Inspection on 19/11/08 for The Knole

This inspection was carried out on 19th November 2008.

CSCI found this care home to be providing an Good service.

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 Knole 12/11/07

The Knole 24/10/06

The Knole 09/01/06

The Knole 26/09/05

The Knole 10/03/05

The Knole 06/09/04

The Knole 25/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

Honeybourne House

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Knole 23 Griffiths Avenue St Mark`s Cheltenham Glos GL51 7BE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Adam Parker     Date: 1 9 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: The Knole 23 Griffiths Avenue St Mark`s Cheltenham Glos GL51 7BE 01242526978 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): knole@langleyhousetrust.org The Langley House Trust Name of registered manager (if applicable) Mr Malcolm James Gardiner Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: All Persons accommodated will be male. Residents must be over 30 years of age. Date of last inspection Brief description of the care home The Knole is a care home operating within Christian principals that provides registered accommodation for up to nine males who have mental health needs. Four places are registered for learning disabilities and up to seven for service users over 65 years of age. The home is a detached Victorian listed building situated in extensive grounds approximately one mile from the centre of Cheltenham. It has recently undergone major renovation. Information about current fees was not obtained at the inspection.Chiropody and personal toiletries are charged extra. The home makes Care Homes for Adults (18-65 years) Page 4 of 26 care home 9 Over 65 0 7 4 9 Brief description of the care home information about the service, including CSCI reports available to people using the service through a service user guide and statement of purpose available in the home. Care Homes for Adults (18-65 years) Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. The inspection took place on one day in November 2008 and included a tour of the premises, examination of documentation and medication systems and discussions with people using the service, staff and management. An (Annual Quality Assurance Assessment) AQAA was completed and provided for the inspection. Although this was brief in its content in places it generally gave us the information we asked for. The previous inspection was on the 12th and 19th of November 2007. Care Homes for Adults (18-65 years) Page 6 of 26 Care Homes for Adults (18-65 years) Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 26 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service receive comprehensive assessments prior to admission involving a number of agencies to ensure that their needs can be met before they are admitted to the home. Evidence: The assessment process and the information obtained for one person admitted to the home since the previous inspection was looked at. Full information about the person was obtained and this included a comprehensive assessment completed prior to admission into the home in conjunction with other agencies and professionals. This is in line with the type of service offered by the home and relevant documentation had been obtained. In addition to this the home had completed an assessment of the needs of the person. When people are admitted to the home they receive an induction and this had been documented using a checklist. Care Homes for Adults (18-65 years) Page 10 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are regularly and actively consulted about their care plans to ensure that their needs and personal goals are met. Evidence: Care plans, risk assessments and other information were contained in folders set out in a new format under a number of headings. Due to the recent introduction of these a number of areas in the files looked at such as Empowerment and Positive values and positive identity did not contain any documentation. Care plans and risk assessments had been reviewed with the person at a key working session. The key working sessions provided an opportunity for people who use the service to make decisions about their lives with assistance and within any limits set by the nature of the service. One example looked at was very detailed and a follow up meeting had been planned. Apart from risk assessments completed as part of the admission of a person into the service, general risk assessments had been completed. These were comprehensive and Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: had regular planned reviews. Specific risk assessments were also seen for such issues as smoking. Care Homes for Adults (18-65 years) Page 12 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to take part in appropriate activities outside of the home, have some links with the local community and pursue a range of leisure interests in order to enhance their lifestyle. Evidence: Two people using the service have been working in a charity shop and another had been working in the kitchen at a local care home for older people. As part of this work the person had also completed a food hygiene course. It was reported that the home had just started involvement with an initiative to get people with mental health problems into work. People using the service have some contacts with the local community through links with a local church where some of them attend services. In addition use is made of a Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: number of local leisure facilities. One person described the benefits of attending evening Yoga classes in the town. Evidence was seen of people pursuing hobbies and interests and some people had been making use of the green houses during the Spring. People using the service have a weekly art session making use of the well equipped art room. The home organises trips out of the home with recent destinations being London and the seaside. The home has an amateur dramatic group and a number of events had been planned for Christmas including a Carol Concert. One person had been visited by a friend from outside of the home and also visits them on a weekly basis. Two people had also visited their families for occasional weekend stays. There were suitable locks for peoples rooms although these could be entered by staff using a master key in the event of an emergency. Mail was logged by staff but delivered to them unopened. People had responsibilities for some house keeping tasks such as washing up and there was a rota for them to do their own laundry. The home makes clear statements regarding the rules on smoking, alcohol and drugs. A choice of main dish is provided each day with the cooked lunch. At teatime a cooked snack is provided. Issues around meal choices had been discussed at residents meetings where menus are planned and requests taken into consideration. One person spoken to about the quality of the meals stated that they depended on the cook although confirmed that he did get food that he liked. Care Homes for Adults (18-65 years) Page 14 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have their health and personal care needs met and there have been some improvements in the administration and recording of their medication. Evidence: The home provided support to people in terms of guidance with such matters as personal hygiene where this was needed although it does not provide personal care. People who use the service were allocated to a member of staff who acts as a key worker to provide consistency of support. There was evidence with one person receiving input from mental health services with Care Programme Approach documentation on file. Visits by the Community Psychiatric Nurse had been recorded. In addition staff were observed dealing with the ordering of a chair for one person who was using the service. A special chair was required due to the persons health problems and a member of staff was dealing with the issue sensitively due to issues around contact with health care professionals. Care Homes for Adults (18-65 years) Page 15 of 26 Evidence: The home provides secure storage for medication and keeps a record of every time the medication cupboard is unlocked. Records had been made of checks on storage temperatures of medication kept in the medication cupboard the majority of these were under 25 degrees Centigrade although a few were above. Remedial action should be taken where temperatures are too high for medication storage. The medication administration records were examined and as at the previous inspection some handwritten directions in the administration charts had not been signed and dated by the staff member making the entry. Neither was there evidence that the handwritten entry had been checked for accuracy by another member of staff. This issue was taken up by the registered manager and placed on the agenda for the staff meeting and it is acknowledged that the home has been working to improve its medication administration and recording procedures. A designated member of staff undertakes a monthly audit of the medication administration records. No gaps in the administration records were seen at the inspection and where medication had not been given for any reason an appropriate code had been used to record the reason for this.All staff who administer medication have completed training in the home with others completing further training from an outside trainer. A new member of staff spoken to confirmed this. The supplying pharmacist carries out regular audits. Care Homes for Adults (18-65 years) Page 16 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available if any person using the servce wishes to make a complaint and although staff training has been completed,improvements to the prevention of abuse policy would furter ensure that residents are protected from abuse. Evidence: The home has a complaints procedure that is included in the service users guide, given to all people using the service. The home has a log for recording complaints, one complaint had been documented involving a complaint by one person using the service against another. Staff in the home have attended the Alerters training in adult protection and two members of management have attended the enhanced training provided by the local authority. Information from the local authority adult protection unit was included in the service users guide. The home had a copy of the Langley House Trusts policy for the prevention of abuse. However the policy gives no guidance on contacting the Commission in the case of registered services or contacting any local adult protection agencies. This should be amended to include these details as a guide to any member of staff dealing with an allegation of abuse against a person using the service.This situation remains despite recommendations at the previous two inspections. Care Homes for Adults (18-65 years) Page 17 of 26 Care Homes for Adults (18-65 years) Page 18 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service benefit from a clean and generally well-maintained environment with improvements to the condition of some toilets. Evidence: The home was generally well maintained following the major refurbishment a few years ago. Communal areas on the ground floor consist of a dining room and two lounges which were all clean and tidy. In the basement there is an art room and a snooker room. As well as the main kitchen there is also a kitchen for people who use the service to use to develop cooking skills. All bedrooms in the home are single occupancy and have been personalised by their occupants. There was a problem in one bedroom with cracked window pains this was pointed out by the person occupying the room. Consideration should be taken to replacing the cracked panes. The home was clean with hand washing facilities available in toilets. At the inspection it was noted that all toilets were in working order with remedial work completed regarding the damp problem in the toilet on the ground floor. In the laundry the wall had been repainted where it had been noted on previous inspections that paintwork had started to flake. Care Homes for Adults (18-65 years) Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment and selection procedures are robust ensuring that people using the service are safeguarded. Staff have access to a training programme that will equip them to meet the specific needs of people using the service. Evidence: Staff undergo a basic staff course after starting work in the home. As well as preventing abuse this course includes communication skills, risk assessment, first aid and other subjects and provides underpinning knowledge for NVQ. One new member of staff was spoken to and they felt that the course provided them with enough skills and knowledge to start working with the people who use the service. In addition further training has been undertaken by staff in Substance Misuse and Managing Diversity. The level of staff trained to NVQ in the home is over 75 . One person spoken to commented on the Good bunch of staff. Records for the most recently recruited member of staff were looked at. Not all the required information was available and a reference was missing from the file held in the home. This was obtained from the registered provider during the inspection visit. Subsequent checks on the documentation revealed that the member of staff had been recruited correctly. However the home should check that it has all the required Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: documentation relating to recruitment in the home for inspection. Care Homes for Adults (18-65 years) Page 21 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems for consulting people who use the service are good with a variety of evidence that indicates that their views are sought and acted upon. Evidence: The registered manager has a background in social work and has completed the registered managers award at NVQ level 4 and is an NVQ assessor. Since the previous inspection he has recently completed training in the Mental Capacity Act 2005 and in housing management. The home has a quality assurance system called the Project Managers Audit Tool (PMAT) where monthly managers reports are produced based on a different theme each month. It was stated in the homes AQAA document that PMAT had been improved and This now highlights areas areas needing attention and provides clear action points. For October, spiritual issues were looked at and the following month it was planned that the subject would be housing. A number of audits also take place on such areas as fire safety,medication and accidents and incidents. There is an annual Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: service user survey with the results collated for an action plan. People using the service are able to influence the way in which the service is delivered at a number of levels. Weekly residents meetings are held in the home where a number of issues are discussed such as menus and trips out of the home.There is also a regional residents forum that two representatives from the home attend and have input into planning and reviewing services. Every year a residents conference is held and another two representatives attend this. Monthly inspections are made of the home under the requirements of The Care Homes Regulations 2001 by a manager from the Langley House Trust. The report for October 2008 was looked at, this was detailed and resulted in a number of actions for the home. Areas looked at in the visit included the premises and the standard of care. The Langley House Trust West area has been awarded the Investors in People Award. Staff have received training in safe working practices in first aid, food hygiene, manual handling and fire safety. The home has ensured the servicing and maintenance of electrical and central heating systems and appliances. Following the renovation of the home, windows had been fitted with restrictors. Work has now been carried out to secure these in place where previously they were easily removable. However on inspection some work was needed to secure the restrictor in bedroom nine which was unoccupied at the time of the inspection visit. It was reported that window restrictors were checked on a weekly basis. A risk assessment had been completed for legionella with control measures in place. It was reported that the home did not have a fire risk assessment although this had been identified as needing to be done. Care Homes for Adults (18-65 years) Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 20 20 Action should be taken where it is found that medication is being stored above the correct temperature. Any handwritten changes to medication charts should be checked and signed by another member of staff to ensure their accuracy. The practice of signing and dating handwritten directions on the medication administration charts should also be used when any medication is stopped and the chart is marked accordingly or when any changes are made to the chart. The prevention of abuse policy and procedure should be updated to include reference to making contact with the Commission and the local authority adult protection unit. Consideration should be taken to replace the cracked panes of glass in room 6. The home should check that it has all the required documentation in relation to recruitment of staff available for inspection. Work should be carried out to secure the window restrictor in bedroom nine. 3 20 4 23 5 6 25 35 7 42 Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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