Inspection on 15/03/06 for Knowsley Manor Nursing Home

This inspection was carried out on 15th March 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 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

Knowsley Manor Nursing Home 18/06/08

Knowsley Manor Nursing Home 02/08/07

Knowsley Manor Nursing Home 28/07/06

Knowsley Manor Nursing Home 21/10/05

Knowsley Manor Nursing Home 30/03/05

Knowsley Manor Nursing Home 15/07/04

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

CARE HOMES FOR OLDER PEOPLE Knowsley Manor Nursing Home Knowsley Manor Nursing Home Knowsley Lane Knowsley Merseyside L36 8EL Lead Inspector Miss Diane Sharrock Unannounced Inspection 15th March 2006 02:00 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 Knowsley Manor Nursing Home DS0000005460.V287766.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. 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. Knowsley Manor Nursing Home DS0000005460.V287766.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Knowsley Manor Nursing Home Address Knowsley Manor Nursing Home Knowsley Lane Knowsley Merseyside L36 8EL 0151 480 6752 0151 480 7225 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) Southern Cross (Hamilton) Limited Mrs Susan Ashcroft Care Home 50 Category(ies) of Dementia - over 65 years of age (50) registration, with number of places Knowsley Manor Nursing Home DS0000005460.V287766.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Service users to include up to 50 DE(E). Maximum no. registered - 50, of which up to a maximum of 50 N (nursing) and up to a maximum of 8 PC (personal care). Two named out of category service users, under pensionable age. To accommodate one named service user under pensionable age in the category of DE The service should, at all times, employ a suitably qualified and experienced manager who is registered with the CSCI. 21st October 2005 Date of last inspection Brief Description of the Service: Knowsley Manor is purpose built, single storey in design for the residential areas of the home. Although the home is registered for 50 beds in total, they actually only ever use their optimum of 48 beds. The home is situated within the Knowsley village, close to local amenities. The home is owned by a private company named Southern Cross Healthcare Limited. The home is registered to provide Nursing care for Elderly Infirm older Persons for Dementia for 42 Service Users and Residential Personal care for 8 service Users over the age of 65. The Responsible Individual is Janette Malham and at present the Company have just employed a new Manager who the Company will need to apply to register with CSCI. Knowsley Manor Nursing Home DS0000005460.V287766.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection of the home. Information for the inspection was gathered in a number of ways, this included, discussion with, relatives and staff, and meeting several Residents a review of records and a partial tour of the building. A selection of Comment cards were also left in the home. What the service does well: What has improved since the last inspection? What they could do better: Knowsley Manor Nursing Home DS0000005460.V287766.R01.S.doc Version 5.1 Page 6 Staff and relatives still feel that staffing levels are not appropriate in the mornings, especially with regard to supervision in communal areas. The home needs to complete a detailed risk assessment of the laundry area until the equipment is replaced. This must include clear details to reduce the risk of cross infection and to make sure there are sufficient supplies of linen and clothing for day-to-day operation 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. Knowsley Manor Nursing Home DS0000005460.V287766.R01.S.doc Version 5.1 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 Knowsley Manor Nursing Home DS0000005460.V287766.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Pre-assessments are carried out prior to residents being admitted to the home EVIDENCE: A recent admission record was reviewed during this visit and showed detailed records of assessments prior to admission. This enabled the homes staff to determine they could provide the care and support needed for the resident. Knowsley Manor Nursing Home DS0000005460.V287766.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7/8 There continues to be progress made within care plans which includes details for health, personal and social care needs of residents. EVIDENCE: Individual plans of care are available and identify relevant aspects of health and personal care and plan accordingly and are very detailed. The care records also showed evidence of individual dementia assessments which give specific details necessary to help support residents. Knowsley Manor Nursing Home DS0000005460.V287766.R01.S.doc Version 5.1 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12/13 The activities programme was displayed and the home has a new activities organiser. Visitors are welcomed and included in the home at any time. EVIDENCE: The home have now managed to appoint their own activities organiser for 30 hours per week. This person has already previously worked at the home and already knew each resident prior to starting her new role. The activities programme was visually displayed in the reception area and gave a lot of details of all planned events. On the day of this visit ‘old time’ music was playing in the reception area, which helped give a welcoming and relaxing atmosphere on entering the building. Two events were being organised, a visiting entertainer was preparing for their singing performance in one lounge. The home have developed an ‘olde world’ cinema in another lounge and staff had organised a ‘western’ film. The activities organiser described how successful this project had been and several residents were seen enjoying this activity. Knowsley Manor Nursing Home DS0000005460.V287766.R01.S.doc Version 5.1 Page 11 Activity records and care plans have also been developed and the organiser described ideas for further development. The home were able to evidence this standard being met and eventually hope to exceed it, especially with regarding all the initiatives already developed. This includes a ‘ memory lane’ sitting area, family room and bedrooms doors developed to replicate personal front doors. Recent resident and relatives meetings and minutes were openly displayed at reception for anyone to take a copy. A recent quality assurance questionnaire also gave people the chance to air their opinions and views on the home. Knowsley Manor Nursing Home DS0000005460.V287766.R01.S.doc Version 5.1 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 The complaints policy is clear and accessible to all parties. EVIDENCE: Following the previous inspection staff have access to the complaints file. One issue was noted to be discussed at the residents & relatives meeting in March, with regard to the laundry. The home have the use of a ‘grumble’ book which is displayed and accessible to all parties in the reception area. Knowsley Manor Nursing Home DS0000005460.V287766.R01.S.doc Version 5.1 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed at this inspection. EVIDENCE: Knowsley Manor Nursing Home DS0000005460.V287766.R01.S.doc Version 5.1 Page 14 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27/30 Staffing rotas showed usual numbers of staff, but on occasions the levels have been lower. Staff and relatives are still insisting staffing levels are not always sufficient. EVIDENCE: Some staff and relatives felt that the current staffing levels were not appropriate to the needs of the residents, especially in the morning. A recent residents/ relatives meeting in March 06 also gave opinions on staffing levels not being appropriate at meal times. Residents and staff comments must be reviewed by the company following this inspection. The legal responsibilities of the company within the Care Homes Regulations 2001 is to always provide suitable numbers of qualified and competently trained staff at all times. Staffing levels must be evidenced by the company to show that they are appropriate to the present dependency of residents at the home. Staffing levels are an on-going issue at the home on each inspection. In reviewing minutes of a staff meeting in November 05 the company’s explanation to staffing levels was to provide a staffing ratio linked to the number of residents. The company had not described any rationale to link these staffing levels to the changing dependency levels of residents. The company must demonstrate that the on-going staffing levels are able to Knowsley Manor Nursing Home DS0000005460.V287766.R01.S.doc Version 5.1 Page 15 accommodate the changing needs and dependencies of residents and must include all relevant parties opinions to this on-going issue. The other object of concern was the homes inability to have a long term manager in place. The operations manager and senior managers acknowledge this issue and have kept CSCI informed. They have ensured senior management of the company have overseen the home over the last few months. The company hope that a successful manager has been appointed following this inspection. Knowsley Manor Nursing Home DS0000005460.V287766.R01.S.doc Version 5.1 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33/36/38 Quality assurance questionnaires have been carried out to elicit opinions of all residents and relatives. Supervision, training and personnel records are developing and being implemented in the home. EVIDENCE: A recent quality assurance questionnaire has been carried out by the company to find out peoples opinions about how the home is being managed. Some opinions have also been followed up by senior management, so that relatives were being given feedback about concerns. This approach was also noted at a recent resident / relative meeting in March 06, where all parties were encouraged to air their views. Issues identified and repeated by relatives and staff during this inspection were that, “the home have not had the stability of a long-term manager”. “The home does not have enough staff at certain times of the day, especially in the mornings and at meal times”. “ The laundry is offering a poor service with on-going problems.” Knowsley Manor Nursing Home DS0000005460.V287766.R01.S.doc Version 5.1 Page 17 Comments identified various problems with the laundry, were the company have had to wait for local gas supplies to supply emergency services. This point was discussed with senior management and it was acknowledged immediate risk assessment must be carried out with appropriate action taken. This should ensure that an adequate standard of laundry should still be offered until the main equipment was fixed and in place. One relative explained that nightwear was being used in the day, this point was passed to senior management who agreed this was inappropriate and that they would look into it further. Personnel files, staff training and supervision records were produced during this visit and evidenced that the home are developing structures to meet these standards. Knowsley Manor Nursing Home DS0000005460.V287766.R01.S.doc Version 5.1 Page 18 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 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 X 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 x X X X X X X X x STAFFING Standard No Score 27 2 28 X 29 X 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X 3 X 2 Knowsley Manor Nursing Home DS0000005460.V287766.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP27 Regulation 26 4) Requirement The Responsible Person is required to submit an action plan to the Commission stating the action taken by the Company following the comments disclosed by Staff and Relatives during the homes unannounced inspection regarding their opinions around staffing levels. The Responsible Person is required to carry out a risk assessment to the laundry area and take necessary action to provide a safe and effective standard of laundry necessary for the function of the home. Timescale for action 02/05/06 2 OP38 13 11/04/06 Knowsley Manor Nursing Home DS0000005460.V287766.R01.S.doc Version 5.1 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 6. Refer to Standard OP19 Good Practice Recommendations To ensure the development of a maintenance and decorating and development plan for the home which should be accessible to everyone and enable all parties to participate and be in formed of developments to their home. Knowsley Manor Nursing Home DS0000005460.V287766.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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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