CARE HOMES FOR OLDER PEOPLE
Knyveton Hall 34 Knyveton Road East Cliff Bournemouth Dorset BH1 3QR Lead Inspector
Carole Payne Unannounced Inspection 15th June 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Knyveton Hall DS0000003952.V300654.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. Knyveton Hall DS0000003952.V300654.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Knyveton Hall Address 34 Knyveton Road East Cliff Bournemouth Dorset BH1 3QR 01202 557671 NO FAX 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) Alan Coggins Limited Mrs Elaine Margaret Coggins Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39) of places Knyveton Hall DS0000003952.V300654.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 1st March 2006 Brief Description of the Service: Knyveton Hall is situated between Bournemouth and Boscombe close to Boscombe town centre and a short drive from the sea front. Bournemouth town is approximately two miles away from the home. There is parking at the front of the premises, street parking is also available. Knyveton Hall is a family run care home for older people who need the support of residential care. Services include personal care, meals, laundry, domestic services and recreational activities. Knyveton Hall is registered to accommodate up to a maximum of 39 older people (age 65 and over), both male and female. The proprietors are Alan and Elaine Coggins who live on the premises. The home is run by Mrs Coggins, she is supported by her sister who is the deputy manager and a care manager. Knyveton Hall is run as a Limited Company, Alan Coggins Limited. The home is arranged over four floors containing 35 single rooms and 2 shared rooms, all floors can be accessed by a passenger lift. Communal areas include three lounges, two on the ground floor and one in the basement and a dining room. The basement lounge gives direct access to the level back garden. Knyveton Hall DS0000003952.V300654.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection was carried out on the 15th June 2006 and took a total of 12 hours, including time spent in preparation for the visit. The inspectors, Carole Payne, Maxine Martin and Chris Main were made to feel welcome in the home during the visits. A team manager from Social Care and Health accompanied the inspectors to meet with the management team and review the needs of people living in the home with a high level of dependency. The registered manager, Mrs Coggins and the deputy manager were present throughout the inspection. This was a statutory inspection and was carried out to ensure that the thirty-five residents who were living at Knyveton Hall were safe and properly cared for. Requirements and recommendations made as a result of the last inspection visit were reviewed. The premises were inspected and records examined. Time was spent in discussion with people living at the home, the management team and staff members on duty. Eleven residents were spoken with and residents were observed enjoying the communal areas and spending time in individual rooms. The pharmacist inspector spoke with a resident and staff and checked residents’ medicines with the records to see if they were given as prescribed and recorded. Thirty-three resident survey forms were returned, eighteen relative / visitor comment cards, two comment cards from General Practitioners and a comment card from a health and social care professional. What the service does well:
A high level of satisfaction with the service was expressed by residents, relatives / visitors, and General Practitioners, who completed comment cards about the service. People living in the home feel that they are ‘treated with respect’ and their right to privacy is upheld. A high number of residents at the home say that they feel that the lifestyle they experience matches their expectations and preferences and satisfies their social needs. They feel that they are supported to maintain contact with family and friends and to enjoy quality time with them. Comments received about the service included: ‘The standard of care and attitude of owner and staff are way above any reasonable expectations.’ ‘Very high standard of care.’ Knyveton Hall DS0000003952.V300654.R01.S.doc Version 5.2 Page 6 ‘Pleased to be spending my last years at Knyveton Hall. I receive kind attention and am grateful for it.’ ‘On the whole very happy and content.’ ‘I enjoy living here very much.’ Two comment cards received from General Practitioners were satisfied with the level of care provided and staff members’ understanding of care needs. Residents, who are able to exercise choices, say that they are able to make decisions about their daily lives. People living at the home enjoy a varied menu, in surroundings of their choice. Residents and their relatives and friends are confident that their complaints will be listened and responded to. People living at Knyveton Hall live in an adequately maintained environment, which is clean. The home participates in quality assurance exercises to ensure that the service is run in the best interests of residents. Staff members are appropriately receiving supervision. What has improved since the last inspection?
Since the last inspection visit, the service has endeavoured to commence the process of putting in place the structures to meet the high dependency needs of some of the people accommodated. Social Care and Health are working with the home to review people’s needs to ensure that supportive systems are in place. Since the last inspection visit the home has worked hard to introduce a new system of assessment and care planning, including a risk assessment process. They are working towards developing care plans, which inform care delivery, with specific reference to personal and social care needs and the inclusion of people’s choices and preferences. The home is, therefore, endeavouring to implement change, which addresses current shortfalls in meeting the healthcare needs of some residents. The service has taken prompt action to address issues, to support improvements in the standard of care, where concerns have been highlighted. For example the deputy manager has looked at how the home can offer residents additional services, such as breakfast dining as a social event, so that people are encouraged to eat, and enjoy a leisurely breakfast.
Knyveton Hall DS0000003952.V300654.R01.S.doc Version 5.2 Page 7 The home has started to record falls occurring in the home as accidents. The home has obtained a lockable trolley to improve medicines storage and to enable them to be taken to residents more safely and easily. A record of alternative meals provided is now maintained. The home has started a complaints log, as recommended in the last inspection report. Since the last inspection one radiator cover has been fitted in the dining room and risk assessments completed regarding the risk of scalding from radiators in the home, which are currently unguarded. This will be reviewed in the colder weather. The deputy manager has produced a detailed induction programme, which she confirms is in line with the specifications of Skills for Care. POVA First checks and Criminal records Bureau checks are now being sought for staff members prior to them starting work. The home has complied with a requirement to make recruitment records available for inspection at all times. Since the last inspection to the home a summary record of completed training has been completed so that training needs can be identified and future training planned. The home has produced a policy and procedure regarding bequests to staff, demonstrating that the home is safeguarding the financial interests of service users. Safety footplates are applied to wheelchairs when in use. One resident who sits in a wheel chair does not have footplates. The home was advised to complete a risk assessment. The management team have recognised some areas for improvement and started or initiated action to make a difference in areas where there have been requirements and recommendations made of the service. What they could do better:
There is a requirement outstanding from the last inspection report issued to the home that written confirmation must be given to people moving into the home that Knyveton Hall is able to meet their assessed needs. This could not be assessed on this visit, as the home had not had any new admissions to the service in the short time interval since the last inspection visit.
Knyveton Hall DS0000003952.V300654.R01.S.doc Version 5.2 Page 8 One comment card received from a health and social care professional identified areas that they felt could be improved, these included: ‘Consistency of care.’ When giving specialist advice that this should be ‘written into a care plan and instructed to all members of staff.’ Concern was expressed that staff do not demonstrate a clear understanding of the needs of service users. It is noted within this report that there is concern regarding the home being able to meet the dependency needs of some people living at Knyveton Hall. The home has started work to address this issue since the last inspection. Staff members need training with regard to assessing, monitoring and responding to residents’ specific needs. This includes understanding the nature of conditions; enabling staff to have insight into the physical and mental needs of people with a debilitating healthcare need; so that from this they develop an empathetic and person centred approach to assessing needs, planning care and reporting and monitoring changes. This will support the meeting of identified needs. Work started to develop assessment and care-planning systems must be continued. Each care plan must give clear guidance to staff on the actions to be taken to meet residents health and welfare needs. Care plans must be written in a language, which is respectful of residents. A letter of Serious Concern was sent to the home following the inspection and the following requirement made: Pressure sore risk assessments must be undertaken for all service users; nutritional risk assessments must be completed; any other actual or potential risks must also be identified and a thorough risk assessment process undertaken. From the outcomes of assessments appropriate action must be taken; including, where necessary, the monitoring of service users weights and their food and fluid intake; referral to the multi-disciplinary team and a plan of care put in place to meet needs and reduce risks. There is an outstanding requirement from the last inspection that residents’ nutritional needs, including food and fluid intake, must be assessed, monitored and reviewed, to ensure that healthcare needs are identified and met. Following this visit the manager has confirmed that she has put in place monitoring charts for the home’s most vulnerable residents. A high number of residents experience falls. The accident reports must be accurately completed, monitored and action taken to minimise risks identified. Records of accidents must be stored on individual files. The medication policy and practice of staff adding medicines to cassettes needs reviewing. The audit trails, monitoring of medication, some aspects of storage
Knyveton Hall DS0000003952.V300654.R01.S.doc Version 5.2 Page 9 and record keeping and assessment of risks for those who self-medicate need improving. In order to monitor and identify residents’ social needs recording of individual social interaction is recommended within this report. There is an outstanding requirement that all staff must receive training in the Protection of Vulnerable Adults. The manager indicated that training had been arranged. The home must ensure that they have received two suitable written references before new staff members start work in the home. Training in mandatory areas of practice is being organised for the coming months and must be completed to ensure that all staff are updated in good practice. Monies received by the service into the home’s account must be paid into an account in the name of the service user. Staff members must not smoke in the laundry, which is not appropriate, given the fire risk and smoking odours alongside residents’ laundry. 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. Knyveton Hall DS0000003952.V300654.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 Knyveton Hall DS0000003952.V300654.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 4 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Standard 3 was not assessed on this occasion, as the home has had no admissions since the last inspection. Social Care and Health are currently working with the home to support the meeting of needs of some residents who require a high level of care and support. The home provides a good service to those people with low dependency care needs. EVIDENCE: As described within this report, some people living at Knyveton Hall have levels of dependency, which the service has not previously catered for. The manager has said that she will only accept residents who are level 1 or 2, with regard to the degree of support that they require (level 3 being the most dependent in terms of residential care.) Concerns regarding a rise in dependency levels have initiated reviews of people’s needs by Social Care and Health. Since the last
Knyveton Hall DS0000003952.V300654.R01.S.doc Version 5.2 Page 12 inspection visit, the service has endeavoured to commence the process of putting in place the structures to meet the needs of these people. As part of this the management team is also planning to update staff members in mandatory aspects of training. It is recognised that essential to this is the training of staff in meeting special care requirements; so that they understand the nature of conditions; enabling staff to have insight into the physical and mental needs of people with a debilitating healthcare need. From this, an empathetic and person centred approach to assessing needs, planning and carrying out care and reporting and monitoring changes, will ensure that people’s needs are fully met and responded to. For example, in relation to the emotional and physical support of a person in need of terminal care. People responding to feedback questionnaires say that they feel that a good service is provided by the home. People spoken with during the visit said that they enjoy living in the home and feel that their needs are supported by the staff members and service provided. Knyveton Hall DS0000003952.V300654.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The management team has started to make progress in developing care plans, which inform care delivery, with specific reference to personal and social care needs. The home is endeavouring to introduce systems of assessment, planning, monitoring and review, which address current shortfalls in meeting the healthcare needs of residents. The home has systems in place for handling, administering and recording resident’s medication to promote their health and wellbeing but some improvements are needed to protect residents. People living in the home feel that they are treated with respect and their right to privacy is upheld; records of care do not at times support this. Knyveton Hall DS0000003952.V300654.R01.S.doc Version 5.2 Page 14 EVIDENCE: Since the last inspection visit the home has worked hard to introduce a new system of assessment and care planning. Six care plans were sampled. The new recording method includes a user-friendly version to inform carers providing care on a day-to-day basis. In house care plans reflected particular wishes in terms of support with personal care, and social interests. This incorporates residents’ wishes and preferences regarding the care that they receive. The deputy manager has completed most of the new documentation. A relative had signed one of the care records, to say that they have been included in the care planning process and a formal risk assessment process had been commenced. Seventeen relatives / visitors said that, where appropriate, they are consulted about their relative’s, friend’s care. The home has partially complied with a requirement issued in the last report regarding recording all falls experienced by residents within the accident records. Records of accidents were seen. One fall experienced by a resident had not been recorded and the importance of accurate recording was discussed. The deputy manager explained that staff members were being supported to develop skills in utilising the recording systems. It was advised that the records be audited periodically and the individual records placed on the relevant resident’s file. There were some references to risk of falls in individual care records seen and consultation with external healthcare professionals. Some residents’ case tracked had high dependency needs and there remained concerns in some areas including reflecting current needs in the care plans, for example in relation to pressure area care and failure to monitor food and fluid intake for people at risk of dehydration or weight loss. The monitoring of weights has started since the last inspection, but has not been completed for all residents who may be at risk. Nutritional risk assessments have been completed for some residents, but on one of the files seen there was no resultant score to indicate the degree of risk and level of action required to meet the person’s needs. One care plan said ‘very skinny so give him large meals.’ But there was no diet chart to monitor this. Formal pressure sore risk assessments had not been completed for some residents who may be at risk of skin breakdown. Where a resident had experienced the breakdown of skin it was not clear in the records the current status of the sore. The deputy manager expressed commitment to ensuring that the foundation of care planning develop in a way, which is supportive to the needs and wishes of residents, with specific reference to healthcare. Following the inspection the deputy manager informed the inspector that she had set up fluid / food monitoring charts for the most vulnerable residents and has called a staff meeting to discuss with all staff members changes to the recording structures, and staff responsibilities in terms of reporting changes, contributing to the
Knyveton Hall DS0000003952.V300654.R01.S.doc Version 5.2 Page 15 assessment process, including reference to the use of appropriate language when recording One comment card returned from a social care professional expressed concern that ‘there is no consistency of care as standard seems to be dependent upon whom is on duty. When giving specialist advice this does not seem to be written in care plan and instructed to all members of staff.’ As noted above some of the concerns relating to meeting the healthcare needs of residents relate to the dependency levels of some of the people accommodated at the home. Due to the vulnerability of some residents, they require assessment and care in relation to skin integrity, nutrition, moving and handling and specific healthcare needs identified and staff members need the skills and empathy to deliver care supportively. In the past the home has met the needs of a group of residents with a low level of dependency and from discussions and feedback from residents, their relatives and visitors, has met their needs in a very inclusive ‘family’ orientated environment. The home is now endeavouring to introduce change to meet the records of care and levels of skills and understanding to support the rises in dependency levels. Twenty-two residents responding to the resident survey said that they always receive the medical support that they need; eleven said that this was usually the case. The home has started to use a separate recording system of General Practitioner and healthcare contacts so that healthcare needs can be monitored and any appropriate action taken. The home has a medicines policy but it did not provide guidance for staff on some aspects of the handling and administration of medicines and needs reviewing and updating (see guidance provided). One resident was self-medicating and others managed some of their own medicines. There was a form that the resident the pharmacist inspector spoke with had signed to say that she wanted to look after her own medicines but no assessment of any risks for her, or others, in the home. Another resident had two of his own medicines, but again there was no risk assessment. The home has a good form for recording resident’s medication and any changes but the one checked did not agree with the current Medicine Administration Record (MAR) chart. There were no copies of prescriptions to confirm the medication prescribed. The pharmacy dispenses most residents’ medicines in monitored dosage cassettes and provides printed MAR charts. I checked four residents’ medicines with the records. Medicine allergies or ‘none known’, where applicable, were not recorded on the MAR chart. Receipt and administration of medicines were recorded on the MAR charts. Changes to medication were clearly recorded but handwritten additions to the MAR chart were not countersigned to show that Knyveton Hall DS0000003952.V300654.R01.S.doc Version 5.2 Page 16 another member of staff authorised to give medication had checked them as correct. Contrary to good practice guidance from the Royal Pharmaceutical Society and CSCI some medicines are added to cassettes in the home and staff could not easily confirm that what they were giving was in accordance with the doctor’s directions on the medicine label. Two doses of an antibiotic had been incorrectly added to a cassette - one tablet instead of the two prescribed. A check of two other medicines not supplied in cassettes confirmed that they were given as prescribed and recorded. The medicines in the other cassettes checked agreed with the MAR charts. Staff members record the date of opening eye drops so that they can be discarded after the recommended 4 weeks use. The date of starting other new packs of medicines is not recorded to provide an audit trail. There was no evidence of any self-monitoring in the home to ensure that medicines are given as prescribed and correctly recorded. A senior carer said that staff members, who give medicines, have done a medication course. I saw some lunchtime medicines given using the trolley, which was locked when left unattended. The home does not have a Controlled Drugs (CD) cupboard or record book and advice on obtaining one was provided. During the inspection staff members were observed providing sensitive support to residents. It was noted that one resident was described as ‘sulking’, another ‘grumpy’ in the daily records. The deputy manager agreed that staff members recording should be respectful of the resident for whom they were caring and intended to address this with staff members. All relatives / visitors to the home returning comment cards said that they could visit and meet with their friend, or relative, in private. Knyveton Hall DS0000003952.V300654.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. A high number of residents at the home say that they feel that the lifestyle they experience matches their expectations and preferences and satisfies their social needs. People living at the home are supported to maintain contact with family and friends and to enjoy quality time with them. Residents, who are able to exercise choices, say that they are able to make decisions about their daily lives. People living at the home enjoy a varied menu, in surroundings of their choice. EVIDENCE: Care plans viewed, particularly the in-house care plan, which is devised for day-to-day use by care staff reflected some of residents’ interests and hobbies, and choices about what they liked to do during the day. Twenty six residents responding to the survey form said that there are activities arranged by the home that they are able to take part in; five said that this was usually the
Knyveton Hall DS0000003952.V300654.R01.S.doc Version 5.2 Page 18 case; one said never, but that they liked the peace and quiet.’ The preinspection questionnaire submitted by the home details some of the activities available to residents, which include a library service, coffee mornings, exercise classes, day groups and day trips. Residents spoken with expressed a level of satisfaction with their lifestyle in the home and said that they were able to make choices about what they would like to do, be it listening to the radio in my room’ or ‘joining in with the exercise classes, which are great.’ It was evident from observation and discussion with some residents that due to their increased dependency levels they are unable to participate in some social events. Recording of individual social interaction will be important in evaluating and identifying the needs of these residents so that action plans can be devised to respond to and enhance their quality of life. Eighteen of the eighteen relatives / visitors to the home returning comment cards said that they are welcome to visit the home at any time. One resident spoken with said their visitors were always made welcome. One resident was enjoying a visit from a friend, whom they were entertaining in their own room. Residents’ views and choices were reflected in some of the care plans seen. and staff were observed offering residents choices at mealtimes. One resident commented that they do what they want, when they would like to. On the morning of the visit, some residents were having a lie in; others were enjoying a late breakfast. In-house care plans reflect people’s choices about the care that they receive. Individual rooms visited were personalised and residents spoken with expressed satisfaction regarding their own rooms. There was concern regarding those people who need some help with eating, as one resident needed help with a pureed diet and was left to try and eat on their own, but was making no progress and still had the food in front of them. This relates to the increase in dependency levels, which the home is experiencing (see Choice of Home, standard 4). Again this relates to the dependency levels of people living at the service and meeting these through caring and supportive structures. The deputy manager has looked at how the home can offer residents additional services, such as breakfast dining as a social event, so that people are encouraged to eat and enjoy a leisurely breakfast. People are offered a choice about what they would like to eat, when and where. On the day of the visit the home flexibly met residents preferences about when and what they like to eat. Thirteen residents responding to the survey said that they always like the meals, seven usually. One resident said that they were given a large portion and would prefer a smaller one. Tables in the dining room are attractively laid and people enjoyed the meal as a social event, when they can meet other residents and enjoy companionable time. A record of alternative meals provided is maintained. Knyveton Hall DS0000003952.V300654.R01.S.doc Version 5.2 Page 19 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. People living at the service, their relatives and friends are confident that their complaints will be listened and responded to. The home is planning training so that staff members are fully aware of abuse and the protection of residents is promoted. EVIDENCE: The home has started a complaints log, as recommended in the last inspection report. The complaints’ policy is displayed in the home. The pre-inspection questionnaire records no complaints in the last twelve months. Eleven people returning survey forms said that they know who to speak to if they wish to make a complaint, eleven said that this was usually the case. Fifteen relatives/visitors to the home said that they were aware of the home’s complaints procedure, three that this was not the case. There have been requirements in recent reports regarding the completion of POVA training for all staff. According to the summary record recently completed by the home thirteen staff members have previously undertaken adult protection training of the twenty care staff working in the home; this does not include ancillary and other staff. No training has been completed since the last inspection. The manager said that she had been talking to a training provider and hoped that this requirement would soon be met.
Knyveton Hall DS0000003952.V300654.R01.S.doc Version 5.2 Page 20 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. People living at Knyveton Hall live in an adequately maintained, comfortable environment. The home is pleasant and satisfactorily clean and hygienic. EVIDENCE: On the day of the visit all areas visited were maintained to a satisfactory level of cleanliness. There were no unpleasant odours in the home. Members of domestic staff seen and spoken with during the visit, were committed to providing a good standard of service and service users spoken with looked forward to seeing them each day. A requirement was issued following the last inspection regarding the completion of risk assessments regarding uncovered radiators in the home, which presented a risk of scalding. Since the last inspection one radiator cover has been fitted in the dining room. The manager confirmed that the risk
Knyveton Hall DS0000003952.V300654.R01.S.doc Version 5.2 Page 21 assessments would be reviewed in the colder weather, and appropriate action taken to ensure that all radiators do not present a risk of scalding. The laundry was visited during the course of the inspection. Staff members had been using the room to smoke cigarettes. The manager said that this is not allowed and will not be tolerated, due to the risk of fire and smoke near the laundry. Knyveton Hall DS0000003952.V300654.R01.S.doc Version 5.2 Page 22 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. From rosters seen and comments from residents, the numbers of staff on duty meets the needs of people living at Knyveton Hall. This will require monitoring and review according to the needs of residents accommodated. Improvements have been made in the home’s recruitment procedures; the manager expresses commitment to ensuring that policy and practices in the future fully comply with legal requirements. The home is making progress in identifying training needs; and planning future training required. EVIDENCE: A staff roster is maintained. Copies of rosters were forwarded to the Commission for Social Care Inspection prior to the visit to the home. Night cover had been omitted from the copy taken of the original and was completed by hand by the manager at the time of the visit, who said that the night duty cover does not vary. There is normally seven staff on duty in the morning, six in the afternoon and two staff on duty at night. On the home’s pre-inspection questionnaire, at the time of completion, no residents were identified as needing the support of two people at night. However, from the records of care
Knyveton Hall DS0000003952.V300654.R01.S.doc Version 5.2 Page 23 seen for one resident, two members of staff were now needed to provide support. At the time of the visit the manager said that one member of staff had a level 1 National Vocational Qualification (NVQ) in Care, four members of staff have a level two and four members of staff are currently taking an NVQ of the twenty care staff working in the home. This is in addition to the level 4 qualifications held by the care manager and deputy manager in the home. Since the last inspection visit the deputy manager said that she has attended training regarding the implementation of the Skills for Care induction programme. She has worked hard to produce an induction programme, which, she confirms, is in line with the standards. The documents produced are very detailed and the deputy manager said that the programme reflects the needs of the home, and allows the service to support and track the progress of new care staff starting work. A brief record of induction commenced was recorded on one file seen. The undertaking of pre-employment checks has been a repeated requirement; the home has partially complied with this issue. Two recruitment files were seen for members of staff who had recently started work at the service. POVA First checks and Criminal records Bureau checks had been received for both members of staff, which the manager confirmed were received prior to the staff members starting work. Copy of proof of identity and a photograph was not in place on one of the files seen. Both files had one, rather than the two, required written references. The manager said that she had taken a verbal reference for one of the employees, which was recorded at the time of the visit. The home has complied with a requirement to make recruitment records available for inspection at all times. Since the last inspection to the home a summary record of completed training has been devised so that training needs can be identified and future training planned. From the details given and discussion with the manager training in mandatory areas of practice is being organised for the coming months. Knyveton Hall DS0000003952.V300654.R01.S.doc Version 5.2 Page 24 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. A team of senior staff, led by the Registered Manager, Mrs Coggins, manages the home. Currently the management team are making progress in addressing requirements issued in previous reports and in consultation with social care professionals need to work to ensure that the management structure can effectively meet the needs of those residents with complex care needs. The home participates in quality assurance exercises to ensure that the service is run in the best interests of residents. The home makes efforts to ensure that the financial interests of residents are safeguarded. Staff members are appropriately receiving supervision. Knyveton Hall DS0000003952.V300654.R01.S.doc Version 5.2 Page 25 Progress has been made since the last inspection to ensure that the health, safety and welfare of residents are promoted and protected. EVIDENCE: Currently the home has a management team led by Mrs Coggins, the registered manager; Linda Walker, deputy manager and Mary Partovi, care manager. Both deputy, and care manager, holds qualifications to NVQ level 4 in care. The deputy manager holds a management qualification. The increase in the level of needs of some residents has impacted upon the need for management in the home to introduce structures of care, which recognise, understand and respond to these residents needs. Since the last visit to the home hard work has put into place a fundamental recording system, which now requires implementation and the involvement of all staff members, so that it effects outcomes for people living in the home. At the time of the visit the manager reported that staff members feel demoralised by the last inspection report. There has also been a report of staff members raising voices with each other. It is important that the management team lead the foundation of progress that has already been achieved forward, that the contribution of each staff member to this progress is recognised, and that focus is maintained upon providing a positive, qualitative and responsive service to people living in the home. Following the inspection the deputy manager outlined motivational questionnaires she has devised to involve staff and make them feel valued for the hard work that they carry out. The service distributed resident survey forms, and other comment cards, provided by the Commission for Social Care Inspection (CSCI) prior to this visit. A completed pre-inspection questionnaire was also returned before the inspection, providing information about the service. The deputy manager confirmed that staff meetings regularly take place and minutes are taken. She also confirmed that there were plans in place to conduct an in-house survey of people’s views at a suitable time, given the recent survey undertaken on behalf of CSCI. The home holds some monies on behalf of two residents accommodated, which are paid into the home’s account. This is undertaken to support the residents. The manager is endeavouring to resource a suitable means of either relinquishing this responsibility or making arrangements for it to be paid into an account in the residents’ own names. Monies held on behalf of residents and the double signatures of staff and residents’ signatures, support records of any expenditure. Receipts of any monies spent on behalf of residents are retained and a separate record completed; one copy being issued to the resident. Knyveton Hall DS0000003952.V300654.R01.S.doc Version 5.2 Page 26 A policy has been produced regarding bequests to staff, demonstrating that the home is safeguarding the financial interests of service users. Staff files seen showed evidence of ongoing supervision. Issues relating to disciplinary matters had also been recorded on individual files. It was advised that a summary record of supervision is completed so that all staff members undertake the minimum of six formal supervision sessions each year. The home has submitted details of the maintenance of equipment in the preinspection questionnaire. The service has completed a summary of staff training currently completed and has identified mandatory areas of training, which require updating, which include manual handling, health and safety and infection control. The manager confirmed that manual handling training has been arranged with Bournemouth Borough Council; four staff members are currently undertaking an infection control course. Three staff members have currently undertaken a course in first aid. During the tour of the home’s environment it was noted that a bottle of bleach had been left in a downstairs toilet. This was drawn to the attention of the manager, who confirmed that it would be safely stored. It was also noted that staff members had been smoking in the laundry. (See The Environment.) Safety footplates are now applied to wheelchairs. It was advised that a risk assessment be completed where a resident chose to sit in a chair without the plates. Knyveton Hall DS0000003952.V300654.R01.S.doc Version 5.2 Page 27 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 X 1 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 X X X X X 3 2 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 X 2 3 X 2 Knyveton Hall DS0000003952.V300654.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes 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 Following assessment, written confirmation must be given to a resident that Knyveton Hall is able to meet their assessed needs. (Previous timescale of 31/08/05 not met.) The timescale of 30/04/06 issued at the last inspection has been extended, as compliance could not be evidenced at this inspection. Staff must receive training with regard to assessing, monitoring and responding to residents’ specific needs. This must include understanding the nature of conditions; enabling staff to have insight into the physical and mental needs of people with a debilitating healthcare need. From this an empathetic and person centred approach to assessing needs, planning care and reporting and monitoring changes, will ensure that people’s needs are fully met and responded to.
DS0000003952.V300654.R01.S.doc Timescale for action 1. OP3 14 31/08/06 2. OP4 12 & 18 31/08/06 Knyveton Hall Version 5.2 Page 29 A care plan must be in place for each resident that gives clear guidance to staff on the actions to be taken to meet residents health and welfare needs. (Previous timescale of 30/09/05,31/05/06 not met.) 3. OP7 15 Progress has been made by the home in meeting this requirement. Care plans must be written in a way, which is respectful of residents. All falls occurring in the home must be recorded as accidents; the accident reports must be monitored and any actions to minimise risks must be reflected in residents’ risk assessments and care plans. 4. OP7 13 & 15 (Previous timescale of 30/04/06 not met.) Progress has been made in meeting this requirement. Records of accidents must be stored on individual files. Pressure sore risk assessments must be undertaken for all service users; nutritional risk assessments must be completed; any other actual or potential risks must also be identified and a thorough risk assessment process undertaken. From the outcomes of assessments appropriate action must be taken; including, where necessary, the monitoring of service users weights and their
Knyveton Hall DS0000003952.V300654.R01.S.doc Version 5.2 Page 30 31/08/06 31/07/06 5. OP7 12(1)(a), 13(4)(c) 15/07/06 food and fluid intake; referral to the multi-disciplinary team and a plan of care put in place to meet needs and reduce risks. This requirement was issued in a letter of serious concern following the inspection with a timescale of 29/06/06. This timescale has been extended to support the home to satisfactorily achieve compliance. A requirement regarding the monitoring of nutritional needs, including food and fluid intake was issued in the last report with a timescale of 15/07/06. (The service has confirmed immediate action to respond to this issue.) 1. The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received in the care home including: a) The system for administering additional medicines not supplied in cassettes must be reviewed and the audit trail for medicines must provide robust evidence that medicines are given as prescribed and recorded. Regular management checks to monitor this and any follow up action taken should be recorded. b) Details of any medicine sensitivity or ‘none known’ should be included on or with the MAR chart. c) There must be a risk
DS0000003952.V300654.R01.S.doc 6. OP9 13 31/07/06 Knyveton Hall Version 5.2 Page 31 assessment that is regularly reviewed for each resident who selfmedicates and staff must record the quantity and date when a medicine is supplied to them to assist with monitoring and review. All staff must receive training in the Protection of Vulnerable Adults. (Previous timescale of 31/12/05 not met.) 7. OP18 18(1) The timescale of 30/06/06 for meeting this requirement has not lapsed. This has been extended to support the home to achieve full compliance. Recruitment procedures must ensure that the information as listed in Schedule 2 is obtained, specifically: 1. Two written references Previous timescales of 01/07/04, 31/03/05, 31/07/05, 04/03/06 not met. 8. OP29 19 This was issued as an immediate requirement during the inspection visit on 15/06/06. Failure to comply with this requirement may result in enforcement action being taken. The home has satisfactorily complied with the remainder of this requirement. 29/06/06 31/07/06 Knyveton Hall DS0000003952.V300654.R01.S.doc Version 5.2 Page 32 9. OP35 20 Monies received by the service into the home’s account must be paid into an account in the name of the service user. The account must not be used by the registered person in connection with operating the home. (Previous timescales of 30/04/06 not met.) Updating of mandatory training in safe working must support safe practice; staff members must not smoke in the laundry and hazardous substances must be securely stored. 31/08/06 10. OP38 18 30/09/06 Knyveton Hall DS0000003952.V300654.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 OP9 Good Practice Recommendations The home should follow guidance from the Royal Pharmaceutical Society including: a) Updating the medication policy with the recommended additions (see guidance provided). b) Medicines not in the monitored dosage cassettes should be administered from the labelled pack they were supplied in. They should not be added to the cassettes for another carer to give, as they will not have access to the doctor’s directions on the label. c) When medicines are handwritten on the MAR chart a second competent person should check the details are accurate and countersign. d) Keeping residents’ medication profiles up to date with any changes. e) Having a CD record book and appropriate storage for CDs. f) Monitoring and recording the maximum and minimum temperature (normal range 2-8°C) of the refrigerator used to store medicines daily when in use. A record of individual social interaction should be maintained so that the social needs of residents can be monitored and any needs identified and responded to, to improve quality of life. 2. OP12 Knyveton Hall DS0000003952.V300654.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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