said, “I have not seen any information or assessment”. A lack of proper assessment means that staff will not be aware of all individual needs and run the risk of admitting people whose needs they cannot meet. Policies and procedures are not in place to give staff and make sure the arrangements for people moving into the service are managed properly. The policies that we were shown were four years out of date and did not follow the practice currently in place in the service. Without clear instructions staff will not be able to make sure that when people move into the home this is dealt with in a way that meets the needs of the person. Information on the home is not easily available and does not support people moving in to make a decision as to whether the service can make their needs. Information known as a service users guide and a statement of purpose has been updated and was available in the office. This did not contain criteria for admission, which would inform individuals, and staff as to what they could support expect within the service. No other copies were available in the home. Individuals spoken with said that they had not seen this information comments included, “I did get a little brochure that told me something and “not seen a big leaflet”. Without clear information people wishing to move in will not be able to make an informed choice as to whether the service can meet their needs. Knotty Ash Residential Home DS0000025353.V367789.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): Standards reviewed 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The variable practice regarding the planning and delivery of care and medications means that all individuals cannot be sure that their health and personal care needs will be met. EVIDENCE: Records looked at show that healthcare professionals are generally contacted when needed and their visits and care directions are recorded. We noted that one individual needed to have contact with an external professional. This needed to be done in order to make sure that the seating in the service met their needs. Staff had not asked for this advice and it was noted that on several occasions throughout the day the person was not comfortable in the seating provided. A community matron is allocated to the home. The community matron works with the local health service and gives the staff support and advice regarding Knotty Ash Residential Home DS0000025353.V367789.R01.S.doc Version 5.2 Page 12 any nursing care. One individual developed an infection for which medication was prescribed and accurately given. There was no care plan put into place at this time that described how staff would support the person with this need. Daily records did not show if the medication had been affective, there were no records available that showed whether the person’s health had improved. Although staff are accessing professional advice as appropriate a lack of clear planning and monitoring of changes in health places individuals at risk. Four care plans for individuals were looked at; none had been regularly reviewed or updated. Information in all the care plans was inaccurate with changes in condition or personal circumstances not included. Instructions in the plans had not been followed. Several care plans said, “weigh monthly” however a review of records showed that the individuals weights had not been monitored. Records were unclear and it was impossible to determine if they had lost, gained or maintained their weight. None of the plans seen had been signed by the individuals living in the home. We spoke to individuals living in the home and their relatives. They told us that they are not aware of care plans and had not seen them. One person said, we talked about this last time you were here and I havent seen the care plan since and another said, no, Ive never seen a care plan. We spoke to relatives who said, Whats a care plan. Staff said that they were not involved in care plans “the manager does all that”, “do not have time to look”, “we get told everything at handover”. We looked at how staff recorded and monitored the care that they gave and noted that staff did not make daily records that would inform what support they had given or what the individual’s condition was. Without good written instructions that inform staff they will be unable to supply care and support that meets individual needs. Medications are regularly audited, staff have received training and a policy and procedure is in place. We noticed that there were three different policies and as such it was difficult to determine which one staff should follow. We looked at this site visit and a pharmacy site visit done earlier in the year. We noted that improvements had been made in the last 12 months in the management of medications. There remain at both visits areas of practice in need of improvement in order to make sure that people living in the home received their medications safely. A review of medication records showed that most of the time medications were being given. In one instance the record of what should be given and the instructions on the box of medications were not the same. The staff in the home had not checked with the doctor if they had changed the instructions for the medications. The same medication was recorded as being frequently refused by the individual living in the service. The deputy manager stated that it was not refused but the night staff made the decision not to give it depending on the individuals’ condition. The medication was not prescribed on a when need basis and there were no written instructions available that support the decision not to give the medication. We noted other issues regarding the management of medications and although not poor practice will prevent medications from being managed properly. These Knotty Ash Residential Home DS0000025353.V367789.R01.S.doc Version 5.2 Page 13 were examples of when staff had not recorded the medications needed or written out instructions properly. We looked at two risk assessments for individuals who managed part of their medications. We noticed that the staff had not reviewed either of these for nearly a year. One risk assessment was for an individual who gave themselves an injection daily. Staff had not observed that they were safe to do so for nearly a year and had not checked that the individual kept the medications safely. The care plan said that staff needed to check that the dose was correct; staff had not followed this plan. There was no risk management plan in place that gave staff clear instructions on how to reduce the risk. Although it is clear that medications continue to improve there are still issues of practice that prevents the service from maintaining the safety of the people receiving medications. Knotty Ash Residential Home DS0000025353.V367789.R01.S.doc Version 5.2 Page 14 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): Standards reviewed 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all the people living in the home receive a lifestyle experience that meets their choices and personal preferences. EVIDENCE: Activities have started and a basic programme has been put into place. A member of the care staff undertakes this role as part of their normal duties; no extra hours are available for this part of the job. The programme of activities has not been taken from individuals expressed preferences or choices. There are no individual plans in place to meet social and equality and diversity needs. Although the care plans have the facility to detail social plans these were not completed or out of date. Several of the people living in the home are able to organise their own activities, such as going out with friends. As yet there is little opportunity for those people less able to communicate or without the support of friends and family. Individuals spoken with said that they tended to sort out their own activities but had enjoyed a recent trip out. Others spoken with said that some activities were “better than none”. The lack of activities taken directly from individual needs, choices and preferences Knotty Ash Residential Home DS0000025353.V367789.R01.S.doc Version 5.2 Page 15 means that many people living in the home will not be offered activities that meet their personal preferences. We observed the lunchtime meal and noticed that a variety of food was available for people to live in home to choose from. The service has recently added an additional alternative to the lunchtime sandwiches and on this site visit this was a burger. All the individuals living in the home spoken said that they enjoyed the food. Two people living in the home told us that the home and recently introduced other alternatives at lunchtime beside sandwiches. The service has listened to the people living in the home and included some of their wishes in arranging the menus. People living in the home told us that were grateful for this as they found just the sandwiches pretty boring. A menu-board was available in the dining room that listed what meals were available each day. Menus were available in the kitchen, which were set for a two weekly cycle. The service does not write the majority of meals from individual choices. There is no information available in the home that details what individuals personal preferences are for meals. Staff do ask each person during the day what meal they would like from those choices. The kitchen staff said that would like to do some training in special diets in particularly in diabetic’s diets. They had asked for this before but as yet it has not occurred. Without including more information about personal preferences and understanding different diets the service will not be able to meet individuals food choices. Knotty Ash Residential Home DS0000025353.V367789.R01.S.doc Version 5.2 Page 16 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): Standards reviewed 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individuals and their families feel safe and listened too. Information and training available to staff was not in enough detail to help them deal with a serious concern correctly. The service is not making sure that all staff are checked as suitable to work in the home. This means that individuals may not be protected from potential abuse. EVIDENCE: We looked at complaint records and noticed that one concern had investigated with a reply sent to the complainant. Investigation records were available, for us to review. According to the staff in the home the family member was happy with the outcome and the issue was dealt with correctly. This showed that the manager can recognise and deal with concerns from family members. When we looked at staff files we noticed that not all the staff had had the correct checks in place and staff on placement from a local colleague had no records available to confirm their suitability to work in the home. The home had not taken the appropriate steps to safeguard the individuals living in the home to make sure that all recruitment checks were in place. Records available in the commission showed that we have received one concern regarding protection of vulnerable adults from social services. We Knotty Ash Residential Home DS0000025353.V367789.R01.S.doc Version 5.2 Page 17 looked at the staff training file and were unable to find any records of recent training in protecting adults from potential abuse. All staff members spoken with were unclear as to how allegations of this nature are dealt with. Three staff members said that they had never received training in this area. There was no training plan available that identified plans for training in the protection of adults. None had seen the policies and procedures in the home showed how the service would resolve issues of this nature, the policy available was four years out of date and was incorrect in explaining how staff were to deal with these concerns. Staff spoken with had not seen the policy from Social Services, that the home must follow should safeguarding complaints be made. Without a proper understanding of dealing with safeguarding concerns staff may not report these correctly or deal with the appropriately should they arise. We spoke to four individuals all felt able to raise their concerns and were happy to tell staff if their was something they did not like. None of those spoken with were aware of a complaints procedure and did not recall seeing one. A policy needs to be in place to make sure that staff have the guidance that they need to deal with all concerns appropriately. All people living in the home were sure that any concerns they had would be addressed. We also spoke to relatives two relatives visiting the home. Both said that they had no concerns about the service, comments included “rest assured I am sure that they would do everything they could to address it”. Individuals living in the home are their relatives feel able to raise concerns and expect that they will be dealt with. Knotty Ash Residential Home DS0000025353.V367789.R01.S.doc Version 5.2 Page 18 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): Standards reviewed 19, 20, 22, 23 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Knotty Ash is decorated in a domestic style that is warm and welcoming. The home is a pleasant, clean and a tidy place to live. EVIDENCE: We looked around the home and noted that there are two lounges a smoking room and a dining room available for people to use. This offers them a variety of space including their bedrooms in which to spend their time. Several individuals were observed to stay in the lounge next to the dining room at mealtimes, as there is insufficient space in the dining room. Those spoken with prefer to eat their meals there and to socialise with each other. Over meals the dining room was very crowded and it was difficult for individuals who were independent to move around. One person was unable to leave the dining room Knotty Ash Residential Home DS0000025353.V367789.R01.S.doc Version 5.2 Page 19 as they wanted as there was no space for them and they had to wait for staff to arrange furniture to leave the room. Not all the furniture was suitable to individual needs. Staff had not provided additional support to make sure that the furniture was more comfortable to the persons need. One person was seen to be sitting uncomfortably throughout the site visit. Every bedroom has a brass plaque outside that has the individuals name on. However these are not easily read by people with visual impairment. All doors are identical including the bathrooms. The service has a variety of areas that are available for individuals to use. Some of the equipment available and signposting in the home may not always be suitable to meet individual needs. Several individual bedrooms were viewed all had personal items in place and were well presented. One person said, “I like my bedroom”. Bedrooms are made to be a comfortable place were people can spends their time if they choose. All areas of the home were clean and well maintained. Individuals spoken with said, “its very clean and tidy”, “it’s a lovely home, its always clean and tidy”. All areas that needed redecorating have been completed. There is a new maintenance man and this seems to have helped. Staff let the maintenance man know about any issues and he sorts them. Handyman is now the fire marshal and checks lighting, alarms etc. Although there is no maintenance plan in place the home is maintained to a good standard. Knotty Ash Residential Home DS0000025353.V367789.R01.S.doc Version 5.2 Page 20 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): Standards reviewed 27, 28, 29 and 30. Standards reviewed 31, 32, 33, 35, 36 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff are not fully checked before they start working and not all staff have up to date training. Both these may lead to individuals living in the home not receiving the care they need or having their interests protected. EVIDENCE: We looked at staffing records and noticed that not all the staff had had proper checks put into place before they started working. This included staff employed by Knotty Ash and staff working on a placement from a local college. Records available in the home were not available for all checks on one person working in the home. Another member of staff had only one reference and no police check. We were informed that the home had undertaken a check known as PoVa first and this was in place. Staff without a police check can start working in the home in exceptional circumstances, with all references, induction, PoVa first and constant supervision in place. We observed the member of staff working independently throughout the day and there were no records that showed that they were constantly supervised whilst on duty. Other staff files checked showed that they had all the appropriate checks in place at this site visit. Not having all the staff working in the home checked that they are fit to do so places people living in the service at risk. Knotty Ash Residential Home DS0000025353.V367789.R01.S.doc Version 5.2 Page 21 We could not locate of inductions or staff training records for individual staff. These were asked for on several occasions but could not be found by the staff working in the service. A training file was located this was not organised. We could not find training plan the detailed what training staff and undertaken or what planned training was in place. We spoke with staff some of which had not received any training for over 12 months. None of the staff spoken with could recall receiving training in adult protection and fire within the last 12 months. We were not able to identify in the training records if staff had received basic training such as fire or moving and handling. Staff told us that some people living in the home had dementia care needs and that they had not received training in meeting this need. Without training to meet their job role staff will not be able to maintain the safety or needs of people living in the home. The staffing levels are not determined by the dependency needs of people living in the home. We looked at the staffing rota and noticed that the staff write on the duty rota when they are available to work in the service. People spoken with said, “the staff here are very nice, nothing is too much for them”, “I like living here the girls and the boys are great”, “staff are busy” and “mostly there is enough staff I never wait very long”. Staff spoken with that they think of themselves a good team who “work well” together. They did find mornings and mealtimes sometimes very busy. Staffing levels are not monitored or determined on the needs of individuals living in the home. This means that the service will not be able to make sure that they always have enough staff available to meet the needs of people living there. Knotty Ash Residential Home DS0000025353.V367789.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There has been little progress in increasing the overall quality of the service. The management of quality does not identify the areas that need to improve. Plans are not in place that help the manager to improve the quality of the service. EVIDENCE: We spoke to people living in the home and staff they told us that the manager is well thought of both by people living in the home comments included, “The manager is a great” and “is really nice he tries very hard”. The service has recruited a deputy manager to give the manager extra support. As yet this extra support has not been fully developed and the manager remains the main member of the management team undertaking the majority of tasks, this includes care plans and audits. The role is still very new and when it is further Knotty Ash Residential Home DS0000025353.V367789.R01.S.doc Version 5.2 Page 23 developed should provide additional support to all the management team. Staff comments included “good management team, very supportive” and “don’t all want the same things done the same way”. The policies and procedures in the home are four years out of date and do not provide staff with the guidance and instruction they need. Several policies such as those around the management of individual money and equality and diversity were not available. A lack of clear guidance will result in staff delivering care and support in an inconsistent manner that does not meet individual needs. We looked at how the service consults people who live in the home. We could find no evidence that individuals’ wishes are used in recognising and maintaining the quality of the service. There were no surveys that asked individuals opinions and no minutes of meetings. People living in the home told us, “not been to a residents meeting”, “we did discuss food a while ago but I don’t remember seeing anything like minutes afterwards”, “We talked about the food and the manager made some changes but that wasn’t in a meeting, do we have them?” “never filled out a survey” and “never been asked what I think of the home” . Information in the home for people that would tell them what services are provided was not given to them and not readily available. Although the home does do audits on some areas within the home such as medications there is no plan produced taken from individuals views that details how the service intends to increase the quality. Without consulting the people who live in the home and checking the quality of the service, the manager will not be able to recognise the areas that are in need of development or put plans in place that address these areas. A review of files and a discussion with staff showed that none received regular supervision. No records were found that showed a discussion with the manager about staff development. We could not find records that detailed what staff meetings had occurred. Staff spoken with could not recall a staff meeting and no minutes were available that detailed staff meetings. Without staff supervision that develops and supports them staff will not be able to develop in a manner that meets the needs of the people living in the service. The arrangements for managing individuals funds where looked at. We found that the majority of individuals look after their own funds or their family look after them on their behalf. For those funds that the service does manage financial records were available. Not all individuals’ funds are separate to the homes account and this places the funds at risk. People who the service manages funds for cannot access these funds without certain members of staff being on duty limiting their access to their money. Knotty Ash Residential Home DS0000025353.V367789.R01.S.doc Version 5.2 Page 24 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 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 X 3 3 X X 3 STAFFING Standard No Score 27 2 28 1 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X 2 2 X 2 Knotty Ash Residential Home DS0000025353.V367789.R01.S.doc Version 5.2 Page 25 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. Standard OP7 Regulation 15 (1) (2) (a) (b) (c) (d) Requirement Care plans need to clearly explain to staff how to meet the needs of the individuals living in the home. Care plans need to be kept up to date and reflect the needs of people that the service supports. Outstanding from 09/11/07 The risk assessments for people who manage their own medications need to be regularly reviewed and monitored to maintain the safety of people living in the home. A plan as to how the risk will be minimised needs to be in place that all staff follow. Records of the administration of medication must be clear and accurate. This needs to be done in order that staff have the correct instructions available to them when giving out medicines. Outstanding from 27/06/08 All staff in particular those staff left in charge of the home need DS0000025353.V367789.R01.S.doc Timescale for action 03/11/08 2. OP9 12 (2) 03/10/08 3. OP9 17 (1)(a) 03/10/08 4. OP18 13 (6) 03/10/08 Knotty Ash Residential Home Version 5.2 Page 26 to have a full understanding by training or other means of the ways to protect individuals living in the home. This will prevent any potential protection of vulnerable adults incidents being dealt with inappropriately. The policy and procedure in this area needs to be updated and accurate in order to support staff to safe guard residents appropriately. 5. OP27 18 (1) (c) (i) (ii) Outstanding from 09/11/07 Staff development needs to be expanded to include, senior care staff role, care planning, fire training, moving and handling, communication with individuals less able to communicate, dementia care and diabetes as examples. This will provide staff with the skills to maintain the safety and meet the needs of people living in the home. Outstanding from 09/11/07 To ensure that people who receive the service are safe, arrangements must be in place to ensure staff are properly vetted and checked, including police, reference checks and receiving appropriate supervision. 03/11/08 6. OP29 19 (1) (a) (b) (i) (ii) (3) (4) (a) (b) (i) (ii) (iii) (c) (5) (a) (b) (c) (d) 03/10/08 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 OP1 Good Practice Recommendations Information in the home such as copy of the statement of DS0000025353.V367789.R01.S.doc Version 5.2 Page 27 Knotty Ash Residential Home 2. OP7 3. OP8 4. OP12 5. OP33 6. OP35 7. OP33 purpose and service users guide that was distributed to people who live in the home and their families. This action would help new and current individuals to make choices within the home. Care staff should be trained and encouraged to develop and write care plans. Care plans should be accessible to all including those who live in the service. Daily records that reflect the care given in line with an up to date care plan need to be in place. Individuals in the home would benefit from these being done on a daily basis in order to monitor the care and support needs of people living in the home. Individuals need to be referred to external professionals were needs are identified that need further assessment. Examples of this would include the need for specialised equipment. An individual likes, dislikes, personal preferences need to be found out and used to determine their individual daily activities, menus and activities. Activities that are suitable to meet the people who live in the home needs, preferences and choices need to be in place. All policies and procedures need to be updated in line with changes in legislation such as the Mental Capacity act. Policies need to give staff guidance and support on the best practice within the service and be accessed by staff as needed. Individual finances need to be reviewed, people living in the home need to be able to access their own funds, as they would wish. Information regarding the management of peoples funds need to be included in the statement of purpose or service users guide Staffing levels need to be determined from residents needs, consistently monitored in order that there are sufficient staff and maintained at all times in order to maintain the safety of the residents. Management needs to consider a formal quality assurance as the present audits whilst increasing quality in some areas have prompted little improvement overall. This should include audits on the key areas such as care plans, staff training and staff recruitment as examples. Policies and procedures need to be updated to provide suitable guidance to staff. Individual surveys to people living in the home and staff should be considered as part of gathering their views about the service. Knotty Ash Residential Home DS0000025353.V367789.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Regional Contact Team Unit1, 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.northwest@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 Knotty Ash Residential Home DS0000025353.V367789.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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