Inspection on 24/01/06 for Knowsley Road (4 - 6)

This inspection was carried out on 24th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Knowsley Road (4 - 6) 20/09/05

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 24th January 2006 9:00 Knowsley Road (4 - 6) DS0000018907.V280224.R01.S.doc Version 5.1 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.V280224.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 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.V280224.R01.S.doc Version 5.1 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) louise@poldercare.com Mr Hendrikus Gerardus De Rooij Mrs Alexandra De Rooij Mrs Alexandra De Rooij Care Home 24 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (24) of places Knowsley Road (4 - 6) DS0000018907.V280224.R01.S.doc Version 5.1 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. 20th September 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 blends into the local surroundings and is not externally identified as a care home. The home is close to local shops, other community amenities and local bus routes on the New Chester Road. Knowsley Road provides care for younger adults with mental health problems, though there are three residents over 65 years of age and this is reflected in the registration conditions. The owners own a similar home in Hoylake and some administrative functions and staff are shared between the two homes. Accommodation is provided in single bedrooms, most of which are spacious and some of which have en-suite facilities, including showers in some cases. The bedrooms are 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.V280224.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. During this unannounced inspection the inspector spoke to eight residents, a relative of one resident, staff, one of the owners and the Care Services Manager. He examined documents – including care plans and some kept on the computer system - 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. The Registered Manager was not on duty and the inspection was dealt with by the Care Services Manager. 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.V280224.R01.S.doc Version 5.1 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.V280224.R01.S.doc Version 5.1 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): 2, 3, 4. New residents are only admitted if their needs have been properly assessed, ensuring that their needs can be met. EVIDENCE: One resident was in the home on a trial basis from an informal stay in hospital. Not all of the information required was available in the home and this is dealt with under Standard 40. The Care Services Manager had a good understanding of this resident’s needs and clear plans were in place for his care. A final decision on long-term care is to be taken by health professionals, the resident himself and staff in the home. Knowsley Road (4 - 6) DS0000018907.V280224.R01.S.doc Version 5.1 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. Care plans are detailed and are 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 which is reviewed each month by a member of staff and any changes are entered on to the plan using the computer system. The care plans deal with issues such as hygiene, medication, activities, motivation and behaviour. Daily reports are made on a dedicated computer program that does not allow retrospective alterations of records. Where residents exercise some independence, such as helping with their own laundry, 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 can only be accessed by staff using a password. Documents are backed up on a central server. Smoking is restricted to one – very well used – smoking room, and the home does not permit alcohol except on certain occasions such as parties and organised social events when the Knowsley Road (4 - 6) DS0000018907.V280224.R01.S.doc Version 5.1 Page 9 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.V280224.R01.S.doc Version 5.1 Page 10 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): 11, 12, 13, 14, 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 some choice and provide 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. The residents spoken to 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 which is used for some short trips out. The Registered Person has designated a member of staff as the Activities Organiser for both homes, and this role runs alongside her other responsibilities. She has developed a programme of activities for the home, though this is in its early stages. It includes time for board games, bingo, cards, discussions and beauty therapy. Activities are discussed at the monthly residents’ meetings. Some residents attend local day centres and one is hoping to start there soon. Another continues to work at a local farm as he has done for some years. One resident told the inspector that he was looking for paid employment and the Care Knowsley Road (4 - 6) DS0000018907.V280224.R01.S.doc Version 5.1 Page 11 Services Manager said that if he wanted to pursue this, the home would support him in doing so. Some residents use the services of a local voluntary organisation called ‘Impact on Mental Health’. The organisation employs experienced people, some of them former social workers, who are well known to the home and take people out into the community to take part in a range of activities. The residents pay for this service and the Registered Person is continuing to pursue the question of CRB checks on Impact staff with the organisation. 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. The inspector spoke to one relative who was happy with the care being provided to her relative. Residents usually make their own breakfast and the main meal of the day is served in the evening. The main meal for the day (curry, which everyone who spoke to the inspector said they enjoyed) was displayed on a blackboard in the dining room. A vegetarian choice is available for each meal and the chef said that she 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 them. Knowsley Road (4 - 6) DS0000018907.V280224.R01.S.doc Version 5.1 Page 12 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, 20. Medication is generally well organised and accurately recorded, protecting the interests of the residents, though there were some minor errors. 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, though there were some minor errors. One tablet could not be accounted for; the number of tablets administered had not been recorded on one occasion; a nasal spray had not been signed and dated when it was opened. Some drugs are stored in the Controlled Drugs cabinet and are recorded in the Controlled Drugs file, though they are not in fact Controlled Drugs. Whilst not strictly necessary this is an acceptable precaution. However, if Controlled Drugs are prescribed they would need to be recorded in a bound Controlled Drugs Register (paragraph 9.4 0f the Administration and Control of Medicines in Care Homes and Children’s Services). Knowsley Road (4 - 6) DS0000018907.V280224.R01.S.doc Version 5.1 Page 13 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, 23. The home has a complaints procedure that 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. The Care Services Manager said that no complaints had been received since the last inspection, though the Complaints Book was not to hand. Adult protection policies are available in the home and staff receive training in the protection of vulnerable adults. Knowsley Road (4 - 6) DS0000018907.V280224.R01.S.doc Version 5.1 Page 14 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, 25, 27, 28, 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 which carries bus routes to Birkenhead town centre. There are also shops and some other community facilities on the main road. The building is not externally identified as a care home and blends in with surrounding properties. There is room for car parking at the front of the house and also on the quiet road. The home was clean and odour free 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 with 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 all 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. One toilet on the second floor needs new flooring as the vinyl is badly marked and lifting from the floor. The garden is large, attractive and well maintained. Knowsley Road (4 - 6) DS0000018907.V280224.R01.S.doc Version 5.1 Page 15 On the day of the inspection some areas of the home were a bit cold, though no residents complained about this. The handyperson was in the process of checking some of the radiators. Knowsley Road (4 - 6) DS0000018907.V280224.R01.S.doc Version 5.1 Page 16 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, 36. The home’s recruitment and training policies ensure that residents have their needs met by competent staff. EVIDENCE: Although some staff and administrative services are shared between the Registered Person’s two homes, most care staff now work mainly in or other of the homes. The owners have recruited several staff from overseas and there are currently staff from Poland, the Philippines and Romania working at Knowsley Road. 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. Criminal Records Bureau (CRB) and POVA (Protection of Vulnerable Adults) checks were in place on the files of all new staff and staff are not allowed to start work without POVA clearance. The home no longer uses agency staff, creating more continuity of care for the residents. Most of the overseas employees working as care staff have nursing qualifications from their homeland which have been identified by NARIC as equivalent to NVQs. On that basis the home now has more than 50 of care staff with NVQ2 or above on its latest rota. Knowsley Road (4 - 6) DS0000018907.V280224.R01.S.doc Version 5.1 Page 17 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. The Registered Manager (one of the owners) was on holiday during the week of the inspection, so additional management cover was being provided by the Care Services Manager (who works at both of the Registered Person’s homes). However, he was not working the same number of hours as the manager and the home’s staffing was therefore very slightly short of the number of staffing hours required. The Registered Person needs to take care to ensure that appropriate care staffing levels are maintained. The home has very effective administrative support, shared with the other home, and domestic staffing, including a handyman. Knowsley Road (4 - 6) DS0000018907.V280224.R01.S.doc Version 5.1 Page 18 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, 38, 39, 41, 42. 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 does not, of course, operate as a nurse in Knowsley Road, which is not registered to provide nursing. The home has begun the process of implementing ISO 9000 quality assurance systems and the administrative staff have devised a schedule to be implemented in both homes. 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. Not all of the information required by Schedule 3 of the Care Homes Regulations was available for the resident who was in the home on a trial basis. The Residents’ Services Manager told the inspector – by phone – that Knowsley Road (4 - 6) DS0000018907.V280224.R01.S.doc Version 5.1 Page 19 the information was on the computer system, but due to an unspecified technical problem could not be opened at Knowsley Road. It would therefore be appropriate for a hard copy of the basic information required by Schedule 3 of the Care Homes Regulations 2000 to be kept in the home, especially for use by, for instance, night staff. Fire safety checks and fridge/freezer temperatures – both kept on the computer - were up to date. The kitchen was clean and food was safely stored (other than one catering pack of soup mix which was a couple of months beyond its sell by date and was disposed of during the inspection. The home’s registration certificate was displayed in the hall. The registration includes a condition concerning people over the age of 65. This reflects the fact that the home has three residents over the normal retirement age, a number which 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 but the details of the incidents are kept on the computer and were readily accessible. These forms should be kept at Knowsley Road. Knowsley Road (4 - 6) DS0000018907.V280224.R01.S.doc Version 5.1 Page 20 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 Standard No Score 1 x 2 3 3 3 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 x 30 3 STAFFING Standard No Score 31 3 32 3 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 x 16 x 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 3 3 3 3 3 3 3 Knowsley Road (4 - 6) DS0000018907.V280224.R01.S.doc Version 5.1 Page 21 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 YA20 Regulation 13 Requirement The Registered Person must make arrangements for the safe administration of medicines received in the care home and must therefore ensure that accurate records are kept of each episode of administration. The Registered Person shall ensure that at all times sufficient staff are employed at the home. The floor covering to a toilet on the second floor is badly marked and lifted and must be replaced. Timescale for action 26/01/06 2 3 YA33 YA24 18 23(2) 01/02/06 01/04/06 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 41 Good Practice Recommendations It would be preferable if essential information required by regulation to be kept in the home and which may be needed by night staff were kept in hard copy as well. Knowsley Road (4 - 6) DS0000018907.V280224.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Liverpool Local 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. Extracts may not be used or reproduced without the express permission of CSCI Knowsley Road (4 - 6) DS0000018907.V280224.R01.S.doc Version 5.1 Page 23 - 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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