Inspection on 25/05/06 for The Knells Country House

This inspection was carried out on 25th May 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Knells Country House 20/11/05

The Knells Country House 26/04/05

The Knells Country House 10/11/04

The Knells Country House 26/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE The Knells Country House The Knells Houghton Carlisle Cumbria CA6 4JG Lead Inspector Mrs Margaret Drury Unannounced Inspection 25th May 2006 09:50 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 The Knells Country House DS0000059723.V291291.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. The Knells Country House DS0000059723.V291291.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Knells Country House Address The Knells Houghton Carlisle Cumbria CA6 4JG 01228 526496 01228 514872 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) Mrs Amanda Farrer Mrs Amanda Farrer Care Home 23 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (23) of places The Knells Country House DS0000059723.V291291.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 23 service users to include: - up to 23 service users in the category of OP (Older people, not falling within any other category) - up to 5 service users in the category of DE(E) (Dementia over 65 years of age) The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 20th November 2005 2. Date of last inspection Brief Description of the Service: The Knells House is owned and operated by The Knells Country House Ltd. and run on a day-to-day basis by Mrs. Amanda Farrer, a partner of the company. The home is situated on the outskirts of the village of Houghton, approximately seven miles from the city of Carlisle. The Home is an older property, which has been adapted for its present use. The accommodation for service users is on two floors and access between the floors is by passenger lift or stair lift, as well as a staircase. The bedrooms are mainly for single occupancy, but there are three bedrooms that can be used by two people sharing. There are two communal lounges and one dining room. There are toilets and bathrooms equipped to assist people with a disability. There are spacious, pleasant gardens surrounding the home with seating areas. There is a car park. The Knells Country House DS0000059723.V291291.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that took place over two half days in May. The registered manager was on duty on the second day of the inspection and was available to assist the inspector during the visit. On the first morning the senior carer on duty assisted the inspector. During the inspection, time was spent talking with the manager, the senior carer, care staff on duty and the cooks. The inspector was also able to speak with residents and a visitor who had brought her dog in to the home also. The inspector also spent time looking at records to do with the day-to-day running of the home and the care of residents. The report refers to “case tracking”, a process by which the inspector is able to focus on a small number of residents and includes a review of their care documentation. It should be noted that this process is not detrimental to the other residents living in the home Time was spent with some of the residents individually and in groups, and most parts of the home were looked at. The fees in this service range from £363.00 - £425.00 per week as at April 2006. There is a charge for hairdressing. What the service does well: All prospective residents have an in-depth assessment before moving into the home to ensure all individual needs can be met. A complete care planning system is in place and those residents who wish, are involved in the process and sign the monthly review forms. The care staff are given all the information they need to deliver a high level of care and meet the assessed needs. All healthcare needs are met and there is an up to date record of professional healthcare visits and appointments documented in the care plan file. Arrangements are made for residents to have access to chiropody, optical services and dental treatment. The Knells Country House DS0000059723.V291291.R01.S.doc Version 5.2 Page 6 There is a limited programme of organised activities for residents to join in if they wish, and Holy Communion is offered to those who want to partake. Catering staff make every effort to ensure that a nutritious and varied menu is provided with a choice provided at all meals. 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. The Knells Country House DS0000059723.V291291.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection The Knells Country House DS0000059723.V291291.R01.S.doc Version 5.2 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 the following standard(s): 2, 3 & 5 The quality in this area is good. This judgement was made using the available evidence including a visit to the service. Admissions to the home only take place if the manager is confident staff have the skills, ability and qualifications to meet the assessed needs. Each resident is provided with a contract and terms and conditions that set out in detail the facilities the home provides. EVIDENCE: All prospective residents are fully assessed prior to admission to ensure the home is able to meet the assessed needs. Information obtained from this assessment is then used as a basis for the plan of care. All residents have a contract and also a copy of the terms and conditions of residency. Copies of these documents are held on each file. All those wishing to move in are invited and encouraged to visit the home to meet the staff and other residents and to enjoy a meal and/or refreshments. This also gives opportunity to view the accommodation provided. The Knells Country House DS0000059723.V291291.R01.S.doc Version 5.2 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 the following standard(s): 7,8, 9, 10 & 11 Quality in this outcome area is good. This judgement was made using available evidence including a visit to the service. Residents health, personal and social cares needs are addressed in the care plans and care needs are met effectively. The home works to an efficient medication policy supported by procedures and practice guidance. Residents are treated with dignity and respect at all times. EVIDENCE: All residents have a plan of care that is generated from the initial assessment. The documentation for the care planning system has now been completed and the inspector was able to case track 4 of the care plans during the visit. They were all found to be up to date and contain a wealth of information to assist the care staff in the delivery of care. The care plans are updated monthly using the information contained in the daily record that is completed by the care staff. Those residents who wish to be are involved in the care planning process as are family members. The Knells Country House DS0000059723.V291291.R01.S.doc Version 5.2 Page 10 All professional healthcare visits are recorded in detail and the manager and senior carer confirmed that they have a very good working relationship with the doctors and district nurses that visit the home. There are currently two residents who need daily visits from the district nursing service. The medication is received in a monitored dosage system and all the care staff responsible for giving out the medication have completed training in “safe handling of medication”. Records were checked and found to be in order. Residents who spoke with the inspector said that the staff always treated them with respect and kindness and that all personal care is given in the privacy of their own rooms. The policy for handling the death of a resident is clear, with residents’ wishes, wherever possible, recorded on the care plans. The Knells Country House DS0000059723.V291291.R01.S.doc Version 5.2 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 the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement was made using available evidence including a visit to the service. The routines of the home are planned around the residents’ needs and wishes. The home encourages residents, wherever possible, to take control of their lives and participate in the running of the home through the resident’s committee. Experienced cooks are responsible for providing good quality nutritious meals that meet the dietary needs of the residents. EVIDENCE: Discussions with the residents evidenced that they all have control over their lives. They can rise when they want to and retire when they wish. Some of the residents were in their rooms during the inspection, whilst others were enjoying conversations in the lounges. Those who spoke with the inspector said, “we can do what we like “ and “ the staff let us please ourselves”. There is a limited programme of activities based on what the residents like to do. Some group activities are organised such as bingo or “memories”. The residents like going out in the home’s minibus, the favourite being to the local garden centres for a look around and a cup of coffee. Visitors are welcome at anytime and are always made welcome. The inspector was able to speak with a visitor who expressed how much she appreciated the The Knells Country House DS0000059723.V291291.R01.S.doc Version 5.2 Page 12 care and support given to her mother. She had brought her dog in to visit her mother and other residents who were sitting in one of the lounges. Residents’ religious needs are met through regular visits from the local clergy and the provision of Holy Communion. One of the ladies goes to a weekly meeting at her Church on Wednesday morning as often as she is able. The home works to a 4-week menu that provides a well-balanced and nutritious menu. The inspector was able to observe lunch being served in an unhurried and relaxed manner. Those residents who spoke to the inspector said how much they enjoyed their meals. Special diets can be catered for and soft diets are provided for those who need them. The Knells Country House DS0000059723.V291291.R01.S.doc Version 5.2 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 the following standard(s): 16, 17 & 18 Quality in this outcome area is good. This judgement was made using available evidence including a visit to the service. The home has a complaints procedure in place that is clearly written and easy to understand. Training in the area of protection is arranged and staff are aware of the procedure to follow. Residents are made aware of their rights and their ability to access places of worship and community facilities of their choice. EVIDENCE: The home has a complaints policy in place and a book to record any complaints and concerns. There have been none to record since the last inspection. Those who spoke with the inspector were aware of the procedure and said they “would speak to Amanda” (manager) if they had any problems. Although very few of the residents were interested in voting in the recent elections the staff did discuss it with them and arranged for postal votes for all who wanted them. Discussions with the staff evidenced that they were all aware of adult protection issues. Staff had completed training in this subject and it is also covered in the NVQ courses. The Knells Country House DS0000059723.V291291.R01.S.doc Version 5.2 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 the following standard(s): 19, 20, 22, 24, 25 & 26 Quality in this outcome area is good. This judgement was made using available evidence including a visit to the service. The home offers very comfortable, homely accommodation and all areas are well maintained. This contributes to a good quality of life for the residents. The home provides aids and equipment to meet the care needs of the residents. EVIDENCE: This home has a very good environmental standard with good quality furniture and fittings. The manager conducts regular inspections of the home and notes any repairs that may be required. Much of the home has been refurbished to include carpets and curtains and many of the bedrooms have also been redecorated. There is ample communal space with the dining room and three lounges. There are well kept gardens with garden furniture for the residents to enjoy during the warm weather. The Knells Country House DS0000059723.V291291.R01.S.doc Version 5.2 Page 15 Nine of the bedrooms have en-suite toilet facilities and there are sufficient communal toilets and bathing facilities to meet the needs of those living in the home. The bedrooms are all suitable for their purpose and are personalised with photographs and ornaments. The home has specialist equipment for those residents requiring them. These include, handrails on corridors, assisted bathing, raised toilet seats and hoists. All of these facilities ensure the residents live in safe, comfortable and suitable surroundings. Domestic arrangements in the home ensure that it is kept clean and the risk of cross infection is kept to a minimum by the staff adopting good practices. The Knells Country House DS0000059723.V291291.R01.S.doc Version 5.2 Page 16 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 good. This judgement was made using available evidence including a visit to the service. Staffing arrangements are good ensuring the needs of the residents are met. Staff are well trained (having completed the required training) and provide a skilled and experienced workforce. EVIDENCE: The staffing arrangements in this home are good with 3 members of care staff plus the manager during the day and 2 waking staff at night. There are also catering and domestic staff on duty during the day. The staff team is both experienced and qualified with many already qualified to NVQ level 2 or above and others working towards the awards. One carer is hoping to qualify as an NVQ assessor and another is going to become a trainer for lifting and handling. The inspector was able to observe the staff and found their attitude to be caring, supportive and enabling. This attitude ensures that the residents can maintain as much independence for as long as possible. The Knells Country House DS0000059723.V291291.R01.S.doc Version 5.2 Page 17 There is a full recruitment and selection process that ensures all the legal checks are completed prior to new staff starting work. This ensures the safety and security of the residents. There is a very low staff turnover and those living in the home benefit from knowing they are cared for by a stable staff team that they are familiar with and have confidence in. There is a good staff training and development programme in place and staff are currently completing a 16 week course in dementia care. The inspector was shown a copy of one of the workbooks used in the course. The Knells Country House DS0000059723.V291291.R01.S.doc Version 5.2 Page 18 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 good. This judgement was made using available evidence including a visit to the service. The manager has the required qualifications and experience and is competent to run the home. She works continuously to ensure a high quality of life for the residents. She is resident focused and leads and supports a strong staff team. The home has sound policies and procedures that are reviewed and updated on a regular basis. EVIDENCE: Discussions with the registered manager confirmed her commitment to giving the highest level of care to the residents. She works closely with the staff team to ensure all the assessed needs are met. She is well qualified, and has considerable experience in the care and support of older people. During the The Knells Country House DS0000059723.V291291.R01.S.doc Version 5.2 Page 19 inspection she demonstrated clear lines of responsibility and delegation to the senior care team but also provided a “hands on approach” when necessary. Discussions with the residents and staff evidenced that she ensures the home is run in the best interest of the residents and that all appreciated the fact that that could enjoy a laugh and joke with her. All staff supervision and appraisals are up to date with records held on staff files. There are procedures in place to ensure that residents’ personal finances are safeguarded even though the families are ultimately responsible for residents’ personal monies. The home has a full set of policies and procedures in place and the manager is always looking at ways to ensure these are kept completely up to date. A review of all policies is due to start within the next couple of weeks. Record keeping is of a high standard, which safeguards the residents. The manager is responsible for health and safety and all fire safety procedures are in place. She ensures that fire drills and fire safety equipment are tested on a regular basis. All risk assessments are in place and reviewed at the same time as the care plans. The Knells Country House DS0000059723.V291291.R01.S.doc Version 5.2 Page 20 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 3 3 X 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 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 3 18 3 3 3 X 3 X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 The Knells Country House DS0000059723.V291291.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Knells Country House DS0000059723.V291291.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP 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 The Knells Country House DS0000059723.V291291.R01.S.doc Version 5.2 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!