CARE HOMES FOR OLDER PEOPLE
Knowle Hill Streetfields Halfway Sheffield South Yorkshire S20 4TB Lead Inspector
Janis Robinson Unannounced Inspection 12th October 2005 09:00 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 Knowle Hill DS0000002978.V252257.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. Knowle Hill DS0000002978.V252257.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Knowle Hill Address Streetfields Halfway Sheffield South Yorkshire S20 4TB 0114 248 3594 0114 248 0018 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) Sheffcare Limited Susan Skinner Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Knowle Hill DS0000002978.V252257.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 23rd November 2004 Brief Description of the Service: Knowle Hill is a purpose built home for older people. It is in a residential area of Sheffield with good access to public services, such as bus routes, shops and public houses. Accommodation is provided over three floors, accessed by a lift. All of the bedrooms are single. Each floor is provided with a communal lounge and dining room. Sufficient bathing facilities are provided. The gardens are landscaped and a small car park is available. Knowle Hill DS0000002978.V252257.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over 6 hours from 8.45am to 2.45 pm. An inspection of a proportion of the environment took place. Records were sampled, including; care plans, medication, complaints, staff training and supervision, contracts and fire records. The inspector spoke with the majority of staff on duty, and twelve residents. Two staff were formally interviewed and discussions with the homes manager took place. What the service does well:
Comments made by residents were very positive. Residents said the home was ‘top class’, ‘can’t be better cared for’, and ‘the staff are wonderful’. The staff spoken with displayed a strong sense of commitment to the home and residents. All of the interactions between residents and staff appeared respectful and caring. The home had a service user guide to provide residents with information about the home. Statements of terms and conditions were undertaken with each resident. Trial visits to the home, to enable prospective residents and their representatives to make an informed decision, were encouraged by the home. Staff undertook a range of training to keep them up to date and meet residents needs. Each resident had a care plan, which outlined all personal, social and health care needs. Access to health care professionals was supported, to maintain residents health. Residents confirmed that the staff were respectful towards them. The routines at the home were flexible, residents were able to choose how to spend their day. A range of activities were offered to residents. The home had an open visiting policy, to maintain contact with residents and their family and friends. A varied diet was provided and choices were offered. Residents said ‘the food is very good, we get spoilt for choice’. The home had a complaints procedure, each resident had been provided with a copy to inform them of their rights. All of the residents spoken with said they had confidence in the homes manager, and the staff at the home, to listen to any concerns and take them seriously. An adult protection procedure was in place, to ensure safety was promoted. The home was clean and free from odours. Homely touches were provided in communal areas to create a comfortable environment. Residents’ bedrooms were individually personalised. Residents were able to bring personal
Knowle Hill DS0000002978.V252257.R01.S.doc Version 5.0 Page 6 possessions with them into the home. The residents spoken with said the home was ‘lovely and comfortable’. Agreed levels of staff were being maintained. The home had a commitment to National Vocational Qualifications (NVQ), to ensure staff had the skills needed to meet the needs of residents. Staff undertook a range of training and individual training records were kept. All of the residents and staff said the management at the home was supportive and approachable. Formal staff supervision took place, to support and develop the staff team. Health and safety systems were in place at the home, fire equipment had been checked and serviced. Some staff had undertaken fire training at the required frequency to ensure they had the skills to maintain safety and respond in an emergency. What has improved since the last inspection? What they could do better:
One contract examined contained out of date information. One medication administration record contained an unexplained gap. One care plan examined did not record any information relating to funeral arrangements. The homes contract had not been updated to include information on potential charges to residents. Areas of the homes decoration were aged and worn. Several bedrooms seen had slight damage to the decoration. Liquid soap was not available in one toilet, and appropriate aprons for staff to wear in the kitchen were not available during the morning of this inspection. Whilst a matrix of staff fire training was maintained, one fire drill had not been written up to evidence all of the required information. Several staff had not participated in a practice drill at the required frequency. Emergency lighting and fire alarm tests did not consistently take place on a weekly basis. The staff mandatory training matrix indicated that several staff were out of date with food hygiene and moving and handling training.
Knowle Hill DS0000002978.V252257.R01.S.doc Version 5.0 Page 7 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. Knowle Hill DS0000002978.V252257.R01.S.doc Version 5.0 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 Knowle Hill DS0000002978.V252257.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,4 and 5. Standard 6 does not apply to this home. The home had a statement of purpose and service user guide, to inform residents about the home. Contracts were in place. One checked required updating to contain relevant information. Trial visits to the home were encouraged to enable prospective service users to look around the home, meet residents and staff. Staff undertook periodic training to keep them up to date and access to specialist services was provided by the home, in order that all needs were met. EVIDENCE: Each resident had been provided with a service user guide, to inform him or her about the home, these contained the full range of information required. The statement of purpose had been updated to include a statement that a £10 charge may be made to access personal records, in some circumstances. Individual contacts, statements of terms and conditions, had been undertaken. The resident or their representative had signed those sampled by the inspector. The contacts included the majority the required information and specified the fees payable and by whom, the rights and obligations of both
Knowle Hill DS0000002978.V252257.R01.S.doc Version 5.0 Page 10 parties and the period of notice. The contracts did not include information on the potential charge to residents to access records. Out of date details were recorded in one contract. All of the residents spoken with felt the home met their needs. One resident said ‘I couldn’t be better looked after, the staff make you feel happy’, and a further resident said ‘the home is wonderful, I couldn’t ask for anything more’. Access to relevant specialists was supported by the home. The residents spoken with confirmed that they had been able to look around the home, stay for a meal and meet residents and staff to provide them with the information they needed before choosing to move in. Knowle Hill DS0000002978.V252257.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 and 11. Each resident had a care plan, to give staff the information needed to ensure all care needs were met. Health care was monitored, assessed and met. Systems were in place to ensure the safe storage and administration of medication, however, one medication administration record had an unexplained gap. Staff appeared respectful towards residents. One care plan examined did not contain information on dying and death. EVIDENCE: Two care plans were examined. The plans contained the full range of information required, and included specific information on all aspects of personal, social and health care needs. The plans included information on the staff action required to ensure assessed needs were met. The residents had signed their plans, where able. Risk assessments were undertaken. The plans were reviewed on a monthly basis. The plans contained detail of all health care contacts, appointments and treatments, and the home supported access to these to ensure health was maintained. Residents said they had regular contact with their GPs, and saw chiropodists, dentists, opticians and district nurses as required.
Knowle Hill DS0000002978.V252257.R01.S.doc Version 5.0 Page 12 Staff were observed respecting privacy by knocking on doors before entering. The interactions between staff and residents appeared respectful and caring. Staff took time to sit and listen to residents. All of the staff displayed a high level of commitment to the residents and the home. Residents spoken to made very positive comments about their care. One resident told the inspector `I feel very lucky, the staff are marvellous, I couldn’t ask for anything more’. Other residents said` the home is wonderful’ `the staff make me happy’ and `I can’t think of how I could be better cared for’. One plan did not contained information on the residents’ wishes regarding funeral arrangements, to ensure these would be carried out. Knowle Hill DS0000002978.V252257.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Residents were able to make choices about how they spent their time. A range of activities was offered to residents, to improve choices and maintain interests. Access to personal records was available. The homes contract required updating to include information on a potential charge to access some records. The home had an open visiting policy, in order to develop and maintain good relationships with residents’ representatives. The home provided a varied menu and choices were offered to respect personal preferences. EVIDENCE: Residents said they were able to get up and go to bed when they chose, and were seen to walk freely around the home. The organisation employed a group of activity workers that visited the home three times each week. A range of appropriate social opportunities were available, such as sing-a-longs and manicures. Weekly chair-exercise classes were available and entertainers regularly visited the home. Residents were free to join in any organised activities. All of the residents spoken with said they enjoyed the range of activities offered, and said enough were provided. One resident told the inspector that they really enjoyed chair exercise, and felt better for this. Residents confirmed that they were able to see their visitors in private. Residents were able to bring personal items with them into the home. All of
Knowle Hill DS0000002978.V252257.R01.S.doc Version 5.0 Page 14 the bedrooms were individually personalised and very homely. Residents could see their care plans when they chose. Access to other personal records was available, however, a potential charge for this needed to be included in individual contracts, to ensure all residents were fully informed. All of the residents spoken with said the food at the home was very good, choices were offered on a daily basis. One resident said that `nothing was too much trouble, we are spoilt for choice’. A further resident said that they were offered alternatives at each meal, and could have food other than that on the menu, any time they chose. Staff confirmed that they had access to food supplies at all times, to cater for residents needs. The cook had a clear understanding of residents individual preferences and displayed a high level of commitment to ensuring residents were happy with the food provided. The homes dining rooms were attractively set out. Knowle Hill DS0000002978.V252257.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The home had a clear and accessible complaints procedure, to ensure residents’ rights were protected and any concerns listened to and taken seriously. An adult protection procedure was in place, to promote residents safety EVIDENCE: Each resident and representative had been provided with a copy of the homes complaints procedure. This contained relevant detail and informed the reader of who to contact outside of the home to make a complaint, should they wish to do so. All of the residents said they had no concerns and could go to the managers and staff to`sort out’ any worries if they had them. No complaints had been received by the home since the last inspection. An Adult Protection procedure was in place, which included the Department of Health guidance No Secrets. The staff interviewed were clear about the action to take if they suspected ill treatment, and could describe some indicators of abuse. Local multi-agency guidelines, to ensure the homes information remained up to date and promoted residents safety, was in place. Residents said they felt very safe at the home. Knowle Hill DS0000002978.V252257.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): The home was clean and free from odours. Parts of the environments decoration was aged and worn. Residents’ bedrooms were, in the main, well decorated. All areas of the home were accessible to residents. Homely touches had been provided to create a comfortable environment. Sufficient bathing facilities were provided. EVIDENCE: The grounds had been provided with new fencing. The hairdressing room was being refurbished. Whilst the home generally appeared to be maintained to an acceptable standard, some parts of the environment had aged decoration and required refurbishment. The ground floor corridor area and some bedrooms had damaged decoration. Communal areas appeared comfortable. All of the bedrooms were clean and contained residents personal possessions. Since the last inspection four bedrooms had been redecorated. Sufficient bathing facilities were available. All of the residents said that they were happy with the accommodation provided.
Knowle Hill DS0000002978.V252257.R01.S.doc Version 5.0 Page 17 On the morning of this inspection one toilet had not been provided with liquid soap. Old tablet soap was available. Blue aprons for staff to wear when entering the kitchen were not available. A supply of these arrived during the afternoon of this inspection. Liquid soap and appropriate aprons must be available at all time to ensure the control of infection. Knowle Hill DS0000002978.V252257.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 and 30 Agreed levels of staff were being maintained. Staff undertook NVQ training. The number of NVQ qualified staff was over the recommended levels of NVQ trained staff had almost been achieved. Staff undertook periodic training to keep them up to date. The home had a training plan and individual training records were kept to monitor staff training. EVIDENCE: The homes rota indicated that agreed levels of staff were being maintained to meet the needs of residents. Residents spoken with felt that enough staff were provided. Of the 22 care staff, 7 staff had achieved NVQ level 2 in care, and 6 staff at level 3. A further 7 staff had almost completed the training at level 3. Staff training records were maintained to ensure all staff had undertaken relevant training. Staff spoken to said that they received sufficient training to be able to carry out their duties. Staff induction met standards. Knowle Hill DS0000002978.V252257.R01.S.doc Version 5.0 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,36,37 and 38 The manager had achieved NVQ level 4 in management and care. The manager’s leadership approach benefited residents and staff. A business plan and insurance cover were provided. Formal staff supervision, to develop and support staff, took place. The homes records were stored securely, to respect residents’ rights. Policies and procedures for the smooth running of the home and care of residents were in place and accessible to staff. Staff undertook mandatory training. Some updates on food hygiene and moving and handling training were required. Fire systems were checked and serviced; some checks did not consistently take place at the required frequency. Not all staff had undertaken fire training at the required frequency. Records of fire drills required some improvement. Knowle Hill DS0000002978.V252257.R01.S.doc Version 5.0 Page 20 EVIDENCE: All of the residents and staff spoken with said the manager at the home was approachable and supportive. Residents surveys were undertaken, to obtain and act on the views of residents. The surveys were audited and the results published in the service user guide. Financial plans were in place and insurance cover had been provided. The certificate of insurance was in display in a communal area of the home. Formal staff supervision took place, to support staff and develop their skills. Records in the home were securely stored to protect confidential information. The home had health and safety systems in place. On the day of the inspection no fire exits were blocked and hazardous substances were securely stored. All staff undertook mandatory training and a matrix was maintained to enable the manager to monitor this. A rolling programme of staff mandatory training was in place. However, the mandatory training matrix indicated that several staff were out of date with aspects of training, such as moving and handling and food hygiene. Fire fighting equipment was checked and serviced. Emergency lighting and fire alarm checks were undertaken. These did not routinely take place on a weekly basis. Staff had not participated in fire drills at the required frequency. Records of drills were undertaken, however, one drill recorded on the matrix had not been written up. Knowle Hill DS0000002978.V252257.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 X 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 3 3 2 3 2 STAFFING Standard No Score 27 3 28 4 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 X 3 3 2 Knowle Hill DS0000002978.V252257.R01.S.doc Version 5.0 Page 22 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 2 Standard OP2 OP9 Regulation 5 13 Requirement All contracts must record the accurate name of the home. Medication administration records must be fully completed. Records must be signed to indicate whether the resident has received their medication. (Previous timescale of 23/11/05 not met) Residents’ wishes regarding funeral arrangements must be recorded. Where this information is refused, this must also be recorded. The potential £10 charge to access some personal records must be included in residents’ contracts. (Previous timescale of 1/05/05 not met) All areas of the home with aged and damaged decoration must be redecorated. The homes corridor and entrance areas must be included in the homes redecoration plans. Those bedrooms with damaged decoration must be included in
Knowle Hill DS0000002978.V252257.R01.S.doc Version 5.0 Page 23 Timescale for action 31/12/05 31/12/05 3 OP11 12 31/12/05 4 OP14 15 31/12/05 5 OP24 OP19 23 31/01/06 6 OP26 16 the homes redecoration plans Systems for the control of infection must be in place at all times. Liquid soap must be provided in toilets at all times. Appropriate aprons for staff to wear when in the kitchen must be available at all times. All staff must participate in a practice drill a minimum of twice each year. Staff fire training must be audited and practice drill training provided to identified staff. Records of this training must be forwarded to the local office of the CSCI. 31/12/05 7 OP38 13 12/11/05 8 9 OP38 OP38 13 18 All practice drills must be fully recorded. Emergency lighting and fire 31/12/05 alarm checks must take place at the required frequency. An audit of staff mandatory 31/12/05 training must take place. Where gaps are identified, training must be provided. All identified staff must be provided with food hygiene and moving and handling training. Knowle Hill DS0000002978.V252257.R01.S.doc Version 5.0 Page 24 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 Knowle Hill DS0000002978.V252257.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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