CARE HOMES FOR OLDER PEOPLE
Knyveton Hall 34 Knyveton Road East Cliff Bournemouth BH1 3QR Lead Inspector
Anne Weston Unannounced 18 July 2005 13:45 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 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 D55 S3952 Knyveton Hall V227773 180705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Knyveton Hall Address 34 Knyveton Road, East Cliff, Bournemouth, Dorset, BH1 3QR Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01202 557671 NA NA Alan Coggins Limited Mrs Elaine Margaret Coggins Care Home only 39 Category(ies) of OP - 39 registration, with number of places Knyveton Hall D55 S3952 Knyveton Hall V227773 180705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 25 October 2004 Brief Description of the Service: Knyveton Hall is situated between Bournemouth and Boscombe close to Boscome town centre and a short drive from the sea front. Bournemouth town is approximately two miles away from the home. There is limited 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 Certificate of Registration has been re-issued to reflect accurate registration of Knyveton Hall as a Limited Company. The previous Certificate of Registration did not detail the correct registration information in respect of the Company. The home is arranged over four floors containing 35 single rooms and 2 double 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 does not offer care to people who have high dependancy needs in relation to their mobility, the home does not therefore use any hoisting equipment to assist with mobility.
Knyveton Hall D55 S3952 Knyveton Hall V227773 180705 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection was carried out on the 18th July 2005 and took a total of 6 hours. The inspector was made to feel welcome, Mrs Coggins, the deputy manager and the care manager made themselves readily available throughout the inspection. This was a statutory inspection and was carried out to check that the 37 people who were living at Knyveton Hall were safe and properly cared for. The premises were inspected and records were examined. Time was spent in discussion with residents, management and staff. Three residents sitting out at the front entrance were spoken with as a group, ten residents were spoken with or observed as a group in the lounge. Eight residents were spoken with individually, five in the privacy of their rooms. Comment cards were made available for use, seven were received back from relatives and one was received back from a community nurse. What the service does well:
Knyveton Hall offered a homely, relaxed and friendly atmosphere. Comments from residents included “I find it quite homely I couldn’t expect better”; “Taking all round it’s nice here” and “Generally speaking they will do anything for you, I can recommend this place to anybody”. The home communicated effectively with health care professionals to ensure that resident’s health care needs were met. Knyveton Hall was well staffed with a stable staff group, residents said they appreciated the relaxed and friendly approach of staff. Flexibility of lifestyle was encouraged, residents had the opportunity to choose their own way of living in the home. The activities programme offered residents participation with a range of pursuits to meet their needs and interests, both collectively and individually. Open visiting arrangements were in place, residents were able to maintain contact with visitors as they wished. All relatives comment cards demonstrated satisfaction with overall care provision. A choice of nutritious meals was available, with individual preferences catered for. Positive comments about the food were received from residents. Discussion with staff and residents and observation demonstrated that people felt management were approachable and accommodating. Overall this was a positive inspection in terms of good outcomes experienced by residents. Knyveton Hall D55 S3952 Knyveton Hall V227773 180705 Stage 4.doc Version 1.30 Page 6 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. Knyveton Hall D55 S3952 Knyveton Hall V227773 180705 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Knyveton Hall D55 S3952 Knyveton Hall V227773 180705 Stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3. Standard 6 is not applicable as the home does not offer intermediate care. The home did not always carry out, or obtain, a documented assessment of need before residents moved into the home. Without this there is no assurance that care needs will be met. EVIDENCE: The care files of four residents were examined. Assessments were in place but some assessments had been carried out, or obtained, after the person had moved into the home. This meant the home had not given written confirmation to all prospective residents to establish that needs had been assessed and could be met. Discussion with management was held around best practice of assessment with prospective residents where distance precluded a representative of the home from visiting and carrying out an assessment. In these circumstances information must be gathered, with permission from the potential resident, from all relevant people involved, including health and social care professionals. Knyveton Hall D55 S3952 Knyveton Hall V227773 180705 Stage 4.doc Version 1.30 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 10 Not all residents had a care plan to effectively provide staff with the information they needed to meet resident’s needs. The home communicated effectively with health care professionals to ensure that resident’s health care needs were met. Residents felt they were treated with respect, the staff approach was familiar and good humoured. EVIDENCE: The care files of four residents were examined. Reviews of care had been carried out and were up to date. One resident had a recent review of care carried out but did not have a care plan in place. Risk assessments were in place but these did not always demonstrate the involvement of the resident. Some risk assessments were not dated and did not evidence who had carried out the risk assessment process. It was clear that care staff received a lot of information on the care needs of residents verbally. Two members of staff who were spoken with said management gave them good verbal information about the care needs of residents. Good daily recording was maintained with changes or significant events well documented. The arrangements in place at the home ensured that each resident received the necessary health care input, as required. It was evident from discussion with management and residents and looking at the care records that residents
Knyveton Hall D55 S3952 Knyveton Hall V227773 180705 Stage 4.doc Version 1.30 Page 10 received appropriate nursing care from the community nursing service and received specialist optical and chiropody services. The comment card received back from a community nurse demonstrated satisfaction with the overall care provided to residents. Staff were observed to be interacting with residents in a friendly and caring manner. Comments from residents included “I’m looked after like a relation” and “Staff are good friends”. It was clear from the time spent with residents that they felt comfortable and relaxed with staff and appreciated their friendly approach. Knyveton Hall D55 S3952 Knyveton Hall V227773 180705 Stage 4.doc Version 1.30 Page 11 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 standard(s) 12, 13, 14 and 15 Residents had the opportunity to choose their own lifestyle within the home, this meant their individual preferences and routines were respected. The activities programme offered residents participation within a range of pursuits to meet their needs and interests. Open visiting arrangements were in place, residents were able to maintain contact with visitors as they wished. Dietary needs of residents were well catered for with a balanced and varied selection of food available that met resident’s tastes and choices. EVIDENCE: Observation and discussion with residents demonstrated they chose their own lifestyles within the home, according to their individual preferences. Some organised activities were provided and individual recreational pursuits were promoted. A mobile library visited the home regularly and had been present in the morning on the inspection day. There was a piano in the main lounge, this was used for musical entertainment. A hairdresser was also regularly available for optional use within the home. Some residents had recently had a manicure. Opportunity for religious observance was offered, various clergy visited the home. One resident said that when they wished to attend their place of worship, Mrs Coggins personally took them. One resident said they enjoyed attendance at the coffee morning in the church hall. Comment was received from residents that they enjoyed the company of the staff group.
Knyveton Hall D55 S3952 Knyveton Hall V227773 180705 Stage 4.doc Version 1.30 Page 12 Residents were permitted to smoke outside the building, residents were observed enjoying a cigarette together outside the front entrance. Contact with residents confirmed that the home operated an open visiting policy. The home welcomed visitors and fully involved them with life in the home, in accordance with resident’s wishes. Visitors were made welcome to stay for lunch. Examination of the food record book and contact with residents demonstrated that the home provided a varied, wholesome and nutritious diet which a choice of menu. Individual preferences were catered for. Positive comments were received about the food including “Food very good”; “Food fairly good” and “Meals are very good”. Food supplies were observed to be plentiful. The food record book did not demonstrate the provision of alternative meal preferences. Knyveton Hall D55 S3952 Knyveton Hall V227773 180705 Stage 4.doc Version 1.30 Page 13 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 standard(s) 18 Not all staff had received proper training in adult protection issues. The policy and procedures alone did not ensure residents were fully protected from abuse. EVIDENCE: The home has an adult protection policy in place. Not all staff had received proper training in the Protection of Vulnerable Adults (POVA). This was evidenced from discussion with management and examination of staff training records. Mrs Coggins said she had asked all staff to read the POVA and No Secrets information but there was no evidence to demonstrate that staff had a good understanding on how to recognise abuse, and of the need to report abuse through Local Authority procedures. Staff have not reported any incidents of abuse. It was clear that management would take any incident of abuse seriously and that they would act to investigate any reported abuse. It was not clear that systems were in place to make adult protection referrals through the Local Authority. The Department of Health practical guide for the protection of vulnerable adults in care homes was sent to Knyveton Hall following the inspection. Knyveton Hall D55 S3952 Knyveton Hall V227773 180705 Stage 4.doc Version 1.30 Page 14 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 standard(s) 19 and 26 Residents live in a safe, homely, comfortable and clean environment with their own belongings around them. EVIDENCE: Inspection of the premises demonstrated that routine maintenance and refurbishment work was being implemented. Improvements had been made in the two ground floor lounges. There were new chairs in the main lounge and a new carpet had been laid in the smaller lounge. Residents did not generally use the basement lounge. Dorset Fire and Rescue Services carried out an inspection of the premises on 9 February 2005, the fire precautions were being satisfactorily maintained. The premises were clean and free from unpleasant odours, laundry facilities were satisfactory. Five domestic staff and one laundry assistant were employed. Knyveton Hall D55 S3952 Knyveton Hall V227773 180705 Stage 4.doc Version 1.30 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 There were sufficient staff to meet the needs of residents. Practices in relation to recruitment needed improvement as residents were potentially placed at risk through lack of protection. The staff training and development programme has yet to be completed, this meant a lack of structure to ensure staff were trained to do their jobs. EVIDENCE: Discussion with staff and observation throughout the inspection demonstrated there was a sufficient number of staff to meet the needs of residents. Residents who were spoken with felt there were enough staff, they said staff gave a good response to the call bell if they called for assistance. There was no formal recorded staff rota, the current staff rota was written on the back of an envelope. Management said the home operated a shift system from 7.30am to 2.00pm, 2.00pm to 9.00pm and a night shift from 9.00pm. The home aims to have six care staff on duty in the mornings and afternoons. At night the aim is for one waking night member of staff with two night staff oncall. Mr and Mrs Coggins and two care staff live on the premises. One staff file was examined. There was no application form, Mrs Coggins gave an assurance that an application form had been completed but could not find it. The POVA First check had not been received by the home until five months after the member of staff had commenced employment. The Criminal Records Bureau check had not been received by the home until 6 months after the member of staff had commenced employment. There were no references obtained for the member of staff.
Knyveton Hall D55 S3952 Knyveton Hall V227773 180705 Stage 4.doc Version 1.30 Page 16 Residents who were spoken with expressed their confidence in the ability of the staff. Staff who were spoken with confirmed their training had included moving and handling, personal hygiene and skin care. Mrs Coggins confirmed there was no structured staff training and development programme in place. Knyveton Hall D55 S3952 Knyveton Hall V227773 180705 Stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36 Informal supervision arrangements were in place, supervision must be formalised to demonstrate monitoring of staff performance. EVIDENCE: Mrs Coggins has overall responsibility for the day-to-day running of Knyveton Hall. She is supported by a deputy manager and a care manager. The care manager had obtained the NVQ Level 4 in Care and is now studying for the Registered Managers Award. The deputy manager is awaiting certification of the Registered Managers Award and is studying for the NVQ Level 4 in Care. Discussion with staff and residents and observation demonstrated that people felt management were approachable and accommodating. Contact with staff and observation through the inspection demonstrated that staff received a high level of informal day to day support. Examination of staff files demonstrated that formal recorded supervision was not being regularly maintained.
Knyveton Hall D55 S3952 Knyveton Hall V227773 180705 Stage 4.doc Version 1.30 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 1 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 x 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 1 x x x x x 2 x x Knyveton Hall D55 S3952 Knyveton Hall V227773 180705 Stage 4.doc Version 1.30 Page 19 YES 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 3 Regulation 14 Requirement The home must either carry out a proper assessment with a resident, or obtain a health and social care assessment summary, before a resident moves into the home. Following assessment, written confirmation must be given to a resident that Knyveton Hall is able to meet their assessed needs. 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. All staff must receive training in the Protection of Vulnerable Adults. Recruitment procedures must ensure that the information as listed in Schedule 2 is obtained, specifically: 1. Two written references 2. When a staff member needs to be recruited immediately Knyveton Hall must obtain a POVA First check, pending the result of the full Criminal
Knyveton Hall D55 S3952 Knyveton Hall V227773 180705 Stage 4.doc Version 1.30 Page 20 Timescale for action 31/08/05 2. 3 14 31/08/05 3. 7 15 30/09/05 4. 5. 18 29 18(1) 19 31/12/05 31/07/05 Records Bureau (CRB) check before conditional employment is confirmed. 3. CRB checks must be routinely obtained for all staff before they commence employment in the home. Previous timescales of 01/07/04 and 31/03/05 not met. Failure to comply with this requirement may result in enforcement action being taken. An action plan must be submitted to the Commission detailing the arrangements for 50 of staff to be trained in National Vocational Qualification Level 2 by 31/12/05. Previous timescale of 31/03/05 not met. The training and development plan must be completed to ensure there is a proper structure in place so that care staff are trained to do their jobs. All care staff must receive regular formal recorded supervision. 6. 28 18(a) 30/09/05 7. 30 18 30/11/05 8. 36 18(2) 31/12/05 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. 2. 3. Refer to Standard 7 15 22 Good Practice Recommendations Risk assessments should be routinely dated and should demonstrate the involvement of the resident, and evidence who has carried out the risk assessment process. Recording in the food record book should provide information on the alternative meal provided where a resident did not choose to have the main menu meal. An assessment of the premises should be carried out by an Occupational Therapist. This recommendation has been carried forward from the previous inspection.
D55 S3952 Knyveton Hall V227773 180705 Stage 4.doc Version 1.30 Page 21 Knyveton Hall 4. 27 5. 35 A formal recorded staff duty rota should be maintained. The staff rota should record any changes made so accurate information is held to demonstrate the hours worked by staff. Where residents are not signing for receipt of their allowances, two members of staff should sign. This recommendation has been carried forward from the previous inspection. Knyveton Hall D55 S3952 Knyveton Hall V227773 180705 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 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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