Inspection on 07/04/05 for Knowle Park Nursing Home

This inspection was carried out on 7th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Knowle Park Nursing Home 22/11/07

Knowle Park Nursing Home 30/01/07

Knowle Park Nursing Home 04/10/05

Knowle Park Nursing Home 01/07/04

Knowle Park Nursing Home 10/05/04

Knowle Park Nursing Home 05/01/04

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 Park Knowle Lane Cranleigh Surrey GU6 8JL Lead Inspector Mrs M McHugh Unannounced 07 April 2005 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 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 Park Version 1.10 Page 3 SERVICE INFORMATION Name of service Knowle Park Nursing Home Address Knowle Lane, Cranleigh, Surrey. GU6 8JL 0208 547 2640 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) South London Nursing Homes Ltd. Mr Stephen John Carroll CRH (N) 45 Category(ies) of Physical disability under 65 years of age registration, with number (PD) 4 of places Old age, not falling within any other category (OP) 45 Knowle Park Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Including 4 beds for physically disabled people from the age of 50 years. Date of last inspection 01 July 2004 Brief Description of the Service: Knowle Park is a large country house surrounded by extensive grounds on the outskirts of Cranleigh. The home is owned by South London Nursing Homes Limited, which has its offices, in the grounds, in an adjacent building. The home provides accommodation and nursing care for up to forty-five residents, over the age of 65 years. The house has been adapted to provide good sized en-suite bedrooms and many communal areas throughout the home, many with scenic views of the countyside. The home is in the process of building an additional wing of four bedrooms and a communal area and is changing an upstairs bathroom into a walk-in shower room. The building work is being done to cause as little disturbance to residents as possible. The home is approached via a long driveway and there is a small visitors parking lots to the front of the home and a larger parking area to the rear. Knowle Park Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over six and a half hours, with two inspectors. An additional pharmacy inspection was carried out by the CSCI Pharmacy inspector, since the last announced inspection. Letters sent to the registered person following that visit can be obtained from the CSCI Surrey Local office on request. A tour of the premises, including the building work, was undertaken and staff and care records were sampled during the day. Staff were spoken with during the course of their duties and twelve of the forty residents were spoken to in depth. What the service does well: What has improved since the last inspection? Giving out and recording medication has improved following the pharmacy inspection in November 2004. Locks have been fitted on shower room doors to improve privacy. Some of the residents prefer to have a shower than a bath and the home is now changing a bath and replacing this with a walk-in shower Knowle Park Version 1.10 Page 6 room on the first floor. Handrails and bathroom safety rails have been fitted throughout the home. The manager has had the time and the support to enable her to settle back into her job following an absence from the home and this was a positive aspect noted. This has also been reflected in the homes response to the requirements of the last inspection. The home is still in the process of building a new wing, training room and redecorating areas of the home and this was all seen as improvements. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Knowle Park Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Knowle Park Version 1.10 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 standard(s) 1 and 2 The home has amended their contracts as previously required to include the residents right to self-administer their medication if they are able to. The home needs to make amendments to their statement of purpose and residents guide to ensure residents and prospective residents have all the information about the home, including the changes. EVIDENCE: Although the statements of purpose and resident’s guide documents have not been updated, residents stated that they were aware of some of the changes made in the home. For example the home is now non-smoking throughout. Discussions with the manager highlighted an area that is not clearly stated in the information documents and this has, in the past, caused some upset with residents and their families. This was used as an example of why the information must be kept up to date and relevant. The individual contracts are in the process of being reprinted with the additional information. In the meantime, the home has added an extra page to the contracts stating that residents, if they are able to, may self-administer their medication, otherwise the staff in the home will be responsible for this task. Knowle Park Version 1.10 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 standard(s) 7, 8, 9 and 10. Progress had been made in respect of the care planning process, record keeping in areas of medication and in fitting privacy locks to bathrooms. The home has maintained the standard in ensuring individual health care needs are met. One area that now needs improvement is that staff have kept some controlled drugs on the premises after the residents have left the home. EVIDENCE: Care plans were available and aspects of health, personal care and social care needs were identified and planned for. These records are reviewed by staff on a monthly basis or as required should care needs for an individual resident change. Significant events (falls or an injuries) were recorded in the accident logbook and in the daily notes if required. The home keeps records of which residents have been seen by the GP, physiotherapist, optician, chiropodist and any other visiting medical professionals. Some residents are able to go out to the village to the dentist and optician and are supported by staff as required. Residents spoken with stated they knew who the doctor was and what days the doctor visits the home. Any resident who is at risk from falls or any other identified dangers in and around the home, have risk assessment plans in place detailing the identified risk and what actions staff and the resident can take to help prevent the risk from occurring. The home has equipment in Knowle Park Version 1.10 Page 10 place around the home to help prevent falls and to protect residents from pressure areas developing. Medication is delivered to the home in individual blister packs for each resident and each medication. The staff have been correctly recording when the medication is delivered into the home and on the individual resident’s medication administration record when medication has been given to a resident. One resident wishes and is able to self-administer their medication and the home has completed a risk assessment for this activity. The resident is provided with their medication on a monthly basis and this is kept in a locked drawer in their locked bedroom. One concern was noted when checking the medication in the home and that was that two sets of controlled drugs were still in the home even though the residents were no longer there. This was not in line with the home’s medication policy. The home is in the process of changing a bathroom into a walk-in shower room as following questionnaires being sent out a few months ago, residents requested to have an additional shower room available to them instead of a bath. The work was in progress during the inspection and residents spoken to were aware of what was being changed. The shower room on the ground floor has had a lock fitted. Residents stated that they were treated with dignity and that their privacy was respected. Knowle Park Version 1.10 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 standard(s) 12, 13, 14 and 15 Social activities were well managed and provided a choice, daily variation and social contact for residents. Visitors were noted in the home throughout the day and the activities record showed religious needs were provided for. Residents had a right to make choices and exercised some control over all aspects o daily living. Mealtimes were well managed, flexible and provided a choice and variety of meals. EVIDENCE: Residents spoken with commented on the range of activities provided and emphasis was put on their choice to attend activities or not. A resident stated that the home provides many opportunities for residents to socialise. The home employs an activities co-ordinator and two assistants who provide activities week day afternoons, arrange outings and organise for outside entertainers to come into the home. An activities programme is displayed in prominent areas of the home with additional activities provided. Church services for different denominations are provided on a monthly basis in the home. Many residents stated that they had had visitors or were expecting visitors during the day. Visitors were noted in the home throughout the day. The Knowle Park Version 1.10 Page 12 manager stated that visitors are encouraged to inform staff if they would like to stay for lunch and that a small fee is charged for their lunch. Some residents are able to go into the village for shopping and trips out and are accompanied by staff if required. The dining room was bright and nicely decorated, with tables laid with linen cloths and flowers. Residents are asked to choose their meal for the following day and the menu cards are placed at each person’s place to help remind them of what they have chosen and to give them the opportunity to review the other choices, if they change their minds. Most residents stated that the food was good and choices offered were satisfactory. A resident felt that the evening meal could be improved, however also stated that the lunchtime meal was the main meal and was fine. Mealtimes were flexible ranging from one to two hours long when food was being served. Tea times provided residents with snacks and cakes as well as refreshments. Residents are able to write comments about meals in a book in the dining room and this was well utilised with positive and negative comments. Knowle Park Version 1.10 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 standard(s) 16 and 18 Complaints were logged in the complaints file and information about action taken was made available. Residents also have access to a comment book in the dining room for complaints in relation to food. Procedures were in place in respect of the protection of vulnerable adults and training and induction was available for staff. EVIDENCE: The home has a clearly written complaints procedure and a log is held of all complaints received by the staff and manager and what action has taken following the complaint. Some residents stated they knew what action they should take should they wish to complain however not all were sure of what the procedure said they should do. However they did state that they would talk to the nurse in charge if they had a problem. One complaint was received into CSCI in the last year and was fully investigated as part of the inspection process at the time. Staff receive training in their induction and full abuse training that teaches them how to recognise signs of abuse and what to do if the witness or suspect that a resident is being abused. Residents spoken to stated that staff were caring, kind and polite at all times. Good record keeping of falls and injuries was an effective way for staff to be able to notice any additional bruising or issues to be reported. The manager stated that she has been unable, to date, to get into any of the Local Multi-agency training days but has received inhouse training and was aware of the procedures to follow. Knowle Park Version 1.10 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 standard(s) 19, 20, 21, 22, 23, 24, 25 and 26. The home is well decorated in keeping with the period of the main house. There are building works and redecoration in and around the home at present. However this has not detracted from the comfort, cleanliness or safety of the home. EVIDENCE: The home is continuing with their rolling building and redecoration plans, with the Garden wing in the final stages of being repainted. Some areas around the home, such as the carpets, were very worn in areas, however with the continued building works planned to complete later this year, the redecoration and refurbishment has been put on hold until it is completed. The manager stated that the carpets have already been ordered. Other areas of the home where the refurbishment and redecoration have taken place were well maintained and homely. Residents stated that they were aware of the building works and how it would change the home when completed. One concern was highlighted during the inspection in relation to having risk assessments in Knowle Park Version 1.10 Page 15 place for staff and residents who have access to the areas of the home where building work is in progress. Residents have access to a number of different communal areas around the home including a drawing room, conservatory, lounge, dining room and seating areas in the vast entrance hall and hallways on the first floor. Residents stated they enjoyed the many different areas to choose from to sit as you could always find somewhere quiet if you wanted to. Each resident has an en-suite bathroom consisting of a toilet and hand basin, as well as there being bathrooms and toilets available throughout the building. The home is in the process of changing a bathroom to a shower room but with some bedrooms out of commission, due to building works therefore there are less residents in the home, this has not impacted on the residents by leaving them short of bathing facilities. Specialist equipment in the form of handrails, safety rails in bathrooms, specialist baths, hoists, wheelchairs, Zimmer frames and specialist pressure relieving equipment was found throughout the home. An occupational therapist completed an assessment of the home in 2003 and most of the recommendations in the report have been put into practice. Residents rooms viewed were large, bright and seen to meet their needs. Residents spoken with stated that they had enough space in their rooms and many commented on the views they had from their windows. Many residents stated that they had brought in personal items to decorate their bedrooms with and some even brought in furniture. It was commendable that the home was clean and pleasant, considering the ongoing building works inside and outside of the home. Certificates on display in the laundry, for the domestic team, showed infection control, safety, food hygiene, fire awareness and NVQ training was done to ensure they home was well maintained and infection was kept to a minimum. Knowle Park Version 1.10 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 The amount of staff available for the shift patterns were sufficient and they were able to meet the needs of the residents. Some progress has been made but more work is still required on the staff files to ensure that they meet with the regulations requirements. EVIDENCE: Residents spoken to stated that the staff were kind, caring and polite although occasionally it did take a long time for call bells to be answered. Residents were not able to clarify a specific time of day when call bells were not answered promptly. During the visit it was noted that call bells were responded to within minutes of the alarm starting and a call bell was tested during the lunch time period and two staff responded within 2 minutes. The manager stated that this had been a concern previously which has been looked into and now all the day staff, as well as the night staff, carry bleeps on their person to show them where the call originates from, so that they can respond as promptly as possible. On the day of the visit there were sufficient staff on duty to answer call bells and respond to residents needs. A sample of staff files were checked and two indicated that the home had not undertaken all the necessary recruitment checks (two references) to ensure the protection of the residents. Criminal Records Bureau checks had been completed on all staff but the information that should be destroyed after 6 months was still available on two files. Knowle Park Version 1.10 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32 and 38 The home has good leadership, guidance & direction and the staff are aware of their responsibilities to ensure residents receive consistent quality of care. Some additional risk assessments are required to ensure residents and staff are safe guarded during the ongoing building works and that fire exits are not blocked at any time. EVIDENCE: The manager has had the time and the support to enable her to settle back into her job following an absence from the home a year ago. This was a positive aspect noted and has also been reflected in the homes response to the requirements of the last inspection. Residents are kept informed of the goings-on in the home with quarterly meetings and it was noted that residents had letters in their rooms inviting them to the AGM later in the month. Residents commented about positive communication between staff and themselves. However, two residents said they were not aware of what was happening with the present building works with lots of noise endured during Knowle Park Version 1.10 Page 18 the day. This was discussed with the manager who thought that alternative means of communicating with the residents, other than verbal should be considered. Individual risk assessments have been developed for each resident and risk assessments identifying areas around the home that must be managed to ensure the safety and welfare of all residents and staff. One fire exit was blocked with a hoist and this was resolved immediately by removing the hoist and placing it in an appropriate place that could not cause harm to anyone. Records indicated that fire drills took place regularly and one was carried out during the visit. All staff were observed to responded quickly and according to the policy & procedure. Knowle Park Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 3 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 3 3 3 3 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 Standard No 16 17 18 Score 3 x 3 3 3 x x x x x 2 Knowle Park Version 1.10 Page 20 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP 1 OP 1 Regulation 6(a), 4(1)(c ), Schedule 1(16) Requirement The service users guide must be ammended to include the homes change of policy to no smoking Ammend the statement of purpose to include number of bedrooms and sizes. This is carried forward from the last inspection report. Timescale of 31/12/04 not met. All medication must be returned to the pharmacy within the timescales identified in the medication policy, following a resident leaving the service. The manager must identify risks for residents, visitors and staff who have access to the areas of the home where there are building works. The registered persons must ensure that all the information and documents stated in Schedule 2 are obtained and held in respect of all staff working in the home. Fire exits must be kept free of obstructions. Timescale for action 21/04/05 21/04/05 3. OP 9 13(2) 12/04/05 4. OP 19, OP 38 13(4) 21/04/05 5. OP 29 19(5)(d)(i ), Schedule 2 13(4)(a) (c ) 07/05/05 6. OP 38 07/04/05 Knowle Park Version 1.10 Page 21 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. 5. Refer to Standard OP 15 OP 19 OP 22 OP 27 OP 29 Good Practice Recommendations The home should keep samples of completed menu sheets, as evidence of good practice. An updated copy of the refurbishment and building plans should be submited to CSCI The home should seek advice about the type of carpeting to be put down in relation to residents with sensory impairment and/or elements of dementia The home should keep a record of fluctuating staffing levels in relation to numbers of residents and their dependency levels CRB checks should be destroyed after 6 months or after the regulation inspector has taken a record of the checks. Knowle Park Version 1.10 Page 22 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing GU7 2QN 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. Extracts may not be used or reproduced without the express permission of CSCI Knowle Park Version 1.10 Page 23 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!