CARE HOMES FOR OLDER PEOPLE
The Knells Country House Houghton Carlisle Cumbria CA6 4JG Lead Inspector
Elaine Brayton Unannounced 26 April 2005 10:15 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. The Knells Country House F58 F10 s59723 The Knells v220766 260405 ui Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service The Knells Country House Address Houghton Carlisle Cumbria CA6 4JG 01228 526496 01228 514872 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) Mrs Amanda Farrer M Farrer Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) including up to five (5) people with of places dementia. The Knells Country House F58 F10 s59723 The Knells v220766 260405 ui Stage 4.doc Version 1.30 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 and up to 5 people with dementia in the category DE/E 2) The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Date of last inspection 10/11/04 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 F58 F10 s59723 The Knells v220766 260405 ui Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection of the home, and took place over one day. During the inspection time was spent talking with the manager and care staff on duty, looking at records to do with the day to day running of the home and the care of residents. Time was spent with of the residents individually and in groups, and all parts of the home were looked at. What the service does well: What has improved since the last inspection?
Since the last inspection a great deal of refurbishment work has taken place, many of the bedrooms have been decorated, with new carpets and furniture purchased. Comfortable chairs had been purchased for the smaller lounge, and there were plans to replace other furniture in the communal areas, replace carpets and re-decorate. A new ramp had been built and was almost complete, which greatly improved the access to and from the home and garden area. The home had purchased a mini bus, and this was used to take residents on outings, individually and in small groups. It was also used to take people for appointments and shopping. Extra staff had been recruited since the last inspection, which provided more flexibility in covering for holidays and sickness. The Knells Country House F58 F10 s59723 The Knells v220766 260405 ui Stage 4.doc Version 1.30 Page 6 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 F58 F10 s59723 The Knells v220766 260405 ui 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 The Knells Country House F58 F10 s59723 The Knells v220766 260405 ui 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) 1, 3, 4 & 5 The homes Statement of Purpose and Service Users Guide was very informative, and provided service users and prospective service users with details of the services the home provides so that an informed decision can be made about admission to the home. EVIDENCE: The Statement of Purpose is in the reception area of the home, available for anyone who wishes to read it. This document contained very useful information about the care and services the home provides. There is a clear admission procedure to the home, which included a full assessment of need being carried out to ensure the home could adequately meet the person’s needs. Residents said that their visitors are always made welcome when visiting them and they were offered a cup of tea or coffee. People could visit the home at any reasonable time. The Knells Country House F58 F10 s59723 The Knells v220766 260405 ui 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, 9 & 10 The home had a clear and consistent care planning system, which ensured residents health, and social care needs were met in a way that promoted their privacy and dignity. EVIDENCE: The care plans contained information about residents care needs, including moving and handling needs, they were regularly reviewed and updated with the resident. The plans provided the care staff with the information they needed to meet resident’s needs. Records were kept about GP appointments and when district nurses visited, and people said that an appointment was made for them if they asked to see the doctor or nurse. The arrangements for storing and administering medication in the home were safe and well organised, and residents received their medication as prescribed, with records kept. The care staff spoke to residents in a courteous and polite way, knocked before entering bedrooms, and closed bedroom doors when assisting people with personal care tasks. The Knells Country House F58 F10 s59723 The Knells v220766 260405 ui Stage 4.doc Version 1.30 Page 10 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, 14 & 15 Social activities and meals were varied and provided residents with a range of choices and opportunities on a daily basis. EVIDENCE: The care staff spoke to residents about their interests and preferences so that suitable recreational activities could be offered to people. Residents said that there was often something going on in the home that they could join in with, including religious services. Residents said that care staff asked them if they wanted to join in with activities, or would prefer to spend individual time with the carer. Records were kept of what activities took place, and what was arranged in the future. The home had a mini bus, which was used to take residents out to social events, shopping or to appointments. Residents said that they decided themselves how they spent their day. The Manager had recently reviewed the menus and there was a choice at each mealtime providing residents with a variety of food. The menus were displayed in the home, so that people could see what was available. Special diets were catered for, and information was recorded about residents’ dietary needs and preferences. Meals could be taken in the dining room or in the person’s own private room. The Knells Country House F58 F10 s59723 The Knells v220766 260405 ui Stage 4.doc Version 1.30 Page 11 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) 16, & 17 The home has a satisfactory complaints system with evidence that residents feel that their views are listened to and acted upon. Staff understood adult protection issues, which protected residents from abuse. EVIDENCE: Residents were given information about how to complain when moving into the home, and said that if they complained about anything it was dealt with promptly. Information about making a complaint was displayed in the entrance area of the home. Some residents were taking part in the national and local elections, mostly through the postal voting system, and care staff was assisting people with this as was necessary. The Knells Country House F58 F10 s59723 The Knells v220766 260405 ui Stage 4.doc Version 1.30 Page 12 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, 20, 24 & 26 Recent investment has significantly improved the appearance of this home during the last 12 months, creating a comfortable and safe environment for people living there. EVIDENCE: Many areas of the home have been decorated with new furniture and carpets purchased, which greatly improved the surroundings for the residents. There were plans to continue with this refurbishment until the whole home had been completed. To help people moving around the home there was a passenger lift, a stair lift hand and grab rails. A new ramp had almost been completed, and this improved the access to and from the garden. The gardens were very attractive and had pleasant areas where people could sit. Resident’s bedrooms were comfortable and many had been recently decorated, and new furniture purchased. People were able to bring their own furniture and other personal possessions into the home with them, and many people had chosen to do this, making those rooms very homely and individual. The Knells Country House F58 F10 s59723 The Knells v220766 260405 ui Stage 4.doc Version 1.30 Page 13 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 Residents are cared for by a skilled staff group, who are appointed following a robust and thorough recruitment procedure, which ensures maximum protection for people. EVIDENCE: There were four members of care staff on duty during the inspection to care for 19 residents, two domestics a cook and a kitchen assistant. These staff were able to attend to peoples needs in a prompt and efficient manner, keep the home clean and provide meals and snacks throughout the day. When a new member of staff is appointed an application form is completed, the person is then be invited for interview, two written references are sought, and the person will not be confirmed in post until a satisfactory Criminal Record Bureau check had been completed. These measures contributed to the protection of residents. Residents said the care staff were helpful, kind and friendly, and that they didn’t have to wait too long when needing help with anything. The Knells Country House F58 F10 s59723 The Knells v220766 260405 ui Stage 4.doc Version 1.30 Page 14 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) 31, 32, 33, 35, 36, 37 & 38 There was clear leadership, guidance and direction to staff to ensure residents receive consistent good quality care. However there were some practices that do not safeguard the health and safety of the people living in the home. EVIDENCE: The manager was very motivated and many of the residents said she spent time talking with them to make sure they were happy with the care and services they were receiving. The staff group found the manager supportive and approachable, which motivated them to improve their knowledge and skills and so continue providing good care to the residents. There was a system that was followed when looking after money on behalf of residents that safeguarded people’s financial affairs. There were some cleaning fluids in the laundry and in a corridor, that were not stored securely, and could be a risk to the health and safety of some residents.
The Knells Country House F58 F10 s59723 The Knells v220766 260405 ui Stage 4.doc Version 1.30 Page 15 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 3 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 x x x 3 x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 2 3 4 x 3 3 3 2 The Knells Country House F58 F10 s59723 The Knells v220766 260405 ui Stage 4.doc Version 1.30 Page 16 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard op38 Regulation 13, (1) Requirement Substances hazourdous to health must be stored securely at all times. Timescale for action 26 April, 2005 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 Good Practice Recommendations The Knells Country House F58 F10 s59723 The Knells v220766 260405 ui Stage 4.doc Version 1.30 Page 17 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
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