Inspection on 20/09/05 for Knowsley Road (4 - 6)

This inspection was carried out on 20th September 2005.

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 Road (4 - 6) 24/01/06

Knowsley Road (4 - 6) 09/02/05

Knowsley Road (4 - 6) 29/11/04

Knowsley Road (4 - 6) 13/02/04

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

CARE HOME ADULTS 18-65 Knowsley Road (4 - 6) 4 - 6 Knowsley Road Rock Ferry Wirral CH42 1QG Lead Inspector Peter Cresswell Unannounced Inspection 20th September 2005 8:55 Knowsley Road (4 - 6) DS0000018907.V252601.R01.S.doc Version 5.0 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 Road (4 - 6) DS0000018907.V252601.R01.S.doc Version 5.0 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Knowsley Road (4 - 6) DS0000018907.V252601.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Knowsley Road (4 - 6) Address 4 - 6 Knowsley Road Rock Ferry Wirral CH42 1QG 0151 643 1299 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) Mr Hendrikus Gerardus De Rooy Mrs Alexandra De Rooy Mrs Alexandra De Rooy Care Home 24 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (24) of places Knowsley Road (4 - 6) DS0000018907.V252601.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Only adults (aged 18 - 64 years) who have a mental disorder may be accommodated. 24 adults with a mental disorder, aged 18 - 64, and may from time to time care for adults with a mental disorder over the age of 64 the total number not to exceed 24. 9th February 2005 Date of last inspection Brief Description of the Service: 4-6 Knowsley Road is a large detached property set in its own gardens. The building is not identified as a care home and blends into the local surroundings. The home is close to local shops, other community amenities and local bus routes on the New Chester Road. Knowsley Road provides care for people with mental health problems aged under 65, though there are three residents over this age and this is reflected in the registration conditions. The owners also own a similar home in Hoylake and some administrative functions and staff are shared between the two homes. Accommodation is provided in spacious single bedrooms, some of which have en-suite facilities, including showers in some cases. The bedrooms are situated on three floors, all of which are served by a passenger lift which, whilst fully maintained, is not in everyday use. There are two lounges, one of which is the smoking room, and a separate dining room on the ground floor. The home restricts smoking to the designated lounge. Alcohol is only permitted under supervision. Knowsley Road (4 - 6) DS0000018907.V252601.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection. The inspector spoke to a number of residents, staff, the owners (one of whom is also the Registered Manager) and the Residents’ Services Manager. He examined documents and toured part of the home, including the kitchen. Some documents relating to staff were brought from the owners’ other home, where they are normally stored. What the service does well: What has improved since the last inspection? 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. Knowsley Road (4 - 6) DS0000018907.V252601.R01.S.doc Version 5.0 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Knowsley Road (4 - 6) DS0000018907.V252601.R01.S.doc Version 5.0 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 The service user guide gives current and prospective residents information about how the home is run, enabling them to make informed choices. New residents are only admitted if their needs have been properly assessed, ensuring that their needs can be met. EVIDENCE: The home has a revised service user’s guide which now incorporates the home’s policy on the use of alcohol and up to date details of the Commission for Social Care Inspection. The guide does not include all of the documents set out in Regulation 5 of the Care Homes Regulations but advises service users where they can be found. The main copy in the home should be filed with these documents. On the day of the inspection the guide was not readily available. No new residents had been admitted since the last inspection but the home’s admission and assessment procedures remain in place. Knowsley Road (4 - 6) DS0000018907.V252601.R01.S.doc Version 5.0 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 and 10. The home’s care plans are detailed and reviewed regularly, ensuring that up to date information is available to staff responsible for day to day care. EVIDENCE: Each resident has a detailed care plan and the residents sign to say that they are familiar with its contents. The plans are reviewed each month by a member of staff and any changes are entered on to the plan using a computer. The care plans deal with issues such as hygiene, medication, activities, motivation and behaviour. Daily reports are made on a dedicated computer program - Care Assist - which does not allow retrospective alterations of records. Some residents exercise some independence, such as helping with their own laundry, and this is identified in their care plan. Risk assessments are completed for every resident. Each resident has a folder on the database, which includes the daily report, accident reports, incidents, a photograph and personal details. The computer has two access terminals, both of which are kept in locked offices, and the program can only be accessed by staff using a password. Documents are backed up on a central server. Smoking is restricted to one – well used – smoking room, and the home does not permit alcohol except on certain occasions such as parties and organised social events when the alcohol is provided by the home itself. There are periodic residents’ meetings but the minutes were not inspected on this occasion. Knowsley Road (4 - 6) DS0000018907.V252601.R01.S.doc Version 5.0 Page 9 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 15, 16, 17. Daily routines in the home are informal and residents can follow their own interests by taking part in everyday activities in the community if they choose to do so. The meals in the home offer choice and a nutritious diet for the residents. EVIDENCE: There are few set routines at Knowsley Road and residents are free to come and go as they please, subject to risk assessments where appropriate. Residents said that some trips out had been organised over the summer though the inspector did not speak to anyone who had actually been on one. The residents spoken to said they were happy to go out on their own to facilities in the community, using public transport. The home does have the use of a people carrier. The Registered Person said that the organisation is proposing to employ an activities organiser to work in both of the company’s homes. There has been no response to a newspaper advert for the job so for the time being a member of the existing staff will take the role on. Relatives and friends are free to visit at any reasonable time and all residents have individual rooms where they can receive visitors if they wish. Some residents attend local day centres and as the inspector arrived one was leaving to work at a local farm where he has been a volunteer for some years. Some residents Knowsley Road (4 - 6) DS0000018907.V252601.R01.S.doc Version 5.0 Page 10 use the services of a local voluntary organisation called Impact on Mental Health. The organisation employs experienced people, who are well known to the home, some of them former social workers, who take people out into the community to take part in a range of activities. The residents in question pay for this service and the Registered Person pointed out that Impact staff do not have CRB checks. This is not a statutory requirement as they are not employed or used as volunteers in the home and do not provide personal care, but it would be good practice for Impact to arrange for such checks and the Registered Person may wish to raise this with them. Residents usually arrange their own breakfast and the main meal of the day is served in the evening. A vegetarian choice is available for each meal and the chef said that he prepares other choices for residents if they want something different. Lunch is a lighter meal but normally includes a cooked alternative such as cheese on toast. Those residents who spoke to the inspector said that they were happy with the food prepared for them. There is a machine in the dining room for drinks between meals and tea breaks, but residents have to pay for these. Knowsley Road (4 - 6) DS0000018907.V252601.R01.S.doc Version 5.0 Page 11 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, and 20. Medication is well organised and the administration of medication is accurately recorded, protecting the interests of the residents. EVIDENCE: Care plans identify any personal care needs and all residents are registered with a general practitioner. Most also receive specialist health care from mental health professionals. Medication is dispensed by the community pharmacist in a Monitored Dosage System, with most tablets provided in blister packs. The inspector checked the Medication Administration Record sheets for three residents and found that they were in order, with all medication signed for. The senior carer on duty confirmed that the records are initialled as soon as the medication has been administered. A copy of the Royal Pharmaceutical Society’s ‘Guide to the Administration and Control of Medicines in Care Homes and Children’s Services’ was available in the medication room. No controlled drugs were in use at the time of the inspection. Some amendments had been made to the MAR sheets where the pharmacist had entered the wrong times for administration – ideally these should be witnessed by a second member of staff. Knowsley Road (4 - 6) DS0000018907.V252601.R01.S.doc Version 5.0 Page 12 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The home has a complaints procedure which is available for residents to use to make their views heard. EVIDENCE: The home has an appropriate complaints procedure which is summarised in the Service User’s Guide. Adult protection policies are available in the home and staff receive training in the protection of vulnerable adults. Knowsley Road (4 - 6) DS0000018907.V252601.R01.S.doc Version 5.0 Page 13 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27, 28, and 30. The home provides clean, well-furnished accommodation that meets the needs of the residents. EVIDENCE: Knowsley Road is situated within 100 yards of the New Chester Road in Rock Ferry and is therefore near to bus routes to Birkenhead town centre. There are also shops and some other community facilities on the main road. The building is not identified as a care home by a sign and blends in with surrounding properties. There is a car park at the front of the house and cars can also be parked on the quiet road. The home was clean on the day of this unannounced inspection. Residents eat in a dining room near the main entrance and also have a TV lounge and a smoking room, which is the only place in the home where smoking is permitted. This policy is set out in the Service User’s guide. The smoking room is very well used and has an effective extractor fan to reduce smoke and smells in the home. Each resident has an individual bedroom, some with en suite facilities, but they were not inspected on this occasion. The home has sufficient bathrooms and toilets and those seen during the inspection were clean, with water delivered at a safe temperature. The garden is large, attractive and well maintained. Knowsley Road (4 - 6) DS0000018907.V252601.R01.S.doc Version 5.0 Page 14 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35. The home’s recruitment and training policies ensure that residents have their needs met by competent staff EVIDENCE: In the past staff have worked at both Knowsley Road and the owner’s other home, Melrose. The Registered Person said that as they began to establish more staff stability it was intended to deploy staff to individual homes. This would help the development of the key worker policy and arrange for more continuity in the care of the residents. The owners have begun to employ additional staff from overseas and currently have staff from Poland, the Philippines and Romania. They are recruited via a specialist agency which screens them, takes up references and arranges for work permits and immigration clearance where necessary. Management conduct telephone interviews, partly to ensure that staff have sufficient command of English for the post. CRB checks are done as soon as the individuals are in the country and POVAFirst checks are done to enable them to be employed quickly. The POVAFirst checks have been taking up to two weeks as the umbrella agency says it is unable to process them immediately. This means that staff who come directly from overseas are on the books of Polder Care before POVA clearance has been received. This contravenes Regulation 19 of the Care Homes Regulations and the guidance issued by the Department of Health about the POVA scheme. However, such staff have only just been admitted to the country following immigration checks and are not allowed any contact with residents until POVA clearance has been obtained. In the circumstances this Knowsley Road (4 - 6) DS0000018907.V252601.R01.S.doc Version 5.0 Page 15 arrangement is acceptable as the staff have not been in the country long enough to be put on the POVA register. If the employees are already in the country before being recruited then no such flexibility applies. The use of foreign workers has also raised some issues about the interpretation of qualifications from other countries. The Registered Person has submitted some of the qualifications of overseas worker to NARIC, a government agency which compares overseas qualifications with those from the UK. Following a meeting with the Commission for Social Care Inspection’s Business Relationship Manager it has been agreed that if the qualification is in a field related to personal care (such as nursing) and NARIC states that it is comparable to a particular level of NVQ then the qualification can be considered equivalent to an NVQ in care. On that basis the home now had more than 50 of care staff with NVQ2 or above on its latest rota. New staff receive induction training, much of it based on a series of training videos and the home continues to provide training for other staff, though full details were not available at the time of the inspection. Knowsley Road (4 - 6) DS0000018907.V252601.R01.S.doc Version 5.0 Page 16 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 40,41 and 42. The home is well managed and records are properly and safely kept, protecting the rights and best interest of the residents. EVIDENCE: The Registered Manager is also one of the owners. She is a Registered Mental Nurse, holds an NVQ4 and is experienced in the fields of mental health care and management. She cannot, of course, operate as a nurse in Knowsley Road, which is not registered to provide nursing. The home’s quality assurance procedures were not examined at this inspection and will be assessed during the next visit. Records examined were up to date and were securely stored. Many of the home’s recording systems are now held on to the computer system and are inputted directly by staff. Staff said that they find this system easy to use and it gives management the advantage of being able to check records from either home. Fire safety checks and fridge/freezer temperatures – both kept on the computer - were up to date and the home has current gas and electrical safety certificates. The kitchen was clean and food was safely stored. The home’s registration certificate was displayed in the hall. The registration now includes a condition concerning people over the age of 65. Knowsley Road (4 - 6) DS0000018907.V252601.R01.S.doc Version 5.0 Page 17 This reflects the fact that the home currently has three residents over the normal retirement age and this number may change either as existing residents age or new residents over the age of 65 are admitted whose needs are primarily related to their mental health rather than infirmity through the ageing process. Accident forms are kept at Melrose - the owners’ other home – once they have been detached from the Accident Book. These forms should be kept at Knowsley Road. Knowsley Road (4 - 6) DS0000018907.V252601.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X 3 3 X 3 LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 3 3 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Knowsley Road (4 - 6) Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score 3 X X 3 3 3 X DS0000018907.V252601.R01.S.doc Version 5.0 Page 19 NO 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. Standard Regulation Requirement Timescale for action 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 Standard Good Practice Recommendations Knowsley Road (4 - 6) DS0000018907.V252601.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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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