Inspection on 26/09/05 for The Knole

This inspection was carried out on 26th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Knole 19/11/08

The Knole 12/11/07

The Knole 24/10/06

The Knole 09/01/06

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 09/07/2008.

CARE HOME ADULTS 18-65 The Knole 23 Griffiths Avenue St Mark`s Cheltenham Glos GL51 7BE Lead Inspector Mr Peter Still Unannounced Inspection 26th September 2005 13:30 The Knole DS0000016612.V249958.R01.S.doc Version 5.0 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 Knole DS0000016612.V249958.R01.S.doc Version 5.0 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 Adults 18-65. 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 Knole DS0000016612.V249958.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Knole Address 23 Griffiths Avenue St Mark`s Cheltenham Glos GL51 7BE 01242 526978 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) knole@langleyhousetrust.org The Langley House Trust Mr Malcolm James Gardiner Care Home 10 Category(ies) of Learning disability (2), Mental disorder, registration, with number excluding learning disability or dementia (3), of places Mental Disorder, excluding learning disability or dementia - over 65 years of age (5) The Knole DS0000016612.V249958.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Residents must be over 30 years of age, of which five will be over 65 years of age at the time of registration All Persons accommodated will be male Date of last inspection 10/03/05 Brief Description of the Service: The Knole is a care home operating within Christian principals that provides registered accommodation for up to ten males who have mental health needs. Two places are registered for learning disabilities and up to five 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. The Knole DS0000016612.V249958.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over 5 hours. 4 staff were on duty with 8 residents, although some were out during part of the day. 3 residents were spoken with and the other residents were observed. This was a difficult inspection to conduct due to the extent of ongoing building works. It was clear that the home was not able to be seen in its best light and once the work is completed and time given to administrative tasks, that a future report will be very different in content. Residents have, in particular, been through a very difficult period with constant upheaval and lack of privacy due to the number of builders and others at the home. Risks are high and the manager should be commended for being very aware and maintaining the high level of contentment found amongst residents. For staff, this has been a very hard time too and it appears that staff are tired of the length of time the work has been underway. It is considered very important for the Trust to provide every support to the manager and his staff team during this final period. The inspector was pleased to see the Trust development officer who showed a good understanding of the problems and of working to resolve them. Since the works are nearly completed, the imposition of requirements regarding a number of Standards, is not seen to be necessary. However a requirement will be made to ensure relevant authorities are kept informed and that any advice or requirement made is acted upon as a top priority to ensure the safety of residents. The current registration details, concerning the category of residents does not completely reflect the current situation and an alternative was discussed with the manager. Should the Trust wish to seek a voluntary amendment to their registration, they should write to the Commission and in any event the current registration detail will need to be addressed. What the service does well: A resident, speaking highly of the home said that freedom within the home is the most important factor. “ I can come down and make a cup of tea at any time and I like this”. Another said they can go to the office at any time with issues and they are always acted upon immediately. A member of staff talked about the ethos of the home and community spirit, which endorses the points above and was observed. Residents spoke openly and talked about the way respect is shown. The Knole DS0000016612.V249958.R01.S.doc Version 5.0 Page 6 The overall risk management of residents is a key aspect for the home and is thoroughly implemented. 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 Knole DS0000016612.V249958.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Knole DS0000016612.V249958.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 The good level of information and the processes prior to admission ensures the home can meet resident’s needs. EVIDENCE: Residents have a trial period as part of the admission process. 3 care plans were inspected and showed thorough assessment in conjunction with other agencies. Any restrictions on freedom, choice, facilities or services are agreed with residents as part of the decision that they live at the home. The Knole DS0000016612.V249958.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,9 Resident’s individual needs, choices and consideration of risks are well met through good levels of recording and constant review, which includes involvement with residents. EVIDENCE: Two care plans were inspected, providing important detail, were found to be well recorded, up to date and signed by relevant staff and residents. One resident said the care plan is reviewed every 2 weeks and another said they are reviewed every 2 to 3 weeks with the key worker and that this is found to be helpful. This resident said that it is helpful with feelings and that any actions, are always dealt with by staff. A needs assessment was read and had been updated on 15/09/05. Two residents talked about risk taking and how staff support this. One resident said they work away from the home during the week and another about their work with horses. The Knole DS0000016612.V249958.R01.S.doc Version 5.0 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 14, 17 Social activities are well managed, creative and provide daily variation and experience for residents living at the home. The arrangements for meals are currently a difficulty whilst refurbishment continues and staff are working hard to ensure it is satisfactory. EVIDENCE: A resident talked about enjoying their college course. Another resident provides voluntary help to a local resident, which has been much appreciated over a long period. Residents use community facilities including a gym. An individual weekly activities record is completed and was seen for one resident, showing variety and was considered to meet the residents’ needs. Another resident said they look forward to going out with a supporter each week and this one to one time is important to them. Choice of meals is available, and a resident said the food is good sometimes and that three members of staff were good cooks. This resident said he was looking forward to the completion of the kitchen, which will include a new and adjacent training kitchen. The manager said they have a plan to appoint a The Knole DS0000016612.V249958.R01.S.doc Version 5.0 Page 11 qualified chef and that residents would be able to gain experience, leading to qualifications within the training kitchen. At the time of this inspection, the kitchen was in the process of being upgraded and could not be used. Food is being brought into the home and it was required that further guidance should be sought from environmental health to ensure arrangements are satisfactory. Prior to the completion of this report, the environmental health officer reported back to the Commission to confirm that they have provided guidance. The Knole DS0000016612.V249958.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 Residents are protected by a good medication recording system and policy procedures for staff to follow. EVIDENCE: Insulin is no longer required for a resident to self medicate. Two records were inspected. They were up to date and had been signed properly on the day of inspection. One resident said he does not look after his own medication. The manager said he will approach the local pharmacy to request reinforcement training for staff in relation to best practice concerning the control, dispensing and disposal of medication. The Knole DS0000016612.V249958.R01.S.doc Version 5.0 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Residents are confident that they are listened to and their requests are actioned. They are also protected from abuse by the homes policy, training and procedures. Residents and staff need to be aware of contact details of the Commission. EVIDENCE: Three residents said they are listened to and that staff take action to meet their requests and resolve issues. One resident said that if something needed doing “it was done” meaning that issues were responded to swiftly. Residents’ meeting records were reviewed and showed how residents are involved in the home. Two residents said the meetings were helpful. One resident said they would be listened to and that they would go to their social worker if they continued to be concerned. This resident said he had the phone number but did not know he could also approach the Commission if he had a complaint and staff were also unaware. The manager said that details were available but agreed to ensure both residents and staff are given the necessary information. Records were seen concerning one complaint, which had been resolved. All staff are provided with protection of vulnerable adults training at induction and sign that they have read the policy. The manager is considering further reinforcement training. The Knole DS0000016612.V249958.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Residents are currently living in an unsuitable environment, where the risks to their safety are increased due to ongoing and significant building works. EVIDENCE: The home was considered to be a building site at the time of this inspection and residents have had to accept this situation for the last five months. Both staff and residents are concerned with the current environment and will be pleased when work is completed. The doorbell was not working since electrical work was in progress and open access to the building meant that anyone could walk into the care home. There were many builders on site and one showed the inspector to the office to meet care staff. The home was dusty and building tools were evident. The kitchen was dirty and a drill had been left on a worktop. The kitchen was not usable and food was being brought in. An electrical cable was seen to be snaking down two parts of the main staircase; the development director of Langley House Trust, who was visiting, made this safe immediately. A snooker room in the basement was not usable due to flooding to the floor. A resident on the second floor had closed their curtain during the day to prevent debris from coming in through the window. One resident said they had not had a carpet in their bedroom since July and that “this makes the discomfort worse”. The Knole DS0000016612.V249958.R01.S.doc Version 5.0 Page 15 This resident felt that residents should not have stayed at the home during this period. Another resident said he had no problems with the building works or lack of bedroom carpet and he also feels safe. A resident said that all the drilling has been bad and he will be pleased when it is finished. The hot water was checked in a number of rooms and found to be very hot in room 8. An alternative temporary relocation for the care home was considered but no suitable place could be found. It is expected that the refurbishment will be mainly completed by mid November and this will be ahead of schedule. Records were seen, which included a ‘hazard analysis critical control points for the Knole’, and this had been updated on 06/10/04; two individual bedroom risk assessments were inspected, which had been updated on 16/06/05 and 20/06/05 respectively. A weekly risk assessment check was inspected and was dated 25/09/05 and this was considered to be a good step in the circumstances. Fire records were seen to be up to date. The manager said he completes a daily tour of the building with site staff to discuss work and likely hazards. The inspector recommended that the fire prevention officer be contacted for further guidance and the inspector made contact with the fire service that said they would visit. The inspector was also concerned that a small fire had occurred at the home recently. The Knole DS0000016612.V249958.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 Residents expressed contentment and are supported mainly, by experienced staff. Further work on ensuring staff feel the points they raise are explored would ensure good moral amongst all staff. CRB checks must be available at the home for inspection. EVIDENCE: Three staff currently hold NVQ level 3 qualifications and 2 are awaiting their certificates. Nine staff are currently undertaking training and of these 3 are nearing completion. Staffing levels were considered to be satisfactory for the 9 residents. On the day of inspection 4 staff were on duty and 1 resident was away on holiday. Some staff had worked at the home for many years, providing good continuity. Supervision is provided monthly with a minimum of 10 sessions a year. Good supervision notes were read for 2 members of staff. One member of staff considered that supervision could be improved and that senior staff should not feel affronted when points are raised. Two staff felt there could be improvements to the way staff are listened to, to ensure good morale. It was said that other staff may have issues but would not necessarily feel the environment promotes ease of openness. A recommendation will be made to explore further ways of encouraging frank and open dialogue. An issue concerning the extent of the working week was raised as well as a concern that some junior staff do not stay at the home for long. The Knole DS0000016612.V249958.R01.S.doc Version 5.0 Page 17 Two staff files were reviewed and were considered satisfactory apart from the lack of CRB checks, which require inspecting. It is understood these are held at the Trust’s head office. An email was seen which said “Nothing adverse”, in relation to the CRB. A requirement will be made that the original CRB documents must be held at the home until inspected by the Commission. The Knole DS0000016612.V249958.R01.S.doc Version 5.0 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 Whilst significant building works are ongoing at the home, it is not possible to say the home is well run. Residents were clear that they are listened to and steps to assess how their views underpin the home’s policies and procedures will provide future evidence. EVIDENCE: The redevelopment of the care home should provide a very positive outcome for service users and staff, however the work has been so significant that it effects the day to day running of the care home and the manager acknowledges that some documentation and information systems have not been attended to since it is impossible in the current environment. The current office was seen to be very difficult for staff to work in and staff were observed to be doing their very best in the most difficult of circumstances. This situation must have a negative impact for residents and it is possible that important aspects could be missed. The manager is well aware of the possible risks and demonstrated every commitment to ensuring resident need continues to be the priority. The Knole DS0000016612.V249958.R01.S.doc Version 5.0 Page 19 The manager intends to conduct a resident survey once works are completed and this was considered to be a good step. 1 resident said he attends resident meetings, is listened to and can voice disagreement. The Knole DS0000016612.V249958.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X X Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 1 X X X X X 1 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 2 2 2 X X CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Knole Score X X 3 X Standard No 37 38 39 40 41 42 43 Score 1 X 3 X X X X DS0000016612.V249958.R01.S.doc Version 5.0 Page 21 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 YA24 Regulation 23 Requirement All hot water outlets shall be checked to ensure residents cannot be scalded and that suitable thermostatic valves are fitted where necessary, following guidance from environmental health. (Room 8 was found to be very hot) Ensure CRB checks for all staff are at the Care Home so they can be inspected by the Commission Ensure service users are safe and follow the guidance of professionals and the agencies involved. (This particularly concerns building works at the care home) Ensure service users and staff have and are aware of the contact details of the Commission Timescale for action 06/01/06 2 YA34 19 16/12/05 3 YA24 23 21/10/05 3 YA22 22 16/12/05 The Knole DS0000016612.V249958.R01.S.doc Version 5.0 Page 22 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 YA38 Good Practice Recommendations The manager in conjunction with his senior team should consider additional ways of ensuring positive, open dialogue with staff so that all staff feel they are listened to and points raised help in the development of the home, to the benefit of residents. Encourage and support staff in the completion of their NVQ level 2 qualification to ensure the Standard is met. 2 YA32 The Knole DS0000016612.V249958.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Knole DS0000016612.V249958.R01.S.doc Version 5.0 Page 24 - 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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