Inspection on 06/02/07 for Knotty Ash Residential Home

This inspection was carried out on 6th February 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 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 02/09/08

Knotty Ash Residential Home 25/09/07

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Knotty Ash Residential Home 69 East Prescot Road Liverpool Merseyside L14 Lead Inspector Mrs Julie Garrity Key Unannounced Inspection 6th February 2007 11:10 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.V329435.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.V329435.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 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.V329435.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th September 2006 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 dinning room and a lounge area for the residents to use a temporary smoking room is available for resident’s usage. 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 adjacent to the home. The fees for the home are at Local Authority rates. Knotty Ash Residential Home DS0000025353.V329435.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 one day. The inspector arrived at the home at 11:10 and left at 16.150. The inspector spoke with 6 residents, 1 visitor, 2 relatives, 5 staff and the manager. 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 and daily records. This site visit included discussions with residents, relatives, visitors, staff and management. 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. Knotty Ash Residential Home has submitted an improvement plan to increase the quality of the service. The home was also reviewed with the improvement plan as guidance. 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 inspection. 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 Residential Home has a strong staff team that work very well together. Residents are treated with dignity with staff trying very hard to meet their needs. Relatives spoken with said that they were always welcomed in the home and that it was “safe place to live”. Staff have good verbal communication skills and discuss the residents care on a daily basis. Staff spoken with demonstrated a genuinely kind and caring attitude. Comments about them from the residents included they (staff) are lovely and very caring attitude. The home is being redecorated and all areas that have been completed have been done to a good standard. The home is clean and tidy and present a comfortable, warm and homely atmosphere that the residents find “comfortable” and “very nice place to live”. Knotty Ash Residential Home DS0000025353.V329435.R01.S.doc Version 5.2 Page 6 There is a strong management team that have worked well together to develop the senior care staff. This has resulted in them making a lot of improvements in the care practices and management in the home. Residents are supported to access the community. Some of the residents are able to do so without the care staff and the home helps make sure that they have the support to keep their independence in this area. What has improved since the last inspection? What they could do better: Due to the large number of serious concerns identified at the last inspection the acting manager had rightly concentrated his efforts in making the home safe. In this both he and his team have been successful, residents are now safeguarded a lot more than they were. However other areas that would increase the quality of the service provided are still in need of improvement. The home needs to develop a quality assurance system taken from the views of all those concerned in the home such as residents, relatives and staff. A Knotty Ash Residential Home DS0000025353.V329435.R01.S.doc Version 5.2 Page 7 plan of how to develop the service including activities, menus and information in the home could then be developed. Staff supervision would also assist in this and promote staff skills and training to make sure that they understand the residents needs more. Further support to maintaining a quality service will be good care plans that clearly detail individual needs, that the residents or their representatives have been involved in. This will help staff deliver a good service to residents in line with the residents’ own choices and needs. 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.V329435.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.V329435.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): Standard 3 was reviewed in this area. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home assesses all residents before they are admitted to the home. This arrangement helps the manager and staff to decide if they can meet the individuals needs and plan the care needed. Where residents’ needs cannot be met action is taken to fix the situation and support the residents and their families. EVIDENCE: All residents are assessed prior to admission to the home. This supports the manager to decide if the residents needs can be meet. A recent event showed that even with a full assessment not all the information needed is given to the manager or the Social Worker to make sure that they can meet the residents’ needs. The manager makes sure that all residents are admitted on a trial period only so that further assessments can be done and that the resident can decide if this is the home for them. Knotty Ash Residential Home DS0000025353.V329435.R01.S.doc Version 5.2 Page 10 Copies of the assessments including those from Social Services were available for the three residents whose records were looked at. This information is used to help the staff plan how to meet the resident’s needs. One relative detailed that before their relative was admitted they came to see the home. They said, “we were made to feel welcome, staff were warm and friendly, they clearly wanted to get to know us, mum and how to look after her. Its been a good choice and we are happy she lives here now”. Another resident came and spent a day and even had an overnight stay to see if she would like the home. The manager explained that where possible residents and relatives are encouraged to spend time in the home before they make a decision. When residents needs change the home actively seeks the support of Social services, this was recorded in care plans of the residents viewed. On resident had been in the home and moved out again. The home had sent their care records to the other home but did not retain records. They need to keep these for three years as a record of the care that the home provided during the residents stay. The manager intends to start a system that allocates staff to all new residents. Known as a keyworker system. Part of their role will be to be involved in the assessments of new residents and to be in the home when the resident is admitted. This will help the residents settle and provide them with a “familiar face”. Once pit into place this is good practice that will increase the quality of the service provided. The home has information for residents, which details the services of the home, qualifications of the staff and vital information such dealing with complaints. A copy of this was available in the main office. Further information that contained, the last report from CSCI and information that would help residents make a decision about moving into the home, was not available. The information is not written in different prints or formats such as tape, Braille or different languages. Two relatives spoken with had made the choice for their relative, they recalled discussion of care needs of their family member but had not been given any information about the home. Knotty Ash Residential Home DS0000025353.V329435.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 7, 8, 9, 10 were reviewed in this area. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of medications has improved, unsafe practice has been significantly reduced and staff are now all aware of how to manage medications properly. Care plans as yet are not fully in place, although a significant amount of work has occurred. Staff still rely on verbal communication and this will result in care not being appropriate. Caring staff has resulted in residents dignity being recognised and maintained. Staff are making sure that residents can access health care as they need or wish. EVIDENCE: Residents were very positive about the care they receive from the staff this included the manner in which staff attended to them. Comments included Knotty Ash Residential Home DS0000025353.V329435.R01.S.doc Version 5.2 Page 12 they are faultless, couldn’t ask for better people and I have no criticism it’s very nice here. Three care plans were looked at in full, the manager has been rewriting these to put them in a more suitable form, which can be easily read by the residents and the staff. This is still being progressed, all the residents have a good assessment but the care plans are still being developed and contained very little instructions to staff as to how to meet the residents’ needs. This manager also plans to include this as part of the responsibilities of the senior staff too make sure that relevant staff write, monitor and update the care plans. As yet the lack of relevant care plans is a priority as without them staff are not provided with the information they need to provide a service that meets the residents needs. Care staff keep daily records, which all though a little brief do detail what care was given to the residents during each shift. Care plans still did not have any evidence that they had been discussed with the residents or their relatives. This should be done so that the residents diverse needs can be fully recognised and supported. Discussions with staff detail that they still relied on verbal communication. However issues about inconstant care have been addressed. A regular senior staff meeting that keeps these staff up to date is now occurring. Brief outlines on the care needs and anticipated care is discussed at these meetings. This has aided in making sure that all senior staff deliver care directions that meet individual needs, in the same way. This helps reduce differences of opinion as to what residents needs are. Once the care plans are fully in place this area will also be addressed and all staff will have to meet the individual care needs of the residents in the way that the resident has requested or wishes. Residents are supported to choose their own GP or stay with their current GP and staff do contact external advice when needed such as dieticians, GP’s and District Nurses. Records in general regarding healthcare in put were better than those seen previously. They now clearly state the purpose of the professional’s intervention or what the action the staff should take. Records also show where resident’s needs had prompted the staff to access specialised service such as changes in weight. Medications were reviewed. Records for medications were now clearer and gave staff proper instruction. The medications are being regularly audited by the manager who then takes action to make sure that staff give medications out safely. This also helps in making sure that staff know what they are doing and can be checked to make sure they maintain a good standard. All medications that arrive in the home on a monthly basis were recorded on. This did not happen for medications for residents that staff have recieved in the middle of the month and means that it is difficult for the manager to check if the medications are given properly. The fridge was not locked and contained one medication that does not need storing in the fridge, Temperatures of the fridge and medication store are not recorded. This needs to be done as an Knotty Ash Residential Home DS0000025353.V329435.R01.S.doc Version 5.2 Page 13 incorrect temperature can effect the medications. An audit of medications showed that in general they are now being given correctly. With the exception of one medication where there was one tablet too many and showed that on one occasion staff had signed for the medication and not given it. However all other medications were accurate. There was also clear evidence that one member of staff had simply signed the medication records on two occasions without checking. This is known as copycat signing and shows that the staff member is not checking records properly. This is weak practice. The manager said that this would be addressed with the staff member. Risk assessments had been written and a copy was seen previous to this site visit however these were not available on the day of the visit and had been miss-placed. Discussions with staff detail that they were mindful all times about the dignity and privacy needs of the residents in their care. They discussed knocking on bedroom doors, keeping residents covered whilst assisting them to bathe and speaking to resident and respectful manner. Observations of staff during the visit showed that staff spoke to residents in friendly tones. They attended to hygiene needs discreetly and made sure that residents were treated in a respectful manner at all times. Comments such as “it’s the residents home” were made by staff and supported by the residents spoken with. One resident said, “they are very nice, kind and loving. I feel comfortable with them, even when I need there help doing things that are private”. When the care plans are completed the manager intends to determine if residents would prefer for their intimate needs to be meet by a female or male member of staff. This equality issue is presently on an informal arrangement, but residents spoken with said that they are usually dealt with by a member of staff of the same sex or will say if that’s not what they want. Knotty Ash Residential Home DS0000025353.V329435.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 12, 13, 14, 15 were reviewed in this area. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents enjoy the food in the home and are supported to exercise some choices in this and other areas. There is little social input and some of the residents are not finding their expectations in this area fully meet. EVIDENCE: All the residents spoken with enjoyed the food. Comments such as the food is tasty, the cook is great and its very nice were made. The chef asks residents what kind of things that they would like to eat. Unfortunately this information is retained by the chef, is not recorded and not shared with the staff. He is very enthusiastic about his job role and tries very hard to provide food he thinks the residents will like. The lack of sharing of information means that a great deal of useful information is available to the chef that is not available for the staff. Information for the residents to enable them to make choices is available on a menu-board displayed in the dinning room. Menus did not reflect a choice, nor did they detail special needs such as soft diet or diabetic diet. Two of the Knotty Ash Residential Home DS0000025353.V329435.R01.S.doc Version 5.2 Page 15 residents spoken with said that they did not always remember what food was available. One resident said, “its a bit of a guessing game, I don’t always remember what I asked for and don’t always know what the choice is”. Mealtimes have been changed to meet resident’s needs, a main meal in the evening and a lighter meal at lunch. Residents spoke with “like it better this way” and “I eat breakfast late so it suits me better”. This is good practice as it shows that the routine of the home can be adapted to meet the resident’s choices. There was an activities board, which has minimal information on. It did detail a game of bingo earlier in the week. However a number of residents were undertaking small activities that they took responsibility for themselves such as knitting and crossword puzzles. One resident said that she was “frequently bored”. 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 get the residents choices wrong. There were some activities available on such as bingo. However there was no evidence that this activity had been decided on by discussion with the residents or that anything other than bingo was available. Some of the residents are able to leave the home on their own without staff support. This is a good opportunity however the opportunity to “nip to the shops” is not available for the more dependent residents as there is no formal activities programme decided on by the residents needs that can be put into place for individual needs. Residents detailed that they went to bed when they wanted and got up when they wanted. 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 “ a nice place to visit” and that they were “always made to feel welcome. Offered a drink and kept up to date with what is happening”. Knotty Ash Residential Home DS0000025353.V329435.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 16, 18 were reviewed in this area. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are confident that they can raise their concerns and that these will be addressed. Arrangements for protecting vulnerable adults are in place staff have received training and guidance, which has given them a basic understanding of how a concern would be investigated. EVIDENCE: Residents spoken with said that the home was very nice and “the staff are caring, I really like it here. The residents detailed that if they did have concerns they just tell someone. One member of staff explained that if residents raised concerns they would be addressed. This would not be written down or passed to the manager, as the member of staff did not see this is a complaint. As such it 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. Records about complaints were viewed at the site visit. One concern was raised with CSCI before this site visit and this was addressed during this inspection. Knotty Ash Residential Home DS0000025353.V329435.R01.S.doc Version 5.2 Page 17 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 residents on a daily basis. This does not provide information that is easily accessible by the residents. The home does have a copy of the social services policy regarding the protection of vulnerable adults. Staff members spoken with had not seen a copy of this and were unaware of its existence. Induction records do not detail any protection of vulnerable adults training. The contents of induction records were not available. Staff spoken with had received training in protection of vulnerable adults. Discussions with them detailed that they had very little understanding of what would happen should and allegation arise. Staff were clear that they would report anything that they thought was untoward to the manager. Training records for the staffing files viewed did detail training in protection of vulnerable adults. A review of staff recruitment showed the home was unable to locate records for one recently recruited member of staff this had been missed by the home as they had recently been trying to bring records regarding staff up to date. The manager decided that the member of staff would be prevented from working in the home until all the checks that showed that the member of staff was safe to work with vulnerable adults had been completed. Confirmation of this was recieved by the home the following day in writing. Knotty Ash Residential Home DS0000025353.V329435.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 19, 23, 24, 25, 26 were reviewed in this area. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Refurbishment and redecoration is in place this will help meet residents individual needs. The home is a clean and comfortable place to live. Residents are supported to have their own possession in the home and make it feel more like the place that they live. EVIDENCE: The home is undergoing a lot refurbishment at the moment. Which will result in more space for the residents and a nicer environment for them to live in. Residents have been kept up-to-date with the progress as it is completed. Windows have been replaced and there are plans to redecorate several bedrooms and replace the carpets in the main corridors. A new conservatory dinning room area has been nearly completed and this will provide a bigger dinning room. The present dinning room presents a risk to staff that find it Knotty Ash Residential Home DS0000025353.V329435.R01.S.doc Version 5.2 Page 19 difficult to move residents around, due to wheelchairs and dinning room furniture. This will be addressed when the dinning room size is increased. The smoking area has relocated to a room that is off the main corridor and is unventilated. The fire brigade has been contacted for advice in this area and has informed the home of how to maintain safety in this area. A new smoking area will be created once the current building work has been completed. Cigarette smoke can be smelt in the main corridor and some of the adjacent bedrooms. This will be resolved when the new smoking area is created. A further two bedrooms will be created in the future. The home is talking to the relevant organisations such as the fire authority in order to make sure that these additional facilities will be safe. The home is decorated in the same style throughout with doors that are identical and corridors that are decorated identically. The manager intends that this will be changed in the future to help resident find their way around the home. Resident’s bedrooms have been decorated to include their own personal items, such as pictures and ornaments. The home has bathrooms that are adapted to meet the needs of the residents and either provides a shower facility or a hoisted bath. 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 a good standard of cleanliness. Knotty Ash Residential Home DS0000025353.V329435.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 27, 28, 29, 30 were reviewed in this area. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff training and recruitment has improved. The better management of these areas means that residents will have staff who are skilled at their jobs and who can provide support to meet their needs. However there are still opportunities for further improvement as vital information regarding the suitability of some staff has been missed. EVIDENCE: 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 there is inconsistent practice from one shift to another and this was “only to be expected”. The manager has tried to address this and the inclusion of good care planning should mean that all staff are aware of how provide care that is to be delivered in line with residents needs. Staff meetings help all staff understand their role. One member of staff also said that staff turnover is fairly low with most staff staying employed within the home for several years. This was also seen in the staffing records with very few new staff employed in the last 12 months. Staff say that mornings are very busy but that there are Knotty Ash Residential Home DS0000025353.V329435.R01.S.doc Version 5.2 Page 21 enough staff available. Residents spoken with said “sometimes there is bit of a wait but the staff are busy”. “If I want something or need something I’ve never been told no it usually happens. Sometimes they forget but that’s only to be expected and it does happen when I remind them”. Resident’s dependency needs are done on assessment. However these have not been updated in the care plans seen. 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. Staff training records were clear attempts have been made to improve this and copies of staff training is now 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 that they need to undertake their job. 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 condition. Two members of staff have received fire 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. Staffing files viewed showed that one recently recruited staff did not have any information regarding their recruitment and the checks needed in order to determine their suitability, available. This had been missed by the home. As they have recently gone through all the files to make sure that all staff had the proper checks in place. The manager dealt with this situation and took a proactive approach to safeguard the residents in his care. Residents spoken with were clear that the staff were so nice” and cant do enough to make sure you are getting what you need” relatives spoken with said that the home was “very lovely, I feel happy to leave my mum in their care I know she is well cared for, looked after and as safe as can be”. Knotty Ash Residential Home DS0000025353.V329435.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): Standards 31, 32, 33, 35, 37, 38 were reviewed in this area. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents, relatives and staff are confident in the manager and his abilities. Plans for the future are designed to increase the quality of the home. EVIDENCE: Residents, families and staff had very positive things to say about the acting manager. They said he was keen to make sure that the residents received the best care. The acting manager has a management qualification and is currently undertaking another management qualification. Confirmation was received after this site visit that the acting manager has now submitted to become the registered manager. Knotty Ash Residential Home DS0000025353.V329435.R01.S.doc Version 5.2 Page 23 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 acting manager on medications and care planning. This identifies issues and supports staff to improve in these areas. Some policies and procedures have not been updated for the last three years. Staff will find it difficult to meet the quality of the service needed without clear guidelines on how to do so. Staff discussed, resident’s questionnaires, which they say are distributed on a regular basis. However as yet this have not been used to make a formal plan on how the home will build on its strengths and address areas in need of improvement. The home has an improvement plan in place from CSCI to improve a number of poor quality areas. The manager and the management team have dealt with this well and have increased the quality of the service. When situations have arisen the manager has made sure that the situation has been dealt with and taken a good approach to resolve it. This shows that the acting manager is aware of what happens in the home and makes sure that any areas that are in need of improving are fixed. 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. Records in the administrator’s office clearly state the amount of money received for residents and the amount of money passed to the manager to give the residents. These tallied on all occasions. 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. Environmental risk assessments that determine how to do things safely in the home and what checks are available and indicate any areas that are a risk and how staff are to deal with this. 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. Knotty Ash Residential Home DS0000025353.V329435.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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 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 2 17 x 18 2 3 x x x 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 x 3 x 3 3 Knotty Ash Residential Home DS0000025353.V329435.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 Timescale for action 06/06/07 2. OP12 3. OP29 4. OP33 The registered person must make sure that care plans are written for all residents, reviewed monthly, involve residents and their representatives in the process. Outstanding from 31/12/06 12 (1) (b) Activities that are suitable to (2) (3) meet the residents’ needs must (4) (a) (b) be developed and put into place. (5) (b) 19 (1) (a) Staffing files must be reviewed (b) (c) (5) and all gaps identified to make (a) (b) (c) sure that staff in the home are (d) (i) (ii) suitable. (iii) 24 (1) (a) The manager must put into place (b) (2) (3) a 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. 06/06/07 06/06/07 06/06/07 Knotty Ash Residential Home DS0000025353.V329435.R01.S.doc Version 5.2 Page 26 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. 2. 3. 4. 6. 8. 9. Refer to Standard OP1 OP7 OP7 OP15 OP27 OP33 OP33 Good Practice Recommendations A service users guide should be developed and a copy given to all the residents. This should be in formats suitable to meet the resident’s needs. 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. Activities boards should be kept up to date and written in formats that meet the resident’s needs. Resident’s dependency needs should be monitored and staffing levels developed to meet those needs. All policies and procedures in the home should be reviewed and update. Residents and relatives meetings should be developed. Systems that include resident’s points of view and manages the home to their specific needs should be put into place. Knotty Ash Residential Home DS0000025353.V329435.R01.S.doc Version 5.2 Page 27 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.V329435.R01.S.doc Version 5.2 Page 28 - 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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