Inspection on 13/03/07 for Knowles House

This inspection was carried out on 13th March 2007.

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

Other inspections for this house

Knowles House 27/01/06

Knowles House 10/08/05

Knowles House 07/03/05

Knowles House 20/07/04

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

CARE HOMES FOR OLDER PEOPLE Knowles House 51 Longstone Avenue Harlesden London NW10 3UN Lead Inspector Tom McKervey Key Unannounced Inspection 13th March 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000033481.V325295.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000033481.V325295.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Knowles House Address 51 Longstone Avenue Harlesden London NW10 3UN 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) 020 8961 9563 020 8963 1946 London Borough of Brent Mrs Petrina I Connell Care Home 39 Category(ies) of Dementia (39) registration, with number of places DS0000033481.V325295.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th January 2006 Brief Description of the Service: Knowles House is owned by Brent local authority and is registered to provide accommodation and personal care for up to 39 older people most of whom are experiencing dementia. The home also offers respite care and two places for emergency care. The home is divided into three floors, but only two floors are currently occupied. All bedrooms are single occupancy, equipped with furniture, washbasins and adequate shower and bath facilities. The home is located in a residential area of Northwest London close to local shopping, transportation, health, social care and leisure services and facilities in Harlesden and Willesden. The home has a large front car park, a paved garden and seating area and also a garden area to the rear of the premises. There is a balcony on the first floor, plus several communal lounges, library and relaxation room where private meetings can be held. There is also a day centre attached to the home that is used by non-residents. The home is staffed by a registered manager, deputy manager and a number of care support staff. The fee for the service ranges from £446 to £596 per week. DS0000033481.V325295.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out as part of the Commission’s inspection programme to check compliance with the key standards. The inspection took place over a period of six hours. The registered manager was present and offered fully assisted with the process. The inspection consisted of a tour of the home, discussions with the manager and staff, several residents, and visitors to the home. The inspector also examined residents’ files, staffs’ records, policies and procedures, and other documents pertaining to the management of the home. What the service does well: What has improved since the last inspection? The Statement of Purpose and Service User Guide have been updated to provide comprehensive information about the service, which enables potential service users to decide if the home can meet their needs. Grab rails have been installed to reduce the risk of falls in toilets and bathrooms. DS0000033481.V325295.R01.S.doc Version 5.2 Page 6 A risk assessment was carried out of the steep steps leading to a flat roof in the respite unit. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000033481.V325295.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000033481.V325295.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The information provided to the residents and their representatives gives full details about the service to help them decide about the home’s ability to meet their needs. Except in emergencies, thorough needs assessments are carried out before people are admitted to the home. EVIDENCE: The Statement of Purpose and Service User Guide have been updated, which was a requirement from the last inspection. Both documents provide DS0000033481.V325295.R01.S.doc Version 5.2 Page 9 comprehensive information about the service. The manager said that all new residents or their representatives are given a copy on admission to the home. There was evidence in residents’ case files, that the manager assesses people referred to the home in addition to assessments by social workers/care managers. There are sometimes exceptions to this when people are admitted in an emergency, but in this case, assessments are carried out as soon as possible. Each resident is initially offered a six weeks trial stay, after which, if the placement is appropriate, the Older People’s Services Panel of the local authority offers a permanent place. Residents who are self-funding their care, are given a contract that details the service to be provided and the fees that are charged. DS0000033481.V325295.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some residents’ care plans are not being reviewed to the required standard, and there was no written plan at all for one person. This could result in staff being unaware of residents’ current needs. There are good records of residents being seen by health professionals and they receive a good quality of care from the staff who treat them with respect and dignity. There are good systems in place for the safe administration of medicines. EVIDENCE: DS0000033481.V325295.R01.S.doc Version 5.2 Page 11 The case files of the last three residents to be admitted were examined. The inspector noted that a new format for care plans was being gradually introduced. The new format was very comprehensive and will cover every aspect of a person’s needs. However, at the time of the inspection, none of the old care plans had been fully transferred to the new system and therefore an assessment of this process will have to be made at the next inspection. It was evident that the existing care plans were not being reviewed monthly, and in one instance, a resident who had been in the home for some weeks, did not have a written care plan. This could result in staff not fully understanding nor meeting some residents’ needs. A requirement is made to address this matters. There was evidence in the case files that care managers from the local authority came to the home on an annual basis to carry out care reviews to ensure that people were still appropriately placed. Residents’ healthcare records were up to date and showed that they were seen regularly by the G.P and a full range of health professionals, when necessary. There was a record of accidents involving the residents, which showed that appropriate actions were taken; for example, referring to the G.P or A&E department. Residents appeared to be well cared for, and those who were spoken to, spoke very highly of the staff, describing them as very dedicated. The inspector spoke to a resident’s relative who was visiting during the inspection. They said that they were very happy with the care and said the staff always informed them about any issues concerning their relative. The medication records were up to date and appropriately signed. The medication was also safely stored and records were available about medicines received from the pharmacy and those disposed of. The residents who were spoken to, said that staff always treated them with respect, particularly their dignity when personal care was provided. The inspector observed the staff speaking to the residents in a courteous and caring manner. DS0000033481.V325295.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is an open visiting policy in place and residents can choose to join in the varied programme of activities. There is a good quality of food provided and residents say they can choose alternatives to the planned menus. EVIDENCE: There is a varied and stimulating programme of activities for residents, including; weekly keep-fit, (a session was taking place during the inspection), reminiscence sessions and outside entertainers. However, not all activities that the residents join in are recorded. DS0000033481.V325295.R01.S.doc Version 5.2 Page 13 A requirement is made about this matter. There are several quiet areas and rooms where residents can sit and meet visitors and a pay-phone was available for their use. The home has a library and a mobile library service is also provided. Several residents told the inspector that they liked to do their own thing” and chose not to join in some of the planned activities. The visitors book showed that relatives and friends visited the residents frequently at various times of the day and evening. Visitors told the inspector they were always warmly welcomed by the staff. The residents spoke highly of the catering service and said they were asked about their preferences regarding meals. The inspector observed that the lunch provided on the day of the inspection, looked appetising and was attractively presented. The cook was able to describe which residents were on special diets. DS0000033481.V325295.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and their representatives speak highly of the service and are confident that complaints would be dealt with appropriately. Staff are generally aware of their responsibilities to protect residents from abuse, but need to understand how to alert responsible organisations outside the home in the event of abuse occurring. EVIDENCE: The complaints book was examined. No complaints had been made since the last inspection. The residents and their relatives are given a copy of the home’s complaints leaflet, which is in large print with pictorial references to meet the communication abilities and needs of most residents. Residents and relatives who were spoken to, said they were confident that any concerns would be addressed promptly by the manager. DS0000033481.V325295.R01.S.doc Version 5.2 Page 15 The inspector spoke to staff individually and held a discussion with a group. It was evident that they were knowledgeable about elder abuse issues and had attended training on this subject. However, they appeared to be unaware of the home’s “Whistle-blowing” procedure. This is an important procedure that provides guidance to staff about how to alert outside agencies, for example Social Services and the Commission for Social Care Inspection, if they suspect abuse is taking place. A requirement is made for staff to be made aware of the Whistle-blowing procedure. DS0000033481.V325295.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a well-maintained and attractive environment. The residents are very satisfied with their accommodation and the home is very clean and tidy. EVIDENCE: The inspector toured the premises. The home was well maintained and offered an attractive and welcoming appearance. Work was in progress to replace the garden wall at the front of the building and repairs were taking place to the internal staircase. DS0000033481.V325295.R01.S.doc Version 5.2 Page 17 New adaptations had been provided to bathrooms and toilet areas since the last inspection. An assessment had been carried out by an occupational therapist of a doorway in the respite unit, which has a high step leading out on to a flat roof. Their conclusions were that a ramp was not possible and they recommended keeping the door locked. The inspector noted that the manager has implemented this. Several bedrooms were visited. All the rooms are for single occupancy and have a washbasin. They were attractively decorated to a high standard and were comfortably furnished. The residents’ names were on their bedroom doors. The residents said they were very satisfied with their rooms. A team of contract cleaners is responsible for the cleaning. At the time of the inspection, the home was very clean and tidy throughout and there were no offensive odours. DS0000033481.V325295.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are sufficient numbers of staff on duty at all times to meet the needs of residents. The staff group are well trained and competent to carry out their duties. EVIDENCE: The duty rota showed that when the home is fully occupied, there are normally six staff on in the morning, five in the evening, and three staff at night. At the time of the inspection there were seven vacancies and the staffing level was reduced slightly to reflect this. The staff who were interviewed, said they thought there were sufficient staff available to meet the residents’ needs. Several agency staff work at the home, but they were all from the same agency and have been working at the home on a regular basis and are well known to the residents. DS0000033481.V325295.R01.S.doc Version 5.2 Page 19 No new permanent staff had been employed since the last inspection, so recruitment procedures were not inspected on this occasion. Only two staff have not yet attained a National Vocational Qualification, but they are intending to undertake this training later this year. A training development officer is employed to plan and supervise the training programme for staff. The inspector viewed copies of certificates awarded to staff on completion of set training programmes. DS0000033481.V325295.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 34, 35, 36, 37 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has the relevant qualifications and experience to manage the service in the best interests of the residents and staff. There are good systems in place to safeguard residents from financial abuse. Staff receive regular supervision to support them in their roles as carers. Installations and equipment in the home are appropriately serviced to safeguard the health and safety of residents, staff and visitors, but evidence is required to show that appropriate insurance cover is in place. DS0000033481.V325295.R01.S.doc Version 5.2 Page 21 EVIDENCE: The manager has been in charge of the home for thirteen years. She is assisted by a deputy manager who is currently training for National Vocational Qualification level 4 in management. An administrator manages the petty cash and invoicing for residents’ personal items. There is additional senior monitoring and managerial input from officers at the local authority, which is responsible for the home. The manager is also responsible for day-to-day management of the elderly day centre, which is attached to the care home. The residents, relatives and staff who were spoken to, expressed confidence in the manager’s ability to run the home effectively. She was described as being very approachable and sensitive, while at the same time, setting high standards for the care of the residents. Documents, policies and procedures and records were organised and easy to cross-reference. The manager said that no staff at the home are responsible for residents’ personal finances and generally this is provided by the residents themselves or their representatives. The administrator showed records of financial transactions, e.g. payment for hairdressing etc, which are invoiced to the responsible person. Staff assured the inspector that they received regular one-to-one supervision by the line managers, which they found supported them in their work. The staff attend training in health and safety and there were service records available for electrical, gas and other appliances. Regular fire drills are carried out every 3 months and weekly fire alarm tests. The passenger lift and all hoists had been serviced in the last year. There was no employer’s liability insurance certificate on display. The manager said that this certificate was held at the local authority, but a requirement is made for this document to be on display at the home. DS0000033481.V325295.R01.S.doc Version 5.2 Page 22 DS0000033481.V325295.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X 2 3 3 3 3 DS0000033481.V325295.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Timescale for action The manager must ensure that 30/04/07 care plans are developed for all residents, (including those on respite care), that reflect their needs, wishes and aspirations. The manager must ensure that 30/04/07 all resident’s care plans are reviewed at least monthly and reflect their current needs. The registered person must ensure that staff are trained in the home’s Whistle-blowing procedure. The registered person must ensure that a current employers liability certificate is on display in the home. 30/04/07 Requirement 2. OP7 15 3. OP18 13(6) 4. OP34 25(2)(e) 31/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000033481.V325295.R01.S.doc Version 5.2 Page 25 Standard DS0000033481.V325295.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 DS0000033481.V325295.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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