Inspection on 09/08/06 for Knowles Court

This inspection was carried out on 9th August 2006.

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

Knowles Court 08/10/07

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 Unannounced Inspection 10:30 9 and 10 August 2006 th th 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.V292730.R01.S.doc Version 5.1 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.V292730.R01.S.doc Version 5.1 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 www.bupa.com BUPA Care Homes (CFHCare) Limited Mrs Dianne Karen Parker Care Home 146 Category(ies) of Learning disability (26), Learning disability over registration, with number 65 years of age (26), Physical disability (120), of places Physical disability over 65 years of age (120) Knowles Court DS0000029184.V292730.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th December 2005 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. All rooms are single, and each house has central communal areas, which provide both lounge and dining space. 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. The home is registered to provide care, with nursing to people with physical disabilities from the age of 18 upwards and people with learning disabilities from the age of 18 upwards. 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 resident’s bedroom. The weekly fees for services provided in the home vary depending on whether or not the resident is funded by the local authority, have nursing needs and fees are supplemented by the nursing care component paid by the health authority or if they pay privately. Details of exact charges can be obtained from the manager. They range from £318.15 for local authority funded residential care to £707.84 for privately funded nursing care. Knowles Court DS0000029184.V292730.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection (CSCI) inspects homes at a frequency determined by the assessed quality rating. The inspection process has become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a visit to the home. All regulated services will have at least one key inspection before 1st July 2007. This is a major evaluation of the quality of a service and any risk it might present. It focuses on the outcomes for people living at the home. All the key National Minimum Standards (which are identified in each section of the report) are assessed and this provides the evidence for the outcomes experienced by residents. At times it may be necessary to carry out additional visits, which might focus on specific areas like health care or nutrition and are known as random inspections. The last inspection was in December 2005. At that time fifteen requirements and three recommendations of good practice were made. This visit was unannounced and carried out by three inspectors over two days. It started at 9.30am and finished at 5.00pm on the 9th August 2006 and was completed on the 10th August 2006. Feedback was given to the manager during and at the end of the visit. The purpose of the visit was to make sure the home was being managed for the benefit and well being of the residents and to see what progress had been made meeting requirements in place from the last inspection. Information to support the findings in this report was obtained by looking at the information supplied in the pre inspection questionnaire (PIQ). Examples of information gained from this document include details of policies and procedures in place and when they were last reviewed, when maintenance and safety checks were carried out and by who, menus used, staff details and training provided. Records in the home were looked at such as care plans, staff files, and complaints and accidents records. Residents, their relatives and visitors were spoken to as well as members of staff and the management team. CSCI comment cards and post-paid envelopes were sent to the home to be given to residents and their relatives before the visit was made. At the time of writing this report twenty-seven resident and six relative survey responses had been received. The evidence gathered at this inspection means that the quality rating has changed for this home and is now good instead of adequate. Knowles Court DS0000029184.V292730.R01.S.doc Version 5.1 Page 6 What the service does well: What has improved since the last inspection? It is clear that the manager and staff have worked very hard to meet requirements made at the last inspection. There were fifteen requirements, eight of these have now been met and good progress is being made towards meeting the remaining seven. New care plan formats have been introduced which will provide staff with detailed information about how residents’ individual care needs are to be met. Work had been done on making the plans more person centred. The document ‘How the resident likes to spend the day- 24 hour plan’ is clearly person Knowles Court DS0000029184.V292730.R01.S.doc Version 5.1 Page 7 centred and the ‘map of my life’ provides staff with useful background information. The activity organisers now work on each house with the house manager. This has led to activities for each house being better suited to the needs and wishes of residents. Training about activities and social stimulation has been given. An extensive range of activities is now on offer, which includes poetry, guest speakers, themed days and meals, cheese and wine parties, indoor gardening and trips out as well as community links with Salvation Army and local luncheon clubs. The complaints procedure has been produced in Makaton for residents living in Newhall house. There has been a big increase in training given to staff. This has included adult protection and abuse awareness, care planning, nutrition, dementia care and specialist training around learning disabilities. Staff were very positive about training they had received and the benefits it gave to them in increasing their knowledge and skills. The manager has successfully completed a management qualification equivalent to NVQ (National Vocational Qualification) level 4. Changes and improvements are being made to the environment, which include walk in showers on Newhall, Devere, and Headley houses. New carpets have been put down on Newhall corridors and communal areas, Ryecroft corridors and in the Devere lounge. What they could do better: The good progress made towards meeting requirements and improving the quality of care provided in the home is to be commended and must be continued. There are nine requirements as a result of this inspection. Six of these are where some progress has been made toward meeting existing requirements. Work on making the care plans more individual and detailed must continue, making sure that residents and their representatives are involved wherever possible. This must be carried forward to show that they are evaluated monthly and that a full review of care needs is carried out at least annually. Issues around dealing with medications were identified on some of the houses. The house managers and the manager were made aware of them and reassurances were given that they would be dealt with immediately. The manager must make sure that there are systems in place for monitoring and auditing all medications received, stored and administered. Accurate records must be kept. Knowles Court DS0000029184.V292730.R01.S.doc Version 5.1 Page 8 The redecoration and refurbishment plans for the home must take into account requirements made in the fire safety officers report and improvements that must be made to Fairfax house to bring it to the same standard as the other houses. The manager must make sure that the increased training provision is continued in order to make sure that all staff receive appropriate training to help them to carry out their roles within the home. This must include infection control, NVQ, health and safety related training and other specialist areas such as dementia and learning disabilities. 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. Knowles Court DS0000029184.V292730.R01.S.doc Version 5.1 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.V292730.R01.S.doc Version 5.1 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 to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 5. Standard 6 is not applicable to this service. The quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. 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: One of the service user surveys said that somebody from the home had been to see them before arrangements were made to come and live at the home. They were given a brochure and their questions were answered. Survey responses and talking to residents and their visitors confirmed that they were given information about the home and the services offered. Knowles Court DS0000029184.V292730.R01.S.doc Version 5.1 Page 11 Pre admission assessments are in place and the document used asks for all the relevant information needed to see if the home can meet the individual’s needs. The most up to date documentation showed that in depth assessments had been carried out. Some residents are being reassessed as they have been living at the home for many years. The new assessment refers to the date of the original; this is good practice and enables a paper trail audit to be carried out if needed. Staff described the admission procedure and said it varies according to individual needs. Visits and overnight stays can be arranged so that any prospective resident can try out the service before moving in. Residents and visitors confirmed that trial visits are offered. One resident said they had been happy with the information obtained by relatives and declined a trial visit. Each resident has an information pack in their room, which includes the Statement of Purpose and Service User Guide, the complaints procedure and the service they can expect. Some consideration should be given to producing this information in a format that is accessible to all service users such as large print, audio, Makaton and easy word and picture format. Knowles Court DS0000029184.V292730.R01.S.doc Version 5.1 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 to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. Residents health, personal and social care needs are met. They are treated as individuals and with respect by the staff team. Practices around dealing with medication mean that there is a risk of errors being made. Knowles Court DS0000029184.V292730.R01.S.doc Version 5.1 Page 13 EVIDENCE: The manager said that new care plan formats have been introduced. The aim of which is to provide staff with detailed information about how residents individual care needs are to be met. Ten care plans were looked at during the visit, at least two from each house. The care plans are written using information from the pre admission assessment and other assessments that are carried out when the resident comes to live in the home. It was evident that work had been done on making the plans more person centred. The document ‘How the resident likes to spend the day- 24 hour plan’ is clearly person centred and the ‘map of my life’ provides staff with useful background information. This was particularly noticeable on Newhall where staff had developed lifestyle plans for residents. Staff on Newhall said they are continuing to develop the plans further to include more information on likes, dislikes, future aspirations and residents’ life histories. Detailed care plans were in place for most residents identified needs and the good progress made must be continued. Examples where appropriate care plans were not seen were given to the house managers and the manager. These included for one resident needing regular pain relief and another who had an allergy to latex. Letters for the residents and or their relatives to sign showing that they had been involved with the care planning process were seen in most of the files but they had not always been dated and signed. Most care plans were evaluated monthly. Some had been reviewed in full with input from the resident, their relatives and other involved people such as social workers and district nurses. Staff said plans were in place to make sure that all care plans were reviewed. Old out of date information was seen in some of the files. This could lead to confusion for staff. The old information should be archived. Due to the complex needs of the residents on the Newhall unit, it is difficult to say whether they were familiar with the content of their care plans. Further work could be done to make the plans more accessible to the residents through the use of symbols or pictures. Risk assessments had been carried out where appropriate and care plans put in place. But some plans were not detailed enough. A resident at risk from falls did not have a plan in place showing how they should be moved safely after a fall. Knowles Court DS0000029184.V292730.R01.S.doc Version 5.1 Page 14 Nutritional assessments are carried out and appropriate plans put in place. Residents weights are checked monthly and records kept. Advice is sought from the GP and or dietician as required. Pressure area risk assessments had been completed for any resident seen to be at risk from developing pressure sores. These were reviewed on a monthly basis. Specialist pressure relieving equipment was provided for those who needed it and all relevant information detailed in the care plans, such as what type of equipment was being used and what settings should be used. If specialist advice and support is needed around pressure and wound care the district nurses or tissue viability nurse are contacted. Staff on the residential house said that they would always contact the district nurse for advice. A visiting nurse said that staff called them in appropriately and followed advice and instructions given. Residents general healthcare needs are monitored and visits from health care professionals such as GPs, dentists, chiropodists, and dieticians are requested. Records are kept of any appointments or visits made. Relatives said that staff were very good at keeping them informed and up to date with any changes to their relatives condition. During the visit, staff were seen offering residents choice and encouraging them to make decisions about things like what to wear and what to eat. A visitor said that they attend relatives and residents meetings in order to “have a say” about the home. Residents and relatives said they were mainly happy with the service provided by the home. One relative said they thought staff were “devoted” to caring for the residents another said “any little niggles we have are usually sorted out”. Staff were seen to be kind and caring, showing respect and courtesy for residents. It was clear that there were good relationships between residents, visitors and the staff team. In discussions with residents it was evident that they enjoyed the good care that was provided and said that staff did respect them. Instances were given relating to bathing and other personal care tasks. Staff were observed knocking on doors before entering and this was confirmed in discussions with residents. Residents confirmed that they had keys to their bedrooms and a lockable drawer. The telephone trolley can be wheeled to bedrooms for those residents who do not have own telephone installed. The home uses a monitored dosage system for medicines. Senior care staff look after medications on Fairfax and nursing staff on the other four houses. Staff said they had been trained to use this system. However, there were a number of medication issues that must be addressed in order to safeguard residents. Knowles Court DS0000029184.V292730.R01.S.doc Version 5.1 Page 15 Handwritten entries on the MAR (medication administration record) charts should be signed and dated. Wherever possible they should be checked and countersigned to make sure they are correct. There were some gaps on the record sheets where they had not been signed by the person who administered the medication. There were occasions when a medicine had not been given, yet the record sheet had been signed to say it had. There were other times when a medicine appeared to have been given but the record sheet had not been signed accordingly. An error in the number of tablets dispensed by the pharmacist had not been picked up when the medication was checked in to the home. One course of antibiotics showed that staff had signed for administering 24 tablets when only 21 had been prescribed. One house had a stock of a controlled drug that had been dispensed in February 2006, which had not been used, and the stock level had not been carried forward into the new controlled drugs register. These were referred to the manager who said that she would deal with them immediately. It was clear that the stock received section of the MAR charts were not always being used which means that there are no clear records of all medications received into the home. Systems for monitoring and recording all medications ordered, received, administered and disposed of must be put in place. Knowles Court DS0000029184.V292730.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. The quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. Residents are satisfied that the lifestyle experienced in the home matches their preferences and expectations. EVIDENCE: An activity organiser has been allocated to each house and together with the house managers are responsible for organising activities. They said that this is better and had improved the organised activities that were being offered as well as making them more suited to the needs of residents on each house. The Knowles Court DS0000029184.V292730.R01.S.doc Version 5.1 Page 17 organisers and some staff have received training about activities and social stimulation. The organiser on the learning disabilities unit has also done training aimed at activities for people with learning disabilities. The activity organiser on Fairfax house was seen encouraging residents to take part in exercises, make fruit salad and discuss music. A large number of residents were enjoying the camaraderie and banter that was taking place although others confirmed there was no pressure to join in, choice was offered. There were tomato plants and kiwi fruit that had been grown by residents. There was an excellent range of activities on offer. The list of activities sent with the PIQ included poetry, guest speakers, themed days and meals, cheese and wine parties, karaoke, indoor gardening and trips out as well as community links with salvation army and local luncheon clubs. Residents were satisfied with the level of activity. One resident said “there’s always something going on if you want to join in.” The care planning process looks at resident’s interests and social life. An activity sheet kept in care plans showed what activities had been joined in with, family visits and one to one chats/sessions with staff. Some residents had thoroughly enjoyed a trip to Southport. Another resident who was a wheelchair user appreciated the level access to the garden and enjoyed spending time there. Some residents do not have English as their first language. Arrangements have been made for one to have cable TV with programmes from their home country being shown. Another has staff available who can speak their language. This resident is also provided with films and music in their first language. Visitors said that they were made welcome by staff and refreshments offered. Residents confirmed this on the day as well as in the survey forms that were returned. Residents said they can choose when to get up, go to bed and how and where they spent their time. One resident was seen exercising control over daily living by independently making use of a WC even though a wheel chair user. This was possible because of the size of the WC. 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 PIQ said that the last visit by the environmental health office had been made in January 2006 and all was satisfactory. The kitchen was clean and well organised and appropriate records about cleaning schedules and food temperatures are kept. The chef said that there were new hot trolleys and he would visit units to make sure meals were being served properly and kept hot. He is made aware of individual residents likes and dislikes as well as any special dietary needs and that he is providing diabetic, low fat and one halal diet. He said that the halal meat is specially ordered. Soft/pureed meals are Knowles Court DS0000029184.V292730.R01.S.doc Version 5.1 Page 18 plated in the main kitchen to make sure they are attractively presented. The organisation has provided information in a diet directory that tells staff about different cultural and specialist diets as well as how to enrich foods for people at risk of losing weight. Menus are displayed in each house which provide at least two choices for each meal. The chef has systems in place for consulting with residents when menus are to be changed. Three months ago he carried out a survey to find out if they were happy with home made soups at tea time. He said most of the responses showed they enjoyed the soup. Residents can choose to eat their meals either in the dining room, lounge area or their own rooms. Dining tables were attractively set and the meal times seen were relaxed and unhurried. Choice was regularly offered whether this was the meal itself, drinks or the size of the portion preferred. Residents on the whole said they enjoyed the meals and had plenty of choice. There were regular supplies of juice and cold drinks. Residents spoken to all said they enjoyed the food at the home. A relative of a resident in the Newhall unit felt that more meal choices could be made for his son if he was actually shown the food rather than just verbally being given the choices. This would be good practice. The chef has already produced files with photographs of different meals that could be used. Knowles Court DS0000029184.V292730.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. The quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. Residents feel safe and are confident that any concerns they might have will be taken seriously and acted upon. EVIDENCE: The complaints procedure is displayed in the reception area of each house as well as being included in the Service User Guide and resident information file kept in each bedroom. Complaints leaflets are easily available in each unit. It is clear, detailed and easy to understand. Newhall house now has one that is suitable for people with learning disabilities. Resident’s surveys showed that they knew who to speak to if they had any concerns and residents spoken to confirm this. Residents and visitors said that they were confident that any concerns raised would be dealt with promptly and properly. Records of complaints received are kept and audited monthly. The PIQ said there have been 6 complaints made in the last twelve months all of which were substantiated and responded to within the 28 day timescales. From January 2006 there was information about eight complaints that had been dealt with by the manager, two of these were after the end of April 2006 after the time Knowles Court DS0000029184.V292730.R01.S.doc Version 5.1 Page 20 when the PIQ had been returned to the CSCI. Most of them were care related issues including concerns that a resident’s blood sugar levels were not being done regularly which was investigated and not upheld as medical advice was that they should be checked randomly once or twice a week which is what staff were doing. Adult protection policies and procedures are in place. Staff have been issued with copies of the adult protection and whistle blowing procedures. Most staff have attended training sessions around adult protection and abuse awareness and plans are in place to make sure it is given to all. The manager said that she is looking into booking somebody on to the local authority adult protections ‘train the trainer’ course. Staff said that they would not hesitate to report suspected or actual abuse to a unit manager or the manager. This has happened where staff have had concerns about perceived bad or poor practice. These have all been dealt with appropriately and the manager informed the adult protection unit and CSCI. Care plans showed that where equipment is used that may be seen as restraint, for example bed rails and seat belts in wheelchairs, there was proper documentation including risk assessments and agreements between all involved wherever possible. One resident said that they knew and understood the reasons for bed rails being in place. Knowles Court DS0000029184.V292730.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25 and 26. The quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. Residents live in a safe, clean and well maintained home. EVIDENCE: The buildings are well maintained. Maintenance staff are employed to deal with regular maintenance and minor repairs. Knowles Court DS0000029184.V292730.R01.S.doc Version 5.1 Page 22 The fire officer’s last visit was in March 2006. A copy of the report was sent to CSCI and this states that the home has agreed to do the required works by March 2007. 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 many had been personalised with resident’s own things. 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. In the PIQ the manager said that walk in showers are being installed on Newhall, Devere, and Headley houses. Also that new carpets have been put down on Newhall corridors and communal areas, Ryecroft corridors and in the Devere lounge. There was a vast difference in decoration and furnishing between Fairfax and Devere houses. Devere is bright well furnished and decorated. Many areas in Fairfax need new carpets and redecoration. Blinds have been fitted in the conservatory located on Devere but staff on Fairfax said they were making their own, as the area was very warm. This information was given to the manager at the end of the visit. Radiators were unguarded but the manager checked with head office and was reassured that they all had low temperature surfaces. Written confirmation of this has been given to the CSCI. The houses had a welcoming atmosphere and staff welcomed residents back onto the unit after a trip out. The home was clean and tidy. Domestic staff are allocated to each unit. They said that they had received training in the use of cleaning equipment and products used. They had also received appropriate health and safety training, including COSHH (Control of Substances Hazardous to Health) and moving and handling. It was clear that they are part of the team and they had a good rapport with residents. 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. The staff said that they had received training around health and safety related topics and infection control and that they felt well supported by the management team. Residents clothes looked well laundered. Knowles Court DS0000029184.V292730.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. The quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. Residents needs are met by staff who have been trained and are on duty in sufficient numbers to do so. 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, the residential unit had five or six staff in the morning, five or four in the afternoons and two at night. Staff felt that if all people on the rota turned up for their shifts then these numbers were satisfactory. Resident surveys and discussions with residents and visitors showed that they felt there were usually enough staff on duty but that they could be a bit busy at times. Knowles Court DS0000029184.V292730.R01.S.doc Version 5.1 Page 24 Five 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 * Enhanced CRB (Criminal Records Bureau) and POVA (Protection of Vulnerable Adults) checks were in place. * 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 completed * For nursing staff there was confirmation that they were registered with the NMC (Nursing and Midwifery Council). Since the last inspection in December 2005 there has been a big increase in the training provided to staff. The manager said that the training programme is ongoing and will make sure that all staff receive training appropriate to the work they are to perform. Information given in the PIQ said that training given over the last twelve months has included: * Care planning * Medication * Dementia care * Nutrition * Falls * Abuse and vulnerable adults * Aggression management * Managing challenging behaviour * Infection control * Wound and pressure area care * Six staff have completed LDAF (Learning Disabilities Award Framework) and valuing people training. * Twenty-four out of sixty one care staff have achieved a qualification equivalent to NVQ (National Vocational Qualification) 2 or higher. * Staff with communication difficulties are enrolled on Skills for Life course to improve literacy and understanding of English. The manager was made aware that if the training about managing aggressive behaviour provides guidance on use of restraint, the training providers must be accredited with BILD (British Institute for Learning Disabilities). The management team are to be commended for the good work and positive attitude towards training that now exists in the home. Staff confirmed that the training had increased and were very positive about increasing their knowledge and skills. Knowles Court DS0000029184.V292730.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38. The quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. The home is well managed and run in the best interests of the residents. Knowles Court DS0000029184.V292730.R01.S.doc Version 5.1 Page 26 EVIDENCE: The manager has successfully completed a management qualification equivalent to NVQ level 4. 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 in their meetings. Dates were displayed for staff meetings and records are kept. Relatives, residents and staff said that the management team were approachable and supportive. Residents and relatives meetings are held on each house at regular intervals and records are kept of issues discussed. The PIQ said that 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. 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 2005 and the results have been published and made available to interested parties. 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. Accidents and incidents that may affect the wellbeing of residents are reported to the CSCI as required by Regulation 37. The PIQ stated that maintenance and servicing of equipment is carried out as required, all checks are up to date and records are kept. The PIQ stated that policies and procedures are in place and there have been no changes since December 2005. If there are changes in legislation any necessary changes will be made by head office and the revised information sent to the home. Knowles Court DS0000029184.V292730.R01.S.doc Version 5.1 Page 27 The fire alarm was triggered during the inspection. Staff responded quickly and efficiently, which was found to be a false alarm. Knowles Court DS0000029184.V292730.R01.S.doc Version 5.1 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 X 3 3 4 X 5 3 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 15 ENVIRONMENT Standard No Score 19 2 20 3 21 3 22 3 23 X 24 3 25 3 26 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 33 34 35 36 37 38 3 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 X X 3 Knowles Court DS0000029184.V292730.R01.S.doc Version 5.1 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 OP7 Regulation 14, 15 Requirement A plan of care must be in place for each resident, which details clearly how all assessed health, personal, psychological and social care needs will be met. These must show all actions taken and provide an accurate picture of the resident’s medical, physical and social well being. The care plans must be kept under review and reflect changing care needs. They must show that wherever possible the resident and their representatives have been involved in this process. (This requirement was first made in May 2005. Progress is being made towards meeting it but the original timescale was not met. It has been agreed to extend the timescale.) 2. OP9 13 The manager must make sure that there are systems in place for monitoring and auditing all medications received, stored and administered. Accurate records DS0000029184.V292730.R01.S.doc Timescale for action 30/12/06 30/10/06 Knowles Court Version 5.1 Page 30 must be kept. 3. OP12 16 The manager must make sure that the programme of social activities to residents, continues to be improved and increased, particularly for those with a learning disability. Activities provided must be appropriate to the needs and wishes of the residents. Steps must be taken to make sure that training around abuse and adult protection continues and is given to all staff. 30/03/07 4. OP18 13 30/03/07 5. OP19 23 An action plan with timescales 30/12/06 detailing when the refurbishment, redecoration and repair works are to be carried out, particularly for Fairfax house and requirements made in the fire safety officer report in January 2006, must be forwarded to the CSCI. The registered person must make sure the infection control training is provided to all staff. (Progress is being made but the timescale of 30th September 2005 and 30th July 2006 have not been met. It has been agreed to extend this timescale.) The registered person must ensure that a minimum of 50 of care workers have achieved NVQ level 2. The registered person must make sure that full employment histories are requested from all prospective employees. Gaps in employment must be explored and records kept. DS0000029184.V292730.R01.S.doc 6. OP26 13 30/12/06 7. OP28 18 31/12/07 8. OP29 19 and Schedule 2 30/11/07 Knowles Court Version 5.1 Page 31 9. OP30 18 The registered person must make sure that staff continue to receive training appropriate to the needs of the service users. This must include all areas of health and safety related training, induction and foundation training to Skills for Care standards and specialist training such as dementia and learning disabilities. The training needs of qualified nurses must also be addressed. (Progress is being made but the timescale of 31st December 2005 and 30th June 2006 was not met. It has been agreed to extend this timescale.) 30/03/07 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. Knowles Court DS0000029184.V292730.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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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