Inspection on 18/06/08 for Knowsley Manor Nursing Home

This inspection was carried out on 18th June 2008.

CSCI found this care home to be providing an Good service.

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 02/08/07

Knowsley Manor Nursing Home 28/07/06

Knowsley Manor Nursing Home 15/03/06

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Knowsley Manor Nursing Home Knowsley Manor Nursing Home Knowsley Lane Knowsley Merseyside L36 8EL Lead Inspector Mrs Joanne Revie Key Unannounced Inspection 18th June 2008 09:00 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.V365751.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. Knowsley Manor Nursing Home DS0000005460.V365751.R01.S.doc Version 5.2 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) www.southerncrosshealthcare.co.uk Southern Cross Care Homes No 2 Limited Mr Mutyavaviri Cliff Tavaziva Care Home 50 Category(ies) of Dementia - over 65 years of age (50) registration, with number of places Knowsley Manor Nursing Home DS0000005460.V365751.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia, over 65 years of age - Code DE(E) The maximum number of service users who can be accommodated is: 50 Date of last inspection 2nd August 2007 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 only ever use 48 beds. The home is situated within Knowsley village, close to local amenities. A private company named Southern Cross Healthcare Limited owns the home. The home is registered to provide Nursing care for older persons with dementia for 50 Service Users over the age of 65. The fees for the home supplied by the Manager are £395.00 to £620 per week. Knowsley Manor Nursing Home DS0000005460.V365751.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes The visit was unannounced and was carried out by two inspectors. Before the visit took place we (the commission) asked the registered manager to complete a document called an AQAA (Annual Quality Assurance assessment). We ask all services to complete this document once a year. This document gives us information about how the service is progressing and any future plans for further development. We also looked at the information that we already had about the service and this coupled with the information from the AQAA helped to form our inspection plan. Before the visit took place we sent out surveys for relatives and for staff to complete. We know that many people who live in the home cannot make their needs and wishes known therefore it was important to seek other people opinions that are familiar with the service. We knew before we visited that the registered manager had left the service the day before and that the deputy manager had agreed to manage the home until a new registered manager was appointed. We spoke with the operations manager who is responsible for ensuring that the registered manager carries out their duties and responsibilities. She explained that she would be available by phone through out our visit and that a manager who worked at another Southern Cross (The organisation that owns and operates this home) home would come to Knowlsey Manor to provide support through out our visit. This explanation is needed to understand who the different managers are who are mentioned through out the report. We held discussions with all these people and also had discussions with seven relatives and eight staff. Comments that these people made to us are included in the summary section of this report. We spent time carrying out a SOFI observation. This is an inspection tool that we use to help us to decide whether staff interact well with the people who live at the home. Knowsley Manor Nursing Home DS0000005460.V365751.R01.S.doc Version 5.2 Page 6 We also looked at a number of records which showed us the support and care that is offered and received by people, whether staff had suitable skills and qualities to work in the home and whether staff were provided in sufficient numbers to meet peoples needs. We looked at the training that staff received and how they manage people medications and finances. Lastly we looked at how management ensures that the risks to people’s health and safety are reduced. We also walked around the building and looked at how the home is decorated, maintained and furnished. What the service does well: Everyone who moves into the home receives a full assessment of their needs. This information is then used to draw up a draft care plan. This means that staff prepare for new arrivals and that they have written instructions available telling them the support and care that someone needs. This reduces the risk of someone’s care and support needs being overlooked. Once someone has lived in the home for a short while, staff compile a more detailed care plan. This contains information about the support and care needed and how a person wishes to receive this. The plans that we looked at were up to date and attention had been paid to identifying any risks, which may cause a persons health to deteriorate. We found that when staff did identify a risk to someone’s health, appropriate action was taken to seek advice from other professionals. Staff follow this advice, which helps to ensure that people stay healthy and well. We found that a variety of different activities are available for people to take part in. Some of theses were group activities as well as individual both inside and outside the home. This helps to promote people quality of life. We found that the cook has a very good understanding of peoples nutrition needs and that a choice of home cooked food is available for the people who live at the home. People told us during our visit that they liked and trusted the staff to care and support people well. Comments included: “ They look after each individual person with care”. “ The staff are very caring -they all give everyone a personal approach” “ They give a high level of care” Knowsley Manor Nursing Home DS0000005460.V365751.R01.S.doc Version 5.2 Page 7 When asked what could be done to improve the service one relative said, “ I cant think of anything specific” which strongly suggests that this relative is happy with the care and support offered. Another visitor commented, “Not everything’s perfect- nothing in life ever is but I would say that most of the staff here are as good as you can get”. . The home employs a long-standing staff team. Staff told us that they believed that they received good training and support, which enabled them to carry out their duties well. Staff told us “ I enjoy my job- its hard work but very rewarding” Time has been spent over the last few years to adapt the environment so that it is suitable for someone who has dementia. This has included providing a memory lane kitchen (1950s style kitchen and living area) and a cinema with old-fashioned cinema seating. This helps a person who has memory problems to reminisce which is a recognised type of therapy in this field. We found that the domestic staff work hard to keep the home clean and that they understand how to prevent infection spreading. This helps to reduce any risks to people’s health and welfare. We found that robust management systems are in place, which means that the incidence of any pressure sores, falls/accidents and weight loss are monitored closely. This is good practise as it shows that senior management are ensuring staff are caring and supporting people in the right way. We found that peoples Health and safety is managed well which helps to ensure that the home is a safe place to live. What has improved since the last inspection? The management of medications has been strengthened and improved which means that people are receiving medications that have been stored in the right way at the right time. We noticed that during our last visit some radiators did not have guards in place. We were concerned that this could cause some people to burn themselves. We noticed during our visit this time that this had been addressed. This shows a willingness to take our advice and to try to keep people safe who live in the home. A new training programme, which has been endorsed by the Alzheimer’s Society, has been put in place. This training is called “yesterday, today and tomorrow”. It is specifically designed to give staff an insight and understanding of people who have dementia. This is good practise. Knowsley Manor Nursing Home DS0000005460.V365751.R01.S.doc Version 5.2 Page 8 The management of personal allowances has greatly improved. Consultation took place with a well-known bank that has provided a service, which is tailored specifically for this purpose. This means that people rights are protected. Efforts have been made to encourage families to be involved in the home. This is good practise. Staff told us that they believed that there were fewer accidents and falls occurring in the home and we found robust procedures in place to monitor levels of these. What they could do better: We had concerns about the organisation of meal times. It appeared that not enough staff were available to meet peoples needs. However re organising the times of meals and reviewing people’s needs could solve this problem. We have made a requirement about this at the end of this report, as people must be supported to eat their meals so that they receive adequate nutrition. Not receiving adequate nutrition could impact on a person’s health and welfare. The promotion of choice needs to be developed further in some areas. Staff should consider taking photographs of the home with them when visiting new people and daily meals should be displayed on a menu board so that people can see what is on offer. Staff need to be reminded to involve people in their care and support and training should be given to staff on the recent changes in the mental health capacity act and supporting people with equality and diversity. These actions would help to include people and encourage them to make choices, which may affect their daily lives. Relatives/representatives could be encouraged to be more involved in peoples care by ensuring reviews of peoples care takes place earlier than six months. This may help reassure people and help to ensure that staff are providing the correct care and support needed. Particularly as many people who live in the home cannot make their wishes known. Some improvements need to be made to the environment of the home. We found that some areas smelt unpleasant and although efforts had been made to address this, this seemed to be reactive rather than proactive. For example we could not find evidence to show that people were being adequately supported with continence needs. Addressing this may eliminate the need to shampoo carpets regularly, which may reduce the unpleasant smells. We have made a requirement about this at the end of this report as living with unpleasant smells can affect people’s quality of life and mismanagement of continence needs can cause distress and discomfort. One person who visits the home told us that ““ There is always a bad smell no matter when you visit. There must be something that can be done about it to alleviate this as other home don’t have the same smell”. Knowsley Manor Nursing Home DS0000005460.V365751.R01.S.doc Version 5.2 Page 9 We also noticed that fitting curtains and blinds could improve some areas. Although opaque glass is in place in these room’s people may become distressed, as they may not understand that their privacy is being protected. This could help improve people quality of life. 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. Knowsley Manor Nursing Home DS0000005460.V365751.R01.S.doc Version 5.2 Page 10 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.V365751.R01.S.doc Version 5.2 Page 11 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): 3- The home does not provide intermediate care therefore standard 6 does not apply. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are provided with information to help them make a decision about moving into the home. Staff plan the care and support needed for each person before they arrive. EVIDENCE: We looked at peoples care records and had discussions with the manager from another home who had come to provide support during our visit, a relative and other members of staff. Knowsley Manor Nursing Home DS0000005460.V365751.R01.S.doc Version 5.2 Page 12 We saw that staff make a draft care plan for any one who is going to move into the home. The information used to form this care plan is gathered during a visit when a senior member of staff meets with someone who is interested in moving in. This is good practise and helps to demonstrate that the staff at the home prepare and plan how they are going to meet someone’s needs. The records that we read were very detailed and gave a good overview of each persons needs and how they would prefer to receive their care and support. The manager that we spoke with told us that relatives and social workers and other health care professionals are involved in this process but we couldn’t find any records to support this. However a relative who was visiting the home during our visit confirmed that she had been consulted and that she had visited the home to look round as her family member wasn’t able to. This is important as people must be given as much information as possible about the home so that they can make a choice about whether they would be happy living there. We read the homes policy on how people are admitted to the home and this stated that everyone was welcome to visit the home before they made the final decision about whether they wanted to move in or not. The manager from the other home also explained that samples of menus/activities and the homes brochure and service users guide is given to all people who are interested in moving in. A service users guide is a booklet which contains information telling people about what they can expect from the service. We believe that using photographs of bedrooms and communal areas etc of the home could develop this further. This could help some people be involved in making a decision who may find reading literature too confusing. Knowsley Manor Nursing Home DS0000005460.V365751.R01.S.doc Version 5.2 Page 13 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 good. This judgement has been made using available evidence including a visit to this service. People receive care and support from staff who understand their needs, however not all staff understand how to treat people as individuals. Medications are managed safely so that the risk of someone receiving the wrong medication is reduced. EVIDENCE: We looked at the care records for four people who live in the home. We saw that each person has a set of detailed, up to date records (known as a care plan) telling the reader the care and support that they needed and how they would like to receive that care. We saw that the plans were reviewed at least every month and that relatives and representatives were invited to a review every six months. Knowsley Manor Nursing Home DS0000005460.V365751.R01.S.doc Version 5.2 Page 14 One relative told us that they had taken part in the review and that they had found it useful. We saw that until this review takes place there were few records to show whether representatives had been consulted about the care given. This should be addressed sooner than six months as representatives may have information or advice about how someone may want to be cared for – particularly if the person involved cant make their needs and wishes known. We saw that the organisation, Southern Cross have developed their own format to record this information and although complicated, staff were keeping clear records. In particular we saw that the risk to peoples health deteriorating was managed well. This is good practise particularly as many of the people who live in the home cant make their needs known and therefore cant always tell staff if they feel unwell. We saw that staff were monitoring people’s needs and health through basic procedures and taking action if these needs changed. For example we saw that staff were weighing people regularly. One person was losing weight so staff had taken action by arranging for advice through a dietician. The dietician had visited and advised that fortified drinks should supplement this persons diet. Staff had liaised with the persons G.P. to obtain these drinks and when we looked at medication records we saw that these were being given four times a day. We saw that the plans contained information on how to reduce the risk of people falling, developing pressure sores and developing malnutrition due to poor appetites. We looked in some peoples bedrooms and saw that if people needed equipment to keep them well and healthy then this was in place, was in good working order and the use of it was written in the persons care records. Staff told us that no one who lived in the home had developed a pressure ulcer and when we looked at care records we found that this was true. We looked at other records which showed that the manager of the home has to inform the operations manager through a monthly report of the incidences of any pressure sores and whether anyone had lost weight and how much. This is good practise as it ensures that any deterioration in these areas is fully investigated. Knowsley Manor Nursing Home DS0000005460.V365751.R01.S.doc Version 5.2 Page 15 We did have concerns about the unpleasant smells in the home. This is explored more fully in the environment section of this report. Action has been taken top address nay smells but despite this we found some areas smelt unpleasant which would suggest that people continence needs are not managed as well as they could be. We looked at people care plans, which told us that people did require support in this area however the plans did not state the exact support or product required. This should be explored and addressed to ensure that the people’s comfort is promoted. One relative that we spoke with told us that their family member had had to stay in hospital due to ill health. On return to the home their health had greatly deteriorated. Staff had provided care and supported which resulted in this person’s health improving once again. This relative described the staff as” excellent”. We looked at how the home manages people’s medications. We saw that when people first come to the home an assessment takes place to see if they can manage their own tablets or whether they require support. On the day we visited no one was managing their own medication. We saw that the home has a dedicated, locked room to store medicine trolleys. This was equipped with lockable cupboards to store stock and a full range of policies and procedures were available for staff to refer to if needed. When we looked at staff training records we saw that all staff who dispense medications had received training on medicine management and that this training had been refreshed recently. We saw that records were in place to show that monthly medication audits were being carried out. The deputy manager explained that either herself or the manager does this. This is good practise as it helps to identify whether mistakes are being made and helps to ensure that staff are managing medications correctly. We looked at storage systems and found that they were tidy and organised and that staff were keeping clear records of all medication received into the home, when it was given or whether it was returned. We checked some stocks of medications and found that the amount available tallied with the amount recorded. This shows that the stock balance was correct which helps to show that staff were managing peoples medication correctly. We looked at how staff support people to maintain their privacy and dignity. We saw some people being supported to spend time alone in their bedroom and watched staff knock on bedroom doors before entering. We also heard staff calling people by their chosen name and saw that this information was also written in their care plan. Knowsley Manor Nursing Home DS0000005460.V365751.R01.S.doc Version 5.2 Page 16 We saw that people wearing clean clothes which coordinated and that the hairdresser was visiting and attending to people’s hair. A designated hairdressing salon is available for this purpose. When we observed how staff interact with people (SOFI observation) we saw that a small number of carers were not as respectful as they could be to people. (Further details of this are recorded in the next section). We had a discussion with the operations manager who explained that she believed that some staff were very “task orientated” and sometimes forgot that they were supporting individuals. We looked at the AQAA that the manager had sent to us and this view was recorded in that also. The operations manager explained that a training programme had been commenced called” yesterday, today and tomorrow”. This training has been endorsed by the Alzheimer’s society and focuses on treating people who have dementia as individuals. We saw records, which showed that this training had commenced. Knowsley Manor Nursing Home DS0000005460.V365751.R01.S.doc Version 5.2 Page 17 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): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Efforts have been made through consultation and information gathering, to give people meaningful recreational activities . There are however, some restrictions regarding recognition of people’s right to choice. EVIDENCE: We looked at activities diaries and spoke with staff. We also carried out a short observation (SOFI) to look at the experiences of people who live in this home, as those who were spoken with were not able to comment in detail. Records showed us that people have the opportunity to take part in a number of in-house activities, which are aimed at providing them with recreation and entertainment. An activities co-ordinator is employed (part time), and is responsible for arranging events, and updating activities diaries. In addition, care staff said they are involved in arranging leisure activities for people each day, such as hand massage and reminiscence. Knowsley Manor Nursing Home DS0000005460.V365751.R01.S.doc Version 5.2 Page 18 Because people who receive the service have dementia and may not always be able to state their preferences, family members are asked for information about the person’s interests and previous lifestyle. In this way, people’s diverse needs are recognised, and staff should have plenty of information about the person, their capabilities and the activities, which would suit them. Four activities diaries were looked at and these included a risk assessment, intended outcomes to the person, and the events that they would be included in. Monthly reviews record which activity the person has taken part in and whether it was enjoyed and of benefit. On the day of the visit, one person went out for a pub lunch with staff, and others watched a film. The hairdresser was on the premises and a number of people had their hair done. To respect people’s cultural diversity, their religion is recorded in their diaries and care plans, and arrangements can be made for religious ministers to visit if the person wants this. The visitors of three people were spoken with and all said they are made welcome by staff. They expressed no concerns and said there was good communication from staff. A visitor said he hoped there would be opportunities to speak with the newly appointed manager as this contact is appreciated, as a way of knowing what is happening in the home. A visitor who calls in every day said the staff are always approachable and helpful. We looked into the way choice is promoted in the home. A member of care staff who commented said that there is no routine for getting up in the morning, and people were seen being escorted into the dining room for breakfast until late morning. We saw that a number of people like to walk around the lounges and corridors during the day and that they have the freedom to do this without interference from staff. For people who need a lot of support, some restrictions of choice were evident. A short observation in the lounge (in A), informed us that, staff did not always explain what was happening to the person when assisting them with the hoist. Staff were efficient in use of the hoist and people were not placed at risk, however they could have felt alarmed by lack of understanding of what was happening. We would recommend that this is addressed through staff training. A short observation in the dining room (in A wing) informed us that demands on staff’s attention during the meal meant that people were not being supported properly with their food. We saw that for one person, the meal was interrupted as the member of staff helping her left to assist someone else who had walked away from the table. Another person received no support for twenty minutes, by which time the meal was cold and had to be replaced. Knowsley Manor Nursing Home DS0000005460.V365751.R01.S.doc Version 5.2 Page 19 There were thirteen people and five members of staff present in the dining room during this meal. We would recommend that management observe mealtimes and make any necessary alterations to ensure that people are supported to eat their meals. For example provide extra staff at busy times. The short observation also showed us of examples of positive staff interaction with people who were in the lounge and dining room. We saw some staff supporting people positively and explaining what was happening. We visited the kitchen and spoke with the cook. She said that nurses provide her with copies of people’s nutritional assessments. This is to ensure that people receive the diet and supplements prescribed and advised for them. The NUTMEG system is followed in compiling menus and this has been established to help people to have a balanced and nutritious diet. The cook confirmed that alternatives are offered to people who may refuse or leave their food to make sure they have enough to eat and the meal is to their liking. The menu is on display in the reception area, however this is written in small print and may not be suitable for people who may have impaired eyesight. To make sure people have information about their meals, menus should be made available in large print and or written daily on the notice boards in dining rooms. Knowsley Manor Nursing Home DS0000005460.V365751.R01.S.doc Version 5.2 Page 20 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 good. This judgement has been made using available evidence including a visit to this service. People know how to complain and trust that action will be taken to resolve their concerns. Staff have the skills and understand how to protect people from abuse. EVIDENCE: We looked at records, which showed us how the home responds to any complaints that are made and, we also looked at the information that we have about the home. We had discussions with management and staff who work at the home and a relative who arrived during our visit. When we looked at our information we saw that no one has told us about any new complaints or concerns since we last visited the home. We saw that information on how to complain was available in the foyer of the home and that people were encouraged to make suggestions to improve the service by completing a comments slip. This is good practise. We met with a relative who told us that they had never needed to make a formal complaint as they simply picked up the phone and spoke to staff who dealt with any concerns straight away. Knowsley Manor Nursing Home DS0000005460.V365751.R01.S.doc Version 5.2 Page 21 We read the homes complaints procedure and saw that it informed the reader of what would happen if they had concerns. This included timescales of when they could expect a response. We looked at records that the home had kept about any complaints that had been made and we saw that efforts had been made to investigate complaints within set timescales and that the complainant had been informed in writing of any delays to this process. We had discussions with the manager who worked at another home who had come to help with our visit. She explained that managers of the homes are encouraged to submit any complaint investigations to the operations manager within 14 days. The operations manager then has 14 days to check the investigation and to ensure that the outcome is correct. This is good practise and is it shows that the organisation takes complaints seriously and ensures that the right action is taken to resolve people concerns. This happens within the timescales set out in the home complaints procedure. This is also good practise as it shows a commitment from the organisation to operate according to its own policies. We discussed whether the outcome of complaints was used as part of the homes annual quality assurance system. When we visited this was not occurring but the manager that we spoke with understood how this would benefit people during our discussion. We would recommend that the home display information on actions taken to improve the service that has come about as a result of a complaint. This would show people that the home welcomes complaints as a way of improving the service and would help to encourage an ethos of “ nothing to hide”. We discussed staff attitude to complaints with the deputy manager and other staff who work at the home. They believed that staff accepted complaints and concerns and did not take them personally. They believed that this was because the organisation was open with them and involved and informed them of any investigations. This is good practise. We saw that one situation had occurred between two people who live in the home and the manager at that time responded to this by telling us about it and by informing the social workers of each person involved. The records also showed us that the relatives of these people had also been involved. The outcome was that the manager had taken correct action to ensure that these two vulnerable people were protected and the home took further action to reduce the risk of the situation re occurring. Staff training records showed us that staff have had training in how to protect people from abuse. We saw that this training is on going and were able to discuss this topic with the trainer. The trainer told us that she had been accredited to deliver this subject through” action on elder abuse”. This helps to show that the training delivered is considered to be of a good standard. Knowsley Manor Nursing Home DS0000005460.V365751.R01.S.doc Version 5.2 Page 22 We had discussions with staff who were able to explain what they would do if they suspected that abuse had occurred and we saw that the home has a variety of policies to guide staff on the processes to follow if they were unsure of the process. We also saw that senior managers are made aware of any potential abuse situations and that they oversee any actions taken to help to ensure that people’s rights are protected. Knowsley Manor Nursing Home DS0000005460.V365751.R01.S.doc Version 5.2 Page 23 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): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The building is clean and generally in good condition, providing a homely environment, however some areas smell unpleasant. EVIDENCE: We walked around the home and looked at all communal areas and some bedrooms, bathrooms and toilets. The home is purpose-built and accommodation is on the ground floor. There is a bright reception area with seating and offices on either side of the main doorway. The manager’s office is on the main corridor. The staff room and laundry are upstairs in a utility area. The home is laid out in two wings. The kitchen has a dining room on either side and next to each dining room is a lounge with plenty of seating and a television set. Knowsley Manor Nursing Home DS0000005460.V365751.R01.S.doc Version 5.2 Page 24 There is also a cinema and reminiscence area for people to enjoy. Bedrooms are for single occupancy and there are toilets and assisted bathrooms on both wings for convenience. People were using all of the communal areas during the visit and appeared to be comfortable in their home. Outside, there is a car park, pleasant, secluded gardens and a decked patio. However the lawns were looking overgrown at the time of the visit. The building was clean and in generally good decorative order though the woodwork in the corridors had some damage to the paintwork and doorways. A small area of the ceiling in the corridor was in need of repair and redecoration and we would recommend that this was addressed. We saw that radiator guards have been fitted throughout the home to protect people from burns. To provide interest to people who live in Knowsley Manor, plenty of orientation aids are in place in corridors, (photographs and art work) and people’s bedroom doors have their names and are numbered to assist them. The reminiscence lounge has been well fitted out to stimulate memory and thought, and we saw two people spending time there during the visit. Most of the rooms, which we entered, smelt pleasant, however odours of urine were evident in some areas of the corridors. We looked at cleaning schedules and there was evidence that carpets are regularly cleaned and shampooed and that staff alert domestic staff if a carpet needs shampooing. We looked at minutes from relatives meetings and saw that the issue of unpleasant smells had been discussed at the forum and that the home had responded by purchasing a new carpet cleaner. However we would recommend that time is taken to ensure that people’s continence needs are assessed thoroughly and met. Living in a home, which smells unpleasant, is not conducive to a quality lifestyle and action must be taken to address this. We saw that people’s bedrooms are individualised with personal items and photographs. Bedrooms, which were seen, had freshly laundered bedding and were clean and tidy and the toilets were clean and hygienic at the time of the visit. Staff said toilets are checked regularly to make sure that they are thoroughly cleaned when necessary and suitable for people to use. We saw that bathrooms are brightly painted to provide interest and are well equipped with moving aids for bathing. We saw that although all bathrooms have occluded glass so people privacy is respected no window dressings such as curtains or blinds were in place. We would recommend that this is addressed, as people may not understand that they are not being exposed and this could help to support people further to meet their privacy and dignity needs. Knowsley Manor Nursing Home DS0000005460.V365751.R01.S.doc Version 5.2 Page 25 A member of domestic staff who was on duty said she has received training in infection control and COSHH (control of substances hazardous to health), and this was confirmed in training records. She said there is always a good supply of cleaning agents in the home. Colour-coded cleaning equipment was observed being used in areas such as the toilets and kitchen, and in this way cross contamination will be avoided. Domestic assistants were seen wearing protective clothing (gloves and aprons) and there are locked areas for the storage of cleaning materials when not in use. We visited the laundry, which is equipped with washing machines with sluicing facilities and dryers, and there are systems in place for the control of infection through the use of colour coded laundry bags. To ensure that there is a record of all cleaning carried out, staff had completed the cleaning schedule when work in each area has been done. Knowsley Manor Nursing Home DS0000005460.V365751.R01.S.doc Version 5.2 Page 26 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): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive care and support from staff who have the skills to meet their needs. Recruitment procedures are robust which helps to protect people’s rights. EVIDENCE: We looked at records which showed us how many staff were available at any one time in the home and the skills and qualities that they had to support people who live there. We discussed how the home is staffed with the manager who came from the other home to help and the deputy manager. The deputy manager explained the staffing levels in the home and how they were calculated. The manager from the other home explained that permission could be sought to get extra staff and that she had never been refused. An example of this would be if someone needed constant support from a member of staff. Knowsley Manor Nursing Home DS0000005460.V365751.R01.S.doc Version 5.2 Page 27 We looked at records, which showed us that the home was staffed as had been explained. We also saw that some staff were working long shifts close together over a number of days. For example one carer had worked four twelve-hour days shifts on the run. We would recommend that this practise is reviewed as staff can become irritable when tired which could impact on the people who live in the home. We also saw that staffing numbers had been reduced recently and that this had been discussed with relatives at a meeting who agreed that this hadn’t impacted on the quality of care in the home. However, as we observed during the lunchtime meal, at times staff are too busy to meet everyone’s needs and an increase in staff at key times may benefit the people who live in the home. We looked at staff personal files and found that the home ensures that necessary checks are carried out to ensure that new staff have the skills and qualities suitable for the role. We also saw that checks were carried out to make sure that qualified nurses were registered to nurse. We saw that eleven of the twenty-four care staff who work at the home have achieved an NVQ (national vocational qualification) in Care and other staff told us during discussions that they were working towards achieving this award. We also looked at what other training was on offer in the home. We saw that training is planned throughout the year and subjects covered include how to move people safely, Abuse awareness, Food hygiene, Fire safety, Bedrails training, Yesterday- today- tomorrow training (focuses on dementia care), Care planning, medication training, Communications, and safe handling of substances hazardous to health. We would recommend that consideration is also given to providing training in the recent changes in the mental health Capacity act and on Equality and Diversity. Attention should also be paid to people’s physical illness and relevant topics should be offered on theses subjects. For example we looked at one persons file that showed that they suffered from diabetes, however no training has been offered on this subject. Knowsley Manor Nursing Home DS0000005460.V365751.R01.S.doc Version 5.2 Page 28 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): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a safe, well-managed home, which is operated in their best interests. EVIDENCE: We looked at how the home is managed and found that robust processes were in place to protect the people who lived there. The deputy manager who is experienced in management and has worked at the home for five years is presently managing the home. Relatives told us that they had great faith in this person’s ability to manage and care. Knowsley Manor Nursing Home DS0000005460.V365751.R01.S.doc Version 5.2 Page 29 We saw that the organisation Southern Cross employ an operations manager who is in regular contact and who can be reached by telephone for advice and support. We saw that systems in reporting have been developed so that any incidents can be investigated and overseen. For example monthly reports are compiled which detail whether any one has developed a pressure ulcer, whether any complaints have been made, whether people have lost weight and if so how much and how many accidents have occurred and what was the outcome. This is good practise. This information is then passed to the operations manager who can ensure that staff have taken appropriate action to maintain peoples health and welfare. We focused on the accident reports, which have been compiled in recent months. We know that the manager informs us when serious accidents happen in the home and that action is taken to reduce the risk of a reoccurrence. We saw in peoples care plans that the risk of accidents occurring is reduced as much as possible and that appropriate equipment is in place to support this. When we looked at the accident report we saw that attention is paid to the time of day that the accidents happened, and how it happened and whether it was witnessed by anyone or not. This is good practise as this information can highlight any trends. For example if the report showed that a large number of falls were occurring in the evening then greater supervision from staff may be required. A member of staff told us that they believed that the number of falls and accidents had reduced in recent months. We looked at how the home consults with people’s relatives and representatives. We saw that at one time not many people attended the relatives meetings however in recent months the number has greatly increased. We saw that relatives had requested that the meeting be held two monthly rather than monthly and that this has been acted on. We saw that comments slips are available in the foyer of the home for people to complete if they choose. We discussed satisfaction surveys with the manager who came to help from another home. She stated that Southern Cross send out surveys to people who live in the home, their relatives and staff every year and that this information is complied into a report. She explained that in the first instance managers are informed of any concerns so that action can be taken quickly. We also saw advertisements for a weekly surgery. This is time that the manager sets aside every week for relatives and representatives to drop into the home to discuss any issues they may have. This is very good practise The manager who came to help from the other home explained that Southern Cross have instigated this practise in all their homes. Knowsley Manor Nursing Home DS0000005460.V365751.R01.S.doc Version 5.2 Page 30 We spoke with a relative who told us that they were aware of the forum, had received satisfaction surveys and were also aware of the weekly surgery but that they simply” picked up the phone” if they had any issues. This person also told us that they believed that the home was managed well. When we looked at minutes from relatives/representatives meetings we saw that their opinion is sought and that feedback is given on any issues that they may have raised in previous meetings. We also saw that the group is made aware of our visits and any outcomes from these. This is good practise. We looked at how people are supported to manage their money. The home has set up a bank account with Barclays bank purely for this purpose. Regular audits are carried out to ensure that monies are managed correctly. We spoke with the administrator who was able to clearly explain this process and show us records that reflected this. We looked at how the home maintains the health and safety of the people who live there and the staff who work there. We looked at a variety of records, which showed us that contracts are in place and regular checks are undertaken to make sure that the home is safe. Staff have had training in vital topics such as fire training and manual handling to enable this to happen. We read minutes of health and safety meetings and saw that these take place every month. We saw that discussions took place regarding whether new staff had completed mandatory training to keep people safe and that a further review of any accidents that had occurred was also carried out. This is good practise. Knowsley Manor Nursing Home DS0000005460.V365751.R01.S.doc Version 5.2 Page 31 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 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Knowsley Manor Nursing Home DS0000005460.V365751.R01.S.doc Version 5.2 Page 32 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 OP15 Regulation 16. -(2) (i) Timescale for action Management must review 31/08/08 mealtime procedures to ensure that sufficient staff are provided to meet people needs. Not providing sufficient staff could impinge on people health and welfare, as people may not receive all the support they need to eat well. The unpleasant smell in some 31/08/08 areas of the home must be eradicated. This can seriously impinge on people’s quality of life and affect self-esteem. Requirement 2. OP26 16. -(2) (k) Knowsley Manor Nursing Home DS0000005460.V365751.R01.S.doc Version 5.2 Page 33 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 OP3 Good Practice Recommendations Staff should ensure that the records any involvement of relatives /representatives and other health care professionals in the assessment process. This would help to show that all interested parties have been consulted about a persons needs. Staff should consider taking photographs of the home to show to anyone who is interested in moving in. This may help someone make a choice who may find literature confusing. Consideration should be given to holding the first care plan review with relatives/representatives earlier than six months. This may help reassure people during the early days when people are settling into the home. People’s continence needs should be explored to ensure that they are receiving the correct support and equipment. Not providing the correct support can cause discomfort and distress. Staff should be reminded on the importance of offering choice and giving clear instructions when giving support to people. Not providing guidance can impinge on people rights to choice and may cause distress. Menus should be displayed in a suitable format for the people in the home to see. Not providing this information could reduce a persons right to choose what food they would like to eat. Management should consider using the outcome of complaints as part of the homes Quality assurance system. This would help to show people that complaints and concerns are acted on and that there is a willingness to improve the service. Improvements should be made to the environment by adding window dressings to all bathrooms and toilets and by ensuring that the corridor ceiling is repaired. Staff commented that there were not enough wheelchairs in the home. This should be explored to ensure that there is sufficient equipment to meet people’s needs. DS0000005460.V365751.R01.S.doc Version 5.2 Page 34 2. OP3 3. OP7 4. OP8 5. OP14 6. OP15 7. OP16 8. 9. OP19 OP22 Knowsley Manor Nursing Home 10. OP27 11. OP30 Staffing levels should be reviewed to ensure that staff are available in sufficient numbers to meet peoples needs at key times of the day. Shift patterns should be explored to reduce the risk of staff becoming irritable with the people who live in the home. Training should be developed for staff on Equality and diversity and the recent changes in the mental health capacity act. People physical needs should be explored and training given on relevant topics. This will help to ensure that staff have the skills to meet peoples needs. Knowsley Manor Nursing Home DS0000005460.V365751.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection North West Regional Contact Team Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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 Knowsley Manor Nursing Home DS0000005460.V365751.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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