Inspection on 08/10/07 for Knowles Court

This inspection was carried out on 8th October 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Knowles Court 09/08/06

Knowles Court 15/12/05

Knowles Court 08/02/05

Knowles Court 19/07/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Abbey The

Grayling

John Street Nursing Home

Pennine Camphill

Snydale Care Home

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Knowles Court 2 Bridgeway Bradford BD4 9SN Lead Inspector Nadia Jejna Key Unannounced Inspection 13:00 8th October 2007 X10029.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 Knowles Court DS0000029184.V346814.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 and Care Homes for Adults 18 – 65*. 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. Knowles Court DS0000029184.V346814.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Knowles Court Address 2 Bridgeway Bradford BD4 9SN 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) 01274 681090 01274 652916 walkerdo@bupa.com www.bupa.com BUPA Care Homes (CFHCare) Limited Mrs Dorothy Walker Care Home 146 Category(ies) of Dementia (30), Dementia - over 65 years of age registration, with number (30), Learning disability (26), Learning disability of places over 65 years of age (26), Old age, not falling within any other category (90), Physical disability (7) Knowles Court DS0000029184.V346814.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Dementia - Code DE(E) Learning disability - Code LD Learning disability - Code LD(E) Physical disability - Code PD The maximum number of service users who can be accommodate is: 146 The residents admitted to the home for residential dementia care to be no younger than 55 years of age. 9th August 2006 2. 3. Date of last inspection Brief Description of the Service: Knowles Court Care Home is situated in Holmewood, a residential area on the outskirts of Bradford. The home is close to local bus routes. The home is made up of five individual single storey houses, which are linked by covered walkways. Newhall provides nursing care for people with learning disabilities, Headley provides residential care for older people with dementia, Fairfax provides residential care to older people and Devere and Ryecrift provide nursing care to older people. All bedrooms are single but do not have en suite facilities. Each house has a central communal area, which is used as a lounge and dining area. Each house has a satellite kitchen so that drinks and snacks can be provided between mealtimes. All have access to gardens and patio areas, and many of the bedrooms are provided with patio doors. There is a central administrative building, which houses the Matrons office, laundry, main kitchen and hairdresser’s salon. There is also a support flat where visitors could stay overnight. Information about the services provided can be obtained from the home in information packs that contain the Statement of Purpose, Service user Guide and complaints procedure. Copies are kept in every bedroom. The weekly fees for services provided in the home vary depending on whether Knowles Court DS0000029184.V346814.R01.S.doc Version 5.2 Page 5 or not the person is funded by the local authority and if they have residential or nursing needs. They range from £318.15 for local authority funded residential care to £707.84 for privately funded nursing care. This information was provided in October 2007. Details of exact charges can be obtained from the manager. Knowles Court DS0000029184.V346814.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The first visit was made on 8th October 2007. The home did not know that this was going to happen. Three more visits were made on 11, 19, 22 and 30 October 2007 so that all five houses could be visited The purpose of this visit was to make sure that the home was being managed for the benefit and well being of the people using the service. During the visit residents, their visitors and staff were spoken to. Records such as staff files, complaints and accidents records were looked at. Before the visit was planned the provider was asked to carry out a quality assessment of the service stating what they did well, what was in place to prove this, what improvements had been made over the last twelve months and what was planned for the year ahead. This document is called the Annual Quality Assurance Assessment and will be referred to in the report as the AQAA. Other information asked for included what policies and procedures are in place, when they were last reviewed and when maintenance and safety checks were carried out. Questionnaires were sent to people living in the home, their relatives and healthcare professionals before the visit took place. These people were selected using information provided in the AQAA. When the visit took place one survey had been returned from a person living in the home, one from a relative, two from healthcare professionals and eight from staff. The information from these was used to inform the visit and is referred to throughout the report. Because people with dementia and learning disabilities are not always able to tell us about their experiences, we have used a formal way to observe people in this inspection to help us understand. We call this the ‘Short Observational Framework for Inspection (SOFI). This involved us observing four people with learning disabilities on Newhall and four people with dementia on Headley on two separate days for two hours and recording their experiences at regular intervals. This included their state of well being, and how they interacted with staff members, other people who use services, and the environment. The information gained has been used in the Daily Life section of this report. What the service does well: Care is provided to people in clean, tidy and well-maintained buildings. There is easy access to the gardens and some people’s rooms have patio doors that open into the garden areas. People can bring in their own belongings to personalise rooms. Information about services provided by the home is available in the homes brochure packs. Additional information about the services provided by the Knowles Court DS0000029184.V346814.R01.S.doc Version 5.2 Page 7 specialist dementia care provided for people on Headley house has been produced. Information from survey responses and talking to people living at the home said that: • They and/or their relatives had been given enough information about the home and the services it provided that helped them to decide if it would be suitable for them. • Somebody from the home had been out to talk to them about their care/support needs before any agreements about moving in where made. • The staff were kind and caring. • One relative said they were delighted with the way their relative had settled into the home and developed relationships with staff and people living in the home. • Staff respected people’s privacy and dignity. • Visitors were welcomed by staff and drinks offered. • People living in the home said they enjoyed the meals provided. • People were aware of the complaints procedure and knew who to speak to if they had any concerns. • The management team has recognised that there were areas where improvments could be made to make outcomes for people living in the home better and said that action would be taken straight away. This would include talking to all the unit managers and looking at the training that could be given to staff. What has improved since the last inspection? What they could do better: Knowles Court DS0000029184.V346814.R01.S.doc Version 5.2 Page 8 Services provided to people living on Newhall need to be changed and improved so that they have a better quality of life and get care and support from staff who have had appropriate training around learning disabilities so that peoples individuality and independence is promoted and protected.. The management team has recognised this and said that it will include redecorating and refurbishing the house so that the environment is comfortable and suitable for people with learning disabilities and increasing the range of social and leisure activities provided. The management team could make sure that peoples identified healthcare needs are looked after and specialist advice asked for when needed by: • Making sure that staff follow guidance provided by the organisation. • Making sure that where a risk is identified the care plan shows what the risk is and what is going to be done to reduce it. For example if they are at risk of losing weight the care plan will tell staff what they need to do to help the person maintain their weight and what specialist advice has been asked for. • Making sure that people are given their prescribed medication at the right times. In order to improve the ways that people living in the home are protected and safeguarded the provider should consider reviewing the adult protection training provided to staff. Recognising people as individuals, respecting and promoting choice and moving away from ‘set times’ for such things as hot drinks should be made part of it. It should also include making sure that all senior staff understand the importance of being able to recognise signs of abuse and take proper action to safe guard people. Requirments and recommendations of good pratcie can be found at the end of this report. 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. Knowles Court DS0000029184.V346814.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Knowles Court DS0000029184.V346814.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents do not move into the home until their needs have been assessed and they and the home are sure that their needs will be met. EVIDENCE: Information from survey responses and talking to people living at the home said that: • They and/or their relatives had been given enough information about the home and the services it provided that helped them to decide if it would be suitable for them. Knowles Court DS0000029184.V346814.R01.S.doc Version 5.2 Page 11 • • • Somebody from the home had been out to talk to them about their care/support needs before any agreements about moving in where made. The staff were kind and caring. One relative said they were delighted with the way their relative had settled into the home and developed relationships with staff and people living in the home. At least three care plans were looked at on each of the houses. Those for people who had not been at the home for very long contained detailed pre admission assessments. They clearly show what the persons needs where and if any additional support or equipment would be needed to help staff meet them. New care plan formats have been introduced by the organisation that have a detailed section about assessing peoples needs that can be used three times as a pre admission assessment, on admission and six months after admission to review and reassess the person needs and abilities. Information about services provided by the home is available in the homes brochure packs. Additional information about the services provided by the specialist dementia care provided for people on Headley house has been produced. Similar information for Newhall house that provides care for people with learning disabilities was not available. It was not clear if the brochures could be provided in different formats such as large print, easy read or in pictures/makaton. Knowles Court DS0000029184.V346814.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. 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. People are treated with respect and their rights to privacy and dignity upheld. Information in the care plans provides staff with guidance about peoples needs and how to meet them. This would be better if the links between healthcare assessments and the care plans were maintained consistently. This would mean that specialist health care and support would always be asked for in a timely manner. EVIDENCE: Knowles Court DS0000029184.V346814.R01.S.doc Version 5.2 Page 13 Since the last inspection in August 2006 the organisation has introduced a new system of care planning to all of its care homes. Training and guidance about how to use it has been given to staff. The aim is to make sure that all people living in their care homes have detailed, individual, person centred care plans that provide staff with all the information needed to meet their needs. After the training sessions had taken place all the care plans had to be switched over to the new format within a set timescale. Staff on all units have worked very hard to meet the deadlines set by the organisation and are still getting used to the new systems. At least three care plans were looked at on each of the houses. The information and levels of detail varied from being very good and person centred to basic and not individual to the person it was about. The management team are aware of this and said that they were auditing the care plans to identify where staff need more help, support and training. One area where particular attention must be paid is around making sure that where specialist healthcare assessments show the person needs additional support and/or advice from healthcare professionals it is followed through and recorded in the plans. For example if the person is at risk of losing weight the care plan should show this and what action is being taken to deal with this. Information and guidance to staff about meeting people’s different cultural and religious needs varied. On Newhall there are two people from different ethnic backgrounds but this was not fully reflected in their care plans other than meeting their dietary needs. Staff were seen to be kind and caring, showing respect and courtesy for residents. From talking to staff it was clear that they had a good understanding of peoples needs and how to help them. It was clear that there were good relationships between residents, visitors and the staff team. People said that the staff were very good, kind and caring. People living at the home and their relatives said that their privacy and dignity was respected. The home uses a monitored dosage system for medicines. Senior care staff look after medications on Fairfax and Headley, while nursing staff do this on the other houses. Staff said they had been trained to use this system and been provided with certificated training about dealing with medications. Some medication issues were identified on two of the houses that must be addressed to make sure people receive their medication safely: • There were some handwritten entries on the MAR (medication administration record) charts that had not been signed and dated. • The section to acknowledge receipt of medications was not always completed. • One person had gone fourteen days out of twenty-five without their morning medications because they were ‘sleeping’. These medications were prescribed daily but they had not been given at a later time. Their Knowles Court DS0000029184.V346814.R01.S.doc Version 5.2 Page 14 • care plan about medications did not reflect this either and professional advice had not been asked for from the GP or the pharmacist. A person prescribed regular painkillers did not have a care plan about pain relief and there were no entries in the care plan or daily records about why they had refused to take a particular pain killer. The manager said that regular medication audits were carried out action plans put in place where problems were found. Reassurances were given that the identified problems would be dealt with straight away. Knowles Court DS0000029184.V346814.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the 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 adequate. This judgement has been made using available evidence including a visit to this service. People on all houses can maintain contact with their family and friends. Increasing and improving the social and leisure activities provided in the home and catering for the different needs and abilities of people living in the home – particularly those with a learning disability - will improve outcomes for people and meet their expectations and preferences. EVIDENCE: Visitors said that they could call in at any time, were made welcome by staff and refreshments offered. Knowles Court DS0000029184.V346814.R01.S.doc Version 5.2 Page 16 People said they can choose when to get up, go to bed and how and where they spent their time. The manager said that links have been made with the local community. Some people go out to the Salvation Army Centre and children from a local school come in to talk to people. A vicar comes in to the home to lead worship sessions for all who want to join in and a Representative from the Roman Catholic Church visits people who want to take communion. The AQAA said that there is an activity organiser on each of the five units and one of them is a senior that co-ordinates activities that include all units and residents. They have received training and support to help them with their roles and more is planned. The manager identified where changes for the better could be made and observations made during the inspection confirm this. For example the learning disabilities unit programme of activities did not have enough outings and no holidays had been planned for people. An action plan has been put in place that intends to address this and improve provision of social/leisure activities for people with learning disabilities. The activity coordinator for Newhall has visited a resource centre that provides social activities for people with learning disabilities to help with this aim. Information from people living at the home and surveys returned said that mostly people were satisfied with the activites provided but sometimes there was not enough for them to do. It was clear from commments made that there were different levels of social stimulationand activity provision on different unit. People on Headley unit had access to a wde variety of activities as well as being encouraged to help with day to day chores such as light dusting and setting tables at meal times. External entertainers are brought in regulalry and people can attend the sessions on different houses if they want to. Some comments were made that more staff on the units would mean they had some extra time to spend with people who stay in their rooms. The kitchen is in the main office building and provides meals for the whole site. Each house has a kitchenette where hot drinks and snacks can be made. The manager said that the last visit by the environmental health office had been made in December 2006 and all was satisfactory. The AQAA said that a full and varied menu is available in the home. The BUPA Menu Master helps to make sure that the menu meets the nutritional needs of the residents. Different dietary needs are catered for including, pureed, vegetarian, diabetic and Halal. A ‘light – night bites’ menu has been introduced that allows people to choose from a variety of hot and cold snacks and drinks at any time of day. The food items are kept in the kitchenettes on each unit. This is a very good idea but is dependant on the staff offering this service to people. On some units the posters advertising the service were displayed prominently and on others they were not seen. Files with photographs of meals and snacks have been produced to help people with communication difficulties make menu choices Knowles Court DS0000029184.V346814.R01.S.doc Version 5.2 Page 17 but they were not being used in all the units. The manager said that she would make sure staff on all units promote and offer these services to people. Information from Newhall unit Two visits were made to Newhall to observe outcomes for people living on the unit and a SOFI observation was carried out. This showed that: • People who can communicate easily received more attention from staff. • There was not a lot of equipment to stimulate people with limited communication. • A musical activity was taking place in one corner of the room and the TV was playing in another corner. • There were no drinks or snacks for people to help themselves to and drinks were only offered to people at the designated ‘drink’ time. On one occasion people were offered hot drinks at 3pm but they were not offered snacks or biscuits. • Some staff interactions were very good, warm and inclusive but many were task orientated, such as giving a drink. This was fed back to the manager and a multidisciplinary team meeting with attendees from the local authority, an advocacy service and senior staff from the home and organisation. The meeting had been called to discuss concerns about the quality of life for people living in Newhall unit. The organisation has recognised that changes need to be made to the way the unit is managed so that people are given more opportunities to develop as individuals and have access to more social and leisure activities. The work on making the unit more suitable for people with learning disabilities will be done in 2008. The organisation has acknowledged that outcomes for people living on this unit can be improved and have made a commitment to achieve this. We saw that the keys for people’s lockable cabinets were kept in the office. A member of staff was using the keys to get money out of the locked cabinets. This was being done to get payments for hairdressing and chiropody from people’s personal allowances and good records kept around why the money was being taken. But the system used means that people who might have the ability to be part of this are not being given the opportunity or support to look after their own money. We looked at the file for one person and there was no reason why he should not have his key or look after his own money. Where people do not have the ability to look after their own money, it would be better to have this written down and the money looked after in a way that does not mean staff are going into people’s private locked cabinets. The manager said that this would be dealt with straight away. Information from Headley unit One visit was made to this unit and a SOFI observation was carried out. This showed that: • There were some different activities taking place and staff were trying to include people. Knowles Court DS0000029184.V346814.R01.S.doc Version 5.2 Page 18 • • • • Staff interactions with people were mainly warm and inclusive. Staff spoke to the individuals and got down to eye level if they were sitting in armchairs. There were occasions when staff walked past somebody who had dropped the book they were looking at and could not pick it up themselves. Staff returned from their lunch break and it was good that they went to sit with people. But they took drinks with them and did not offer or give drinks to the people they were sat with. People had to wait until ‘drink’ time at 3pm. At 3pm when people were offered drinks and snacks not all people on the unit were given one. I saw that there were at least three people who did not get a drink and staff were not seen taking drinks or snacks to people in their rooms. This information was fed back to the manager who said that appropriate action would be taken to make sure peoples needs were met. Knowles Court DS0000029184.V346814.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. 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. People are aware of the complaints procedure and confident that their concerns will be listened to and acted upon. The organisations policies and procedures help to protect people from abuse and this would be improved if staff awareness of the different types of abuse was increased. EVIDENCE: Information provided in the AQAA said that the organisation has a clearly defined company complaints policy with agreed timescales for managing complaints. The policy includes a three tier framework including the home, the regional management team and the national Quality and Compliance department. During the visit information about the complaints procedures and policy was prominently displayed in the different houses. The AQAA said that the home has received twelve complaints over the last twelve months. Infromation about some of these was looked at. They were about different iissues such as problems with the laundry, inappropaite Knowles Court DS0000029184.V346814.R01.S.doc Version 5.2 Page 20 comments made to somebody and general care related issues. All the complaints had been upheld but records of all the outcomes were not available. The manager said that where the concerns could be dealt with immediatley they had been and records not made of discussions held. The organisation has robust policies for dealing with allegations of abuse or neglect. Staff can not only raise concern within the home they have access to senior staff outside the home. There have been some issues in the home where referrals have been made to the adult protection unit and there has been collaberation between all agencies involed to protect people living in the home. However one of the complaints looked was about an injury to a care worker caused by a person living in the home. The matter was still under investigation but information from the manager indicated that this was something that could have been referred to the adult protection unit as the member of staff had allegedly not respected the persons wish or choice to be left to rest. The manager said it was some time since she had done any training around adult protection. To make sure that all senior staff understand the importance of being able to recognise signs of abuse and take proper action to safe guard people they should attend the specialist training course for care home managers run by the local authority adult protection unit. Knowles Court DS0000029184.V346814.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in clean, safe and well maintained home that is suitable to their needs. EVIDENCE: The buildings are well maintained. Maintenance staff are employed to deal with regular maintenance and minor repairs. Knowles Court DS0000029184.V346814.R01.S.doc Version 5.2 Page 22 The fire officer’s last visit was in September 2007 and the manager is waiting for the report. If any work needs to be done the ‘Estates’ department will deal with it. Each house has easily accessible garden areas. Some resident’s rooms have patio doors that open into the gardens. Resident’s rooms are furnished in a homely manner and it was clear that people could bring in their own things to personalise the rooms and make them ‘theirs’. At the centre of each house there is a large lounge/dining area with an adjoining kitchenette. The units are all on one level therefore all areas are easily accessible to wheelchair users. Various aides are available in bathrooms to aid those less able such as hoists, grab rails and raised seats. The manager said that plans have made to upgrade the environment for Newhall in 2008 to make sure that it is suitable for people with learning disabilities. This is long overdue as the unit does look ‘tired and shabby’ and the organisation has said in the past that this would have been completed in 2007. Headley unit was redecorated when it became a specialised dementia unit. The lounge area is homely, but the corridors look the same as the bedroom doors are all same colour. Memory boxes have been put on the doors to help people recognise their own rooms. Clear signposting of toilets and bathrooms has been used. The garden areas have been securely fenced so people can walk around safely and there is a pleasant central garden area where they can sit outside weather permitting. Fairfax unit has had some areas redecorated and new floor coverings provided in all bedrooms. Aprons, gloves and equipment are available to reduce the risk of cross infection. Staff were seen using it appropriately. The laundry is in the central building. It is a good size, suitably equipped and staffed to meet the laundry needs of the site. Resident’s clothes looked well laundered. Knowles Court DS0000029184.V346814.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the 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 adequate. This judgement has been made using available evidence including a visit to this service. The gaps in training provided to staff means that they might not have the knowledge and skills needed to meet people’s needs. EVIDENCE: Each house has it’s own staff team and duty allocations. They showed five or six staff were on duty for the mornings, four for the afternoons and three at night plus at least one nurse on every shift for the nursing houses. Fairfax and Headley the residential units had five or six staff in the morning, four in the afternoons and two at night. Staff on duty during the visits said that if all people on the rota turned up for their shifts these numbers were reasonable but there had been problems with sickness and absences. Information from people living at the home and in returned surveys said that: • The staff were very good, ‘fantastic’ and caring but it would be better if there were more staff available. Knowles Court DS0000029184.V346814.R01.S.doc Version 5.2 Page 24 • • More staff on duty would let staff spend a bit more time with people and not have to rush. More staff would mean better person centred care and give more time to interact with and help people. The manager said that staffing levels had been set by the organisation and could not be changed until the quality assurance department came to do an audit of peoples needs. Four staff files were looked at. These showed that: • Application forms had been completed but they ask for ten years employment history rather than the required full employment history. • Reasons for gaps in employment were not always recorded. • Two written references were in place for three people before employment was offered but not for the third person. The manager said she had spoken to the referees and obtained verbal references but had not kept a written record. • Enhanced CRB (Criminal Records Bureau) and POVA (Protection of Vulnerable Adults) checks were in place before employment was offered. • Proof of identity and checks that they could work in the United Kingdom was available. • Terms and conditions of employment were issued. • Induction training had been started. • For nursing staff there was confirmation that they were registered with the NMC (Nursing and Midwifery Council). Information provided with the AQAA, from staff surveys and from looking at training records showed that there is an ongoing training programme. This includes an induction training package that is to the Skills for Care common induction standards. There is a positive commitment towards National Vocational Qualification training and twenty one people have already achieved level 2 or higher, but the target of 50 with this qualification has not been reached yet. The manager is aware that not all staff have received all the training needed about maintaining the health, safety and well being of people living in the home and themselves. This is partly because it is a big home with a large staff team and there have been people leaving and starting work. Making sure people receive appropriate training is an ongoing process. The manager said plans are in place to make sure it is provided and has identified who needs what. This will include meeting people’s specialist care needs such as learning disabilities, dealing with challenging behaviour and dementia. Knowles Court DS0000029184.V346814.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) 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 home is being managed and run in the best interests of people who live in it. The management team are proactive and will make sure that the health, safety and well being of people and staff is promoted and protected. Knowles Court DS0000029184.V346814.R01.S.doc Version 5.2 Page 26 EVIDENCE: There has been a change of manager since the last inspection in August 2006. The manager is a registered nurse with many years experience of managing care homes and she has successfully completed the registered managers award. The homes management team comprises of the manager, a clinical services manager, a catering manager, an administrator, a receptionist, managers for each house and a maintenance manager. They meet at least four times a year and the minutes of their meetings are passed onto other staff via meetings. Staff meetings are also held on each house and any issues or concerns raised at management meetings will be discussed if they are appropriate to that house. Dates were displayed for staff meetings and records are kept. People living in the home, their relatives and staff said that the management team were approachable and supportive. Meetings are also held on each house at regular intervals for people living in the home and their relatives to discuss what is happening and any issues they might have. The manager said that issues identified during the inspection process would be discussed with the individual house manager and action plans would be put in place to deal with them. Annual quality assurance surveys are carried out by the organisation, which includes finding out residents views of the services they receive. The last one was in Autumn 2006 and the results have been published and made available to interested parties. The people who responded to the survey were satisfied with the services provided by the home and very positive comments were made about the staff. In addition to this the responsible individual makes monthly visits to the home to assess residents and staff views of how the home is being managed. Copies of these reports are sent to the CSCI as required by regulation 26. The home acts as appointee for 54 residents. The company is the named appointee and benefits are paid into the company bank account. Computerised records are kept that detail the amounts to be paid towards fees and how much is left over as personal allowance. The personal allowances are held in the bank account and interest is paid on the amount each individual holds. Monies can be returned to residents and also held in safekeeping for them to use whenever they want to. Appropriate records of these financial transactions were seen. The administrator said that these accounts are audited monthly. In addition to this the home has a ‘mobility fund’ that some people on Newhall unit contribute towards. Up to five years ago the money was used to pay for the minibuses that are used to take people from Newhall to day centres and trips out. The organisation was paying for the buses but this cost is going back to the people. The fund has been ‘dormant’ for five years and people have Knowles Court DS0000029184.V346814.R01.S.doc Version 5.2 Page 27 been receiving the full amount of their mobility allowances through the personal allowance systems. This system will need to change if the mobility fund is to pay for the buses again but before it does the following steps should be taken: • People or their advocates who will be contributing to the fund must be consulted about whether or not they want to be part of it. • Written agreements must be put in place between people who will be part of the fund and the organisation. • A policy about how the money will be used so that it will equitable for people contributing should be put in place. Accidents and incidents that may affect the wellbeing of residents are reported to the CSCI as required by Regulation 37. The AQAA stated that maintenance and servicing of equipment is carried out as required, all checks are up to date and records are kept. Knowles Court DS0000029184.V346814.R01.S.doc Version 5.2 Page 28 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 3 2 3 3 3 4 X 5 3 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 ENVIRONMENT Standard No Score 19 2 20 3 21 X 22 X 23 X 24 3 25 X 26 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 3 33 3 34 X 35 2 36 X 37 X 38 3 Knowles Court DS0000029184.V346814.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 13 Requirement The manager must make sure that where specialist healthcare assessments show the person needs additional support and/or advice from healthcare professionals it is followed through and recorded in the plans. This will make sure peoples healthcare needs are met. The manager must make sure that there are systems in place for making sure people receive their medication as prescribed their doctors. An action plan with timescales detailing when the refurbishment, redecoration and repair works are to be carried out - particularly for Newhall house and requirements made in the fire safety officers report must be forwarded to the CSCI. The manager must make sure that full employment histories are requested from all prospective employees. Gaps in DS0000029184.V346814.R01.S.doc Timescale for action 31/12/07 2. OP9 13 15/12/07 3. OP19 23 30/03/08 4. OP29 19 and Schedule 2 15/12/07 Knowles Court Version 5.2 Page 30 employment must be explored and records kept. (This requirement was made at the last inspection and was not met.) In order to protect people living in the home the manager must make sure that satisfactory pre employment checks are in place before offering employment. This must include two written references. 5. OP30 18 The registered person must 30/03/08 make sure that all staff receive training appropriate to the needs of people living in the home. This must include all areas of health and safety related training and specialist training such as dementia, dealing with challenging behaviour and learning disabilities. In order to protect people who have agreed to pay money into the mobility/residents fund the provider must make sure that: • People contributing towards it should be consulted and agree about how it will be managed. • A policy will be put in place after the consultation setting out how the fund will be managed, what money can be used for and how it will be made equitable for the people who contribute. • There are contracts/agreements between the home and people who contribute. • Detailed records of monies received and used are kept. DS0000029184.V346814.R01.S.doc 6. OP35 17, 20 Schedule 4 (9) 31/12/07 Knowles Court Version 5.2 Page 31 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 OP1 Good Practice Recommendations The registered person should look at providing information about services provided in the home a format suitable for people with learning disabilities. Care plans should be kept up to date and show all actions taken, providing an accurate picture of the persons medical, physical and social well being. This will make sure that staff have information and guidance about people’s health, personal, psychological and social care needs and how to meet them. The manager should make sure that the programme of social activities continues to be improved and increased, particularly for people with a learning disability or dementia. Activities provided must be appropriate to the needs, abilities and wishes of people living in the home. The manager should make sure that all staff, including herself, have received training around the different types of abuse, adult protection and what action to follow if it is suspected. This will help to protect and safeguard people living in the home. The provider should consider more flexibility around staffing levels so that they can be altered to suit and reflect the needs people living in the home. The manager should make sure that at least 50 of care workers have achieved a qualification equivalent to NVQ level 2. 2. OP7 3. OP12 4. OP18 5. OP27 6. OP28 Knowles Court DS0000029184.V346814.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. 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