CARE HOMES FOR OLDER PEOPLE
Knowle Hill Streetfields Halfway Sheffield South Yorkshire S20 4TB Lead Inspector
Shirley Samuels Key Unannounced Inspection 30th January 2007 09:15 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.V324726.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. Knowle Hill DS0000002978.V324726.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Knowle Hill Address Streetfields Halfway Sheffield South Yorkshire S20 4TB 0114 248 3594 0114 248 0018 diane.harrison@sheffcare.co.uk www.sheffcare.co.uk Sheffcare Limited 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) Ms Diane Helen Harrison Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Knowle Hill DS0000002978.V324726.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 2nd February 2006 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. Information about the service is provided to service users and their representatives in the form of a service user guide. Information is posted in the entrance to the home along with the inspection report. Information is also posted on each unit. The fees range from £308.00-£348.00. There are additional charges for Hairdressing, chiropody, toiletries, papers magazines and external activities. Further information about fees can be obtained from the service. Knowle Hill DS0000002978.V324726.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This site visit was carried out over six and a half hours from 9:15 to 3:45.Ten service users, three staff, one relative one professional visitor and the manager were spoken to. Seven questionnaires were completed and returned from service users and seven from relatives. Before the visit the manager provided information about the home, which included details of the building, policies and procedures, service users, staff and professional visitors. A selection of records were checked, an inspection of the building was made and observations were made of the interaction between staff and service users. The manager was given feedback at the end of the inspection. What the service does well:
Service users are assessed before coming into the home to make sure that the service will be able to meet their needs. Each service user has a care plan that details their health, personal and social needs. The appropriate professionals, eg opticians, dentist and doctor, provide health care for service user. There were procedures in place to manage medication and in the main the procedures were carried out safely. Service users were treated with dignity and respect. Service users said, “the staff are always respectful” “ they are always kind and polite”. There are activities that take place in the home and some opportunities for service users to go out on trips. Contact with family and friends is encouraged and relatives said they were “always made welcome” and “the staff are easy to talk to”. Service uses were able to make choices about how they spent their time and about every day decision e.g. what to wear and choice of food. Service users dined in small dining areas in groups of up to ten, they said, in the main they liked the food provided and they always got a choice. There was a complaints procedure and service users knew about this. The home has had one complaint since the last inspection. This was investigated in line with procedures and brought to a satisfactory conclusion. Service users were protected from abuse and staff knew the procedures to follow if they suspected abuse or if an allegation was made to them. The premises were safe clean and reasonably maintained. Windows had recently been replaced and some areas decorated. Some areas remain in need of attention. The manager said these areas had been identified and an action plan was in place to address these issues on a rolling programme. Staff took precautions to reduce the risk of infection and to reduce the spread of infection during any breakout. The staff rota showed that the staffing level was enough to meet the needs of the service users most of the time. There were
Knowle Hill DS0000002978.V324726.R01.S.doc Version 5.2 Page 6 procedures in place to use agency staff if staff shortages accrued. The staff said that they only worked under numbers if it was unavoidable. Three relatives said “there is always enough staff on duty”. The recruitment procedures involved full checks and interviews and references for all potential staff. Staff received the training they needed to make sure they were able to do their jobs. The manager was qualified, experienced and promoted confidence in both staff and service users. Service users, relatives and other people involved with the home were asked what they thought of the service and how they felt the service could be improved. Service users were happy with the arrangements for the management of their finances and were able to manage their finances themselves if they wished. Staff were aware of their responsibility for maintaining a safe environment and for the health safety and welfare of service users and for themselves. What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Knowle Hill DS0000002978.V324726.R01.S.doc Version 5.2 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 Knowle Hill DS0000002978.V324726.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users did not move into the home without having their needs assessed. The home did not provided intermediate care. EVIDENCE: Service user files checked all contained an assessment carried out before they moved into the home. This made sure that staff had the information they needed to make a judgement about how they could meet service users needs. Knowle Hill DS0000002978.V324726.R01.S.doc Version 5.2 Page 9 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): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each service user had a care plan that detailed their health social and personal care needs. There health care needs were met and in the main the medication system was well managed and safe. Service user experience of the home was in line with what they expected. EVIDENCE: Each service user had a care plan which detailed their needs, action required by staff and of the action taken by staff. Service users and relatives said they “were consulted about the care plan and kept informed of changes”. The records showed that care plans were reviewed regularly. This made sure that staff had the information they needed to care for service users. Knowle Hill DS0000002978.V324726.R01.S.doc Version 5.2 Page 10 In the main records were kept of appointments and visits by health care professionals. Service users said “staff do not hesitate to contact the Doctor if I am ill”. Relatives said they were always “kept informed of important matters affecting their relative/friend”. The district nursing service made regular visits to the home and found service users to be clean, well groomed and well cared for. The district nursing staff said they had a good working relationship with the home and in the main felt that the staff supported them appropriately during their visits. This ensured that service users health care needs were met. There was an example of a chiropody visit and service users weight not being recorded. One service user was observed to have very long toenails. The manager said that the chiropodist was overdue and that she would chase this up immediately. If they were able to do so service users were able to administer their own medication. There were procedures in place for booking medication into the home, administration and returning. The home used a blister pack system. Staff received training and were monitored to make sure they maintained their competency. A medication fridge was provided for medication that needed to be refrigerated and controlled drugs were stored administered and recorded appropriately. There was one example of medication not being administered in line with the instructions and was signed for when it had not been administered another example was found of discontinued medication not being removed from the drug trolley. The key to a drug trolley was left unattended in a “hidey place”. This compromised the procedures in place to maintain the security of medication. Service users said the staff are “polite”, “caring” and “kind”. They felt they were treated with dignity and respect and that their right to privacy was maintained. Staff were able to verbalise how on a daily basis they respected the rights of service users. Relatives said they were satisfied with the overall care and treatment provided. Knowle Hill DS0000002978.V324726.R01.S.doc Version 5.2 Page 11 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): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users were able to take part in activities that met their social religious and cultural needs. Contact with family and friends was encouraged and service users were offered choices and encouraged to make decisions about every day activities. Service users were provided with meals that were wholesome appealing and balanced. EVIDENCE: A variety of activities took place inside and outside of the home. Service users said “they had a choice of whether they took part or not” some said they “preferred their own company”. One service user who was blind had talking books, enjoyed listening to the TV, radio and music tapes. Fund raising was done to support the entertainment budget. Service users did have to contribute for trips outside of the home. This provided stimulation and social interaction.
Knowle Hill DS0000002978.V324726.R01.S.doc Version 5.2 Page 12 Service users were able to keep in touch with family and friends, who were able to visit the home at any reasonable time. Relatives said they were always made welcome and were invited to relatives meetings were they were informed about up and coming events, and service development as well as having the opportunity to discuss any issues. Service users were able to manage their own financial affairs, they were able to bring personal possessions into the home to personalise their bedrooms. They were encouraged to make choices about every day activities. Service users said the food was “alright”, “very nice”, “always plenty”, “always hot”. The majority said they “usually liked the food”. Some said on occasions they did not receive what they had ordered. Drinks and snacks were provided in between meals and service users were able to have a drink whenever they wished. There were service users on special diets these were provided. Knowle Hill DS0000002978.V324726.R01.S.doc Version 5.2 Page 13 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): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints were taken seriously and investigated. There were procedures in place to protect service users from abuse. EVIDENCE: Records were kept of complaints which detailed the content of the complaint, the findings of an investigation and if the complainant was satisfied with the outcome. Relatives said they were aware of the complaints procedure and service users said they knew who to talk to if they were not happy. The relative spoken to said, complaints and concerns were taken seriously, as in the past, action had been taken when they had raised concerns. Since the last inspection the home had received one anonymous complaint, which was investigated, and the outcome recorded. There have been no concerns are complaints received by the Commission For Social Care Inspection about the service. Staff have received training on the protection of vulnerable adults and were able to verbalise the action they would take should they have concerns or if an allegation of abuse was made to them. Service users said “they felt safe at the home” and “staff treated them with respect”. There have been no allegations of abuse made at the home.
Knowle Hill DS0000002978.V324726.R01.S.doc Version 5.2 Page 14 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): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment was safe reasonably maintained, clean and hygienic. EVIDENCE: Service users said that the home was clean. “My room is cleaned regularly and the carpet is shampooed”. The staff said “the home was clean but in need of some refurbishment and decoration”. They also commented that the bedrooms were too small and created difficulties when trying to use the hoist and wheelchairs. One service user said” “I am impressed with the cleanliness and odour free state of the home”. Knowle Hill DS0000002978.V324726.R01.S.doc Version 5.2 Page 15 Since the last inspection some refurbishment and redecoration had taken place. The manager said other areas were identified for improvement and would be addressed on a rolling programme. Knowle Hill DS0000002978.V324726.R01.S.doc Version 5.2 Page 16 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): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. In the main there are enough staff on duty to meet the needs of service users. Staff are appropriately qualified and trained to do their job. Service users are protected by the recruitment procedures. EVIDENCE: The rota showed that the staffing levels agreed at he time of the registration were being maintained the majority of the time. Staff said that in the main they felt their was enough staff on duty, but that this did depend on the needs of the service users who came into the respite beds and if any of the long term care service users were ill. The staff said they worked well together and supported each other when staffing was unavoidably short. Some relatives said they did not feel there was always enough staff on duty especially at weekends. Staff also said that additional staff a couple of days a week would allow staff to take service users out a little more. Service users said that staff always came when they called for help and offered assistance in a patient manner.
Knowle Hill DS0000002978.V324726.R01.S.doc Version 5.2 Page 17 The manager said that 73 of the staff were trained to NVQ level 2 in care this ensured that service users were cared for by staff who had a good understanding of the needs of older people and how to promote independence respect and dignity. There was a recruitment procedure, which ensured all checks were carried out to protect service users and to secure the best person for the job. Three staff files were checked, they included all the documentation required by The Care Homes Regulations. New staff received induction training and worked alongside experienced staff to develop skills for the job. There was a training plan in place and staff were able to identify training needs as part of their personal development. Knowle Hill DS0000002978.V324726.R01.S.doc Version 5.2 Page 18 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): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is qualified and has the relevant experience to manage the home. The home is run in the best interest of the service users and there are procedures to ensure that service users financial interest were safeguarded. There were procedures to ensure the health safety and welfare of service users and staff. EVIDENCE: The staff spoke positively about the manager, they said she was approachable and carried out her responsibilities responsibly and with confidence.
Knowle Hill DS0000002978.V324726.R01.S.doc Version 5.2 Page 19 Service users gave feedback about how they felt about the service. A representative of the organisation visited the home monthly and reported on the conduct of the home. A report was completed which included details of findings and any action points. Relative and service users meetings were held records of these were examined. Service users account sheets were checked and found to be in order. All transactions were recorded and receipts were in place for all spending. All staff had received health and safety training. Staff were observed using appropriate moving and handling techniques and protective clothing in including gloves and aprons were provided. Accidents were appropriately recorded and followed up. Wheelchairs were used with footplates to reduce the risk of accidents and injuries to service users. Hazardous substances were appropriately stored and staff were able to verbalise the action they took on a daily basis to promote the health safety and welfare of service users and themselves. Knowle Hill DS0000002978.V324726.R01.S.doc Version 5.2 Page 20 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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Knowle Hill DS0000002978.V324726.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 17 Requirement Records must be kept in care plans of service users weight and visits made by the chiropodist. Medication must be administered as detailed on the prescription label. When administering medication staff must cross reference thoroughly to make sure that tablets are not missed. Medication that has been discontinued must be removed from the drug trolley and returned to the pharmacy. Service users must be provided with the meal they have ordered if for any reason this is not available service users must be consulted and offered alternative. Timescale for action 10/02/07 2 OP9 13 10/02/07 3 OP9 13 10/02/07 4 OP15 16 10/02/07 Knowle Hill DS0000002978.V324726.R01.S.doc Version 5.2 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP27 Good Practice Recommendations The staffing levels must be kept under review to ensure that they meet the needs of service users. Knowle Hill DS0000002978.V324726.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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
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