Inspection on 29/09/05 for Knotty Ash Residential Home

This inspection was carried out on 29th September 2005.

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.

Other inspections for this house

Knotty Ash Residential Home 02/09/08

Knotty Ash Residential Home 25/09/07

Knotty Ash Residential Home 06/02/07

Knotty Ash Residential Home 02/03/06

Knotty Ash Residential Home 13/03/05

Knotty Ash Residential Home 02/07/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Knotty Ash Residential Home 69 East Prescot Road Liverpool Merseyside L14 Lead Inspector Pat Kearney Unannounced Inspection 29th September 2005 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.V256769.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V256769.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Knotty Ash Residential Home Address 69 East Prescot Road Liverpool Merseyside L14 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0151 254 1099 Knotty Ash Home Ltd Debra Margaret Murphy Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Knotty Ash Residential Home DS0000025353.V256769.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th March 2005 Brief Description of the Service: Knotty Ash is a residential care home providing 24-hour personal care and accommodation for 30 older people. The home is privately owned, the home is currently in the process of being sold to Meridian Care Ltd and it is anticipated that the purchase will be completed within the next three months. There have been several changes of manager in the past eighteen months. The current acting manager had been had been in post for three weeks at the time of this inspection. The home is located in a residential area, within close proximity of the Old Swan shopping area of Liverpool. The home is a purpose built twostorey building that was opened in 1997. All bedrooms have en-suite facilities. Communal space within the home consists of a conservatory area, a large main lounge and a separate dining room. Knotty Ash Residential Home DS0000025353.V256769.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This statutory unannounced inspection 10 00 hours on 29th September 2005 and lasted almost five hours. The home owner Mrs Brenda Hancock, the newly appointed acting manager and administrator were all present during the inspection. The acting manager and administrator were in the process of interviewing for senior care staff. A member of the senior care staff accompanied the inspector during the inspection. Seven service users five relatives and six members of staff were spoken to during the inspection. The home owner said that progress was being made in the selling of the home to Meridian Care Ltd and that she was hoping to complete the sale in the next three months. A full tour of the premises took place. All relevant documentation and records for service users and staff were reviewed which included care plans.staff personnel files, policies & procedures and medication charts were examined. What the service does well: What has improved since the last inspection? Knotty Ash Residential Home DS0000025353.V256769.R01.S.doc Version 5.0 Page 6 The home has been without a manager for three months this together with the proposed selling of the home to Meridian Care Ltd. has limited any development in the home since the last inspection. The administrator who has many years experience working for the company has returned to work at the home during the transition period prior to the home being purchased by Meridian Care Ltd. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Knotty Ash Residential Home DS0000025353.V256769.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Knotty Ash Residential Home DS0000025353.V256769.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1.2.3.4.5.6. The homes Statement of Purpose and Service User Guide is being reviewed and updated to provide sufficient information for prospective service users to be clear about the services the home provides to meet their needs. EVIDENCE: The manager had been in post for three weeks prior to this inspection. The manager had commenced work on reviewing the Statement of Purpose and Service Users Guide. On the day of the inspection progress had been made with the review of the Statement of Purpose which was almost complete, but required further information to be included. The format of the Statement of purpose was clearly written, detailed, well spaced and produced in large print making it easily accessible to the older people who would be the target audience. The manager said she would complete the work on both document and send copies to the Commission for Social Care Inspection (C.S.C.I. ) The homes pre admission document is currently being reviewed and updated to ensure a comprehensive pre assessment is completed. Knotty Ash Residential Home DS0000025353.V256769.R01.S.doc Version 5.0 Page 9 Service users and relatives interviewed during the inspection all confirmed that they were able to visit the home prior to admission. On the day of the inspection there were prospective service users visiting the home and staying for lunch prior to making a decision to move into the home. A large selection of service users files were examined at random none had a costed contract in. The home does not provide intermediate care. Knotty Ash Residential Home DS0000025353.V256769.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7.8.9.10.11. Care plans do not show a clear or consistent approach to recording information Daily recordings lack information about visits by health care professionals and details about any other critical incidences making it difficult for the changing needs of service users to be met. The homes procedures for administering medication needs to improve currently the system places the service users at risk and harm. Personal support in this home is not always offered in such away that service users’ are treated with respect and protect service users’ privacy and dignity. EVIDENCE: All service users in the home have an individual care plan, which is formulated on admission to the home, it is reviewed monthly by the senior care staff. Records viewed showed an inconsistent approach to the care planning process and gaps in information were evident. Care plans had not been reviewed for some time. Knotty Ash Residential Home DS0000025353.V256769.R01.S.doc Version 5.0 Page 11 Service uses do not self medicate.. Medications are administered by the senior care in the home. The protocols for the receipt, storage, disposal, and documentation of medications in the home currently do not meet the regulation and guidance issued by the Royal Pharmaceutical Society of Great Britain and National Minimum Standards for Older People. During the inspection a quantity of prescribed creams and lotions were in a service users bedroom some were dating back to 2002. No Medication Administration Charts were available for all the prescribed creams and relatives raised concerns with the inspector that these creams were not being administrated to the service user. The manager told the inspector that she had written to all the G.P.’s with patients at the home requesting a full review of the individual service users current medication. There was written evidence that this had taken place. The community pharmacist is due to complete an audit of medication held at the home and is providing training on the administration of medication. Service users and relatives told the inspector that the majority of staff treat them with dignity and respect. Service users commented that the majority of staff are “angels” and “I don’t know what we would do without them” Both service users and their relatives raised concerns regarding personal care and staff attitudes In particular one service user stated “Just the odd one is sharp and impatient” with them. This was supported by a relative who asserted that “Some staff rush Mum and snap at her which upsets her and that at times her buzzer is hidden from her” When informed of this practice the manager said she would address the issues with all staff. Knotty Ash Residential Home DS0000025353.V256769.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12.13.14.15. Dietary needs of service users are well catered for with a balanced and varied selection of food available that meets service users tastes and choices. Organised social activities for service users are not being undertaken on a daily basis in the home, this may lead to boredom, frustration and apathy amongst the service users. EVIDENCE: There were a number of relatives and friends visiting service users on the day of the inspection all said they felt able to visit as often as they wanted to and the majority of the relatives spoken to said they were made welcome by staff. Relatives were able to visit service users in their own rooms or in communal lounges. Service users spoken to said they could choose how they spend their day, some service users said they would “like to have more to do “ and others said “that the activities held at the home were not held often enough, and sometimes the days seem very long” All service users commented that the food was “good and they enjoyed their meals” they said “that there was always a choice.” Knotty Ash Residential Home DS0000025353.V256769.R01.S.doc Version 5.0 Page 13 On the day of the inspection the dining room was bright and the tables were laid ready for the next meal. Place mats were being used for each place setting which were colourful and clean. The environmental health officers had completed an unannounced inspection in the kitchen on 27th July 2005 the outcome of which was a positive report which the inspector saw. Knotty Ash Residential Home DS0000025353.V256769.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16.17.18. A complaints procedure is in place in the home, and residents spoken to are confident that their concerns will be listened to, taken seriously and acted upon. Staff have a working knowledge and understanding of Adult Protection issues which protects service users from abuse. EVIDENCE: The home has a complaints procedure, and a complaints record. No internal complaints were recorded in the last year. During the inspection a relative raised concerns with the inspector when questioned the manager said she had arranged a meeting with the person concerned to discuss their concerns. That meeting was due to be held the week following the inspection.A copy of the outcome is to be forwarded to the C.S.C.I. Service users and their relatives told the inspector that they were “Able to raise any issues of concern with the senior staff and they would be addressed” There have been no complaints recorded at the home or with C.S.CI. since the last inspection. The Manager has undertaken Adult Protection training and showed an in depth knowledge of the Protection of Vulnerable Adults.( POVA).Some staff have completed Adult Protection training others spoken to said they could not Knotty Ash Residential Home DS0000025353.V256769.R01.S.doc Version 5.0 Page 15 remember but when questioned about adult protection issues were able to demonstrate a knowledge of the issues and the implications for their practice. Knotty Ash Residential Home DS0000025353.V256769.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19.20,21.22.23.24.25.26., The standard of décor and furnishings within this home is of a good standard,the home presents as a homely and comfortable environment for the residents. EVIDENCE: Knotty Ash is accessible, safe and maintained to a good standard both inside and out. On the day of this unannounced inspection the home was clean, odour free and the domestic style furniture and fittings result in a comfortable homely and pleasant environment. All service user have bedrooms which have en-suite facilities. The bedrooms reflect service users individual tastes and preferences and contain a number of their treasured possessions. Knotty Ash Residential Home DS0000025353.V256769.R01.S.doc Version 5.0 Page 17 Communal spaces are light bright and comfortable although the dining room décor was looking dated and would benefit from redecoration. Knotty Ash Residential Home DS0000025353.V256769.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27.28.29.30. The majority of staff have a good understanding of the service user’s support needs. This is evident from the positive relationships, which have been formed between the majority of staff and service users. Staff personnel files did not contain all the appropriate documentation needed to ensure the health and safety of both residents and staff. EVIDENCE: Service user’s and their relatives were very positive about the level of care provided by the majority of staff within the home. There were a couple of service users and their relatives who said that on occaisions some staff were “sharp with Mum and hurried her” and that “ sometimes the nurse call system was hidden from her” The newly appointed manager said she would address these issues through the staff training programme. A random sample of the staff personnel files were viewed not all the files seen had all the relevant documentation to safeguard the service users. Personnel files were disorganised and it was difficult to establish what training had been completed and when mandatory training had been completed or updated. There was evidence that newly recruited staff had not had an induction. The manager said that staff would be attending a T.O.PP.S induction course organised through Learn Direct. Six members of the care staff currently hold an N.V.Q Level 2 Award which is equivalent to 32 of staff. Knotty Ash Residential Home DS0000025353.V256769.R01.S.doc Version 5.0 Page 19 On the day of this unannounced inspection there were interviews taking place to recruit senior care staff. The manager has developed a pro forma for the recruitment and selection of staff. The documentation viewed demonstrated that all safety checks would be completed prior to the offer of employment. Knotty Ash Residential Home DS0000025353.V256769.R01.S.doc Version 5.0 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31.32.33..36.37.38. The newly appointed manager has a clear development plan and vision for the home which will improve the health safety and welfare of service users and staff and is in the process of communicating those plans to service users, relatives and staff. EVIDENCE: The former manager left the home in June 2005 since June the home has been managed by senior care staff and the owner of the home said that she “visited the home on a daily basis “ during this time. The Regulation 26 visits by the Registered Provider have not been forwarded to the C.S.C.I office. The newly appointed manager had been in post for three weeks prior to this unannounced inspection and was still completing her induction. The induction was being conducted by the Homes Administrator who has worked with the company for a number of years. Knotty Ash Residential Home DS0000025353.V256769.R01.S.doc Version 5.0 Page 21 The manager has many years experience working with the service user group holds the N.V.Q. 4 Registered Managers award, N.V.Q. Level 3 Mental health and D32 D33 assessors awards. The manager said she had conducted an audit which had identified a number of areas that needed to be changed to improve the quality of care provided at the home. She discussed the changes during the inspection and was clear about how these issues should be addressed and was in the process of developing an action plan. Service users knew the manager first name and said she was available if they had any concerns which they wanted to raise and said they were confident that their concerns would be addressed. Relatives interviewed said that “she had introduced herself to them” and understood that she was in the process of organising a relatives meeting to discuss with them her plans. The manager is currently in the process of reviewing all the current practices at the home and said that she fully appreciated the benefits of regular staff supervision in providing a quality service to service users and it’s role in developing staff and would commenced supervision once her induction was completed. The homes certificates of insurance and worthiness for machines, gas, electricity, fire equipments, lift, hoists and Portable Appliance Testing were in date and valid. On the day of this announced inspection financial accounting systems were not available, the home owner explained that the day prior to the inspection the auditors from Meridian Care Ltd had collected all the accounts as part of the prospective purchase process. Liverpool City Council environmental health officer has visited the home with no requirements being made. The Regulation 26 visits by the Registered Provider have not been forwarded to the C.S.C.I office. Knotty Ash Residential Home DS0000025353.V256769.R01.S.doc Version 5.0 Page 22 Knotty Ash Residential Home DS0000025353.V256769.R01.S.doc Version 5.0 Page 23 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 1 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x x 2 2 3 Knotty Ash Residential Home DS0000025353.V256769.R01.S.doc Version 5.0 Page 24 Are there any outstanding requirements from the last inspection? 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 1 Regulation 4 Requirement Timescale for action 01/12/05 2 2 17 3 3 14 4 7 15 The Registered Person shall ensure that the Homes Statement of Purpose is updated and include the services and faciliites provided by the home for service users The registered person must 15/11/05 produce a statement/contract of the terms and conditions to the service user and/or their representative. Acopy of which must be kept on the service users file. The Registered Person shall not 15/12/05 provide accommodation to a service user at the care home unless the needs of the service user have been assessed by a suitably qualified person.The current review of the preadmission document must be completed and the document introduced ensuring that the needs of the service users are fully assessed prior to admission. The Registered Person must 01/12/05 ensure that the service users care plans are valid and up to date at all times. DS0000025353.V256769.R01.S.doc Version 5.0 Knotty Ash Residential Home Page 25 5 10 4 6 38 23 7 38 26 The Registered Person shall 15/11/05 ensure that the care home is conducted in such a manner which respects the dignity and privacy of service users at all times. The registered person shall 15/11/05 ensure that the health safety and welfare of service users and staff is maintained at all times. Records required by regulation are maintained at the care home. The Registered person must 15/11/05 complete the monthly visit to the care home and produce a written report which must be forwarded to the C.S.C.I. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Knotty Ash Residential Home DS0000025353.V256769.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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