Inspection on 30/11/05 for Knowle House Nursing Home

This inspection was carried out on 30th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Knowle House Nursing Home 17/07/07

Knowle House Nursing Home 19/04/06

Knowle House Nursing Home 23/06/05

Knowle House Nursing Home 05/01/05

Knowle House Nursing Home 06/08/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Knowle House Nursing Home Lingfield Road East Grinstead West Sussex RH19 2EJ Lead Inspector Mrs J Hough Announced Inspection 30th November 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Knowle House Nursing Home DS0000031332.V256439.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 House Nursing Home DS0000031332.V256439.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Knowle House Nursing Home Address Lingfield Road East Grinstead West Sussex RH19 2EJ 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) 01342 317740 Yourcare Ltd Post Vacant Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Knowle House Nursing Home DS0000031332.V256439.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd June 2005 Brief Description of the Service: Knowle House is registered to provide personal care and nursing for 35 residents aged over 65 years in the category (OP). Knowle House is a large detached three-storey house situated in a residential road near the town centre of East Grinstead. Accommodation is provided in 19 single bedrooms, 12 of which offer en-suite facilities, and 8 shared bedrooms, 2 of which offer en-suite facilities. A passenger lift provides access to most of the bedrooms. There is a lounge and conservatory, which is also used as a dining room situated on the ground floor, and there is a small lounge on the second floor. Knowle House is owned by Yourcare Ltd and Dr Sivasubramanian is the Responsible Individual for the company. The Registered Managers post is at present vacant. Knowle House Nursing Home DS0000031332.V256439.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection took place over 6 hours and Joice Martin the deputy manager provided the information required. Dr Devikaran Sivasubramaniam was available at the end of inspection for feedback on the findings of the inspection. A tour of the premises took place and some of the resident’s bedrooms were seen. Records were examined with regard to care plans and assessments, medication, complaints log and maintenance records. Further information was gathered from the pre-inspection questionnaire and one comment card from the Commission was completed and returned. Nine residents, two visitors and four members of staff were spoken with as part of the inspection. Not all the standards were assessed at this inspection as were fully met at the last inspection carried out on 23rd June 2005. What the service does well: The home had a homely atmosphere and was clean and comfortable. The residents spoken with expressed no worries or concerns and said they were well looked after and the staff were kind to them. The staffing numbers appear appropriate to provide the residents with a good standard of care and observations of the staff and residents on the day showed the staff to be courteous and caring. The home employs two activity organisers who are planning a programme of events after talking with the residents about what they would like to do. The resident’s private accommodation is furnished to suit their needs and some have their own small items of furniture and possessions making their rooms personal to them. Knowle House Nursing Home DS0000031332.V256439.R01.S.doc Version 5.0 Page 6 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. Knowle House Nursing Home DS0000031332.V256439.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Knowle House Nursing Home DS0000031332.V256439.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&4 The Statement of Purpose and Service User Guide needs reviewing. The staff are provided with the appropriate training for them to carry out their role and responsibilities. EVIDENCE: The Statement of Purpose and Service User Guide needs reviewing and amending, and a revised copy should be made available to the Commission of Social Care Inspection. Information was made available on the training the staff had received in the last year, that included the principles of care, infection control, food hygiene, health and safety, the role of the care worker, manual handling, fire safety and abuse. Knowle House Nursing Home DS0000031332.V256439.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 & 11 Some of the care plans examined were of a poor standard. The medication procedures for the home ensure safe practice. EVIDENCE: Three care plans and assessments were examined in detail. Two of the assessments were brief and some of the sections left blank. The care plans did not identify all the health, personal and social care needs of the residents. Elimination and personal cleansing charts, nutritional and pressure sore risk assessments were not fully completed and updated. There was a general lack of recording of the interests of the residents and the information on the social activities they had participated in. The plans gave no evidence of having been reviewed and updated on a monthly basis. The care plans were poorly written and identified a need for some staff to have training in assessing and writing a care plan, taking into account that the care plan is the basis for the care provided to the individual resident. Knowle House Nursing Home DS0000031332.V256439.R01.S.doc Version 5.0 Page 10 However, the residents spoken with felt they were looked after well by the staff, and the residents seen during the day looked clean and presentable and well cared for. The medication administration records were examined and were generally well maintained and accurate. There was only one chart where some gaps were noted in recording the administration of one medicine on two evenings. Written entries on the medication administration records were not signed and dated in all cases, and did not give the number of medicines held as stock. The Controlled Drugs were checked and were recorded and stored appropriately. However, the Controlled Drug cupboard contained several Controlled Drugs that were no longer in use, and should have been disposed of. The home has a contract with a waste disposal company for disposing of all the unwanted medicines in the home. At the last inspection it was noticed that the small medicine fridge was being kept in a cupboard that was considered to be too warm. The fridge had now been moved to a more suitable area. The induction programme for new staff includes the principles of good care, and the importance of respecting the privacy and dignity of the residents. The residents spoken with said that all personal care was provided in the privacy of their rooms or in the bathrooms and in the shared rooms screens were used. The home continues to care for those residents who are declining in health and during their final days, unless there are strong medical reasons that prevent this. Knowle House Nursing Home DS0000031332.V256439.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 & 13 Visitors are made welcome in the home. The residents are given the opportunity to choose when and what they do. EVIDENCE: The assessments of the resident’s interests and social activities were brief and in some cases lacked any information. One resident had no past or present history recorded in relation to hobbies and interests, although his wife apparently visits him on a daily basis. The home has two activity organisers who cover Monday to Friday up to 2pm. One of them has just taken up the post and said she is in the process of getting to know all the residents to find out what they would like to do in the way of activities, and plan an activity programme for the future. The residents spoken to seemed content to watch television and talk with the other residents and did not express any wishes or preference for any special activity to take place in the home. The residents spoken with said they are able to choose when they get up and go to bed depending on staff being available, and they are given a choice of Knowle House Nursing Home DS0000031332.V256439.R01.S.doc Version 5.0 Page 12 what they want to eat at each meal. Some of the residents chose to stay in their own rooms and others liked to sit in the lounge and conservatory. The home has an open policy for visitors but does ask them to avoid mealtimes where possible. Visitors can sit in the communal areas or in the resident’s bedrooms if preferred. Two visitors spoken with said the staff made them very welcome on each visit. Knowle House Nursing Home DS0000031332.V256439.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17 & 18 The home has a complaints procedure. All staff in the home receive training on abuse. EVIDENCE: The home has a complaints procedure and eleven complaints were recorded in the past year. Two complaints had been received recently following a social workers visit to the home to review two resident’s care needs, and these complaints were not recorded in the complaints log with the actions taken. A separate investigation is being held by Social Services to ensure that the needs of one resident can be met by the home. All the staff have had training on abuse in the past year, and the staff spoken with understood their responsibilities in immediately reporting any incidents or suspicions of abuse in the home. Knowle House Nursing Home DS0000031332.V256439.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,22,23,25 & 26 The home is comfortable, clean and generally well maintained. Some maintenance work and checks are outstanding to meet the requirements of the fire safety standards. EVIDENCE: The home is situated in a residential area close to the town centre of East Grinstead. The home is comfortable and generally well maintained. The home is decorated as and when needed or when resident’s rooms become vacant. Some redecoration was needed in some small areas of some of the resident’s rooms where it seemed beds or furniture had scratched the walls. There is a large garden to the rear of the home that is accessible to the residents. An assessment of the fire safety standards was carried out in November this Knowle House Nursing Home DS0000031332.V256439.R01.S.doc Version 5.0 Page 15 year and the requirements made at this inspection are in the process of being referred to contractors for attention. On touring the premises it was seen that in one of the resident’s room there was a fire exit and the furniture in the room required re-arranging to ensure a clear access to the door at all times. The home has a lounge and conservatory for communal use that is furnished to a good standard. There are plans in place to remove the conservatory and extend the lounge in the near future. The home provides the appropriate equipment with 2 standing hoists and 2 portable sling hoists Grab rails are positioned in areas where needed in corridors, bathrooms and toilets. The resident’s bedrooms seen were furnished to suit their individual requirements and some were furnished with their own small items of furniture and possessions making them cosy and personal to them. Emergency lighting is provided in most areas of the home, but following the fire safety inspection a requirement was made that the emergency lighting be extended into further areas of the home. On the day of inspection the home was clean and fresh. A comment had been received with regard to a strong smell being present in one of the resident’s bedrooms, that was found to be still present on the day of inspection. The cause was said to be a wet carpet around the washbasin and measures were being taken to remedy the problem. Knowle House Nursing Home DS0000031332.V256439.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 29 The number of staff on duty at each shift appears appropriate to care for the residents. The home does not always follow the correct recruitment procedures. EVIDENCE: The staff rotas show that there is a good level of staff working on each shift and the staff spoken with all said they felt the numbers were appropriate for the number of residents. None of the residents spoken with said there was a lack of staff. Two staff files were seen of new members of care staff employed by the home. On examination it was noted that Criminal Records Bureau checks had not been applied for and the home was using the police checks from a previous employer as being satisfactory. A requirement was made that a CRB check must be carried out on both employees. Knowle House Nursing Home DS0000031332.V256439.R01.S.doc Version 5.0 Page 17 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): 33,36,37 & 38 The home sends out surveys to gain the views of the residents and relatives. The in house maintenance checks have not been carried out within the set timescales. EVIDENCE: The home has a quality assurance system in place that includes questionnaires being sent to residents/relatives each year. The last survey was carried out in January 2005 when 32 surveys were sent out and 18 were returned that gave positive feedback. The results of the surveys are collated and any changes that are needed as a result of the feedback are actioned. Formal staff supervision for all staff has commenced in the home, but due to the registered managers post being vacant is overdue for some staff. All personal and home records are kept secure in a locked filing cabinet. The maintenance records seen for all in-house checks were in some cases not being carried out within the specified timescales. The maintenance man for the home is on long-term sick leave and the temporary maintenance man has Knowle House Nursing Home DS0000031332.V256439.R01.S.doc Version 5.0 Page 18 recently left. The home needs to make interim arrangements for someone to carry out the in-house maintenance checks. The fire alarm system is being tested by staff and was last carried out on 26th November 2005. Authorised persons carry out the servicing and maintenance of all equipment and systems in the home at the required intervals. However it was found on the fire safety inspection that the checking of the fire fighting equipment was overdue. As previously mentioned there are outstanding requirements from the fire safety inspection carried out on 10/11/05. A Health and Safety inspection was carried out in the home on 20/10/05 and one requirement was made with regard to the first floor bathroom and the hot water temperatures. A hot water sign is now in place and the inspector was told that all bathing of residents is supervised and the hot water temperature is taken before each use. Staff had attended regular training in manual handling, infection control, food hygiene and fire safety. Knowle House Nursing Home DS0000031332.V256439.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x x 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 3 2 3 x 3 3 x 3 3 STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 3 x x 2 3 2 Knowle House Nursing Home DS0000031332.V256439.R01.S.doc Version 5.0 Page 20 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 15(1) Requirement Timescale for action 31/12/05 2 OP16 22 3 OP29 19 The registered person must ensure that a care plan is generated from a comprehensive assessment and sets out in details the action needed by staff to ensure all aspects of the health, personal and social care needs are met. The registered person must 31/12/05 ensure that all complaints must be recorded following the home’s complaints procedure. The registered person must 31/12/05 ensure all new staff have a new Criminal Records Bureau check prior to commencing work in the care home. 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 1 Good Practice Recommendations The Statement of Purpose and Service User Guide be DS0000031332.V256439.R01.S.doc Version 5.0 Page 21 Knowle House Nursing Home 2 3 36 38 updated and a copy supplied to the Commission of Social Care Inspection. All care staff receive formal staff supervision at least 6 times per year. All in house maintenance checks be carried out within the appropriate timescales. Knowle House Nursing Home DS0000031332.V256439.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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