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Inspection on 25/09/07 for Knotty Ash Residential Home

Also see our care home review for Knotty Ash Residential Home for more information

This inspection was carried out on 25th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

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

Knotty Ash has a staff team that have worked in the home in some cases for many years. This has supported the residents to feel safe in the home and form good relationships with the care staff. Residents spoken with made positive comments such as, "it`s a nice home always treated nicely", "Like the nurses", "staff are all nice" and "staff look after everybody". Visitors and relatives said that they are always made welcome in the home and that their relatives are well looked after. A good standard of personal care was provided with residents being able to access a hairdresser on a weekly basis. All of the residents looked very well presented, with well cared for clothing and several were supported to wear the clothing of their choice. The home was very clean and tidy and residents are encouraged to bring in their own items from their previous homes to make their bedrooms their own.

What has improved since the last inspection?

There have been changes in the environment of the home with the creation of additional bedrooms an additional lounge and a separate smoking room. Resident`s and relatives spoken with thought that this had improved the appearance of the home and gave them different places to spend their days. Care plan have been simplified and are now easier to read with some of them having been shared with the residents or their relatives to inform them of the residents care needs. Since the last inspection the acting manager has undergone his interview with the commission and is now the registered manager of Knotty Ash. Medication management has continued to improve with better medication policies and procedures, training for staff and regular reviews of staffs practice in giving out medications. This has helped safeguard the residents who receive medications directly from the staff. All staff in the home have now been checked to determine if they are suitable to work with in the home and training analysis has taken place with particular emphasis on a formal training qualification in care for staff involved in providing care to the residents.

What the care home could do better:

Poor practice is still evident in the home, in particular senior care staff do not fully understand their role and had not appropriately managed the home in the absence of the manager. Medications were administrated on one occasion in an unsafe manner, staff had not been replaced when unable to attend their work and at least one member of staff had no idea how to deal with serious concerns and would have mishandled complaints of this nature in the absence of the manager. Training for staff is still in need of further development and there are several residents living in the home with needs that staff have no training, understand or experience of. Information in the home is also in need of development this includes care plans, statement of purpose, service users guide, policies and procedures, menus and activities. Care plans did not detail to staff how to meet resident`s needs and in one instance had been signed by a resident without being informed of its contents. Menus and activities had not been developed from residents, personal preferences, choices, needs or equality and diversity needs and did not demonstrate that residents were offered a choice. Statement of purpose, service users guide and policies and procedures were inaccurate anddid not reflect the services provided or provide staff with information on how to maintain their best practice.

CARE HOMES FOR OLDER PEOPLE Knotty Ash Residential Home 69 East Prescot Road Liverpool Merseyside L14 1PN Lead Inspector Mrs Julie Garrity Key Unannounced Inspection 10:15 18 and 25 of September 2007 th th 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.V346770.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.V346770.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 Knotty Ash Home Ltd Mr Andrew Feeney 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.V346770.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: 30. Date of last inspection 6th February 2007 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 purpose built with 26 bedrooms on the ground floor and 3 bedrooms on the top floor. There are handrails and a lift to assist in the residents accessing all areas of the home. There is a dining room, a separate smoking room and two lounge areas for the residents to use. All bedrooms have en-suite 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 and prospective residents easily identify the home. There are gardens surrounding the Home and a large park is located at the front to the home. The fees for the home are at Local Authority rates although private residents can be accommodated. The current rate of fees range from £315.50 to £405 and this depends on the resident’s needs and the service that they require. Knotty Ash Residential Home DS0000025353.V346770.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out over a period of two days. The inspector arrived at the home at 10:15 on the first day. A total of 10 hours 25 minutes was spent at the site visit over the two days. The inspector had to undertake two days as the manager was on leave at the first visit and staff did not have access to a number of vital documents. The second day of the site visit was to review these documents and to give feedback to the manager. The inspector spoke with 5 relatives, 10 residents, 1 visitor and 9 staff over the two days. The inspector 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 CSCI offices. Records viewed included care plans, medications, staff files, staff training, residents records, menus, medications audit, activities board, statement of purpose, service users guide, the homes policies and procedures and daily records. The inspector followed an inspection plan written before the start of the inspection to ensure that all areas identified in need of review were covered. All of the Key standards were covered in this inspection, these are detailed in the report. Feedback was given to the manager at the end of the second days 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: Knotty Ash has a staff team that have worked in the home in some cases for many years. This has supported the residents to feel safe in the home and form good relationships with the care staff. Residents spoken with made positive comments such as, “it’s a nice home always treated nicely”, “Like the nurses”, “staff are all nice” and “staff look after everybody”. Visitors and relatives said that they are always made welcome in the home and that their relatives are well looked after. A good standard of personal care was provided with residents being able to access a hairdresser on a weekly basis. All of the residents looked very well presented, with well cared for clothing and several were supported to wear the clothing of their choice. Knotty Ash Residential Home DS0000025353.V346770.R01.S.doc Version 5.2 Page 6 The home was very clean and tidy and residents are encouraged to bring in their own items from their previous homes to make their bedrooms their own. What has improved since the last inspection? What they could do better: Poor practice is still evident in the home, in particular senior care staff do not fully understand their role and had not appropriately managed the home in the absence of the manager. Medications were administrated on one occasion in an unsafe manner, staff had not been replaced when unable to attend their work and at least one member of staff had no idea how to deal with serious concerns and would have mishandled complaints of this nature in the absence of the manager. Training for staff is still in need of further development and there are several residents living in the home with needs that staff have no training, understand or experience of. Information in the home is also in need of development this includes care plans, statement of purpose, service users guide, policies and procedures, menus and activities. Care plans did not detail to staff how to meet resident’s needs and in one instance had been signed by a resident without being informed of its contents. Menus and activities had not been developed from residents, personal preferences, choices, needs or equality and diversity needs and did not demonstrate that residents were offered a choice. Statement of purpose, service users guide and policies and procedures were inaccurate and Knotty Ash Residential Home DS0000025353.V346770.R01.S.doc Version 5.2 Page 7 did not reflect the services provided or provide staff with information on how to maintain their best practice. 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.V346770.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.V346770.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 were 1, 3, 4 and 5. 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. The staff in the home make sure that all new residents are given an opportunity to visit the home and have a full assessment to see if the staff can meet their needs before they move in. However there are residents who staff do not have the skills to care for admitted to the home as the home failed to make sure that it had the assessments from outside professionals before the resident was admitted. Information for people who want to move into the home that would help them decide if the home can meet their needs is not readily available, inaccurate or not in formats to meet the residents needs. EVIDENCE: All residents are assessed by staff from the home before they move in. This supports the manager to decide if the residents needs can be meet. The manager makes sure that all residents are admitted on a trial period only so Knotty Ash Residential Home DS0000025353.V346770.R01.S.doc Version 5.2 Page 10 that further assessments can be done and that the resident can decide if this is the home for them. Residents and their families are all encouraged to visit before they are admitted. Residents spoken with said, “I came to have a look around the home before I moved in. The manager and I had a good chat. We talked about what it would be like to live here and how staff would help. I was given a choice of rooms and choose this one. They were all very kind and friendly and it’s the reason I choose to live here.” Copies of the assessments including those from Social Services were available for the three residents whose records were looked at. However in two instances these were not obtained until after the resident had moved in. In one instance this assessment showed that the resident was assessed for a care need that the home is not registered for and staff have no training. This is not good practice as it means that residents may move into the home and staff are unable to meet their needs. When residents needs change the home actively seeks the support of Social services, this was noted in care plans of two residents. Relatives spoken with said, “they say my mum’s needs have changed and they can’t meet them. The manager has arranged a meeting with Social Services to sort this out, but mum is happy here and I hope she doesn’t have to move”. The home has information a copy of this was available in the main office. However this was out of date, confusing and not written in a format to meet the residents needs. No other copies were seen in the home. Residents and relatives spoken with said, “have never seen any information about the home”, “Not seen an inspection report, but its lovely here”, I haven’t seen any information about the home we just discussed it” and “I’ve never seen an report from you, there isn’t one in the home, is there?” Knotty Ash Residential Home DS0000025353.V346770.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 were 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. Although improving, the variable practice regarding the planning and delivery of care and medications means that all residents cannot be sure that their health and personal care needs will be fully met. EVIDENCE: Records show that healthcare professionals are contacted when needed and their visits and care directions are recorded in the daily records. Staff or relatives escort residents to external appointments in order to make sure that they get the health care they need. A community matron is allocated to the home, which gives them nursing in put for residents whose healthcare needs change. Four care plans for residents were viewed, all had been regularly reviewed but not updated, three care plans had signatures of residents or their relatives dated when the plan was put into place. A relative spoken with said, “I haven’t Knotty Ash Residential Home DS0000025353.V346770.R01.S.doc Version 5.2 Page 12 seen a care plan for my mum”. Residents spoken with made the following comments, “Not seen a care plan” “Don’t know what a care plan is” “I saw something that said what I needed. I signed it I saw the bit that said needs to get out and about and that was it”, “Nobody has discussed a care plan with me” and “No idea what your talking about”. All the care plans contained assessment information, although in some cases vital needs had been missed such as need for creams, behavioural needs and communication needs. None of the plans contained details about the preferred routines of the residents. The manager explained that recently one of the night carers had worried about a resident who got up very early each morning. The manager had detailed that the resident had done this all their lives as part of their occupation. This information was essential in determining and meeting the residents needs but had not been available. There was very little instructions to the staff as to how to meet the residents needs and although care plans were regularly reviewed changes in residents needs or the actions that staff needed to take were not included. Care staff detailed that they did not read the plans as they had no time, did not write into daily records or in put into care plans in anyway. The lack of clear instructions to staff and not involving staff who deliver daily care is poor practice and will result in residents not receiving the right care to meet their individual needs. Staff spoken with are aware of how to maintain the dignity of residents and how to do this is also part of their training. However daily records kept for one resident were not sensitive to residents privacy and dignity and a member of the care staff was observed to enter residents bedrooms without knocking on their bedroom doors first. These actions do not recognise the rights of the residents in the home or maintain their privacy and dignity needs. Residents spoken with said, “Like the nurses”, “staff are all nice” and “staff look after everybody”. Medications are regularly audited, staff have received training and a policy and procedure is in place. Medications were looked at, at this inspection and showed that they were being given correctly to the residents. However the home is not checking that residents are bringing in the correct medications when they move in and prescriptions are not checked before they go to the chemist, as a result the home has too much stock of a number of medicines. On the day of the inspection a member of staff was observed undertaking very poor practice and had several different medications of several different residents to give out. This practice runs the risk of confusing medications and giving the wrong medications to a resident, this is also against the homes policy and procedure. A number of other issues regarding the management of medications and although not poor practice will prevent medications being managed properly. These were detailed to the manager who explained that the auditing of medications would include these areas as well in the future. Knotty Ash Residential Home DS0000025353.V346770.R01.S.doc Version 5.2 Page 13 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 were 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. A limited range of activities within the home and community means that many residents do not have a range of opportunities to participate in stimulating and motivating activities. Information such as menus, activities and community events are not detailed to residents in a manner that supports them all to make an informed choice. EVIDENCE: Most of the residents spoken with liked the food. Comments such “The food is very nice” “Its tasty food, well cooked and I enjoy it”, “sandwiches are a little bland, would be nice to have a little mustard or mayonnaise” other comments included “I only know what the food is when it arrives”, “Sometimes they ask me what I want” and “There isn’t a choice is there” were made. The chef asks residents what kind of things that they would like to see on the menu. Unfortunately this information is retained by the chef, is not recorded and not shared with the staff. Information for the residents to enable them to make choices is available on a menu-board displayed in the dining room. This is not always written in large print and is difficult to read. Menus did not reflect a Knotty Ash Residential Home DS0000025353.V346770.R01.S.doc Version 5.2 Page 14 choice of all meals, a choice of sandwiches does provide a different choice, but not a choice of meals. Mealtimes were altered recently in discussion with the residents. There is no information that details special needs such as soft diet or a diabetic diet. There was no activities displayed on the day of inspection, the activities coordinator was off sick and had not been replaced during this absence. As a result no activities at all were taking place. The manager and staff do discuss with residents how they would like to spend their time. However this was not detailed in the residents care plans or in any other records in the home. This means that staff will not meet the residents choices, this is particularly important for residents less able to voice the choices as staff need to support their preferred routines, as apposed to taking a guess and appose a routine on them not of their choosing. There are no residents or relatives meetings that would help determine and promote residents personal choices. Staff spoken with have little or no understanding of equality and diversity although they consider each resident as an individual they have strict routines within the home that they stick to are unaware of any policies and procedures that promote the equality and diversity needs of the residents and have very little information available that would guide them in residents personal choices and help them to support residents individual equality and diversity needs. Relatives are encouraged to visit the home and arrangements can be made for residents to visit relatives and friends. Relatives spoken with felt that the home was “very welcoming, pleasant to visit” and “my mum’s home and it feels like that. Staff are very kind and make me feel very welcome when I arrive”. Knotty Ash Residential Home DS0000025353.V346770.R01.S.doc Version 5.2 Page 15 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 were 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and their families feel safe and listened to. However formal processes need to be further developed so that the home’s procedures are available, understood and consistently applied. EVIDENCE: Residents spoken with said, that they all felt safe, listened to, and able to speak to the staff and manager if they were not happy about anything to do with their care. Comments such as “Staff are great, if I had a problem they would see to it straight away” “Great staff, so kind, I have absolutely no issues, but if I did I’m sure it wouldn’t be a problem”. Relatives said, “I am sure if I had a problem they would fix it”, “The manager is great, if we have any issues we can tell the staff and it gets sorted. There has been a few bits over time and its always been dealt with.” However neither of the relatives or the residents had seen a copy of a complaints process and were unaware as to how their concerns would be dealt with. Several members of staff explained that if residents raised concerns they would be addressed. This would not be written down and not always passed to the manager, as the member of staff did not see this is a complaint. As such it Knotty Ash Residential Home DS0000025353.V346770.R01.S.doc Version 5.2 Page 16 may re-occur without the manager being aware of the situation and being given an opportunity to make sure that the complaint was fixed. The manager writes down information regarding complaints and a record is kept that detail the nature of the complaints and what action will be taken. Complainants are responded to in writing. However on some occasions staff do not detail minor concerns to the manager and address them themselves, whilst it is good that staff try to address issues immediately the manager needs to be aware of this information in order that he can deal with it appropriately. The manager explained that currently there is no process for staff to record any concerns. The complaints procedure is available and is displayed in the main entrance of the building. It is however in standard print and not in an area accessed by very few of the residents on a daily basis. Although there is a copy of information that would be useful to the residents in the home this is the managers office and additional copies have not been given to the residents, their relatives or the staff. The home does have a copy of the social services policy regarding the protection of vulnerable adults. Staff members spoken with had received training in the protection of vulnerable adults and records within the home supported this. However all staff spoken with had not seen a copy of the relevant policies and procedures and were unaware of their existence. Induction records do not detail any protection of vulnerable adults training. All but one staff member spoken with had received training in protection of vulnerable adults. Discussions with the staff detailed that they had very little understanding as to what would happen should an allegation arise, senior staff spoken with were also not aware and their lack of understanding runs the risk that an allegation of this nature would not be appropriately dealt with. The homes policy and procedure on dealing with abuse and supporting staff to blow the whistle was out of date and inaccurate. Knotty Ash Residential Home DS0000025353.V346770.R01.S.doc Version 5.2 Page 17 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 were 19, 21, 22, 24 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Several areas of the home have been redecorated and new furniture supplied this has continued to help improve the appearance of the home. Residents supported to have their own possession in their rooms and this helps their bedrooms look comfortable. EVIDENCE: The home has had a lot refurbishment in recent months. This has resulted in a variety of areas for the residents and a nicer environment for them to live in. A new conservatory/ lounge room area has been completed and a larger lounge has been reduced in size of accommodate new bedrooms for residents. A separate area for those residents who smoke has been created. This is well used by the residents and is very smoky, ventilation is not available in this room other than opening the door. The manager has consulted with Knotty Ash Residential Home DS0000025353.V346770.R01.S.doc Version 5.2 Page 18 environmental health and says that they were happy with the present arrangements. The furniture in the dining room has been rearranged to reduce the risk to residents and staff in moving residents around the room. All the new space created has been redecorated apart from one area in the main corridor which is in need if decoration. The manager is aware of this and this is to be decorated in the next few weeks. Despite the refurbishment the dining room is not large enough to accommodate all the residents who do not want to eat in their bedrooms at mealtimes. Several residents stayed in the lounges to eat their meals. Staff spoken with said that they preferred to eat there and one of the residents spoken with said that they “like it better in here, the dining room gets a bit crowded”. The home is decorated in the same style throughout with doors that are identical and corridors that are decorated identically. Each bedroom has a brass nameplate outside it with the name of the resident written on it. Some of the residents have needs, which makes it difficult for them to locate their own bedrooms and bathrooms independently of the staff. The manager says that they are all aware of where their bedrooms are and with prompting can negotiate their way to their bedrooms. Resident’s bedrooms were viewed. All the residents spoken with were happy with their bedrooms, comments such as “its bright”, “very clean” “I brought a lot of stuff from my house, the staff help me arrange it and get all the bits and bobs I like in place. It makes it nicer” and “my room is lovely, its clean and bright, I really like it”. All the bedrooms have been decorated to include resident’s own personal items, such as pictures and ornaments. The home has bathrooms that are adapted to meet the needs of the residents and either provide a shower facility or a hoisted bath. There is no maintenance schedule available, but this is to be included in the manager’s quality audits that are to be done on a monthly basis. The kitchen and laundry areas were both very clean and tidy. A full cleaning schedule was available for the kitchen. This makes sure that all staff in the kitchen can keep up with the cleaning and maintain it to a good standard of cleanliness. Knotty Ash Residential Home DS0000025353.V346770.R01.S.doc Version 5.2 Page 19 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 were 27,28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is showing improvement in staff recruitment and the manager has good plans to improve staffing and training. Staff who are responsible for the home in the absence of the manager are in need of developing their skills and obtaining a better understanding of the responsibility of their role in order that they have the skills to consistently provide a quality service. EVIDENCE: Residents spoken with spoke positively about the staff including, “Staff are lovely, they can be very busy at time”. “They help me as I need” and “Staff are great, such nice attitudes and they work very hard”. Positive comments were supported by relatives who agreed saying, “caring staff, they work hard and are always smiling” and “I feel happy leaving my mum here she’s safe” Staff spoken with all said that they thought they were a good team and that they supported each other regularly. There have been some disagreements and misunderstandings recently but the manager has made sure that this has been addressed and action taken. One member of staff said that staff turnover is fairly low with most staff employed in the home for several years. This was also seen in the staffing records with very few new staff employed in the last 12 months. Knotty Ash Residential Home DS0000025353.V346770.R01.S.doc Version 5.2 Page 20 Resident’s dependency needs are done when they move into the home and updated for each resident. Staffing levels are not put into place in line with the assessed dependency needs of the residents. The duty rota detailed four staff all day and three staff overnight and this had been the same for several months. If staff needed to escort residents to an appointment extra staff were made available. On the day of the inspection it was detailed that on a number of occasions staff had not met the staffing levels agreed on by the manager. The activities coordinator had been absent and their hours had not been covered in their absence. The manager had been on leave and the senior staff in the home had not made sure that staffing levels were maintained in to provide a good quality of service to the residents. Poor practice was observed by a senior member of staff who stated that she had been aware that it was poor practice but had done it incorrectly as the home was “short staffed”. Senior staff had not maintained the best practice in place in the home in the absence of the manager. Staff training records were viewed and attempts have been made to improve training with copies of staff training available in all staff files. The manager has a plan in place as to what training staff need and makes sure that they all receive the training needed to meet the needs of the residents. Plans for the future include dementia and diabetes. Some staff have been given an overview of diabetes and found that this helps them provide a more suitable approach to the care needs of residents with this need. Two members of staff have received fire marshal training and it is their role to make sure that all staff receive this in the future. Most staff have received training in protecting adults, however some staff were still unsure of how complaints of this nature were dealt with. Staff files viewed were all up to date and included relevant checks on staff such as police check, references and are they are suitable to work with elderly people before they start working. This is good practice and makes sure that all new staff are suitable to work with the residents living in the home. Knotty Ash Residential Home DS0000025353.V346770.R01.S.doc Version 5.2 Page 21 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): Standards reviewed were 31, 32, 33, 35, 36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The overall quality of the home continues to develop in a number of areas. However senior care staff are not sufficiently skilled to adhere to good practice and maintain the quality of the service in the absence of the manager. Quality assurance needs to be further developed in order to make sure that the home can sustain quality and protect the residents. EVIDENCE: Residents, families and staff had very positive things to say about the registered manager. Comments such as, “the manager is a lovely guy always happy to take care of us. Can ask him anything and he will sort it” and Knotty Ash Residential Home DS0000025353.V346770.R01.S.doc Version 5.2 Page 22 “the manager is lovely, he’s made a big difference”. The manager has a management qualification and is registered with the Commission. On the first day of the site visit the manger was on leave and senior care staff had taken over the responsibility of the home in his absence. They did not have access to the managers office which included policies and procedures a key had been left with the administrator, who was available 3 days a week in office hours only and as such there was very limited access for staff responsible for the home. Senior care staff had been in charge of the home but had not replaced all absent staff to maintain the staffing levels and had undertaken poor practice, which under discussion the member of staff concerned was clearly aware that poor practice placed the residents at risk. There is no formal quality assurance system available that would enable all the people involved to increase the quality of the service provided. There are audits done by the manager on medications and care planning. The manager is about to start a full audit and quality assurance on a monthly basis this will form the start of their quality assurance. The majority of policies and procedures have not been updated for the last three years and are inaccurate. Staff will find it difficult to increase the quality of the service needed without clear guidelines on how to do so. Staff and residents say that there have been no residents or relatives meetings in the last few months and there are no minutes available in the home. Weekly senior staff meetings have been to make sure that the senior staff are aware of their job roles and to make sure that this is done. Supervision of staff is not yet formalised but this will also be used to develop areas of quality and make sure that staff are competent and trained to do their jobs. The home is not appointee to any of the residents and does not take responsibility for resident’s personal funds. Residents or their relatives manage their own money. The home does hold small amounts of money for residents that are passed on to the residents on a weekly basis. Where money is held for residents the manager does not have direct access to these and unless the residents takes their own money on a weekly basis they can only access their own funds when the administrator is in the building which is limited. Certificates for the home were viewed such as gas electricity, lift and moving and handling equipment and these were all up to date. Maintenance checks on hot water and fire alarms are done regularly. Call system checks are not undertaken and as such the staff cannot be sure that a resident is always able to access help as needed. The fire safety risk assessment has been with advice from the Fire Authority. Staff are now receiving regular fire training although the trainer does not always keep these records up to date staff confirmed that this was occurring. Fire training for residents is not yet in place but will be considered in the future. On the site visit several doors were wedged open with items that would Knotty Ash Residential Home DS0000025353.V346770.R01.S.doc Version 5.2 Page 23 present a hazard if there was a fire such as chairs, plastic wedges and small tables. Knotty Ash Residential Home DS0000025353.V346770.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 1 X 2 2 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X 3 3 X 3 X 3 STAFFING Standard No Score 27 2 28 2 29 3 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.V346770.R01.S.doc Version 5.2 Page 25 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 OP1 Regulation 4 (1) (a) (b) (c) (2) (3) (a) (b) 5 (1) (a) (b) (c) (d) (e) (f) (2) (3) 6 (a) (b) Requirement The statement of purpose and service users guide needs to be updated to reflect the changes in the home and the manner in which it operates. Information needs to be readily available to residents and their families in order for them to be fully aware of the services that the home provides. A copy of the up to date statement of purpose needs to be sent to the Commission. All residents coming into the home need the external professionals assessment. The home can not admit resident for which staff do not have the skills experience or training and the assessment undertaken by the home needs to explore this and include the assessment from external professionals. Care plans need to clearly explain to staff how to meet the needs of the residents. Where residents are consulted about their care plans staff need to determine that they have a good understanding of what is in the care plan before they sign it. DS0000025353.V346770.R01.S.doc Timescale for action 09/11/07 2. OP3 14 (1) (a) (b) (c) 25/10/07 3. OP7 15 (1) (2) (a) (b) (c) (d) 09/11/07 Knotty Ash Residential Home Version 5.2 Page 26 4. OP9 13 (2) 5, OP12 Staff need to maintain the best practice of management of medications and always follow the policies and procedures in place in the home to maintain the safety of the residents when giving out medications. 12 (1) (b) Activities that are suitable to (2) (3) meet the residents’ needs, (4) (a) (b) preferences and choices. That (5) (b) also meet individual equality and diversity to make sure that they can maintain their independence and enjoy their lives need to be developed and maintained even in the nascence of the activities co-ordinator. Activities need to be viewed as part of resident’s daily lives and included in their general lives in the home. 22 (1) (3) (4) (8) Information about complaints need to be passed to the manager in order that they can be appropriate investigated and prevented from re-occurring. Residents and relatives need information that tells them how to raise a concerns and how it will be dealt with. All staff in particular those staff left in charge of the home need to have a full understanding of the POVA policy and how this would be put into place. 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. Staffing levels need to be determined from residents needs, consistently monitored in order that there are sufficient staff and maintained at all times DS0000025353.V346770.R01.S.doc 09/11/07 09/11/07 6. OP16 09/11/07 7. OP18 13 (6) 09/11/07 8. OP27 18 (1) (a) 09/11/07 Knotty Ash Residential Home Version 5.2 Page 27 9. OP27 10. OP33 11. OP38 in order to maintain the safety of the residents. 18 (1) (c) Staff development needs to be (i) (ii) expanded to include, senior care staff role, care planning, communication with individuals less able to communicate, dementia care, diabetes and all staff need a clear understanding of PoVA and how these would be dealt with. A plan needs to be developed taken from residents needs and used to develop staff skills. 24 (1) (a) The management team needs to (b) (2) (3) put into place the formal quality assurance system that is taken from the expressed views of residents, staff, relatives and all stakeholders. A copy of this and the plan in place must be published and made available to all interested parties. This information will support the home to develop the quality of the home and support interested parties to be informed about the quality of the service provided in the home. Outstanding from 06/06/07 23 (4) (a) Fire doors and the smoking room (c) (v) (5) in the home need to be reviewed with advice sought from the local fire service and environmental health. 09/11/07 09/11/07 25/10/07 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 A copy of the statement of purpose and service users DS0000025353.V346770.R01.S.doc Version 5.2 Page 28 Knotty Ash Residential Home guide that was distributed to residents and their families would help new and current residents to make choices within the home. 2. OP7 Care staff should be trained and encouraged to develop and write care plans. Care plans should be accessible to all including the residents. Daily records should be meaningful and detail how the resident’s care needs were meet. Staff should not write statements that are derogatory in nature and do not protect residents equality and diversity needs. Residents likes, dislikes, personal preferences need to be found out and used to determine their individual daily activities, menus and activities. The environment needs to be reviewed in order to make sure that its layout and decoration meets the needs of all the residents and supports them to maintain their independence. Residents finances need to be reviewed, residents need to be able to access their own funds as they would wish and the manager and staff needs to be able to support residents in to managing their funds in a manner that meet their needs. Information such as Service users guide, care plans, menus, activities, fire instructions and making complaints need to be made available to residents in formats that meet their individual needs and support them to make independent decisions 3. OP7 4. 5. OP12 OP24 6. OP35 7. RCN Knotty Ash Residential Home DS0000025353.V346770.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Knotty Ash Residential Home DS0000025353.V346770.R01.S.doc Version 5.2 Page 30 - 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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